Jaclyn Sanderson
Federal and Provincial Health Systems in Canada
Health Canada. (2005, May 16). Canada Health Act - Links to Provincial and
Territorial Health Care Web Resources. Retrieved October 1, 2022,
from https://www.canada.ca/en/health-canada/services/health-care=
system/canada-health-care-system-medicare/provincial-territorial-health
Summary:
Canada has a universal health care system funded through taxes. This means that any Canadian citizen or permanent resident can apply for public health insurance.
Each province and territory has a different health plan that covers different services and products. There are some important differences between each plan so make sure you know what your plan covers.
College of Allied Health Professionals of PEI. College of Allied Health Professionals of PEI. (n.d.). Retrieved October 1, 2022, from https://www.cahppei.ca/
Summary:
The College is here to ensure that the registered allied health professionals provide competent and ethical services to the public.
If there are any concerns regarding the work of Medical Laboratory Technologists (MLTs), Medical Radiation Technologists (MRTs) or Respiratory Therapists (RTs) practicing in PEI, any member of the public can file a complaint. One can do this through a formal complaint process.
Understanding Health and Determinants of Health
Brook. R. H. (2017). Should the definition of health include a measure of tolerance? JAMA, 317 (6), 585-586.
Huber, M. (2011). HEALTH: HOW SHOULD WE DEFINE IT? BMJ: British Medical Journal, 343(7817), 235–237. http://www.jstor.org/stable/23051314
Summary: In 1948 the World Health Organization officially defined health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The definition has remained unchanged for more than 60 years. When it was adopted, tools to measure health did not exist. Indeed, it was decades before a comprehensive set of tools to measure physical, mental, and social well-being were developed.
Let's Learn Public Health. (2020). Retrieved 5 October 2022, from https://www.youtube.com/watchv=zSguDQRjZv0&ab_channel=Let%27sLearnPublicHealth
Summary: Public health focuses on improving the health of a population and preventing health problems before they happen. It is a broad field and covers a range of topics such as air pollution, epidemiology, communicable disease control, risk assessment and health promotion.
Sartorius N. The meanings of health and its promotion. Croat Med J. 2006 Aug;47(4):662-4.
Tulloch, A., Davies, P., & Fitzpatrick, M. (2005). What do we mean by health? CommentaryCommentary. British Journal of General Practice, 55(513), 320-323.
Summary: The Constitution of the World Health Organization, which came into force on April 7, 1948, defined health “as a state of complete physical, mental and social well-being.” The writers of the Constitution were clearly aware of the tendency of seeing health as a state dependent on the presence or absence of diseases: so they added to that definition that an individual, if he is to be considered healthy, should not suffer from any disease (….“and not merely the absence of disease or infirmity”). In that way, the definition of the World Health Organization simply added a requirement to the previous position that allowed to declare someone healthy if no disease could be found: the step forward that could have been taken in the conceptualization of health as a dimension of existence which can co-exist with the presence of a disease or impairment was thus not taken.
Image: Definitions of health – HSC PDHPE
Social Determinants of Health
Canada, P. H. A. of. (2022, June 14). Government of Canada. Social determinants of health and health inequalities - Canada.ca. Retrieved October 5, 2022, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Summary: Many factors have an influence on health. In addition to our individual genetics and lifestyle choices, where we are born, grow, live, work and age also have an important influence on our health.
Government of Prince Edward Island. (2022). 2021 Chief Public Health Officer Report. Retrieved on October 16, 2022 from https://www.princeedwardisland.ca/sites/default/files/publications/cpho21_report_web.pdf.
Summary: Health inequities are differences in health between population groups that arise due to social and economic conditions.
The report provides a summary of the overall health of Islanders by presenting indicators:
population health status (i.e. Indicators related to disease rates)
health determinants (i.e. indicators of social and behavioral factors that increase disease risk)
“The findings of this report show PEI is doing better than or as well as Canada on most indicators of health status due to lower disease rates,” Dr. Morrison said. “Although we are doing better in one category, PEI is challenged in areas of many health determinants, an area of concern for the Chief Public Health Office.”
The report’s findings indicate a need to focus attention in PEI to halt or change existing trends related to mental health, unhealthy eating, physical inactivity, smoking, and vaccine uptake among Grade 9 students specifically.
