An inconvenient truth: a sustainable healthcare system requires chronic disease prevention and management transformation

Healthc Pap. 2007;7(4):6-23. doi: 10.12927/hcpap.2007.18992.


Canada's initial success at shortening wait times will not transform our healthcare system unless it is matched with equal success in the prevention and management of chronic diseases. A growing body of evidence highlights the significant gap between recommended care and actual care received for those at risk for or living with chronic illnesses. This quality gap not only results in significant preventable morbidity and mortality but also lengthens wait times for healthcare services and threatens the sustainability of our healthcare system. A national strategy on chronic disease prevention and management (CDPM) that leverages the federal, provincial and territorial (FPT) response to wait times will not only transform chronic illness care but also help to ensure the sustainability of our healthcare system. We begin this paper by highlighting some of the facts behind this inconvenient truth. We then review and provide examples of several best practices in CDPM. We suggest that these best practices provide the foundation for a national CDPM strategy and argue that the FPT mandate for wait times be expanded to encompass CDPM and result in "care guarantees." We conclude with a high-level preliminary analysis of costs and benefits of this strategy to transform CDPM in Canada.

MeSH terms

  • Canada
  • Chronic Disease / economics
  • Chronic Disease / prevention & control*
  • Chronic Disease / therapy*
  • Cost-Benefit Analysis
  • Diabetes Mellitus / therapy
  • Disease Management*
  • Financial Management
  • Humans
  • National Health Programs / economics
  • National Health Programs / organization & administration*
  • Practice Guidelines as Topic
  • Primary Health Care / organization & administration
  • Quality of Health Care / economics
  • Quality of Health Care / organization & administration*