The Lung Association of Saskatchewan requests that the provincial government take action on the four following lung health policy priorities:
- Coordinated provincial action to improve prevention, diagnosis and treatment of chronic lung disease;
- Stronger legislation and programs to reduce public and on-the-job smoking exposure, restrict tobacco access and support smoking cessation;
- Better access to specialized medical care and education services for children suffering from asthma and other lung diseases; and,
- Legislative and regulatory action on indoor and outdoor air quality to reduce the burden on lung health.
Policy Issue 1
Coordinated provincial action to improve prevention, diagnosis and treatment of chronic lung disease
Pilot projects in the Saskatoon Health Region have shown that providing integrated exercise and patient education programs is a viable method of delivering an important component of therapy for most chronic diseases. A proposal to expand this program to all health regions over the next 5 years was recommended for the 2007-08 health budget but was rejected. The pilot study showed that the savings in direct costs to the health regions more than covered the costs of running the program.
Expand and integrate exercise rehabilitation programs and patient education services for patients with COPD, heart disease, diabetes and other chronic illnesses with an eye to full implementation by all regional health authorities no later than 2012.
A pilot project in the Saskatoon Health Region has demonstrated that home-based testing is a medically and economically viable way of increasing the capacity for testing for sleep apnea. The waiting list for sleep apnea testing in Saskatchewan is currently about 3 years even though Canadian guidelines call for a maximum wait of 2 - 6 months. Saskatchewan’s two sleep labs need to be expanded and funding needs to be allocated to
Allocate funding in the next provincial budget to increase capacity for sleep apnea testing.
Spirometry is a simple breathing test which measures how much air a person’s lungs can hold and how fast he or she can exhale. This test is used to diagnose asthma and COPD as well as to assess flare-ups and the effect of treatment.
Asthma is the most common chronic disease of childhood and COPD is the 4th leading cause of death in adults. Yet, despite this reality, less than 20% of patients with these diseases have had a spirometry test even though it is standard medical care according to Canadian guidelines. More funding needs to be allocated to make this crucial test accessible across the province.
Beginning in the 2008-2009 provincial budget, provide increased access to spirometry in order to help ensure earlier and more accurate diagnosis of such lung diseases as COPD and asthma.
Some medications that are part of standard medical care according to current Canadian guidelines are listed on the Saskatchewan formulary with exceptional drug status. In some cases patients must fail a course of substandard treatment before they are allowed to receive the recommended and necessary treatment.
Exceptional drug status is a barrier for certain drug plans and some pharmacies will not even process claims for such drugs.
Remove existing barriers to access for medications prescribed in accordance with Canadian treatment guidelines for the management of COPD and asthma and to include such drugs in any provincial drug plans.
Patient education is critical for people living with chronic lung disease. Saskatchewan is fortunate to have over 100 health care professionals who have completed a training course in asthma and/or COPD education and have passed a national certification exam.
The cost to train a health care professional is about $1000 and The Lung Association of Saskatchewan has the capacity to train many more educators.
A pilot project in Regina has shown that integrating respiratory educators in family physician clinics leads to improved health outcomes with better adherence to Canadian treatment guidelines and increased access to spirometry.
All health regions should have respiratory educators on staff to provide services both in health centres and family physician offices.
Improve health outcomes and reduce the financial and social burden that lung disease places on our province by allocating funding for Certified Respiratory Educator positions within health regions and integrate this service with family physician clinics.
Policy Issue 2
Stronger legislation and programs that reduce public and on the-job smoking exposure, restricts tobacco access and supports smoking cessation
Although many work-places are already smoke-free, thousands of Saskatchewan residents are forced to breathe toxic tobacco smoke and sacrifice their health in order to maintain their employment.
In order to address this issue, all that is required is for the provincial government to introduce changes within Section 77 of “The Occupational Health and Safety Regulations, 1996” to make all work-places smoke free.
Immediately implement regulations to make all work-places smoke-free.
For many individuals, a pharmacy represents their most frequent contact with a health setting or a health professional. Yet, Saskatchewan continues to allow the sale of tobacco products in our province’s pharmacies.
Tobacco is a deadly addiction, and one that costs too many of our citizens the right to a long and healthy life.
