Health and wellness: Promoting healthy aging for overall wellbeing

A proactive approach to healthcare, consisting of healthy lifestyle choices and chronic condition management is integral to our overall wellbeing.

Introduction

The terms health and wellness are often used interchangeably but have different meanings. In 1948, the World Health Organization (WHO) defined health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” The organization suggests that the primary determinants of health include:

1. an individual’s social and economic environment,
2. the physical environment,
3. and their characteristics and behaviours.

On the other hand, wellness has been closely linked to the WHO’s definition of health. According to the National Wellness Institute (NWI), wellness is “an active process through which people become aware of, and make choices toward, a more successful existence.” In other words, wellness involves taking a proactive approach toward one’s health rather than a reactive approach.

The pursuit of health and wellness is a fundamental human goal. Today, with advances in medical science and technology, we have a far better understanding of the complexities of human health and the knowledge to intervene in ways that can help people live longer, healthier lives. Taken together, health and wellness can be defined as a holistic approach to achieving physical and mental wellbeing. This all-encompassing approach recognizes that our health is shaped by a complex interplay of social, environmental, and individual factors, and that we must take a proactive approach to maintaining and improving our wellbeing. Conversely, neglecting one’s own health can have far-reaching consequences, such as reduced quality of life, unplanned healthcare expenses, and adverse lifestyle changes. These consequences are further amplified by aging due to the higher prevalence of chronic health conditions later in life.

We will explore the importance of health and wellness, structural-demographic shifts that have amplified the necessity of promoting healthy practices, the benefits of taking a proactive approach to healthcare, and strategies for achieving optimal health and wellbeing over the course of our lives. The importance of being aware of health and wellness as one ages and keeping these insights top of mind when planning for the future is paramount to all Canadians. Awareness and understanding of the changing landscape of health and wellness will help people make decisions for healthier futures and ideally improve overall quality of life in later years.

Health and wellness is often overlooked

Although multiple studies have demonstrated the benefits of pursuing healthy activities, many people often overlook or neglect their health. From putting off doctor visits to engaging in unhealthy behaviours, there are several reasons why individuals may avoid prioritizing their health. We discuss some of these reasons below, drawing upon the insights of several academic studies and surveys.

1. Busy lifestyles could cause people to put their self-care on the back burner. A full-time job is one major factor that tends to overshadow health and wellness. A survey conducted by Automatic Data Processing (ADP) Canada¹ reveals that while most Canadians reported feeling fulfilled in the workplace, they also had trouble setting boundaries between work and personal life. Over one-third of all respondents had difficulties in maintaining a work-life balance. As a result, about 32% reported feeling tired or overworked. This is despite companies offering flexible work arrangements since the COVID-19 pandemic. Management may also be less conscious of an employee’s workload due to reduced line of sight arising from work-from-home arrangements. This could cause them to unknowingly overload employees with tasks. According to a separate survey by Robert Half², about 60% of workers say they require more than eight hours to complete their daily tasks. Additionally, half of all individuals say they never fully disconnect from work during business hours and feel obligated to respond to messages immediately, even during breaks.

2. A lack of awareness is another factor preventing people from pursuing a healthy lifestyle. This can take different forms, such as not knowing the risks associated with unhealthy habits or a lack of education. Many people may not understand that daily choices such as the foods they consume, amount of exercise they get, quality of sleep, and stress management can all impact their wellbeing. Without this knowledge, seeing the value in changing daily habits can be challenging.

3. Education is an essential factor in determining good health. According to the Centers for Disease Control and Prevention, adults who did not finish high school are more likely to suffer from obesity (37.8%), far higher than the average college graduate (22.2%)³. A separate study by Cutler and Lleras-Muney (2006), cited by the Organisation for Economic Co-operation and Development (OECD)⁴, found that individuals with more years of schooling were less likely to pursue risky behaviours, like smoking, drinking, or using other illegal substances. Conversely, those with a higher education level were more likely to exercise and obtain preventative care, such as vaccines, mammograms, and colonoscopies.

