The Canadian Chronic Disease Surveillance System (CCDSS) is a collaborative network of provincial and territorial surveillance systems. This surveillance system is used to estimate and report on the current burden and trends over time for over 20 chronic diseases and conditions, and other selected health conditions in Canada (Government of Canada, 2021). It collects data on all residents who are eligible for provincial and territorial health insurance. It is able to cover 97% of Canada’s population, and provides a comprehensive picture of chronic disease in Canada (Government of Canada, 2021). It uses datasets provided by the provinces and territories using a unique personal identifier to the corresponding physician billing claims, hospital discharge records and prescription drug records (Government of Canada, 2021). The CCDSS is funded by the Public Health Agency of Canada (Government of Canada, 2021).
Manitoba provides data and analyses towards the Canadian Chronic Disease Surveillance System which is funded by the Public Health Agency of Canada. Manitoba Health and Seniors is a department within the Government of Manitoba that guides the planning and delivery of health care services for Manitobans. The
epidemiology and surveillance unit is part of the Public Health Branch within this department. The role of the unit is to support the public health system by monitoring, analyzing and reporting on the occurrence, spread, and severity of communicable and non-communicable diseases and conditions in Manitoba. The unit systematically receives and manages reportable communicable disease data as determined by the Public Health Act. The unit is responsible for notifying public health offices across Manitoba of cases of communicable diseases, and for managing the flow of information to and from these offices to support health investigations. Within the surveillance unit, epidemiologists analyze the data collected to create reports and updates that can be used for planning, implementing, and evaluating public health interventions and programs (Government of Manitoba, n.d.).
Fig.1 Epidemiology and Surveillance Unit work to support the public health system and the health of Manitobas.
In Ontario, the Ministry of Health and Long-Term Care has developed a policy framework to guide the redesign of health care practices and systems to improve chronic disease prevention and management in Ontario. The Ontario Chronic Disease Prevention and Management Framework is an evidence-based, population-based, and client-centered approach. It supports health care system changes that will reduce the focus on reactive, acute health care and provide more focus on the prevention and management of chronic disease. This framework addresses the distinct needs of clients with chronic conditions. Its goals are:
· to provide multifaceted, planned, pro-active seamless care in which the clients with chronic conditions will be full participants in managing their care and will be supported at all points within the system
· to organize and deliver the expert care they need when and where they need it, without the clients having to struggle through the system on their own, moving from provider to provider
· to provide effective chronic disease management that includes the implementation of prevention measures to halt the disease’s progress and to prevent complications and co-morbidities (Government of Ontario, 2007).
Fig. 2 Ontario’s Chronic Disease Prevention and Management Framework
Shared Health Manitoba is a government health body in Manitoba that works with the regional health authorities in the province to deliver patient-centred, accessible and responsive health care to Manitobans. The formation of Shared Health has been part of Manitoba’s broader health system transformation. Shared Health is moving forward with a plan to modernize Manitoba’s health care system for individuals. This includes the development of a new provincial model that supports an integrated network for accessing and delivering services. The Integrated Network Model will reconfigure care to improve the health and well-being of all Manitobans through provincial standards that elevate care and innovative approaches to ensure equitable care delivery. The network model is intended to facilitate the relationship between providers and the flow of patients in the province. Its goals are:
· to standardize pathways that streamline how patients and providers navigate the system
· to broaden inter-professional supports and scope of practice for primary health physicians and primary health providers to bring care closer to home
· to implement community-based case management and care coordination, including for Indigenous communities
· to develop education and skill building tools for patients and caregivers to promote self-management, including for diabetes
· to optimize a hybrid digital and in-person care experience for everyone (Shared Health MB, n.d.).
Fig. 3 Shared Health Manitoba Integrated Network Model
The Winnipeg Regional Health Authority is the largest regional health authority in Manitoba. It provides guidance to the other four regional health authorities in the province. It conducts ongoing surveillance for the collection, collation and analysis of data so that this information can be acted upon in a timely fashion. It receives funding from the Public Health Agency of Canada through Manitoba Health. Its major initiatives include:
Ongoing epidemiological support for outbreak investigations
Developing a chronic disease surveillance strategy
Population-based surveillance reports
Capacity building and development of team members
Teaching and training of graduate students, medical residents and field epidemiologist training recruits from the Canadian Field Epidemiology Program (Public Health Agency of Canada)
Applied public health research (Winnipeg Regional Health Authority, n.d.).
