Health 102 – Topic 1
Setting the Context
Learning Objectives for this Topic
Gain a better understanding of how complicated defining health can me. Its
hard to define health
Understanding the current “health status” of Canadians. How healthy we are,
and why we have some problems and not others
Walking through an applied example of why change is required. Why we
need to change
What is health?
World Health Organization’s Definition: Health is a state of complete physical,
mental and social wellbeing and not merely the absence of disease or infirmity.
(Most people use this since it is used for the global population)
Problems with the WHO definition:
1. Absoluteness of the word “complete”
This would result in most of us being considered unhealthy most of the time.
Criticized because of the word “complete”.
- Almost everyone has something wrong at some level at any given
time, there are so many medical problems, and not everyone is
It also contributes to the ‘medicalization’ of society; if someone is not
considered “healthy” they should always be seeking medical health.
- New screening technologies let us find abnormalities that might never
cause illness or disease. For Example, breast cancer rates keep
increasing, but this is because of increased screening, and modern
technology. (pin prick) We are finding more diseases, and more
people are becoming ‘unhealthy’. The small amounts of cancer found
can actually be fought off by one’s immune system, yet we diagnose
people with this disease, when they really don’t have anything.
- Pharmaceutical companies produce drugs for conditions not
previously defined as health problems e.g., Acne or Peyronie's Disease
2. The nature of the disease is changing
- Instead of infectious diseases, people are now dying from chronic
(non-communicable diseases) Definition is not accurate anymore,
because now we have more diseases. 100 years ago, we had these
infectious diseases killing people, but now there are a lot more.
- In Ontario, the two large killers are cancer and cardiovascular disease.
79% of people are dying from chronic diseases, not infectious
diseases. “In our aging society, chronic illnesses are now the norm, this makes the
WHO definition counterproductive because anyone with any level of chronic
diseases is considered ill. “
Public Health Agency of Canada (PHAC) Definition: “Health is a capacity or
resource rather than a state, a definition which corresponds more to the notion of
being able to pursue one's goals, to acquire skills and education, and to grow.”
- Even if you are a little unhealthy, if you can grow, you are considered healthy.
Aboriginal Medicine Wheel Definition: The Medicine Wheel is a symbol that
represents the circle of life. It is a very deep and complex symbol. A full
understanding of all the teachings related to the Medicine Wheel would take a
lifetime. A core concept of the Medicine Wheel is balance, harmony, and
interconnectedness. Its not just physical health, its also spiritual and mental health
A Medicine Wheel can represent:
The four stages of life: infant, youth, adult, and
elder The four races of humans: black, yellow, white, and red The four seasons, the
four cardinal directions, etc. you expect different things from different parts of the
circle Medical Definition of Health:
- Based on germ theory
- Has been the same since the 19 century
- Treats health as the absence of disease
- Assumes that all diseases are caused by specific etiological agents
- Individuals (patients) are passive recipients of intervention aimed to cure.
You go see a medical professional, they intervene, and then you get treated.
In the PHAC and Aboriginal definitions, people are encouraged to
make their own decisions and improve their own health
Example of a Medical Model Definition: (maybe not the best if you're working in
public health, but it could help with people in another profession)
The American Society of Anesthesiologists (ASA) defines health in 6 simple ways:
1. A normal healthy patient.
2. A patient with mild systemic disease.
3. A patient with severe systemic disease.
4. A patient with severe systemic disease that is a constant threat to life.
5. A moribund patient who is not expected to survive without the operation.
6. A declared brain-dead patient whose organs are being removed for donor
Clicker Question: Within a public health system, the PHAC definition is the
most appropriate. (Depends on situation) In the future, these definitions are
not important, you should focus in the issue of wellbeing.
What is WELLBEING?
“The presence of the highest possible quality of life in its full breadth of
expression focused on but not necessarily exclusive to: good living standards,
robust health, a sustainable environment, vital communities, an educated
populace, balanced time use, high levels of democratic participation, and
access to and participation in leisure and culture.”
- Physical, and also emotional wellbeing: Cancer survivors have a great
amount of wellbeing, and they consider themselves to be very healthy. • Moving from the center to the left shows a progressively worsening state of health.
• Moving to the right of center indicates increasing levels of health and wellbeing.
- Farthest you can go is the neutral point, at the neutral point, you are
healthy. Being neutral is better than being sick. You can also have a
higher quality of life, on the more blue side.
How healthy are Canadians?
