We Still Have a Long Way to Go: Patterns of Health and Healthy Lifestyles Across the Generations

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We Still Have a Long Way to Go Patterns of
Health and Healthy Lifestyles Across the
Generations

• 19th John Friesen Conference
• April 23 24, 2009
• Andrew Wister, Ph.D.
• Professor Chair
• Department of Gerontology, SFU

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Key Questions

• 1. Are current and future cohorts/ generations
  becoming healthier?
• 2. What can we do to improve?

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Population Aging

• 2001 13.6 of population
• 2006 - 14.6
• 2011 15.3 Projected
• 2021 20.4
• 2031 25.2

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Population Pyramid, 1981, 2001, 2006, Canada
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Apocalyptic Prophesizing

• Dychtwald (1997) Baby boomers are train wrecks
  about to happen (pandemic of chronic disease,
  mass dementia, inadequate pensions pressures on
  deteriorating health care system)

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Health System and Societal Costs

• Over 120 billion in 2007
• Over 180 billion in total costs to the economy
• Not surprising that someone has to be blamed
  often older adults
• Prevention may be the largest untapped area for
  cost savings

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What Constitutes Good Health?
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Life Expectancy at Birth, Canada, 1979-2004
82.6
80.2
77.8
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Compression of Morbidity

• Onset of disease and disability compressed into a
  shorter time frame (Fries, 1983)
• 1982-1999 2 per year decline in functional
  disability, 1 decline in mortality
• Evidence from 1991 - 2007

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Compression of Disability

• Moderate support, but mostly for less severe
  disability, 75 but also declining recovery
  (Wolf et al., 2007)
• Less support when examining other measures of
  health (chronic illness, perceived health)

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Have Rates of Chronic Illness Declined?

• 1978/79 to 1998/99 decreases in arthritis,
  hypertension, heart disease, bronchitis/emphysema
  for person 45-64 (Statistics Canada, 1999)
• Increases in diabetes, asthma migraines
• For 65, no declines (positive trends) but
  diabetes, dementias, asthma up
• Cancers show unique and complex trends

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A Health Paradox

• Rising life expectancy and disability compression
  concurrent with rising rates of many chronic
  illnesses
• Due to changes in utilization and health care?
  Improved services and technology to facilitate
  independence? Or healthy lifestyles?

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Have Lifestyles Improved Over Time?

• Some state that older adults today and the
  future older adults of tomorrow (the boomers) are
  healthier than previous generations because they
  are wealthier, exercise, eat better, and
  knowledgeable about healthy lifestyles

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Lifestyle Factors and Health Risk

• Smoking increases mortality by 50 and doubles
  incidence of cancer and cardiovascular disease
  (CACR, 1999)
• Quitting can lower risks within one year

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Lifestyle Factors and Health Risk

• Physically inactive have a 90 higher risk of
  developing CVD 60 osteoporosis and 40 higher
  risk of stroke, hypertension, colon cancer, and
  diabetes (Katzmarzyk et al., 2000)
• Benefits of physical activity can be realized
  immediately no matter what age

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Lifestyle Factors and Morbidity Risk

• Obese individuals are more than twice as likely
  to have arthritis, heart disease, breast colon
  cancer (Cairney and Wade, 1998)

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Generational Movements Through Time

• Unique health and illness trajectories connected
  to the size and composition of cohorts, and to
  earlier life experiences, normative milieu and
  historical events
• Upward bound age escalator

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The Exercise-Obesity Paradox

• Paradox - exercise and obesity moving in opposite
  directions
• Is the exercise measure flawed?

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Leisure-time Physical Activity Inactive,
Canada, 1994/95 2002/03

Age NPHS 1994/95 CCHS 2002-03
35-44 59.8 50.1
45-54 60.8 51.6
55-64 56.8 51.0
65-74 58.3 50.3
75 64.6 59.6
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Exercise and Obesity Correlation

• Among 35-54 ages in 2000/01, there is a 25
  relative risk reduction in obesity rate (gt30)
  among frequent exercisers compared to
  infrequent/sedentary
• 19 relative risk reduction in infrequent/sedentar
  y activity among those who are not obese,
  compared to those who are not

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Dr. Phil Says Television Watching is the Culprit

• Most studies linking TV and exercise or obesity
  are cross-sectional
• Therefore problems of causality which comes
  first?

