Paramedics bring a patient to the emergency department at Toronto Western Hospital on July 14, 2022. Researchers at the University of Toronto’s Dalla Lana School of Public Health say the rising burden of illness is mostly due to the long-predicted aging of the population, led by baby boomers reaching their 70s and 80s.Fred Lum/the Globe and Mail
The number of Ontarians who will be living with major illnesses by 2040 is forecast to balloon to more than three million, which threatens to break the province’s already strained health care system, a new report is warning.
Researchers at the University of Toronto’s Dalla Lana School of Public Health say the rising burden of illness is mostly due to the long-predicted aging of the population, led by baby boomers reaching their 70s and 80s.
But Ontarians are also getting sicker regardless of age, with more people acquiring more chronic diseases – including diabetes, renal failure, cancer and osteoarthritis – now than in the past, according to the U of T study, set for release Wednesday.
The report aligns with other research that predicts a rising tide of seniors and working-age Canadians with major illnesses will pose a significant challenge to the health system, said Laura Rosella, an epidemiologist and co-author of the study.
“Overall, we expect this picture to look strikingly similar across Canada,” she said in an interview.
The new report was produced in collaboration with the Ontario Hospital Association, which has been warning for years that, without long-range capacity planning and technological transformation, the acute-care sector is at risk of being swamped by the elderly and the chronically ill.
“We’re looking at a reality where the public system simply won’t be able to cope, which are pretty strong words to use, but it’s the truth,” said Anthony Dale, president and chief executive officer of the OHA, which speaks for hospitals across the province.
Mr. Dale pointed out in an interview that, although Premier Doug Ford’s Progressive Conservative government has overseen the largest increase in hospital capacity in decades, the system is still just “treading water.” The province has added about 3,500 new beds and about 35,000 staff to the hospital system since 2019, according to the OHA. Ontario’s population grew by 10 per cent, or about 1.4 million people, during the same period, driven almost entirely by immigration.
Prior to pandemic-era increases in capacity, Ontario’s hospitals relied on new medical technologies such as minimally invasive surgeries to provide more care to more patients without adding beds.
Mr. Dale said the looming burden of illness identified in the U of T study means the health system will need technological and organizational revolutions on a grander scale.
“We’ve known this day is coming. It’s effectively already here,” he said. “We have to really focus now on prevention and chronic disease management and rely far more heavily on innovation to get us through this, because sticking to the status quo is a recipe for failure.”
The U of T research drew on population forecasts and administrative health data about the prevalence of chronic disease to project the number of people who will be living with major illnesses in Ontario by 2040.
The authors slotted people into the “major illness” category if they had at least one high-acuity condition such as dementia, or a combination of less-acute diseases, such as diabetes, hypertension and osteoarthritis.
Multimorbidity projections in Ontario
Population aged 30 and older, in millions
Major illness
Some illness
No illness
12
8
4
0
2010
2020
2030
2040
the globe and mail, Source:Rosella LC, Buajitti E, Daniel I, Alexander
M, Brown A. Projected patterns of illness in Ontario: Dalla Lana
School of Public Health; 2024.
Multimorbidity projections in Ontario
Population aged 30 and older, in millions
Major illness
Some illness
No illness
12
8
4
0
2010
2020
2030
2040
the globe and mail, Source:Rosella LC, Buajitti E, Daniel I, Alexander
M, Brown A. Projected patterns of illness in Ontario: Dalla Lana
School of Public Health; 2024.
Multimorbidity projections in Ontario
Population aged 30 and older, in millions
Major illness
Some illness
No illness
12
8
4
0
2010
2020
2030
2040
the globe and mail, Source:Rosella LC, Buajitti E, Daniel I, Alexander M, Brown A. Projected
patterns of illness in Ontario: Dalla Lana School of Public Health; 2024.
The report predicts that 3.1 million Ontarians will fit that definition in 2040, up from 960,000 in 2002 and 1.8 million in 2020.
Among Ontarians 65 and older, 53 per cent are expected to live with major illness by 2040, up from 41 per cent in 2002 and 46 per cent in 2020. Working-age adults won’t be spared by their youth: Just more than 10 per cent of people aged 30 to 64 are expected to be in the major illness category in 2040, up from 5.7 per cent in 2002 and 9.2 per cent in 2020.
“In several chronic illnesses – cancer, diabetes, stroke, cardiovascular disease – there have been some shifts to earlier ages, and there’s a lot of hypotheses about why that’s happening,” Dr. Rosella said. Some theories include the rising prevalence of obesity and physical inactivity, particularly among patients in poor neighbourhoods, she said.
Reducing rates of chronic disease will be key to keeping the health system afloat over the next 16 years, said Adalsteinn Brown, dean of the Dalla Lana School of Public Health and another author of the study.
“There’s obviously a need to move toward much more aggressive approaches to supporting health promotion and trying to delay the onset of the disease,” he said in an interview. “There’s a significant need to move care into the community. You just can’t build hospitals fast enough.”