Future of Health in Canada

jc645587
Nov 29, 2022
5 min read

Updated: Dec 6, 2022

Throughout the last few months, most of my posts have tied to smoking cessation, chronic disease management and the social determinants of health in relation to my profession. This week I decided to continue with that focus and discuss the future of smoking cessation and the role of health care systems.

The 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 (Tobacco Use Falling: WHO, 2021). Sixty countries are now on track to achieving the voluntary global target of a 30% reduction in tobacco use between 2010 and 2025: two years ago only 32 countries were on track (Tobacco Use Falling: WHO, 2021). 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 (Tobacco Use Falling: WHO, 2021).

The WHO MPOWER measures are in line with the WHO FCTC and have been shown to save lives and reduce costs from averted healthcare expenditure, including monitoring tobacco use and prevention policies, protecting people from tobacco smoke, offering help to quit tobacco use, warning people about the dangers of tobacco, enforcing bans on tobacco advertising, promotion and sponsorship, raising taxes on tobacco (Tobacco Use Falling: WHO, 2021). All these measures are highly cost-effective, impactful and provide significant return on investment and therefore WHO recommends adopting these.

In the future, health care systems should be focusing on investing each year in evidence-based cessation interventions such as brief advice (consults/counseling from health care providers), national toll-free quit lines such as Smokers Help Line, and online/text-based cessation support, could help 152 million tobacco users successfully quit by 2030, saving millions of lives and contributing to countries’ long-term economic growth (Curry et al., 2008).

Additionally, in the future with the aging population and therefore, aging smoking population, there will be a significant impact on healthcare costs as this population ages. Smoking status has a significant impact on health care costs among patients with cancer (Curry et al., 2008). On average, smokers incurred higher healthcare costs than non-smokers. These findings provide a further rationale for efforts to introduce evidence-based smoking cessation programs 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 (Curry et al., 2008).

Likewise, in the future to help prevent smokers and children starting smoking, the government must continue to have laws in place to prevent this. The province of Prince Edward Island (PEI) has the Smoke Free Act which prohibits smoking in a public place or workplace and no smoking in a motor vehicle in which a person under 19 is present (Smoke-free Places Act, 2018). The primary purpose of the Smoke-Free Places Act and Regulations is to protect citizens from the harmful effects of second-hand smoke and the unknown effects of vapours from an electronic smoking device (Smoke-free Places Act, 2018). Secondarily, it is meant to reduce consumption of tobacco products in the province. The legislation prohibits the use of tobacco products and electronic (vapor) smoking devices in any public or work place in the province including hospitals, school grounds, community or church halls, restaurants, bars, shopping malls, movie theatres, rinks and office buildings (Smoke-free Places Act, 2018).

A designated smoking area is permitted providing no part of the place is used for a child-care center, school or hospital and as long as the designated area is in compliance with the regulations of the Smoke-Free Places Act (Smoke-free Places Act, 2018). Laws in PEI changed in March 2020 to prohibit the purchase of tobacco products and electronic smoking devices under the age of 21 (Tobacco Tax Rates, Government of Prince Edward Island, n.d.). Additionally, in the province of PEI, electronic smoking or vape products can only be sold in "tobacconist shops," described as an "age-restricted location" where, "at least 50 per cent of the retailer's product display space is devoted to the sale of tobacco, electronic smoking devices, or a combination of both” (Tobacco Tax Rates, Government of Prince Edward Island, n.d.). At this time P.E.I. was one of the first provinces in Canada to increase the age to access tobacco and vaping products to 21, a move supported by both the Canadian Lung Association and the Canadian Cancer Society (Smoke-free Places Act, 2018).

To meet global targets in reducing tobacco use, cessation services need to be scaled up, along with strengthening tobacco control measures (Isaranuwatchai et al., 2019). Offering cessation services can accelerate the downward trend in tobacco use prevalence, saving more lives and protecting the health of more people (Isaranuwatchai et al., 2019). I have previously talked about efforts in my health authority, Health PEI, taken to reduce smokers’ burden on the health care system. Every time a patient is admitted to a Health PEI facility, they are asked a series of questions, one being if they are a smoker. Today, this includes vaping, cannabis and tobacco use. Patients are flagged this way, and a consult is sent to a Respiratory Therapist. We do a full consult with the patient, and discuss nicotine replacement therapies, which are free while in hospital, long term follow up information can be sent to the Smoker’s Help Line as well, and patients will be called after discharge home. There is also the new Provincial Smoking Cessation Program which allows twelve weeks of a NRT pharmacological treatment to be paid for by the government. This has been quite successful with patients thus far and although is quite expensive, could be a federal program in the future.

Population-level cessation interventions include brief advice, national toll-free quit lines, and mCessation (support through mobile phone text messaging) (Isaranuwatchai et al., 2019). These interventions cost very little yet deliver significant returns on investment within 10 years. With the changing way of virtual health care, using text messaging and emails or other forms of social media is a great way to get patients involved and complete consults. Also, with the shortage of family doctors, if other allied health professionals can prescribe for NRT and do so over the internet or pone, this would be a proactive way to help the smoking patient population (Isaranuwatchai et al., 2019).

Lastly, in the future, there needs to be work in social media and the entertainment industry to reduce smoking in films, tv or social media frameworks (Smoking Cessation, 2020). Generally, we have seen that if youth see people smoking, they are more likely to start this habit. Also, I think that all health care professionals should be trained in smoking cessation, as it is something they will encounter quite often in a health care career. Knowing how to counsel patients and offer pharmacotherapy replacement during their hospital stay is an important first step of quitting in most cases (Smoking Cessation, 2020). Health systems need to work on integrating cessation interventions into routine care), protocols for providing cessation interventions, a conversation guide on how to help walk patients through the quit process, and many others (Smoking Cessation, 2020).

References

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

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

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-