Welcome, ladies and gentlemen.
I'm Joy Smith, the chair of the health committee.
My apologies go to the witnesses. We had votes following question period today, and it takes a while to get through those votes and to get here on time.
I want to thank you so much for coming today. We have been doing a wonderful study here in the health committee that has permeated the technological innovation subject matter. We've come up with many exciting guests who've had many exciting, innovative ideas, and we're very happy to have you here today.
We have with us, from the Public Health Agency of Canada, Ms. Kim Elmslie. Welcome back.
From the University of Ottawa Heart Institute, we have Ms. Heather Sherrard, vice-president of clinical services. I must say it is a world-renowned institute. It is extremely progressive. We're very happy to see you here today.
We also have Dr. Robyn Tamblyn, scientific director, Institute of Health Services and Policy Research. Welcome. We're glad you're here.
And we have Dr. Peter Selby, associate professor of family and community medicine and psychiatry with the Dalla Lana School of Public Health at the University of Toronto. We're very happy to have you here.
We are going to begin with Ms. Elmslie from the Public Health Agency for a 10-minute presentation, please.
Madam Chair, honourable members of the committee, I am very pleased to be here today to speak to the use of innovative technology to support the prevention and management of chronic diseases.
As the committee members have heard before, chronic diseases are a significant burden to individuals, families and caregivers, as well as to the Canadian health care system and economy. Most hospitalizations, disabilities and premature deaths are associated with chronic diseases and injuries.
Today, three out of five Canadians live with one or more chronic diseases, and eight out of ten have at least one risk factor—such as physical inactivity, unhealthy diet, smoking and being overweight or obese.
The impact of chronic diseases on the Canadian economy is at least $190 billion annually.
With such a profound impact on the quality of life of Canadians, it is important that we make use of innovative technology to support the prevention of chronic diseases.
Today I will focus my comments on type 2 diabetes and describe how we are using a web-based technology to support Canadians in preventing this chronic disease.
About 2.5 million Canadians live with diabetes and many more are unaware they have this disease. Type 2 is the most common form of diabetes. It accounts for 90% to 95% of all diabetes cases. At the Public Health Agency of Canada, we estimate there are five million Canadians over the age of 20 who are currently pre-diabetic—that's one in five adults. By 2016, we estimate an additional one million new cases of pre-diabetes, and may I say that is driven by increasing overweight and obesity in our population. These are sobering statistics. Pre-diabetes is a key risk factor for developing type 2 diabetes.
Early detection and intervention is an effective diabetes prevention strategy. If we can stop progression from pre-diabetes to diabetes, we will achieve savings both in health and economic terms, and stopping progression means changing the risk factors we can change. Some risks are not modifiable, such as advancing age, our ethnicity, our family history, but other risk factors, such as overweight and obesity, physical inactivity, and an unhealthy diet can be changed.
I don't want to imply to you that changing these behaviours is easy. We know this is not the case. We also know that the environments in which we live can make it more difficult to make these changes, but within this complexity there are tools we can provide Canadians to help them assess and understand their risk and work with health professionals to stay healthy.
Let me describe now how we at the Public Health Agency of Canada are helping Canadians take control of their own health. We've developed a risk assessment tool called CANRISK. It's a scientifically validated Canadian diabetes risk questionnaire, and it's targeted at adults aged 40 to 74. This is a made-in-Canada risk assessment tool. It was adapted from the Finnish version, but CANRISK takes additional risk factors for our Canadian context into consideration: ethnicity, education, and gestational diabetes, to name a few.
Using web-based technology, CANRISK is a simple tool that calculates a risk score for pre-diabetes and diabetes. As each question is answered, information on healthy living and diabetes prevention pops up on the screen, so users receive educational material at the same time they're thinking about their diabetes risk.
CANRISK was first announced by the federal health minister in November 2011, when it was rolled out in partnership with Shoppers Drug Mart and at Pharmaprix in the province of Quebec. This was an important first step to making this tool available to Canadians. By putting CANRISK in pharmacies, Canadians can receive counselling and further information from these trusted health professionals in their communities. New collaborations are taking place to expand the reach of CANRISK.
