In October, the Dalla Lana School of Public Health at the University of Toronto released Projected Patterns of Illness in Ontario – a sobering new study that shows there will be significant strain on the health care system over the next two decades. The study, conducted in partnership with the Ontario Hospital Association (OHA), finds millions more Ontarians will be living with chronic illness in the next 20 years. Overall, the province will face a level of demand for health services like never before.
As the most recent comprehensive public report to quantify chronic disease and multimorbidity in Ontario, the study projects that 3.1 million adults will be living with major illness in Ontario in 2040, up from 1.8 million in 2020. Moreover, approximately one in four adults over the age of 30 will live with a major illness in 2040, up from approximately one in eight individuals in 2002.
“Planning for sustainable and equitable health care that's responsive to emerging trends requires projections of what chronic disease rates are likely to be in the future," said Dr. Adalsteinn Brown, Dean of the Dalla Lana School of Public Health and co-author of the study. “Our projections suggest that more Ontarians will be living with major illness, and the number of cases will rise for many chronic conditions. Given these findings, it's clear that new solutions are needed now, including significant efforts in chronic disease prevention and management."
In addition to more people living with major illnesses, the number of illnesses any individual will be living with will also increase significantly. The conditions expected to increase the most in number are those that increase with age, including osteoarthritis, diabetes, and cancer. Multimorbidity is also rising, which refers to the presence of two or more co-morbid chronic conditions. Multimorbidity is a major driver of demand for health services and costly for hospitals as people living with multimorbidity have unique and complex health care needs.
Canadians are living longer, with life expectancy growing to 81.5 years as of 2020-2022. An aging population contributes significantly to the estimated increases. Underlying structural and social determinants of health and an increase in chronic disease risk factors also contribute to these estimates.
“As we look to the future, it's clear that Ontario's reached a turning point," said Anthony Dale, President and CEO of the Ontario Hospital Association (OHA). “Ontario's health system is already grappling with rapid population growth, increasingly complex health needs and intense pressures on existing capacity. These findings confirm that maintaining the status quo is not an option. Health care in Ontario needs an innovation revolution. Without it, the system won't be able to cope."
Ontario's health system must galvanize around the findings of this study and aggressively focus on prevention, early detection and effective treatment of chronic disease. Past successes, including reductions in chronic disease risk factors such as smoking and improved management of cardiovascular health at the population level, dramatically reduced the burden of chronic disease.
Ontario urgently needs a long-term health services capacity plan, so the province is truly ready to meet the needs of its rapidly growing and aging population. Expanding services that support and encourage seniors to age at home, such as access to home and community support services, primary care and supportive housing, will also ensure that long-term care and hospital capacity are available for people with the most complex and serious needs.
“Over the past several decades it is biomedical and technological innovation that has driven clinical improvements, cost savings and improved access to care in hospital settings," said Dale. And now, artificial intelligence, gene therapy and personalized medicine are demonstrating astonishing potential."
Ontario's hospitals are already embracing change – and are Canada's engine room for health research and innovation. Anchored by enormous health research capability and top talent, Ontario hospitals can spread and scale innovations across the province, creating a future with less disease, better treatment and universal access to care. This future is within reach.