Public Health Agency of Canada. (2022). Social determinants of health and health inequalities. Government of Canada. Retrieved on October 11, 2022 from https://www.canada.ca/en/public health/services/health-promotion/population-health/what-determines-health.html.
Summary: Public health policy in older industrialized societies is being reconfigured to improve population health and to address inequalities in the social distribution of health. The concept of social determinants is central to these policies, with tackling the social influences on health seen as a way to reduce health inequalities. But the social factors promoting and undermining the health of individuals and populations should not be confused with the social processes underlying their unequal distribution. This distinction is important because, despite better health and improvement in health determinants, social disparities persist. The article argues that more emphasis on social inequalities is required for a determinants-oriented approach to be able to inform policies to address health inequalities.
Raphael, D. (2003, January 1). Addressing the Social Determinants of Health in Canada: Bridging the Gap Between Research Findings and Public Policy. POLICY OPTIONS -MONTREAL-, 24(3), 35–40.
Summary: Late 2002, 400 social and health policy experts, community representatives and health researchers from Canada met at York University in Toronto at a conference entitled “Social Determinants of Health Across the Life-Span” to consider the state of ten key social determinants of health across Canada, explore the implications of these conditions for the health of Canadians, and outline policy directions to strengthen these social determinants of health.
Multilevel Approaches to Understanding Health - Beyond the Individual
Philadelphia Department of Public Health. Tobacco policy and control program: making the healthy choice the easy choice. Get Healthy Philly Annual Report 2011–2012. http://www.phila.gov/health/pdfs/commissioner/2012AnnualReport_Tobacco.pdf. Accessed October 27, 2022.
Summary: Overweight, obesity, and tobacco use are major preventable causes of disability, disease, and death. In 2010, 25% of Philadelphia adults smoked, and 66% were overweight or obese. To address these health threats, the Philadelphia Department of Public Health launched Get Healthy Philly, an initiative to improve the city’s nutrition, physical activity, and tobacco environments. The objective of this assessment was to identify residents’ perspectives on threats to health and opportunities for change in the local food and tobacco environments.
Quit Smoking, Government of Prince Edward Island. (n.d.). Retrieved October 27, 2022, from
https://www.princeedwardisland.ca/en/information/health-and-wellness/quit-smoking
Summary: The PEI Smoking Cessation Program helps PEI residents who wish to stop smoking or using other tobacco products by: covering 100% of the cost of nicotine replacement therapy (NRT) products (i.e., nicotine gum, lozenges, patches, and inhaler) and specific smoking cessation prescription medications.
Sorensen G, Barbeau E, Hunt MK, Emmons K. Reducing social disparities in tobacco use: a social-contextual model for reducing tobacco use among blue-collar workers. Am J Public Health. 2004 Feb;94(2):230-9. doi: 10.2105/ajph.94.2.230. PMID: 14759932; PMCID: PMC1448233.
Summary: Tobacco use remains the leading preventable cause of death in the United States. Adolescence presents a critical window for preventing tobacco use, as most adults started using tobacco before reaching age 18. One framework that is useful for understanding adolescent tobacco use is the social ecological model, which defines risk and protective factors for health behaviors, like tobacco use, at multiple levels of influence.
Smoke-Free Places Act - princeedwardisland.ca. Smoke-free Places Act. (2018). Retrieved
October 27, 2022, from https://www.princeedwardisland.ca/sites/default/files/legislation/s-04-
2-smoke-free_places_act.pdf
Summary: No person shall smoke in a public place or workplace except as permitted by this Act and the regulations. Smoking in a motor vehicle in which person under 19 is present. No person shall smoke in a motor vehicle while any person under the age of nineteen years is present in the motor vehicle regardless of whether any window, sunroof, car-top roof, door or other feature of the motor vehicle is open.
Stuber, J., Galea, S., & Link, B. G. (2008). Smoking and the emergence of a stigmatized social
status. Social Science &Amp; Medicine, 67(3), 420–430.
https://doi.org/10.1016/j.socscimed.2008.03.010
Summary: Despite increased awareness of the harms of cigarette smoking as well as improved prevention efforts, tobacco and smoking-related morbidity and mortality continue to be a leading cause of death and disability in the United States. This study used the Social Ecological Model (SEM) as a framework to explore four levels of influence on smoking behaviors.