4. The cost associated with pursuing a healthy lifestyle is another hurdle, specifically when it comes to diet. Researchers at the Harvard School of Public Health (HSPH)⁵ found that diets rich in fruits, vegetables, fish, and nuts, cost significantly more than unhealthy diets, such as those consisting of processed foods, meats, and refined grains. On average, healthy diets cost ~US $1.50 more per day or US $550 more per year than unhealthy diets. Although this may not appear material, this added cost can significantly burden low-and middle-income families.

5. Societal stigma can be a significant barrier to people engaging in healthy behaviours. The American Psychiatric Association⁶ surmised that more than half of people with mental illness do not receive help for their disorders. Often, people avoid or delay seeking treatment due to concerns about being treated differently. These effects can persist even after an individual overcomes the initial hurdle of seeking help. A study by Oexle N et al. (2017)⁷ found that self-stigma was associated with poorer recovery from mental illness after one or two years from when treatment began.

Ignorance is not bliss

Avoidance can be a typical response for many individuals regarding their health. One reason could be the belief that they are healthy and do not require medical attention. Sometimes, this belief may lead individuals to overlook significant health concerns or neglect preventative measures. A 2019 Cleveland Clinic survey⁸ found that 72% of men would rather do household chores than visit the doctor for a checkup. Results from a separate survey commissioned by hearing solution manufacturer GN Group⁹ showed that 60% of people avoided seeking help for medical issues. The leading root causes for delaying care were financial worries (51%), not believing it is a serious issue (42%), and being too busy (30%). The average person who put off a serious health concern had done so for nearly a year, with 11 months between realizing they had a medical issue and seeking care. About a quarter of individuals did so out of fear of receiving an unwanted diagnosis.

However, this ignorance is bliss approach can make things worse down the line, with one-third of respondents admitting that their condition became more severe because they put off seeking help. The risk of this is higher in later years. Although almost half of all Canadian seniors (46.5% of men and 48.3% of women) perceived their health as good or excellent¹⁰, health conditions can deteriorate quickly. For instance, the prevalence of high blood pressure among Canadians aged 65 and over was 44%, nearly two times¹¹ higher for those aged 50 to 64. The same trend can be observed across a range of other diseases like ischemic heart disease (~6x), diabetes (~4x), stroke (~6x), and cancer (~4x), which are far more prevalent in the age 65+ cohort versus younger adults.

Contextualizing demographic trends –
People are living longer than ever before

Like many developed countries, Canada is experiencing a significant shift in its demographic makeup as people are living longer than before. This trend is driven by a confluence of factors, including medical advancements, declining birth rates, and better living conditions. According to Statistics Canada¹², the number of seniors (age 65 and over) has doubled since the turn of the century, while the median population has aged by 4.2 years. Seniors now account for ~19% of the domestic population. By 2040, the age 65+ cohort will be 1.5x larger than it is now and account for nearly a quarter of all Canadians.

Canada’s aging population could present several opportunities in the coming decades. Specifically, this demographic shift could give rise to new technologies and innovations that improve quality of life, result in more significant wealth accumulation, and increase demand for certain goods and services. At the same time, aging populations could also present particular challenges. As mentioned earlier, older adults are more susceptible to chronic illnesses. This will increase the demand for healthcare services that need to be planned for by both individuals and society:

1. Healthcare services: older adults are more susceptible to chronic illnesses, creating greater demand for primary care services, hospitals, and long-term care facilities.

2. Pension and social security benefits: longer lifespans will increase demand for social security programs, such as the Canada Pension Plan and Old Age Security benefits. This increased demand can pressure government budgets and challenge the sustainability of social security programs. Businesses could also feel the pinch and be required to do more to bolster employer-sponsored pension plans.

3. Economic implications: aging populations, in conjunction with declining birth rates, can lead to lower labour force participation, diminishing the output potential of an economy. Additionally, older adults typically spend less and save more, which can weigh on long-term economic growth potential.

Life expectancy matters, but so does quality of life

In addition to life expectancy, the quality of life one leads should also be considered, particularly in the later years of life. Health-adjusted life expectancy is a measure that assesses the number of years an individual can expect to live in good health based on current mortality rates and the prevalence and severity of diseases. According to data compiled by the Public Health Agency of Canada¹³, total life expectancy at 65 is about 21 years, but the health-adjusted life expectancy is far lower at 15 years. This means the average person can expect to live about six years in poor health.

