Strategic Context

Enjoying good health and a high quality of life depends on many factors, including access to quality education, meaningful employment, stable family and community environments, and making healthy lifestyle choices. The Ministry of Health operates within the broader economic, social and environmental influences that impact the health of the population.

Access to high quality health services also has an impact on health status. In British Columbia, our publicly funded health system is directed by the Ministry of Health and delivered primarily by B.C.’s health authorities and health care professionals. In the past 35 years, the scope of the health system has expanded beyond traditional hospital and physician services to include comprehensive public health programs, a broad team of service providers, prescription drugs, home and community care and more. Innovative new programs, along with established programs that have been provided for decades, combine to ensure British Columbians have access to a reliable, quality health system and the best health outcomes in the country.

The Ministry of Health and broader health system is significantly challenged by the increasing demand for health services in British Columbia. The most significant factors increasing demand are the province’s aging population, a rising burden of illness from chronic diseases, and advances in technology that are enabling new procedures and treatments. In addition, the Ministry is challenged in meeting this rising demand by increasing world-wide competition for health professionals and health workers, and the need to direct investments to maintain and improve the health system’s physical infrastructure (buildings and equipment).

British Columbia also faces a challenge in ensuring that all parts of society and all populations can access health services and enjoy good health. Currently, B.C.’s Aboriginal population does not generally enjoy the same level of good health as the rest of the province’s population. Government will work with First Nations and other partners to improve Aboriginal people’s health and close this gap in health status.

The Aging Population

Between 2001 and 2006, the British Columbia population grew by 5.4 per cent from 4,078,447 people to 4,310,452 people, and all of this increase was from the population aged 45 or older. While the population under 20 years old decreased, and the 20 to 44 age group remained relatively constant, the 45 to 64 aged population increased 16 per cent and the seniors population aged 65 or older increased 10 per cent, with the over 85 year old segment growing faster than any other age group.¹

The aging population is a significant driver of demand as the need for health services rises dramatically with age. For example, compared to a typical 65 to 74 year old, a typical 85 years or older person uses three times more acute care services, 12 times more community services and 25 times more residential care services. In 2005/06 those over 65 made up 14 per cent of the B.C. population, but used 47 per cent of acute care services, 49 per cent of PharmaCare expenditures, 71 per cent of home and community care services and 93 per cent of residential care services.²

A Rising Burden of Chronic Disease

Chronic diseases are prolonged conditions, such as diabetes, depression, hypertension, congestive heart failure, chronic obstructive pulmonary disease, arthritis and asthma, which often do not improve and are rarely cured completely. It is estimated that approximately one in three British Columbians now has at least one confirmed chronic condition. As most chronic diseases are more common in older populations, it is expected their prevalence will continue to increase as the population ages.

Chronic disease, particularly in advanced stages, creates demand for acute hospital care services. For instance in 2005/06, 44 per cent of coronary bypass surgeries, 47 per cent of dialysis, 60 per cent of lower limb amputations and 58 per cent of retinal surgeries were performed on patients with diabetes. Furthermore, while people with chronic conditions represent approximately 34 per cent of the B.C. population, these individuals consume approximately 80 per cent of the combined physician payment, PharmaCare and acute (hospital) care budgets.³ Overall, the increasing prevalence of chronic disease and the resulting burden of illness is a significant driver of demand for health services.

Advances in Technology and Pharmaceuticals

New treatments and technologies are improving health care but also creating increased demand by expanding the number of patients who can be treated and changing how and where services can be delivered. For example, before the development of microsurgery and laser treatments, cataract removal was only recommended for people with very serious visual impairment. Now, due to changes in technology, cataract removal is recommended for a wider range of patients and can be done as a day procedure. Similarly, many new diagnostic procedures have been made available over recent years, and MRI, CT scans, and non-invasive cardiology tests are now common diagnostic services.

New treatments, coupled with the aging population, are driving demand across a number of surgical procedures, particularly angioplasties, cataracts and hip and knee replacements. This is demonstrated by the increased numbers of these procedures — between 2000/01 and 2006/07 angioplasties increased by approximately 59 per cent, cataracts by 33 per cent, hip replacements by approximately 61 per cent and knee replacements by approximately 121 per cent, while the general population only increased by 5.4 per cent and those over 65 years of age by 10 per cent.

Advances in drug therapy, again along with the aging population, are increasing demand on B.C.’s PharmaCare program. Increased use of drug therapy, newer and more expensive drugs entering the market and the emergence of new diseases and new areas of pharmacology are all creating increased demand for prescription medication.

Human Resources and Health System Infrastructure

Although education and training programs for health professionals and health workers in British Columbia have been significantly expanded in recent years, ensuring the availability of human resources remains a challenge for the Ministry. As the population ages so too does the health care workforce. Looming retirements in the health workforce combined with the rising demand for services and increased international competition for health professionals impacts the province’s ability to maintain an adequate supply and mix of health professionals and workers for British Columbia’s health system.

Another financial challenge in delivering health services is the need to maintain and improve the health system’s physical infrastructure. The Ministry is faced with the continuous need to update or expand health facilities, medical equipment and information technology to ensure the health system provides high quality and safe health care to British Columbians.

Aboriginal Health

Another key challenge for the Ministry is improving the health status of British Columbia’s First Nations population. While the health status of Aboriginal people has improved significantly in several respects over the past few decades, the Aboriginal population in B.C. continues to experience poorer health and a disproportionate rate of chronic diseases and injuries compared to other B.C. residents.

In February 2007 the Provincial Health Officer released an interim update of selected health status indicators from the 2001 Report: The Health and Well-Being of Aboriginal People in British Columbia. The report looked at indicators such as low birth weight, infant mortality and premature death from cancers, diabetes, HIV disease and suicide, as well as deaths related to smoking, alcohol and drug use. For all measures of premature mortality examined in the report, whether during infancy or later in life, Status Indians die at earlier ages and at greater rates than other B.C. residents. This is true for the major disease and injury causes of death, and for the major risk factors of alcohol, drugs, or smoking. While the trend shows improvement for some health indicators for Status Indians, there is a persisting gap in health status between the First Nations population and the rest of the B.C. population that cannot be explained by some specific genetic risk alone.⁴