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Monday, January 31, 2011

Improve your health literacy with the Health Council of Canada’s new Citizen’s Guide to Health Indicators

John G. Abbott, CEO, Health Council of Canada

Canadians encounter more and more decisions about their health and health care system every day. Which long term care facility will be best for my aging parent? How do I know if my child is considered overweight?  It is essential that citizens are provided with the facts to make informed decisions and better understand the decisions that governments and health care providers make about our system.

Health indicators are the high-quality statistics that make up these essential facts. These statistics allow us to measure and compare important factors that are influencing our health. Our new Citizen’s Guide to Health Indicators is a useful resource for interested citizens wanting to understand the origins of health indicators, as well as their purpose and sometimes their pitfalls.

While indicators are very useful for those in the health care field, they are also particularly important for consumers of health care. The Toronto Health Policy Citizens’ Council advocated for mandatory reporting from Ontario hospitals on issues like patient experience, wait times and emergency rooms. They suggest this information be available in one central location so that patients can make informed decisions about where to go for care.

For example, in the future, as this particular indicator develops, a care-giver with an aging parent will be able to use health indicators to advise their parent which long-term care facility best suits their parent’s needs. They will be able to look at an indicator like falls, which details the percentage of residents who have had a fall in the last 30 days. Or they will be able to consider the percentage of residents with bed sores. Each of these indicators will help the care-giver compare long term facilities for their parent and go beyond just observational visits to make a more informed decision.

We’ve created this guide to make it easier for care-givers, patients, interested citizens, board members and others involved in the health care system to better understand the facts they are receiving about health care. As we rely on indicators to show us how our system is performing, understanding the limitations is important for all parties involved.
For more information, the download the guide  or see what our guest bloggers are saying.

Key Words: Health Indicators, Health Promotion

Health Indicators? Body Mass Index - A Good Start on a Long Journey

Dr. Ali Zentner is a Specialist in Internal Medicine, Obesity and Cardiac Risk Management. She currently practices in British Columbia and Alberta with an office in West Vancouver. Ali is one of the experts on the hit CBC show Village on a Diet and is one of leading medical consultants for CBC's Live Right Now campaign.

I’ve been thinking a lot lately about heath indicators. What is it that makes one measurement superior to another? As a doctor, I am always in search of effective ways in which to measure a patient’s health risk and to convey this risk with accuracy and validity. In a world where the intangible reigns supreme, patients now, more than ever, need some concrete and reliable assessment of their own health risk as a platform to substantiate lifestyle goals and means to achieving these goals.

Let’s be clear.  As a medical community I don’t think we will ever agree on anything, for that matter. In fact, I am a fan of our discord. The variability in our ideas means there is variability in our treatment approaches. Now in an age where chronic disease prevails, medicine needs this kind of diversity more than ever.

And now we come to the topic of obesity in Canada and the body mass index (BMI). In obesity medicine, our three main health indicators are: BMI, waist circumference and co-morbid risks.

BMI has had significant criticism in the past over its usefulness in certain ethno cultural groups and in the overweight population.

Here is my take on the issue.

In patients whose BMI is over 30…. the point is moot. Those patients are obese, regardless of waist circumference and ethnocultural status. I have yet to meet a man or woman with a BMI of 31 who has a “low risk waist”. If you are out there, email me and I will happily print a retraction.

The key here is what is BMI as a determinant of risk? Increased BMI has clearly been demonstrated in a variety of studies as being a marker of increased co-morbid diseases.

A prospective collaborative analysis of BMI versus mortality among 894,576 people in Europe, Asia and North America published in Lancet in 2009 showed an increase in cardiovascular risk factors in patients with body mass indices greater than 25 kg/m2. This study also demonstrated an increased risk in cause specific mortality (namely cardiovascular mortality) in this patient population. The key here, however is patient risk overall.

Make no mistake - I think BMI is a good marker of risk BUT IT DOES NOT STOP THERE.

The key as a physician is for me to use BMI as a screening for other co-morbidities that may exist among patients. Furthermore, it must encourage me to look beyond just the number.

My biggest issue with BMI is that the current numbers clearly are geared towards a Europid population. When it comes to Canadians of non-European descent, the BMI at its current levels for overweight and obese Canadians falls desperately short.

I would argue that we as a country would benefit from a new classification of BMI that was ethnocultural specific. The International Diabetes Association has in fact risk-stratified waist circumferences in accordance with a patient’s ethnocultural background.

This to me is an ideal opportunity for us to widen the spectrum regarding this health indicator.

Overall when it comes to “health indicators”, my position is clear - they are a great place to start the screening process but they are by no means the whole picture.

As with the body mass index, it is a tool for physicians to BEGIN to identify a patient’s risk; a good place to start.

And so the dialogue begins. The dialogue about a patient’s risk profile, lifestyle and physiology and where to begin treatment and management.

If, as they say every journey begins with one step, then BMI may be the beginning of that journey. Where we take things as physicians or patients really is a whole new journey in itself.

Key Words: Health Indicators, Health Promotion