Tobacco Tax Rates, Government of Prince Edward Island. (n.d.). Retrieved October 27, 2022,
from https://www.princeedwardisland.ca/en/information/finance/tobacco-tax-rates
Summary: The Health Tax Act came into force on April 10, 1941 and a tax rate of 10 per cent was charged on the retail price of all tobacco products sold on Prince Edward Island. Regulations under the Act were first proclaimed on January 29, 1942. A formal Tobacco Tax Notice – Rate Change is produced and posted on our website whenever there is important information regarding rates to be communicated to Tobacco Tax manufacturers, wholesalers and retailers. If applicable, notices are also forwarded by email and/or mail to respective tobacco tax manufacturers, wholesalers, and retailers.
Photo: (Philadelphia Department of Public Health, 2022)
Chronic Disease Prevention and Management COPD
Benady, S. (2010). The human and economic burden of COPD: A leading cause of hospital admission in Canada. Canadian Thoracic Society. www.respiratoryguidelines.ca/sites/all/files/CTS_COPD_report.pdf
Summary: To report the global, regional, and national burden of chronic obstructive pulmonary disease (COPD) and its attributable risk factors by age, sex, and sociodemographic index. Despite the decreasing burden of COPD, this disease remains a major public health problem, especially in countries with a low sociodemographic index. Preventative programs should focus on smoking cessation, improving air quality, and reducing occupational exposures to further reduce the burden of COPD.
Bourne, S., DeVos, R., North, M., Chauhan, A., Green, B., Brown, T., Cornelius, V., & Wilkinson, T. (2017). Online versus face-to-face pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: randomised controlled trial. BMJ open, 7(7), e014580. http://dx.doi.org/10.1136/bmjopen-2016-014580
Summary: To obtain evidence whether the online pulmonary rehabilitation (PR) program ‘my-PR’ is non-inferior to a conventional face-to-face PR in improving physical performance and symptom scores in patients with COPD. PR is an evidenced-based and guideline-mandated intervention for patients with COPD with functional limitation. A 6-week programme of online-supported PR was non-inferior to a conventional model delivered in face-to-face sessions in terms of effects on 6MWT distance, and symptom scores and was safe and well tolerated.
Canadian Chronic Disease Surveillance System. (2018). Report from the Canadian Chronic Disease Surveillance System: Asthma and chronic obstructive pulmonary disease (COPD) in Canada, 2018. https://www.canada.ca/en/public health/services/publications/diseases-conditions/asthma-chronic-obstructive-pulmonary disease-canada-2018.html#a2.2.2
Summary: Breathing is something many people take for granted. However, in Canada, 3.8 million people over the age of one are living with asthma and 2.0 million are living with chronic obstructive pulmonary disease (COPD), both of which can impact a person’s ability to breathe. Individuals living with asthma or COPD may experience impaired participation in daily life, school, work, and social activities. Collectively, there is also an impact in terms of lost productivity and health care costs, especially considering the increasing prevalence of both asthma and COPD. This report describes the occurrence of asthma and COPD in Canada as identified through the Canadian Chronic Disease Surveillance System (CCDSS) from 2000–2001 to 2011–2012. It is the first national report on asthma and COPD using the CCDSS.
Canadian Foundation for Healthcare Improvement. (2015). COPD in Atlantic Canada: Health, care, and costs. https://www.cfhi-fcass.ca/sf-docs/default-source/newsevents/inspired roundtable-resources/atlantic-copd-fact-sheet.pdf
Summary: Canadian patients living with chronic obstructive pulmonary disease (COPD) do not receive adequate care. As a result, COPD is a costly disease to treat – negatively affecting both hospital resources and healthcare dollars. COPD patients would experience improved quality of life if they received more appropriate supports.
The Canadian Foundation for Healthcare Improvement (CFHI) and Boehringer Ingelheim Canada Ltd. (BICL) helped 19 teams implement INSPIRED programs across 78 organizations to improve COPD care. This proactive program supports patients living with late-stage COPD, and their families, transition from the hospital into supported care in the community. It was modelled on the INSPIRED COPD Outreach Program™ developed by Medical Director Dr. Graeme Rocker and his team of respiratory therapists and spiritual care practitioners at the Nova Scotia Health Authority in Halifax. INSPIRED delivers self-management support education, individualized action plans, telephone help lines, home visits, psychosocial and spiritual care support, and advance care planning where needed.