In order to facilitate the use of this risk assessment tool and meet the demands of health practitioners, CANRISK is available in 11 alternate languages that can be used by Canada's ethnic populations, some of whom are at higher risk for type 2 diabetes. In addition to English and French, the CANRISK assessment tool and its accompanying guide to diabetes prevention are available in Chinese, Vietnamese, Korean, Spanish, and Punjabi, to name just a few. So far, over 51,000 Canadians have accessed CANRISK online.
Of course we want to keep pace with the advances in telecommunication technologies, so we've developed a mobile phone application for this risk assessment tool. As health professionals are increasingly exploring the use of mobile technologies to access the latest guidelines and tools, they're better able to support their patients in real time, both in the doctor's office or, in this case, at the pharmacy. For example, with our Apple iPhone you can simply search the app store, download CANRISK, and use it for free. Users can seek further information about diabetes and its risk factors, and they can share the web link to CANRISK with friends and family through social media sites or by e-mail. We're also planning to develop an app for Android devices.
Since the launch of the mobile app—and that was only about two months ago—CANRISK has been downloaded over 500 times from countries all over the world: from France, China, Hong Kong, Thailand, Switzerland, and Russia, as well as from the United Kingdom and the United States. Indications are that CANRISK is catching on. People want to access and use it.
I want to emphasize how CANRISK use is spreading in Canadian pharmacies. We started our collaboration with Shoppers Drug Mart/Pharmaprix, but CANRISK is also now available in Pharmasave and Rexall stores. We are working with others as well and are aiming to have CANRISK in over 2,000 pharmacies across the country.
Why are we focusing on pharmacies? More and more pharmacists provide a point of regular, frequent contact for many Canadians. They answer a broad range of health questions, and they can provide reliable information and encouragement on ways to live healthier and prevent chronic diseases. They are integral parts of communities and they know the contexts in which their clients live. This ongoing relationship is important to the sustained message on healthy living.
I am proud to tell you that the Canadian Pharmacists Association is promoting and evaluating the use of CANRISK by its members because it wants to help build its capacity to deliver public health messages on diabetes prevention and to support Canadians in taking action to prevent type 2 diabetes and other chronic diseases.
So simple technologies, delivered in the right place and at the right time, with credible support and encouragement, are a component of our prevention work.
There is currently significant momentum in Canada to develop partnerships that support healthy living and ultimately prevent chronic diseases. These partnerships include the public, private and voluntary sectors.
The Public Health Agency of Canada is encouraging innovation through these partnerships, and CANRISK is one good example.
Thank you for the opportunity to present today and tell you a bit about some of the work we're doing in improving the care for patients with chronic disease, primarily in the area of cardiac disease.
I'll be specifically speaking about programs that operate in the Ottawa region, but many of its parts have been implemented in other regions and provinces in Canada.
In today's environment, we're seeing a growth in the number of patients who have chronic diseases. We've already talked about how people often have more than one chronic disease. In cardiac we find that it's a disease of the elderly, that individuals living in rural communities tend to have a greater preponderance of the disease, and they often have less access to services and specialists than their urban Canadian counterparts. The health care challenges for these people are: making sure they receive care that is based on best practices; helping them learn to live and cope with their chronic disease; providing support to the family, and this most often is an elderly spouse who may also have a chronic disease; preventing adverse events, particularly around medications; keeping them out of hospital, unless they need to be there; and improving their quality of life.
In our region we've developed an innovative e-health strategy that actually allows us to deliver different care by connecting patients to us virtually, without actually requiring them to come to the facility. This is an integrated model with three layers, and each layer provides an e-health strategy that works for the specific needs of the patient as they move through the course of their disease. This is chronic, and many of them will come to an end stage in this disease.