Health-adjusted life expectancy in Canada has improved in recent decades, rising about 1.6 years since 2000, but has not kept pace with overall life expectancy. According to the WHO, global life expectancy has increased by 6.6 years, compared to 5.4 years for health-adjusted life expectancy. This difference is likely attributable to decreasing mortality rates rather than a reduction in the number of years lived with a disability or other chronic conditions. Advancements in medical technology have likely made such health conditions more manageable, prolonging life spans, but they have not eliminated them.

As populations age, gains in life expectancy may not necessarily translate into a similar increase in health-adjusted life expectancy due to chronic conditions being more prevalent later in life.

Older people are more susceptible to chronic conditions

As we age, our bodies become more vulnerable to various chronic conditions and other health issues. Chronic conditions, such as diabetes, heart disease, and arthritis, are more prevalent among the older cohort and can significantly impact overall health and wellbeing. Moreover, the prevalence of multiple chronic conditions, known as multimorbidity, can further increase the risk of adverse health outcomes. A study by Marcel E. Salive (2013) found that multimorbidity prevalence increases substantially with age (Figure 1).

Sources: Scotia Wealth Management, Marcel E. Salive (2013)¹⁴

The absolute number of morbidities also increases with age, with older individuals likely to have more chronic conditions than younger individuals
(Figure 2).

Sources: Scotia Wealth Management, Sakib, M.N., Shooshtari, S., St. John, P. et al. (2019)¹⁵

Top aging concerns: Chronic conditions

Many countries are in the midst of a significant shift in their demographic makeup as people live longer than before. According to a study conducted by Ansah & Chiu (2023) on the U.S. population aged 50 or older, the number of people with at least one chronic condition is projected to double from 71.5 million in 2020 to 142.7 million by 2050¹⁶. At the same time, multimorbidity is forecasted to rise by a similar magnitude, from 7.8 million in 2020 to 15.0 million in 2050.

The impact of chronic conditions is very material as they account for 7 in 10 deaths each year, according to the National Center for Chronic Disease Prevention and Health Promotion¹⁷. Some of the most common chronic conditions include hypertension, arthritis, heart disease, cancer, and dementia.

Hypertension

• ~8 million adults in Canada (one in four) are affected by high blood pressure.¹⁸
• Over 90% of Canadians are estimated to develop hypertension if they live an average lifespan.¹⁹
• Globally, hypertension causes 19% of deaths and 7% of disability. It is also responsible for up to 50% of heart disease and stroke deaths and is a leading cause of kidney disease and failure.¹⁹

Arthritis

• ~6 million Canadians suffer from arthritis (one in five). By 2040, 50% more people will have arthritis (about 1 in 4).²⁰
• Its prevalence increases with age, as nearly half of all seniors over 65 have arthritis.²⁰
• This disease is not just limited to the older cohort. Over half of all people with arthritis are under the age of 65.²⁰

Heart disease

• Heart disease is the second leading cause of death in Canada. Every hour, about 14 Canadian adults aged 20 or over will die from diagnosed heart disease. About 1 in 12 Canadians over 20 live with a diagnosed heart disease.²¹
• The death rate is 2.9x higher for those diagnosed with heart disease than those without, 4.6x higher for those who have had a heart attack versus those who have not, and 6.3x higher for those with a diagnosed heart failure.²¹
• Men are 2x times more likely to suffer a heart attack than women. They are also diagnosed with heart disease ten years sooner than women.²¹
• The death rate from heart disease has continued to fall, down about 21% from 2000-2001 to 2017-2018.²¹

Cancer

• An estimated 2 in 5 Canadians will be diagnosed with cancer in their lifetime.²²
• Although overall cancer rates are declining, the number of cases and deaths continues to climb due to population growth and aging demographics.²²
• Cancer remains the leading cause of death in Canada. About 1 in 4 will die from cancer.²²
• Lung cancer accounts for a quarter of all cancer deaths.²²

Dementia

• The number of annually diagnosed cases of dementia in Canada is expected to increase by ~51% between 2020 and 2030.²³
• By 2050, more than 1.7 million Canadians are expected to be living with dementia, which is close to triple the amount in 2020.²³
• Women are more likely to be diagnosed with dementia than men, and this trend is expected to continue.²³
• Dementia is not an individual journey; the hours of care provided by family and friends is equivalent to over $7.3 billion dollars. The number of care partners for people with dementia in Canada is projected to reach 1 million (188% increase) by 2050.²³

Implications of chronic conditions and longer lifespans

While chronic conditions may not be immediately life-threatening, they are long-lasting and often incurable. As such, they can profoundly impact one’s quality of life and often require ongoing management through treatment and medication. We explore some of the implications of chronic conditions below.

