This past Tuesday we heard from Dr. Richard Lewanczuk, Senior Medical Director of Primary Health Care for Alberta Health Services. He spoke to us about what drives health care costs, and what we can do about it. He said that Alberta has the second most expensive health system in Canada and that we have built more hospitals than anywhere else in Canada. He showed us statistics from around the world that show that the more you spend on tertiary care such as expensive infrastructure and equipment the worse your health care outcomes become. Areas that have put their funding into primary care and community supports have the best medical outcomes.
He said that the most costly diseases to the health care system are not things like cancer, strokes or heart disease, they are hypertension (high blood pressure), diabetes, depression, asthma and dyslipidemia (high cholesterol). They are all quite common chronic ailments. He said that about twenty five percent of the population never sees a doctor in a year and that just five percent of the population uses sixty-five percent of our health care resources. Most of these are due to hospitalization. It takes just two weeks in hospital per year to put someone into this five / sixty-five club.
The biggest users of our health care funds are the frail elderly and older people with multiple chronic illnesses. Frail can be defined as being unable to manage their day to day activities (such as shopping, paying bills, banking or filing their own taxes). A big factor that helps to define frail, is a walking speed of less than 0.8 meters per second, or the speed it takes to cross the street in the time of a walk light. This is, oddly enough, a big factor in being able to get out to run errands, socialize and go shopping. Once people have trouble walking fast enough to cross the street safely, they stop going out, become more isolated and slow down even more. He said that in some parts of the US they have increased the timing on their walk lights and have seen a decrease in their health costs as a result.
He also explained that the most common complicating factor that results in hospital admissions for many people is the fact that they are unable manage their health problems at home due to lack of family, friends or community supports. He said that in many cases when physicians are asked why they admitted a particular person to hospital, the reply is often- well they probably could have managed their problem at home… but… they do not have the supports they need to be able to manage at home. In particular, in Alberta, we see a larger number of people who live in rural areas admitted to hospital for the very reason that they have fewer nearby family, friends or community supports to call on. In most cases the medical reason in the frail elderly is a urinary tract infection or fall, but another common reason is a caregiver who is not able to cope, or caregiver burn out.
He said that if we want to predict who will be admitted to hospital within the next year, the people we should ask are the primary care people, family doctors and nurses, but also, another good person to ask is the local Meals on Wheels driver, who has daily contact with many of our isolated elderly. He said that loneliness is a very big factor for many elderly people. Human contact, or physical touch has been shown to have an impact on our immune systems and can improve our health. Touch has been shown to decrease stress, lower blood pressure, and even help alleviate pain through release of oxytocin.
Studies in Great Britain have shown that one in five visits to the family doctor by both young and old people, are mostly for the conversation, and just the opportunity to talk to someone. Loneliness is a problem for all ages in our modern society, and studies have shown that social media do not alleviate the need for actual face to face conversation, hugs or touch. We are becoming more and more isolated from each other as technology moves forward, and we are losing the daily contact we used to have with the postman, the store clerk or the bank teller. Simple things such as sitting with someone, sharing a laugh, giving a hug or sharing a meal can make big difference. He said that volunteering has also been shown to be beneficial for the volunteer by decreasing the rate of decline in their health and giving them better functioning in many ways both physical and mental.
It seems clear that we need to continue to volunteer, stay in contact with others, and keep busy as long as we can and do as much as we can for others to help alleviate loneliness, so that as a bonus we will lower the cost of our health care at the same time.