The first layer is telemedicine. This is a high bandwidth video conferencing capability. It allows us to add diagnostic capability. For example, we connect an electronic stethoscope to the system. We can hear the heart sounds of people who live in Nunavut and we can actually make a diagnosis. We can also send electrocardiograms and X-rays. It allows a cardiologist at the institute to conduct a full cardiac exam without ever having the patient leave their home community. This is a huge benefit to the family and patients. They don't have to travel. In addition, we can have the local health care provider—who's usually a family physician—with them so that the plan of care is well understood and discussed all at one time.
In a large study done in 2001, the institute found there were significant cost savings to patients and families, as well as improved access to services, using this technology. This led to the creation of the provincial system in Ontario called OTN, which now connects all of our hospitals. Today we can connect with hospitals across Canada and internationally to discuss patients.
We've expanded these initial services now to provide patients access to services that are not available unless you live in an urban city. For example, our rehab program broadcasts its classes on exercise, diet, and healthy lifestyles to the telemedicine stations in our partner hospitals that may not have these kinds of services. We also use it for follow-up visits for patients who prefer not to travel to a larger city. As a final service, we can see complex, admitted patients in hospitals where the local providers may be struggling with the diagnosis. They take a mobile telemedicine station to the bedside of the patient and we assist them with the diagnosis.
As a final use, we actually help to link families and patients when patients have to stay in Ottawa, for example, for long periods of time. This is particularly helpful for our patients from Nunavut. They become quite socially isolated while they're here, so we connect them to their families for a visit by using these stations.
The benefits of this system are reduced travel costs to patients and families, improved access, people can stay in their home communities, we have an ability to support local family physicians in complex care, and they reduce readmissions to hospital.
Of the strategies I'm going to talk to you about, this is our most expensive, and it has to be done centrally. You have to come to a site that has a telemedicine station, but it has the highest bandwidth and we can do the most detailed work with it.
The second layer is our home monitoring program. This program uses portable home monitors about the size of two pounds of butter. We give them to the patients to take home. These devices are plugged into their telephone jack and they're able to transmit their actual vital signs in the same way we would take them in a hospital. So we can assess blood pressure, pulse, weight, electrocardiogram, oxygen levels, and blood sugar levels. The data comes into a central station. We have a nurse there who can assess the results, based on a pre-set parameter. If the patient is outside of range, the nurse may call them back and adjust their medications or they may offer them some advice around diet or other compliance issues.
The system also allows us to pre-program questions—in eight different languages—that we would normally ask a patient. It speaks to the patient and the patient simply presses a button responding yes or no. This adds additional symptomatic screening capability that we don't have because we can't see the patients.
In addition, once a week we do a regular medication update to make sure they're still on the right medications and that no one has inadvertently changed them off their best practices. I can say that on every call we usually find a problem.
There's a considerable amount of medication management that has to be monitored. The typical monitoring period lasts three months, and during this time, in addition to seeing how they're doing, we actually have a predefined teaching program to help them learn to deal with their disease. In the Ottawa region, we have 150 of these monitors; 90 are located at the Heart Institute. The remaining 60 have been sent out to the local hospitals so that they can actually provide them locally to patients. Again, they don't have to come in to the city to receive the service.
Because these transmissions use a regular telephone system, we've sent monitors with patients all across Canada. We do see patients from across the country, and we've been able to use this because it plugs into the telephone system. The patients just simply ship it back on the bus when they're done.
We've started these systems for many years, and we've found the following. Patients are statistically more likely to be on best practices. They have a lower rate of readmission. The old, elderly, or people over the age of 85 do not require any more interventions and they're very capable of using the system. There's a high degree of satisfaction with patients and family physicians. By way of comparison, an average nurse in a centre like ours can look after three or four patients and sometimes up to six. These nurses who manage these systems look at 30 patients at a time. The cost of a monitor is $5,000. The cost of an average readmission is $7,000. In the first year, we saved $340,000 in one year looking after patients with this technology.