Canada is a pretty healthy country
Life expectancy: Males 79, Females: 83, both: 81 Better than the global
average. (On average, a longer life expectancy here, instead of Mexico or
America) Why? Because of public health insurance. Everyone in Canada has
excess to medicine, and people in the Sates do not. Things are improving in
Canada, and soon more people are expected to live over 85 years. Medicine
that is available to all Canadians is also called socialized medicine. But in the
States, you have to have health insurance, and you have to go through
‘medicate’. If, in the Sates, you don’t have insurance, it is very expensive to
have a medical issue. Living in Canada, we can have a very good life
expectancy, perhaps the only country competing with this is Japan. *Graph
showing improvements of life expectancy in Canada.
Average death rate is pretty low 70/1000 adults dies pre-maturely, which is
Infant mortality rate is 6/1000 and global average is 57/1000, as Canadians,
we are doing well.
Age Pyramid: Left side male, right side female. Baby Boomers are growing
old, so therefore, we have an aging population. But we have a problem:
people at the top are less healthy, and people at the bottom are the
healthiest. We are worried about when all of these baby boomers actually get sick? Crisis coming: Health Systems are at their max, (wait lines, wait times,
hospital space) as things get worse, we will have more problems.
Canadians are primarily dying from car accidents (injuries), this age group is
ours; our demographic.
Few deaths due to infectious diseases, more deaths due to non-
communicable diseases (in Canada), Few deaths due to injuries. We are
higher than the regional average because people in different regions are
dying from different things.
As communicable disease death rates get lower, non-communicable death
rates will increase. People have to die of something.
Clicker Question: Medical Professionals are not given the correct training, to
deal with the medical problems today. Smoking cessation, instead of tropical
illnesses. Doctor training at McGill University. Doctors also need to be trained
for infectious disease, incase there is an outbreak.
Cancer Problems in Canada
Canadian Cancer Society: In 2012, there will be 186,400 new cases of cancer and
75,700 deaths from cancer in Canada
– More new cases than the entire population of PEI
– More deaths than the population of Victoria BC
Four Types of Cancer:
New Cases Deaths
All 186,400 75,700
Lung (men & women) 25,600 20,100
Breast (women) 22,900 5,200
Prostate (men) 26,500 4,000
Colorectal (men & women) 23,300 9,200
“Unlike any other cancer, if you have lung cancer (largely prevalent in
population), it will most likely kill you. It is not the most deadly Cancer,
Pancreatic Cancer is.
Things are pretty bad now, in Canada, but they will continue to worsen
Clicker Question: Three things that cause cancer rates to increase:
Increasing cancer burden due to risk behaviors, population growth, and
aging population. Not genetics because genetics does not change.
Age structure, Population growth, risk behavior (burdening, in order)
Increasing expenses for cancer
The total cost of cancer in Canada was estimated to be $14.2 billion in 1998 – Direct cost of healthcare services was $2.5 billion
– Indirect cost due to mortality and lost productivity was $11.7 billion. People
who die, after being trained, we lost a productive member of society, they
cannot pay taxes anymore
Professor’s Email: A direct cost is a medical expense associated with
treatment or diagnosis, and indirect cost would be one associated
with a person no longer being able to contribute to society as a whole
(e.g., if they die early they stop being a productive member of the
work force, they stop paying taxes, they are not around to raise
children, they stop buying goods and services, etc.).
Future costs will increase dramatically as a result of the infrastructure demands
required for treating cancer (e.g., hospitals, oncologists). We need more hospitals,
train more doctors, and more assistants. This is very expensive, and takes a lot of
time. The problem will get even worse.
Conservative estimates suggest: Over the next 30 years:
– The Canadian economy is expected to lose over $540 billion in wage-based
productivity due to cancer
- The Federal and Provincial governments combined are expected to lose over $248
billion in tax revenues as a result of cancer disability (We are the future tax payer)
$29,425 per Canadian (start saving your pennies)
– The direct health care costs associated with cancer are expected to exceed $176
billion over the same period.
Recent evidence from BC: We spend most of our money on health and
education. They will be bankrupt (just by spending money on health and
education) by 2017 in order to balance their budget. Provincial Revenue
grows at 3% per year. These are services that we expect to get for free,
meaning that other services from other ministries will be cut. So now, they
are trying to come up with solutions, all provinces are in the same boat; they
all need to figure it out. Provinces are under a lot of financial problems; BC
shows portfolios for education and health (two largest ministries). If
revenues, and education grows 3% (cost) a year each, they cancel each other
out, but then health portfolios increase by 8% (increase in cost) per year. BC
will be screwed in a few years, as there is a huge health crisis happening.
- No need to memorize stats, but what do the numbers m