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

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


1
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

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

3
Population Aging
  • 2001 13.6 of population
  • 2006 - 14.6
  • 2011 15.3 Projected
  • 2021 20.4
  • 2031 25.2

4
Population Pyramid, 1981, 2001, 2006, Canada
5
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)

6
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

7
What Constitutes Good Health?
8
Life Expectancy at Birth, Canada, 1979-2004
82.6
80.2
77.8
9
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

10
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)

11
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

12
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?

13
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

21
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

22
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)

23
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?

29
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
30
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

31
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?

32
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

33
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)

34
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

35
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

36
The Bad News
  • Over 25 of energy burned by adolescents and
    adults originates from the Other Food Group
    (Starkey at al., 2001)

37
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)

38
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

39
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)

40
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

41
Food Consumption Conclusion
  • Therefore it is both the quality and the quantity
    of food consumption that is the problem

42
Why Do We Have Poor Lifestyles?
43
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

48
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

49
  • http//www7.nationalgeographic.com/ngm/0511/sights
    _n_sounds/index.html

50
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

51
Longevity
  • Income
  • Sense of belonging, social connectedness
  • Physical activity
  • Nutrition
  • Moderate wine

52
Improving Population Health
  • How do we get people to sustain or improve health
    behaviours over the life course?

53
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

54
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

55
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)

56
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)

57
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

58
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

59
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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