The third layer is automated calling, and the strategy was developed for the longer to medium term. We run five services under this program, but I'm going to restrict my comments to one related to heart attacks. We work with a local company, and we just use a simple automated calling platform. We have clinicians who develop a series of questions in the same way they would ask questions of a patient during a follow-up visit. The patient is called at regular intervals and responds to the questions, and the voice is captured in the system as a text response. A nurse can see what the patient has actually said, yes or no, to the question, and in the event that they see a wrong response—a patient may have stopped taking a medication—they'll call them and see what the issue is.
Each of these five systems are separate and they deal with different diseases and conditions that patients may face. This is the least expensive of all of the strategies, and it has the largest and easiest reach. If you have a phone, you can get a call. For example, patients with heart attacks often stop taking their medications once they're feeling better. This is a huge problem, since those medications will prevent them from having future heart attacks. The calling system for heart attacks calls people at day four, after they get home, and at months one, three, six, nine, and twelve. Their individual medications have been loaded into the system, and it simply asks them if they're continuing to take each of those medications. If they answer that they've stopped taking them, a nurse will call them and work with their family physician and/or the patient to get them back on the desired medications.
Again, these systems have been tested for effectiveness. We've just finished a large randomized control trial, with 600 patients receiving the call and 600 not. The patients who received automated calling are statistically more likely to be on best practice medications at the end of a year, and they are also statistically less likely to have a readmission during the course of that year.
The benefits to patients are that they have a smoother transition from hospital to home. We can give them additional support and reassurance as they learn to live with their disease. We're able to identify problems that are happening and intervene in a more timely way, and it removes geography as a barrier to care. This system has also been used by patients across Canada, and it is being implemented in other facilities in Ontario and across other provinces.
In conclusion, the e-health technology, when implemented properly, can be used to better clinically manage patients and to better support their families. It removes the barriers of geography, resource inequities, age, and regional disparities. It's inexpensive compared to hospital care, and it keeps the patients closer to home. There's a high degree of satisfaction with these systems from patients, and there does not appear to be any specific difficulties in using them with the elderly.
As a final comment, the clinical needs of the patients have to drive the type of technology you choose. That's why we have three layers. Some of the least expensive technology, when implemented in an innovative way, brings the best outcomes.
Thank you very much for inviting me. It's a true pleasure to be able to speak to you about the use of technologies for chronic disease prevention and management.
As my other colleagues have mentioned, I think we're all aware that we are aging well in Canadian society, as people are in many other countries. We are now essentially facing a situation where many people have chronic conditions that they live with for a fair length of time, including the cancers. This has meant that we've had to retool and rethink how we deliver health care. You don't do that through the emergency department or through acute hospital beds.
Most countries that have made a lot of progress here have invested in building a very different kind of community-based primary health care system. CIHR, along with its partners in the provinces and territories, has put funding into this area to try to create some innovations at the front line. I think that's very exciting.
One thing that will be a key enabler and an accelerator of change will be the appropriate use of e-technologies within these new models of care. My colleagues have actually provided examples of the wonderful things that can be done. I think this is really where we could actually see transformative change and a way of delivering care that you could never have had before, in a way that's cheaper, faster, and better. That's hard to believe. We aren't Walmart yet, we're not Amazon.com, but we could really make dramatic changes in the way we deliver care that would improve the experience for patients.
In thinking about Canada, telehealth and tele home care are two areas where we can make huge strides, not only in the rural and remote areas, but even in downtown Toronto. We may be able to actually monitor what's going on at home, so you wouldn't need to be trotting down to the downtown hospitals in Toronto.
To see how we could build some traction in this area, CIHR began funding what we call catalyst grants, simply getting a handle on what was there. Some very exciting things happened, and I think this is because we have research talent and a very highly educated workforce who are incredibly creative and very frustrated about how things are going, and they want to do it better. I think it's an exciting time.
In this particular small area—and it was not a huge investment—we had a number of phenomenal examples of improving the patient experience. For example, the Hospital for Sick Children created this new peer-to-peer support mentoring system for adolescents who had juvenile arthritis. Juvenile arthritis is a really rare condition. To get a bunch of kids in a room—10-year-olds and 8-year-olds, and so on—so that they can collectively learn from each other and share their experience would be impossible. It is now possible through social networking and technology.