Department of Health and Wellness. (2014). Prince Edward Island chronic obstructive pulmonary disease (COPD) trends 2001-2011. http://www.gov.pe.ca/photos/original/dhw_cho_copd2.pdf
Summary: In 2011, there were just under 8,000 Islanders living with COPD. For the most part, COPD is a preventable disease. The number of new cases of COPD can be reduced and the health of these Islanders with COPD can be improved. Since smoking is the cause of approximately 90% of COPD cases, the best way to prevent or slow the progression of this disease is by not smoking. PEI has supported tobacco reduction through the Smoke-free Places Act and by supporting smoking cessation programs.
Global Initiative for Chronic Obstructive Pulmonary Disease. (2020). Remote COPD patient follow-up during COVID-19 pandemic restrictions. https://goldcopd.org/wp content/uploads/2020/09/GOLD-COPD-Follow-up-Telemedicine_091820_Final.pdf
Summary: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) works with health care professionals and public health officials around the world to raise awareness of Chronic Obstructive Pulmonary Disease (COPD) and to improve prevention and treatment of this lung disease. Through the development of evidence-based strategy documents for COPD management and events such as the annual celebration of World COPD Day, GOLD is working to improve the lives of people with COPD in every corner of the globe.
Najafzadeh, M., Marra, C. A., Lynd, L. D., Sadatsafavi, M., FitzGerald, J. M., McManus, B., & Sin, D. (2012). Future impact of various interventions on the burden of COPD in Canada: 88 A dynamic population model. PloS One, 7(10), e46746. https://doi.org/10.1371/journal.pone.0046746
Summary: Chronic obstructive pulmonary disease (COPD) is a growing economic burden worldwide. Smoking cessation is thought to be the single most effective way of reducing the economic burden of COPD. The impact of other strategies such as interventions that predict risk of disease, reduce progression of disease, or reduce exacerbations has not been systematically studied.
Public Health Agency of Canada. (2018). Report from the Canadian Chronic Disease Surveillance System: Asthma and chronic obstructive pulmonary disease (COPD) in Canada, 2018. https://www.canada.ca/en/public-health/services/publications/diseases conditions/asthma-chronic-obstructive-pulmonary-disease-ca
Summary: COPD is a chronic disease that is characterized by shortness of breath, cough and sputum production. The disease is progressive (i.e. it tends to get worse over time) and debilitating. It primarily affects the population age 35 years and older. Long-term exposure to lung irritants is the primary cause of COPD. In Canada and other developed nations, the primary irritant that causes COPD is tobacco smoke. Individuals living with COPD often find that the disease limits their mobility and impacts their ability to engage in activities of daily living. Although there is currently no cure for COPD, its symptoms can be managed with medications, other therapies and lifestyle changes. Early detection through lung function testing is key to managing COPD and slowing its progression. The Public Health Agency of Canada (PHAC) works with the provinces and territories, through the Canadian Chronic Disease Surveillance System (CCDSS), to collect and report national surveillance data on COPD.
Statistics Canada. (2019). Leading causes of death, total population, by age group. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039401
Summary: Asthma and COPD are significant public health concerns in Canada. As we strive to improve our understanding of the full burden of these diseases, expanding surveillance and research efforts will provide a strong foundation. A continued focus on optimizing surveillance methodology is important to ensure accurate measurement of the prevalence and incidence of asthma and COPD, and the burden that these diseases have on individuals, the health care system and society as a whole. These data can support the design of new policies and programs to reduce the impact of these diseases on Canadians.
Statistics Canada. (2020). Canadian health characteristics, annual estimates. https://www150.statcan.gc.ca/t1/tbl1/en/cv.action?pid=131000960
Summary: Chronic obstructive pulmonary disease (COPD) is a chronic, irreversible disease and a leading cause of worldwide morbidity and mortality. In Canada, COPD is the fourth leading cause of death. This systematic review was undertaken to update healthcare professionals and decision makers regarding the recent clinical, humanistic and economic burden evidence in Canada.
