The Chief Public Health Officer’s Report on the State of Public Health in Canada 2018

Preventing Problematic Substance Use in Youth

A Message from Canada's Chief Public Health Officer 

I am pleased to present my annual report, which is a snapshot of the health of Canadians and a spotlight on the prevention of problematic substance use among youth. 

This year I am introducing a new dashboard of health indicators to provide an overall picture of the health status of Canadians. In reviewing the dashboard, it is evident that Canada continues to be a healthy nation. We are generally living long lives and rank among the top or middle third for most indicators when compared to other high income countries.

I do remain concerned, however, about the influence of persistent health inequalities and the impact of social and economic factors as barriers to living well and to the elimination of key infectious diseases.

Major chronic diseases, including cancer, cardiovascular diseases, neurological disorders, chronic respiratory diseases, and diabetes continue to be the leading causes of all deaths in Canada. It is important that as we age, we live in good health. Many chronic diseases can be prevented or delayed by approaches that get to the root causes of risks such as tobacco smoking, physical inactivity, unhealthy eating, and harmful use of alcohol. At the same time, mental health impacts every aspect of our lives, including relationships, education, work, and community involvement. Although the majority of Canadians report positive mental health, a third of us will be affected by a mental illness during our lifetime.

There are also worrying trends in relation to some infectious diseases. We are seeing a rise in sexually transmitted infections, while antimicrobial resistance (AMR) remains a global threat to our ability to cure infections. Lastly, as I highlighted in my previous report, tuberculosis is having a serious and ongoing impact on some First Nations and Inuit communities. Many cases of infectious diseases can be prevented or eliminated by reducing risks of exposure and ensuring access to screening and treatment – provided that partners also tackle underlying social factors by improving living conditions and confronting stigma.

To address key public health issues, I set out my vision and areas of focus for achieving optimal health for all Canadians earlier this year. I will champion the reduction of health disparities in key populations in collaboration with many partners and sectors. I will focus efforts in the areas of tuberculosis, AMR, built environments, sexually transmitted and blood-borne infections, children and youth, and the prevention of problematic substance use. 

This brings me to this year's focus on preventing problematic substance use. The growing number of opioid-related overdoses and the over 8000 deaths since 2016 are tragic and unacceptable. The national life expectancy of Canadians may actually be decreasing for the first time in decades, because of the opioid overdose crisis. At the same time, because of its social acceptance, we have lost sight of the fact that continued high rates of problematic alcohol consumption are leading to a wide-range of harms. In fact, 25% of youth in grades 7 to 12 use alcohol excessively. I am also aware that the change in legal status of cannabis means we need to make sure that youth understand that legal does not mean safe.  

We have to think about how to reverse these trends for future generations. That is why this report centres on youth and explores the reasons for harmful substance use, as well as effective approaches to prevent problematic use. 

There is a complex interplay of factors that may lead youth to use substances. We know that the marketing, advertising, and availability of a substance can increase substance use in youth. We also know that youth are more likely to use substances as a coping mechanism when they have experienced abuse and other forms of trauma. But we also know that there are protective factors that can help build youth resilience, such as stable environments and positive family and caregiver relationships.

The interconnected nature of these factors means there is a critical need to collaborate across many sectors to develop comprehensive prevention solutions. The next generation of interventions can connect sectors such as housing, social services, education, public health and primary health care, at multiple levels to implement coordinated policies, public and professional education and programs. We can also work together with the media and private sector to promote new social norms around lower risk use of substances.

Our efforts need to value the experiences and voices of youth and those who use substances. The media, health care, and social service organizations can help to eliminate stigma and discrimination by adopting equitable and compassionate policies, practices and language.

There will never be just one answer to this ever-shifting issue of problematic substance use. This is a key moment in Canada to examine how we address substance use across all areas of potential action: prevention, harm reduction, treatment and recovery. My aim with this report is to draw attention to the central role of prevention. As important initiatives like the Canadian Drugs and Substances Strategy advance, this report can help to inform these collective efforts to prevent substance use from becoming problematic.

I hope my report will stimulate discussion and lead to renewed action to achieve this goal.

- Dr. Theresa Tam, Chief Public Health Officer of Canada

 

Click here to view the report. 

Click here for pdf version.

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