Higher healthcare costs

2021 marked an important demographic milestone for the baby boomer generation as they began turning 75 years old. As part of Canada’s largest cohort, the growth rate of individuals aged 75-94 is projected to be over four times faster than the overall population. This is according to a Canadian Medical Association (CMA) study for the 2021 to 2031 period. As a larger proportion of this population enters the age associated with higher healthcare needs, this will result in rapid growth and demand for long-term care facilities and home care services. The cost of providing long-term and home care is expected to almost double by 2031, from $29.7 billion to $58.5 billion.²⁴

According to the CMA study, approximately 380,000 individuals required long-term care in 2019. However, this demand is projected to surpass 600,000 by 2031, representing a 1.6x increase compared to 2019. Moreover, the Conference Board of Canada released a separate report stating that by 2035, Canada will require an additional ~200,000 long-term care beds, nearly double the existing capacity. Accommodating this added capacity is estimated to cost approximately $64 billion in capital spending and $130 billion in operating spending between 2018 and 2035.²⁵

The COVID-19 pandemic has altered Canadians’ attitudes toward long-term care, leading to a greater preference for home care solutions. The Canadian Institute for Health Information reported that over 80% of COVID-related deaths during the first wave of the pandemic were linked to long-term care facilities.²⁵ This statistic has lowered the appeal of nursing homes, as revealed by a survey conducted by the National Post. The survey polled adults aged 50-69 living in Ontario and Quebec, finding that 72% of respondents were less inclined to enter a nursing home, while 70% had serious concerns about health risks associated with long-term care facilities. The number of Canadians demanding home care services is predicted to surpass 1.7 million by 2031, representing a 1.5x increase compared to current levels. Notably, home care has already accounted for the largest part of care demand and is expected to comprise 75% of total care demand by 2031.²⁴

Longevity risk

As life expectancy rises, Canadians face a growing risk of outliving their savings. This is known as longevity risk, and it can have significant consequences for retirees in the form of unexpected medical bills and long-term care costs, for example. As a result, there are more Canadians over 65 in the labour force than at any other time in history. Currently, the Canadian labour market consists of over 1 million people over 65 compared to ~215,000 at the turn of the century. As a percentage of the entire Canadian labour force, the age 65+ cohort now represents over 5% of the labour market, nearly four times higher than in the year 2000.

Although some people prefer to work longer because their job brings them fulfillment, others have to do so out of necessity to help fund a longer retirement period. Facing the reality of having to work longer can create feelings of stress, anxiety, or frustration. Retirement is a major life milestone that many Canadians look forward to. But having to work longer than they had planned to or desired can be disappointing, especially if they were looking forward to travelling, pursuing hobbies, or spending time with loved ones.

Caregiving responsibilities

Chronic conditions not only affect the quality of life of those who have them, but also have significant emotional and financial consequences for their families. Caring for a loved one with a chronic illness can become a full-time job and affect the ability of family members to work, study, or socialize. As a result, caregivers can experience stress, anxiety, or depression as they struggle to balance their caregiving responsibilities with other aspects of their lives.

The cost of managing chronic conditions, such as medications, medical appointments, and specialized equipment or care, can be significant. Additionally, missing time from work to care for a loved one could impact one’s compensation. According to the Family Caregivers of British Columbia²⁷, 70% of family members are caught having to strike a balancing act between their job and caring for a loved one. One in four caregivers had to change their work situation significantly, leading to reduced hours, job loss, or early retirement.

Unexpected risks

Falls are a circumstantial factor that heavily affects the elderly population. According to the “Seniors’ Falls in Canada” report by the Public Health Agency of Canada, falls are the leading cause of injury among older Canadians, with 20-30% of seniors experiencing one or more falls each year. Falls can result in chronic pain, reduced mobility, loss of independence, and even death.²⁸ Unexpected falls and accidents can alter daily routines and lifestyles. For example, seniors may require assistance walking with the use of walkers and canes after injury, or they may require additional care for daily tasks such as bathing and cooking, which they had previously done independently.