World Health Organization. (2017). Chronic obstructive pulmonary disease (COPD). https://www.who.int/en/news-room/fact-sheets/detail/chronic-obstructive-pulmonary disease-(copd)
Summary: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. Nearly 90% of COPD deaths in those under 70 years of age occur in low- and middle-income countries (LMIC). Early diagnosis and treatment, including smoking cessation support, is needed to slow the progression of symptoms and reduce flare-ups. Environmental exposure to tobacco smoke, indoor air pollution and occupational dusts, fumes and chemicals are important risk factors for COPD. COPD results from long-term exposure to harmful gases and particles combined with individual factors, including events which influence lung growth in childhood and genetics. COPD causes persistent and progressive respiratory symptoms, including difficulty in breathing, cough and phlegm production.
Image: The promise of technology to help solve chronic disease management challenges - STAT (statnews.com)
Photo retrieved from: (Canadian Foundation for Healthcare Improvement, 2015).
Photo retrieved from: (Canadian Foundation for Healthcare Improvement, 2015).
Vulnerable Populations
Government of Canada; Indigenous Services Canada. (2021). Indigenous health
care in Canada. GOC. Retrieved November 10, 2022, from https://www.sac-isc.gc.ca/eng/1626810177053/1626810219482
Summary: This resource provides an overview of federal, provincial, and territorial legislation and policies that promote Indigenous health. Details on the role of Indigenous Services Canada is also discussed; the department is responsible for providing services for Indigenous peoples that complement those that are provincially and territorially provided.
Joy, Jimmy. (2022). Addressing racism in respiratory therapy educational programs:
An Integrative literature review. Canadian Journal of Respiratory Therapy 58:91-97. doi: 10.29390/cjrt-2021-073
Summary: The impacts of racism on the experiences of under-represented minorities in health education programs such as respiratory therapy can impede the ability of these students to succeed in these programs and in the healthcare workplace. This can exacerbate the discrepancy between the racial diversity of the healthcare workforce and that of the population that they intend to serve.
Nguyen, N. H., Subhan, F. B., Williams, K., & Chan, C. B. (2020). Barriers and Mitigating Strategies to Healthcare Access in Indigenous Communities of Canada: A Narrative Review. Healthcare, 8(2), 112. https://doi.org/10.3390/healthcare8020112
Summary: The objective of this review is to document contemporary barriers to accessing healthcare faced by Indigenous people of Canada and approaches taken to mitigate these concerns. Barriers to healthcare access and mitigating strategies were aligned into three categories: proximal, intermediate, and distal barriers. Indigenous people in Canada face systemic/policy barriers to equitable healthcare access. Addressing these barriers by strengthening services and building capacity within communities while integrating input from Indigenous communities is essential to improve accessibility.
Wylie, L., & McConkey, S. (2018). Insiders’ Insight: Discrimination against Indigenous Peoples through the Eyes of Health Care Professionals. Journal of Racial and Ethnic Health Disparities, 6(1), 37–45. https://doi.org/10.1007/s40615-018-0495-9
Summary: Experiences of discrimination are commonplace, with patients noting abusive treatment, stereotyping, and a lack of quality in the care provided, which discourage Indigenous people from accessing care. This research project examined the perspectives of health care providers and decision-makers to identify what challenges they see facing Indigenous patients and families when accessing health services in a large city in southern Ontario.
Vunerable Populations: Indigenous Mental Health Resources
Gould, B., MacQuarrie, C., O’Connell, M. E., & Bourassa, C. (2021). Mental wellness needs of two Indigenous communities: Bases for culturally competent clinical services. Canadian Psychology / Psychologie Canadienne, 62(3), 213–226. https://doi.org/10.1037/cap0000247
Summary: To address known gaps in mental health care and services for Indigenous peoples, we explored the mental wellness needs of members of 2 Prince Edward Island Mi’kmaq communities. A community-based, participatory research method within an Indigenous relational paradigm drove the research approach. Mental wellness was conceptualised by each Mi’kmaq community as holistic and requiring attention at a cultural and systems level that includes past and present acts of colonization. Both the creation of stronger community ties based on traditions, pride, and connection and the establishment of intergenerational care across the life span were considered important by band members. Although diagnosis and treatment were also deemed important, mental wellness was perceived as being broader than a specific mental health phenomenon. Therefore, we encourage clinicians to blend multiple cultural worldviews and healing approaches, such as “two-eyed seeing,” that embrace the value of both Indigenous and non-Indigenous ways of knowing when providing mental health care.