Similarly, for adolescents who are confronted with the challenge of having cancer, they set up a new communication tool. Teens like to text—we don't, but they do—so they set up this new collaborative way of actually connecting to their team in a way that was cool. It was not cool to have cancer, but this was a cool way of actually getting more timely and accessible health care.
A McGill team actually developed an e-health promotion program to deal with cardiovascular risk factors. They provided not only encouragement and incentives for doing that, but a way of monitoring and showing progress for people who are using that program, to reduce blood pressure, overweight, and so on.
We've seen some very exciting things happen with only a small bit of investment, so we know there is huge talent and huge potential out there. I'm speaking now from the funding agency perspective. The question is, what's the recipe for ramping up the progress? What's the recipe for putting Canada in a leadership position here, as we have assumed in the area of telehealth, for example?
In looking at the pieces, what we definitely need is a high-functioning science and technology innovation system. We need some alignment between what we're doing in industry, what we're doing in research, and what we're doing in clinical care. We need these three things to be aligned.
We spent some time looking at Israel this past year because they are at the top of the leader board in this area. A number of lessons were learned in our visit with them. It has to do with really getting the right people—and I think we have the right people—getting an interest sectoral science agenda between engineering, social sciences, and health, and connecting with the industries that could develop a high-content capacity in this area.
I'm simply delighted to hear Heather's story, because that's exactly the kind of thing we think could really happen.
To look at where we go with this and in what three target areas we think we can make big changes in a short period of time, one is in the area of ramping up people's capacity to manage their own conditions, through patient portals and so on. This is using technology to empower people to manage their chronic conditions. It includes linking to primary and secondary service delivery through their personal health records or through web-based communication; developing intelligent monitoring algorithms, so that, for example, when you're monitoring someone's glucose, weight, and blood pressure, you in fact have computerized algorithms that say this person is in trouble and you should get going in a certain direction, similar to the way they've used their interactive voice recording system to monitor those kinds of things; having a capacity for personal social support and innovative social networks for people who have specific conditions, and not just in Canada but around the world. We have really great examples, such as PatientsLikeMe for people with ALS, which is a very rare condition, being able to share that condition with each other.
The second area in which we think we'll see real capacity to do something much needed and very creative is in going down the route of individualized advanced decision support—supporting health professionals in doing the right thing at the right time for the right person—and being able not to target it to the average, but to say people like you, who have these preferences and want to see these outcomes in this period of time and who have this kind of genotype profile, should do this for it.
If you take, for example, antidepressants, half of the first antidepressants you use don't work. You can't predict right now who it is going to work in and who it is not going to work in. We will soon have the capacity to do this. Then it's a question of how you deliver it right to the point of care—to patients themselves, to pharmacists, to physicians who are actually prescribing those medications.
That's a second exciting area.
The third exciting area has to do with population and health system monitoring. We have pioneered the capacity in Canada. We have a social health care system, we have a lot of population-level data, and we have shown how we can use it to assess variations in practice, the risks and benefits of medications, and epidemics and infectious disease outbreaks. We could do much more of that.
Big data and big data analysis, such as you see in the private sector, could come to health care, and it could dramatically change how we do things. You would have more just-in-time information to manage. You would know, for example, whether the vaccination rate was falling in certain regions, and the corollary—that we now have a measles outbreak or, worse yet, a polio outbreak—could be something you would learn now and not two, three, or four months later, as we did in the case of Walkerton. So there are opportunities there.
We feel this needs to be taken from a global perspective so that we're sharing the experience, sharing in the innovation, and sharing in the marketplace, where Canadian innovations can go. We think that's an important piece.
Along with that is that Canada has really excelled in being able to run a health care system with a single payer. Lower- and middle-income countries are wanting to move down that pathway. We have the talent. We could build the tools to allow them to do that well.
