Cover

When breathing becomes a chore

Who would have thought the worst respiratory problems were in centres on the East Coast?

John DeMont October 25 1999
Cover

When breathing becomes a chore

Who would have thought the worst respiratory problems were in centres on the East Coast?

John DeMont October 25 1999

When breathing becomes a chore

Cover

Health Report

Who would have thought the worst respiratory problems were in centres on the East Coast?

John DeMont

Hector Archibald was out walking the dog near his home in Dartmouth, N.S., one day in 1984 when he noticed something was wrong. The uphill grade that used to be so easy left him winded by the time he hit the top. A few days later, he found he had to stop partway up the hill to catch his breath. When the retired navy lieutenant, then 57, could no longer make it to the crest, it was time to see a doctor. The diagnosis made his heart sink: emphysema, an essentially incurable respiratory disease that kills lung tissue and cuts offbreathing. “It was hard to hear,” recalls Archibald, who had quit smoking 17 years earlier. “I liked being busy.” Now 72, his condition has

worsened to the point where he has to breathe oxygen from a canister 24 hours a day. Going for a walk has been out of the question for the past four years. “Everything,” says Archibald, resting in the bungalow he built to avoid going up and down stairs, “is just so hard for me now.”

And so it is for huge numbers of his fellow Maritimers, according to a comparison of the health of residents in 17 major centres. The survey, based on 1996 data from Statistics Canada and the Canadian Institute for Health Information, shows that people are more likely to die of respiratory disease in Nova Scotia’s Central Regional Health Board region— covering Halifax and much of the mainland—than anywhere else in the country. The region’s men are particularly badly off, dying of respiratory causes at a rate of 98.3 per 100,000 population, strikingly higher than the national rate of 70.1. Women in the central region die of the same diseases at a rate of 67.3 per 100,000, well above the national rate of 59, but lower than the 72.4 recorded in neighbouring New Brunswick’s Region 3 Hospital area, incorporating Fredericton and a large rural area.

Dennis Bowie, head of respirology at Nova Scotia’s biggest hospital, the Queen Elizabeth II complex in Halifax, calls the statistics “alarming.” To CIHI vice-president Dr. John Mil-

lar, whose organization gathers and analyzes health statistics, they could hint at even deeper problems. “In general,” he stresses, “if people are susceptible to one type of disease, it raises major questions about their underlying ability to stay healthy and fight off others.”

Who would have suspected Nova Scotia and New Brunswick as hot spots for respiratory disease? After all, they look nothing like the smoggy, heavy-industry centres normally associated with the problem. But a few danger signs have been flashing. The incidence of asthma, in particular, appears to be on the rise in Nova Scotia. And just last year, Environment Canada launched a smog forecasting program in Fredericton, Moncton and Saint John, N.B. The concern was that New Brunswickers could be inhaling air fouled by electricity generation plants and the exhaust from motor vehicles—possible sources of a number of respiratory ailments.

But experts are at a loss to explain the mortality figures, broken out at the community level for the first time for this survey. A look at the important non-medical factors that help determine health provides some hints. New Brunswickers, followed closely by Nova Scotians, are the most seriously overweight people in Canada. As a group, residents of the Adantic region exercise less than other Canadians. Newfoundlanders

lead the national numbers in heavy drinking, with Nova Scotians close behind. Those factors, say doctors and researchers, can contribute to the high rates of arthritis, diabetes, circulatory disease, chronic pain and other ills plaguing the region.

But when it comes to chronic respiratory diseases like bronchitis and emphysema, however, one factor stands out among all others: smoking. The Atlantic provinces all have smoking rates at or above the national average of 28 per cent of the population 12 or older—peaking at 32 per cent in Prince Edward Island. But, as across Canada, the rate is frighteningly high among young people. “Smoking is the major cause of death in this country,” says Dr. Jeff Scott, Nova Scotia’s medical officer. “The sad thing is that it is so preventable.”

There is no wonder doctors in Nova Scotia and New Brunswick are anxious for governments to attack the behaviour most commonly associated with all these diseases. Along with an extensive public education program, New Brunswick has banned the sale of tobacco in drugstores. It is also setting up “sting” operations to try to catch—and prosecute—store owners who sell cigarettes to underage youths. Although municipalities in some parts of the country have restricted smoking in public places and the workplace for several years, New Brunswickers have not taken that step. But last week, a poll conducted by Ottawabased Ekos Research Associates reported that two-thirds of New Brunswickers would support smoking bylaws to restrict smoking in their communities.

In Nova Scotia, Premier John Hamm, a former physician, promised during the July provincial election campaign to ded-

icate part of provincial tobacco tax revenues to reducing the province’s smoking rates. But real progress can still be hard to achieve: at the local level, legislation to ban smoking in public places has been stalled before a Halifax municipal council committee that includes business advocates worried about what such a move would mean to local restaurants, bars and stores.

But smoking itself does not come near to explaining the rash of respiratory deaths in the region. Nova Scotia’s central region has the third-worst record in the country, behind Hamilton and Vancouver/Richmond, when it comes to death from pneumonia and influenza—ailments not normally linked closely to tobacco use. That is even though Nova Scotia offers free immunization programs for high-risk seniors. And despite its dismal overall respiratory data, the Halifax region actually posts the lowest death rate in the category of bronchitis, emphysema and asthma—conditions more closely associated with smoking.

I One underlying cause of the surprising data could be a 1 particularly virulent influenza strain that hit the province in s 1996—the year on which the survey is based. Moreover, rei gional numbers are bound to fluctuate considerably from S year to year. Tracking data over the years to come will inevitably even out some disparities. Meanwhile, QE II’s Bowie says he has “no explanation” for the high mortality rates.

He and other health-care professionals say respiratory disease sufferers are receiving high-quality care in the Maritimes. New Brunswick’s Region 3 Hospital Corp. has one

full-time respirologist, at the Dr. Everett Chalmers Hospital in Fredericton, while the central regional health board in Nova Scotia has eight, all at QE II. That is hardly a surplus of resources; a patient who wants to see a specialist in Halifax on a nonemergency matter may have to wait as long as six months. But Bowie and his colleagues say they can still offer patients the best new techniques and treatments.

Hector Archibald can vouch for that. More than two years ago, he underwent a “lung reduction” procedure in which damaged sections were removed in the hope of improving his breathing. “But it did nothing for me,” he says. “I’m still getting worse all the time.” For sufferers of debilitating respiratory ailments, life is hard—no matter where they call home. 03

DYING BREATH Deaths from pneumonia, flu, bronchitis, emphysema, asthma and all other respiratory diseases, per 100,000 population in health regions in 1996