Kim Critchley, Fiona Walton, Vianne Timmons, Janet Bryanton, Mary Jean McCarthy, & Jennifer Taylor. (2005). Personal Health Practices Around Physical Activity as Perceived by the Aboriginal Children of Prince Edward Island. International Journal of Indigenous Health, 3(1), 26–33. https://doi.org/10.18357/ijih31200612306
Summary: The study focused primarily on three of the determinants of health: early childhood development, education, and personal health practices and coping. The purpose of this article is to disseminate some of the personal health practices around physical activity as perceived by the Aboriginal children and to identify current health behaviours and/or needs of active, healthy lifestyles. Given the lack of information regarding the health status of this population, the Abegweit and Lennox Island First Nations bands collaborated with the University of Prince Edward Island’s Faculty of Education, School of Nursing, and Department of Family and Nutritional Sciences to gain a more comprehensive profile of the perceptions, health behaviours and needs of Aboriginal children living on reserve in both of these Island communities.
Wilk, P., Maltby, A. & Cooke, M. (2017). Residential schools and the effects on
Indigenous health and well-being in Canada—a scoping review. Public Health
Reviews, 38(1), 8. https://doi.org/10.1186/s40985-017-0055-6
Summary: This scoping review looks at the physical and mental health effects of residential schools on previous attendees and their successive generations. The authors analyze physical, mental and emotional, and general health of residential school survivors and their descendants compared to individuals who did not share these experiences. The review found that those who attended residential schools and their descendants had poorer health in all three categories analyzed than the general population.
Future Directions
Curry, S. J., Keller, P. A., Orleans, C. T., & Fiore, M. C. (2008). The Role of Health Care Systems in Increased Tobacco Cessation. Annual Review of Public Health, 29(1), 411–428. https://doi.org/10.1146/annurev.publhealth.29.020907.090934
Summary: Measurable progress in addressing tobacco use through the health care system is summarized, including accountabilities for addressing tobacco in national health care reporting systems, increases in reported advice to quit smoking from health care providers, and wider availability of insurance coverage for tobacco cessation treatments. Despite progress, significant gaps remain be[1]tween what is possible and what is done by health care systems to impact tobacco cessation.
Isaranuwatchai, W., de Oliveira, C., Mittmann, N., Evans, W. K. B., Peter, A., Truscott, R., & Chan, K. K. (2019). Impact of smoking on health system costs among cancer patients in a retrospective cohort study in Ontario, Canada. BMJ Open, 9(6), e026022. https://doi.org/10.1136/bmjopen-2018-026022
Summary: Smoking is the main modifiable cancer risk factor. The objective of this study was to examine the impact of smoking on health system costs among newly diagnosed adult patients with cancer. Specifically, costs of patients with cancer who were current smokers were compared with those of non-smokers from a publicly funded health system perspective. On average, smokers incurred higher healthcare costs than non-smokers. These findings provide a further rationale for efforts to introduce evidence-based smoking cessation programmes as a standard of care for patients with cancer as they have the potential not only to improve patients’ outcomes but also to reduce the economic burden of smoking on the healthcare system.
Smoking Cessation. (2020, July 7). Centers for Disease Control and Prevention. https://www.cdc.gov/grand-rounds/pp/2020/06232020-smoking-cessation.html
Summary: The fourth WHO global tobacco trends report released today, shows that there are 1.30 billion tobacco users globally compared to 1.32 billion in 2015. This number is expected to drop to 1.27 billion by 2025. Millions of lives have been saved by effective and comprehensive tobacco control policies under the WHO Framework Convention on Tobacco Control (WHO FCTC) and MPOWER – a great achievement in the fight against the tobacco epidemic. To meet global targets in reducing tobacco use, cessation services need to be scaled up, along with strengthening tobacco control measures. Offering cessation services can accelerate the downward trend in tobacco use prevalence, saving more lives and protecting the health of more people.
Image: How Much Does Canada Spend on Health Care? (ephpp.ca)