We have some challenges. One challenge that I'd say has been very difficult for us is in the capacity to use the data assembled through these multiple sectors to create new knowledge, to create new intelligence, and be able to monitor how things are going in health care. We have some privacy issues that we have not successfully dealt with. We worry about data travelling across city lines, regional lines, provincial lines, and even national lines, so that's getting in our way.
Canada, which once led in this area, is now falling behind, because we do not have a policy framework that will successfully manage this way of providing access to managers of the health care system, providing access to researchers, and being able to deliver this point-of-care information back to citizens who need to know it now, not later. I think there are solutions, which we hope to push in that direction as a collaborative, and I look forward to your feedback and suggestions in that regard.
Finally, let me mention that I think we see the e-health initiative being nicely married with the strategy for patient-oriented research, which truly is trying to transform the way we connect research to the backbone of the care delivery system and change outcomes, not when the study is done, but as knowledge is accumulated through time. I think that's one of the most exciting things we're doing. It will be in the area of community-based primary health care and mental health, which we see as some of the early strategic priorities, and we're looking at other areas in which we think we can excel as Canadians.
We see this as a way forward. We have assembled an international advisory group of small and medium-sized industry representatives, scientists, leading clinicians, and funders from around the world to help us understand how we could do this collectively.
Thank you very much for your attention. I look forward to any questions you might have.
Honourable chairperson, members of Parliament, colleagues, and other attendees, thank you for the privilege of addressing you on this very important topic, which is very close to my heart.
I've been asked to address how innovative technologies can be used to support the prevention and management of chronic diseases. It is very difficult to follow my colleagues, who have spoken very eloquently about various aspects. I hope to add a little bit more to these. I have made a submission as a brief and trust it will be useful to you as you deliberate.
There are two key messages that I have for you today. One is that our health behaviour—what we do—is determined by a variety of interacting and competing factors between our environments, whether social, geographical, economic, or family environments, and our biology, whether that be our genetics or what the environment has done to our genetics—what is known as “epigenetics”.
So how we act today is best understood from a developmental context of our brains, from before we were born until what we do now. It determines how we think about things, how we feel about things, and how we act. This means that the actions—especially the habits—of what we do today are shaped by our early experiences and by the current opportunities and constraints of our environment, which help us to act in a healthful way or not.
That's one message. The second is that the technological advances in the products, practices, policies, and communications through such means as social media are double-edged swords. They can promote ill health by exposing us to harmful messaging or making us more sedentary, or they can play a major role in empowering us to take action, whether at an individual level, a family level, or a community level. However, the use of these technologies needs to be promoted, and they need to be situated within the broader context of health behaviour change interventions, rather than in isolation.
Never before has society faced such a radical shift in how we live. Think about it: in the last 50 years, we have seen a huge shift, from most of us being paid to expend our energy to now, in this knowledge economy, having to pay to expend energy. I find it ironic that I drive to a gym, pay a membership, and then pedal a stationary bicycle for no purpose at all other than to get my heart going. Then I sit back in my car and drive home. That's the change. Our ancestors never did that, and I'm sure, when they look down on us, they must be wondering what on earth we are up to. That's it.
We've also tamed the production and distribution of food so that it is low-cost and packed with calories that we can consume ad lib, no problems, in ways that go far beyond what we need. What does that lead to?
Moreover, the use of tobacco and alcohol is endemic and accounts for significant ill health and premature death. Moreover, the pressures of modern living, despite everything we have, are leaving us more stressed, with less time to sleep. Taken together, our successive advancements are also making us more prone to develop such chronic diseases as cancer, heart disease, depression, etc.
Now we are closing in on a health care cliff whereby most chronic diseases will take up most of our health care resources—approximately $83 billion in 2005, and I think much more now, as you mentioned, Kim.
The good news is that as our health care system matures into its forties, it's starting to develop a little less myopia and starting to look into the future, so that we begin paying attention a bit more to prevention. We need to do that.