In Ontario, “Public Health Ontario” has a Chronic Disease database for data and analysis. Here, individuals have access to statistics and information related to chronic diseases and conditions. They have access to the following information:
· Burden of chronic diseases in Ontario
· Cancer incidence
· Cancer mortality
· Chronic disease hospitalization
· Chronic disease incidence and prevalence
· Chronic disease mortality
· Self-reported chronic problems
· Environmental burden of cancer
· Taking action to prevent chronic disease (Public Health Ontario, 2022)
This information is found from local public health units, as well as the Local Health Integration Network (LHIN).
In Ontario, Cancer Care Ontario (CCO) Health has also created a Chronic Disease Prevention Strategy. This strategy has the following goals:
1. Work with partners to champion chronic disease prevention in Ontario
2. Promote chronic disease prevention policies and programs
3. Undertake primary, secondary and tertiary prevention
4. Inform chronic disease prevention through research, and population health assessment and surveillance. (CCO, 2021).
This framework looks at prevention of multiple chronic disease across the board in Ontario and is continuously re-evaluated based off events (this framework is a re-invention of a previous framework, prior to COVID-19 called “The Progress in Prevention: Achievements from the Chronic Disease Prevention Strategy 2015-2020) (CCO, 2021). The CCO has also led in the development of the “Occupational Disease Surveillance System” which links provincial health databases with job information to support studies of occupational disease (CCO, 2021).
In comparing Ontario and Manitoba, the approach to chronic disease surveillance, prevention and management seems very similar. At the provincial level, the focus is on collecting and providing data and analyses towards the Canadian Chronic Disease Surveillance System. Similar to Public Health Ontario, the Epidemiology and Surveillance Unit in Manitoba gathers and shares information on the burden of chronic disease, the incidence and prevalence of chronic disease, and mortality rates related to chronic disease within the province. Both provinces use their public health branches to collect and analyze data to create reports and updates that can be used for planning, implementing, and evaluating public health interventions, policies and programs (Manitoba Health and Seniors Care, n.d.; Public Health Ontario, 2022).
Both provinces are making major changes in their health care systems in order to be proactive in addressing chronic disease. Both provinces are moving toward a philosophy that supports the prevention and management of chronic disease rather than the current system which is designed to address acute illness in a reactive manner. The focus is to reorganize the system so that clients will experience seamless care and be full participants in managing their care with support at all points within the system. There will be development of education and skill building tools to assist clients in self-managing their disease. Technology will play a more prominent role in connecting clients with care providers, especially in remote areas as well as allowing a team-based approach to information sharing. There will be more focus on effective chronic disease management that includes the implementation of prevention measures to halt the disease’s progress and to prevent complications and co-morbidities.
One difference appears to be that the province of Ontario places more emphasis on cancer incidence and mortality and the environmental burden of cancer, whereas the province of Manitoba tends to focus more on diabetes and renal disease (Public Health Ontario, 2022; Shared Health MB, n.d.)
Both Public Health Ontario and the Winnipeg Regional Health Authority prioritize chronic disease data collection and analysis as well as continuous chronic disease surveillance. One difference noted is that the Winnipeg Regional Health Authority prioritizes capacity building and
development of team members as well as teaching and training of graduate students and medical residents (Winnipeg Regional Health Authority, n.d.). This aspect of promoting education and training from within the surveillance system was not mentioned in the Public Health Ontario chronic disease surveillance document.
References:
CCO. (2021, November 25). Chronic disease prevention strategy 2020 to 2023: Digital Outline. CCO Health.
Government of Canada. (2021). Canadian Chronic Disease Surveillance System (CCDSS).
Government of Manitoba. (n.d.). Health and Seniors Care. Epidemiology and Surveillance.
Government of Ontario (2007). Preventing and managing chronic disease: Ontario’s framework.
Public Health Ontario. (2022). Chronic disease data. Public Health Ontario. https://www.publichealthontario.ca/en/data-and-analysis/chronic-disease
Shared Health MB (n.d.). Manitoba Clinical Prevention and Services Plan.
Winnipeg Regional Health Authority. (n.d.). Population and Public Health. Surveillance.
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