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Television Watching and Poor Lifestyles

• Jeffery French (1998)
• TV watching associated with obesity at cross
  sectional level, but only among low-income women
• At longitudinal level, no associations were
  supported

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Population-Level Evidence

• Canadian TV watching dropped from 23.3 hours/week
  in 1991 to 21.5 hours/week in 2000 (Statistics
  Canada, 2001)
• For workers, average time spent watching TV
  dropped from 95 minutes in 1986 to 79 minutes in
  2005 (Statistics Canada, 2007)

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Technological Inactivity

• Computer use at work has doubled between 1989 and
  2000 (33 to 57) (GSS 2000)
• 80 of Canadians work at their computer every day
• But, it is not enough to tip the scales, given
  exercise improvements

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Nutrition and Food Consumption Patterns The Good
News

• Consumption of fruits has increased 27 between
  the 1970s and 1997 (Alain, 1999)
• Low fat milk up (e.g., 1 milk up from 12 in
  1990 to 27 in 1997)
• Consumption of red meat down

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The Bad News

• Over 25 of energy burned by adolescents and
  adults originates from the Other Food Group
  (Starkey at al., 2001)

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Pop Consumption is Up

• Pop consumption in Canada doubled between 1975
  and 1997, from 60 liters to 106 liters per person
  per year (Alain, 1999)

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Fast Food Supersized

• 20 of all meals are consumed out of the home
  (Struempler, 2002)
• Especially fast inexpensive meals
• McDonalds continues to lead the way

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Bigger Is Not Always Better

• Average serving size has increased between 20 -
  70 over past two decades
• 2-3 times the USDA recommended food size
  (Kendall, 2000)

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Binkley et al., 2000 Study, International Journal
of Obesity

• Collected information on foods purchased in 24
  hours before survey
• Fast food sources predict obesity in men and
  women

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Food Consumption Conclusion

• Therefore it is both the quality and the quantity
  of food consumption that is the problem

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Why Do We Have Poor Lifestyles?
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Age-Related Barriers to Physical Activity

• Boomers report time issues more often, seniors
  repot energy
• Perception that when we age, we need to slow down
• Health is a major issue for older adults
• Energy drops from some
• Fear of falling
• But, it is never too late Plethora of
  Intervention Studies

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Time Constraints on Eating Healthy

• 13 of Canadians reported that they did not have
  time to prepare a healthy meal
• 74 eat in a hurry
• 39 eat in a vehicle at least once a week because
  of a busy work schedule (FPT Advisory Committee
  on Population Health, 1999)
• 40 of Canadian older adults report that they do
  not have the time or energy to exercise regularly

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Too Many Diets, Contradictory Information

• Over 50,000 diets in existence
• Disagreement over what is good and what is bad
• Concept of lifestyle change is not part of most
  diets

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The Power of Media Messaging

• Presentation of fast food is a multimillion
  dollar industry (Schlosser, 2002)
• Low fat everything rather than making substantive
  changes to lifestyle habits
• Positive lifestyle messages must compete on an
  uneven playing field
• Messaging active lifestyles is easier than you
  think axioms of inertia

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• http//www7.nationalgeographic.com/ngm/0511/sights
  _n_sounds/index.html

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Exceptional Old Age

• Okinawa, Japan Reason for living social
  connectedness physically active low caloric
  intake fish soup (highest obesity rate due to
  change in diet)
• Sardinia More males less stress family and
  social connectedness Mediterranean diet
  mountain walking
• Loma Linda Seventh-day Adventists Sabbath
  (day off) social capital physical activity
  nutrition
• Genetics Epi-genetics Gene-environment
  interaction

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Longevity

• Income
• Sense of belonging, social connectedness
• Physical activity
• Nutrition
• Moderate wine

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Improving Population Health

• How do we get people to sustain or improve health
  behaviours over the life course?

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Getting People to Think

• Increase confidence to make a change (efficacy)
  involves getting people to be introspective about
  health
• Must keep messages simple but potent
• Notion of health credit investments into
  health multiply and carry forward

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Facilitating Community Change

• Innovations Diffusion lifestyle change through
  natural networks (Rogers, 1983)
• Mass Media more effective in creating knowledge
  of innovations and agenda setting
• Interpersonal Channels better in changing
  attitudes behaviour
• Health Promotion

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Innovations in E-health

• Interactive, tailored designs are more effective
  because more engaging, higher expectations, and
  motivational
• Higher levels of fitness (Hurling et al., 2006)
• Interactive cardiovascular interventions showed
  improved quality of life (Delgado et al., 2003)

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Programs Policies

• ParticipAction program between 1971 and 2000,
  it was run on less than 1 million per year
• Being reinvented
• Canadas Physical Activity Guide to Healthy
  Active Living (1998)
• Older adult version (1999)

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Programs Policies

• Integrated Pan-Canadian Healthy Living Strategy
  (2002)
• 300M over 5 years
• Population health approach Phase One targets
  physical activity, eating habits and healthy
  weights

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A Coordinated Approach

• Many provinces have their own health promotion
  platforms to motivate Canadians to lead healthier
  lives
• ActNow BC/2010 Olypics
• Active2010 (Ontario)
• Healthy U (Alberta)
• Saskatchewan in Motion

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Framework for Healthy Living in BC

• Four Cornerstones
• Age Friendly Communities
• Mobilize and Support Volunteerism
• Promote Healthy Lifestyles
• Support Older Workers

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