Moreover, we have a population ever increasingly informed about health and health behaviours, but clearly not in numbers sufficient to prevent the tsunami of chronic disease that's going to come exponentially, as Kim was just saying in talking about diabetes.
I and many others before me have identified the core modifiable behaviours that account for about 200 chronic diseases that are estimated to account for seven years of lost life, at least in Ontario. Often these behaviours cluster in the same individual and often in the same community. We can also understand them as being socially infectious. Many good researchers have found that these behaviours don't just occur in isolation; they tend to occur in communities and they tend to be infectious.
If we as a society collectively address the problems of tobacco use, excessive and risky use of alcohol, poor nutrition, including excess salt intake, physical inactivity, stress, and poor sleep, we can reduce illness and approximately prolong healthy years of life—not life on a respirator—by about three and a half years. Taken together, I call this a health promotion six-pack. If we all strengthened and implemented this broadly across the country, it could help address things like obesity, heart disease, cancer, lung disease, Alzheimer's, and diabetes, just to name a few that we are now trying to address separately.
So how do we reach everybody across Canada? Clearly, we are aware of the geographical variations in health status in the urban versus rural divide, the spread across various sectors of society, maldistribution of health care resources across the country, and that we'll never have the health human resources necessary for that one-to-one promotion of health. Clearly, policy-level interventions are necessary to promote health, such as taxation on certain products, reducing the access and attractiveness of unhealthy behaviours, and, as I said, the promotion of the health promotion six-pack. These make it easier for all of us to do the right thing for our health.
In addition, there are other ways to increase health literacy in our society and empower us. Here's where I see technology has that role in potentially scaling up what we know needs to be done.
Roughly, if you take a look at these risk behaviours, you can step back and ask what are the core, the dominance, of these behaviours and this is what we can modify. Clearly, we can modify it at the individual level, but we can sometimes modify it at the product level. For example, there are product innovations that may be able to help us reduce the harm from certain of these products—medications and medication reminders to help people stop unhealthy behaviours, or create safer products that might have less salt or less sugar. Good examples that are emerging now that need to be paid close attention to are things like electronic cigarettes. Suddenly, most of the carcinogens or cancer-causing chemicals are being eliminated from that. We need to be able to study that. We need to be able to develop that. That's technology really taking out the harm from cigarettes that we need to focus on, and it needs to be proven. It needs to be studied scientifically. We need to invest in those kinds of scientific studies to make sure they come in and don't cause more harm than good. Moreover, we may need to look at design innovations that get us to move more or get us to pick healthier choices when we eat food. However, the biggest developments that have been published and that I'll speak about are communication technologies to promote and assist with behaviour change, and these are typically reminders.
What's very interesting is that our brain is the only organ that outsources its functions. Your heart doesn't say “I've had a bit too much beating and I'm going to get a machine to help me do that”; that's called sickness. But our brain constantly writes it down and puts it on a BlackBerry, or what have you, to help us remember. So we outsource a lot to remind us of one thing that can help us. It helps us check on weight, blood sugar, track calories, reduce the amount one drinks, or even help quit smoking. These can be done through websites, social media pages, web-based tools, video games, and apps that can be downloaded on to your phone and therefore don't need an active Internet connection that you can take with you to make it mobile.
This explosion of interest has been due to the development, reach, and adoption of the Internet and mobile technologies, and it has enhanced connectiveness among society, even among people who don't know each other. These online communities are powerful networks that are constantly forming, reforming, dissolving, and often mirror real-world networks, except that the geographic and socio-economic divide is being bridged. In other words, we have networked intelligence potentially among these members in these communities. This flow of information can be fairly rapid, but we need to figure out ways in which this information can flow. For example, we've had this broadband initiative in Canada that has increased access in remote areas of this country. This increases the possibility of mitigating the inequity of access of evidence-based information to empower health.
At least 80% of Canadian households had access to the Internet in 2010, according to StatsCan. Two-thirds use it to search for health information, and the numbers are growing exponentially, especially in rural areas and by women.