Pharmacies should not sell products that are one of the causes of chronic disease, while at the same time dispensing medications intended to make people healthy.
Ban tobacco sales in all pharmacies.
The federal tobacco control act allows retailers to advertise tobacco products for sale. Provincial measures can – and should - be taken to make this change in order to reduce exposure of young people to this form of tobacco advertising.
In addition, cigarette packaging is also a form of advertising. Leadership at both the national and provincial level is necessary to ensure that all tobacco products are sold in plain packaging.
Ban all signs advertising the sale of tobacco products at all retail locations
Take leadership in working with provincial and federal counterparts to initiate the plain packaging of all tobacco products.
Saskatchewan presently has the highest smoking rate of any province in Canada. Yet, at the present time less than 0.5% of tobacco tax revenue is used to prevent the problems caused by tobacco. In contrast, other provinces have significant budget allocations for tobacco control. By increasing the amount of tobacco tax revenue to 2%, a great deal more progress could be made in the fight against tobacco.
(Note that 2% of tobacco taxes amounts to about one-half of a cent per cigarette sold)
Dedicate 2% of provincial tobacco taxes to tobacco control and prevention activities beginning in the next budget.
In order to reduce incidence of tobacco-related health issues, more must be done on the ground in health regions to ensure that smokers have access to cessation programs and activities.
It should also be routine for health professionals to compile a tobacco use history of their patients, and to follow-up where necessary, with cessation possibilities/programs.
Provide funding to initiate tobacco cessation activities for all patients entering an acute or long-term medical facility or other medically-related health care facility (such as dental clinics, etc).
Policy Issue 3
Better access to specialized medical care and education services for children suffering from asthma and other lung diseases
Infants and children in Saskatchewan with lung disease have the lowest rate of access to a pediatric respirologist of any province in Canada. Presently, there is only one in the province and he spends more than half of his time in critical care leaving less than half time for respiratory care.
A general paediatrician in the Department of Paediatrics at the University of Saskatchewan receives a guaranteed salary while a lung specialist does not. By contrast, other provinces offer a guaranteed salary for lung specialists, making it very difficult to recruit such people to Saskatchewan.
Provide access to appropriate specialists for children’s lung health by removing disincentives that currently exist for recruiting pediatric respirologists to Saskatchewan.
Policy Issue 4
Legislative and regulatory action on indoor and outdoor air quality to reduce the burden on lung health
Radon is a naturally occurring gas that is the second-leading cause of lung cancer in Canada.
Some areas of Saskatchewan have been shown to have high levels of radon gas production in the soil. Homes constructed in these areas are at risk of having radon leak into them, potentially causing numerous health problems for the residents.
While radon can not be stopped from occurring, preventive work - such as radon testing, monitoring and remediation – prior to and post construction could significantly reduce the exposure of individuals and families to radon gas.
Introduce requirements for all municipalities to conduct radon testing in areas designated for new housing developments.
Recognizing that remedial work can be done for under $2000, create an incentive program for home owners that would allow for their homes to be tested for radon and remedial action taken, where necessary.
Burning of crop residue (stubble burning) is on the decline in Saskatchewan but is still all too common even though agricultural experts recommend against burning. It is a known contributor to green house gases and air pollution.
Many individuals living with lung disease and other illnesses such as heart and circulatory problems, are adversely affected by the smoke from burning crop residue.
The education program that Saskatchewan has attempted is not working. In contrast, the success of legislation in Manitoba to control the burning of crop residue in Manitoba is a positive example of how to deal with this problem.
Ban open field and windrow burning of crop residues by legislative means such as the steps taken in Manitoba.
Saskatchewan is very dependent on the burning of hydrocarbons to produce electricity. This is detrimental to the health of our citizens as it diminishes the province’s air quality.
Alternative, non-polluting and renewable energy sources are an alternative that should be explored with vigour.
Increase the use of wind, solar and geothermal sources of energy.
Home builders and home owners rarely incorporate energy saving measures and nonpolluting, renewable energy production in their homes to the degree that is currently achievable. Changes to the provincial building code would make these measures more common, while increased demand for alternate energy systems would make this area more viable.
Revise existing provincial building codes to require the inclusion of some degree of non-polluting, renewable energy production in all new homes.