There are over 20 million mobile phone users in Canada, with over six and a half million of these with smart phones, with half of them accessing the Internet using that smart phone. Using downloaded apps is the top monthly Internet activity; 85% of smart phone subscribers download an app. According to Quinn Street, the number of mobile health apps has nearly doubled worldwide, from 124 million in 2011 to 247 million in 2012.
We know that although younger people are most likely to use their mobile phones, older individuals have begun to use them as well, and we shouldn't make any assumptions about age. The trend is only going to go up. As I age, I don't see myself giving up my own smart phone.
Thank you very much, Madam Chair.
I want to thank the witnesses here today. I think we're having an excellent study.
I liked what Dr. Selby said. I think I belong to that demographic that would drive to the gym, get out, get on the bike, and then drive back, but I think that too many of my friends actually made pit stops at a restaurant that had a bar, went to the bar, had the chicken wings, and then had a cigar afterwards.
Voices: Oh, oh!
Mr. Colin Carrie: What you stated about these different apps really spurred my interest. You've done a lot of work with addiction. Are there any apps out there that you recommend? I'm curious, because you said there were so many apps out there, and I was wondering about that.
Also, Ms. Elmslie, are there apps out there that Health Canada actually recommends, even with regard to this committee, in order to get the word out? This sounds like a really great way of managing some of these chronic diseases, and a lot of people don't know about it.
I was wondering, Dr. Selby, if you could comment on that, and maybe you could, Ms. Elmslie.
I'd be glad to, and I'll keep this brief.
As the federal public health agency, a big part of our role is surveillance of chronic disease. That means we're working across the country with the provinces and territories, with StatsCan, and CIHI, the Canadian Institute for Health Information, to provide good information on how chronic disease rates are changing in our country and where there are pockets of problems.
The reason we do surveillance is not so that we can talk about a lot of statistics; it's about targeting interventions where they can do the most good. It's also about helping our stakeholders—because we work with partners all the time—to know where their interventions can be best placed to make a difference. That's a foundation of public health, as you know, and that's one of the things we do at the agency and the centre.
The other really important thing is around identifying best practices and working with our partners to scale those up. That's an important federal role. You can imagine that if every jurisdiction across the country were trying to identify best practices there would be so much duplication; everybody would be doing the same thing. We have one place where we can devote our expertise and resources to pulling together what is known about what works in chronic disease prevention.
That's not an easy question to answer. That comes back to what colleagues have said about intervention science and research, and investing in that. That's the only way we're ever really going to know what works in communities. We're all different, and our communities are all different, in chronic disease prevention.
Those are the two areas where, as a federal agency, we're adding value to prevention. We're identifying best practices and working with partners to scale those up in a way that prevents us from being inefficient in the use of our resources to do the right things that are working to prevent chronic disease for Canadians.
That's where I was going with that, actually. It provided advice on what I should do to reduce my risk.
Mr. Kellway, you made a comment about showing up with a knife at a gunfight. I guess it's better to show up with a weapon of some sort, because then at least you stand a chance of drawing some blood.
Knowing that this is an audience you are trying to reach out to, and knowing that information is key to getting people to the position you talked about, Ms. Sherrard, of being ready to make the necessary changes, what other technologies are you looking at to move that thought process forward, to get people into that position?
Dr. Selby, you talked about people driving to the gym. Just get people thinking about how ironic it is that we actually drive to the gym, get on a treadmill, get back in the car, and drive back home. It's to get people thinking about these factors that can lower our risk levels, and I am wondering if you have something else.
I was thinking about the tools we had before. All too often what we had in the past was probably a pamphlet at the doctor's office to read while we were sitting in the waiting room or something of that nature. This is something more innovative. It gets people moving to where we are today with technology, people of my age who use an iPad or whatever, and my parents. I jokingly talked about my mom and dad. On the weekend, I helped my mom try to do something on her computer, and that's weird because I'm not technologically advanced. So many people have gone in that direction. Elderly people are intrigued now as well.
Do you have any thoughts or ideas on how to leverage that tool?