Chronic conditions can also arise from unforeseen circumstances. Injuries and illnesses at an elderly age can turn into more severe cases due to increasing frailty as seniors age. Minor illnesses can develop potential side effects, or unexpected complications can occur during recovery, which can lead to chronic conditions and needing additional attention and care. Unplanned incidents such as injury or illness can greatly impact the aging population’s daily routines, and incur sudden, long-term unexpected costs.

The big picture: Economic and societal implications

The impact of aging populations extends beyond individuals and can have broad implications for society and the economy. As people age, they become more susceptible to chronic conditions, increasing demand for healthcare services, including medical professionals, facilities, and specialized equipment. As the demand for such services increases, it can strain the healthcare system, leading to longer wait times for medical procedures, higher healthcare costs, and reduced access to care for some individuals. Ultimately, this strain can have a ripple effect on the economy as a whole, leading to slower economic growth and reduced productivity.

Social security programs could also come under pressure. As more people age and retire, the number of individuals relying on social security payments increases. At the same time, a declining birth rate could mean the number of people contributing to these systems declines. As a result, governments may need to allocate a larger portion of their budgets toward healthcare and social security, which could lead to higher taxes or reduced benefits for some individuals.

The impact could trickle down to businesses as well. Governments may encourage or mandate employers to offer more comprehensive medical benefits to address the higher prevalence of chronic conditions or to boost contributions to employer-sponsored pension plans. Additionally, unhealthy employees may experience reduced work capacity due to their condition. They may also need to take time off work for medical visits. These factors can reduce efficiency, weighing on a business’s profitability.

Prioritizing health and wellness can help address demographic and healthcare challenges

Aging populations and the increase in chronic conditions present significant challenges for individuals. However, it is important to recognize there are steps people can take to mitigate the effects of these trends on their health and wellness. By prioritizing preventative healthcare and making lifestyle modifications, individuals can take an active role in improving their overall health and reducing their risk of chronic conditions.

Numerous studies point to certain modifiable behaviours that can help to reduce the risk of chronic illness. According to the WHO, 80% of premature deaths from heart attacks and strokes could be avoided by controlling the main risk factors: tobacco, unhealthy diet, and physical inactivity. The Canadian Cancer Society says that 4 in 10 cancer cases can be prevented through healthy living and policies that protect the health of Canadians. The Canadian Society for Exercise Physiology says that adults with pre-diabetes saw a 10% reduction in vascular disease events after improving daily step counts by 2000 to 3000. And the Centers for Disease Control and Prevention found that quitting smoking reduces the risk of 12 types of cancers and can add as much as ten years to life expectancy.

Finally, regular doctor visits are one of the most critical tenets of preventative health. In the past, people used to visit their healthcare practitioner only when they were sick. Now, more people are pre-emptively seeking medical advice as they look to take ownership of their health. A study by Liss et al. (2021) found that general health checks were associated with increased chronic disease recognition and treatment and moderate improvements in controlling risk factors like cholesterol and blood pressure. It also increased preventative and diagnostical testing, such as colorectal and cervical cancer screening. Patients who visited a healthcare provider reported improved outcomes, such as quality of life and self-rated health.

Although the effectiveness of general health checks in reducing mortality rates is up for debate, there is growing evidence to support their benefits in identifying chronic diseases. As such, prioritizing regular health checkups and working closely with a primary care provider is essential to ensure one receives the care they need and maintains optimal health.

Conclusion

Prioritizing health and wellness can help mitigate some of the challenges facing our aging population. Several chronic conditions can be prevented or delayed through healthy lifestyle choices, such as regular exercise, a balanced diet, and avoiding unhealthy practices like smoking and excessive alcohol consumption. For individuals already living with a chronic condition, health and wellness practices can help manage symptoms and improve quality of life. This can include stress reduction techniques and physical therapy, enabling individuals to remain relatively healthy and active despite their condition. Not only can this have an impact on an individual, but it can have far-reaching benefits at the societal level by lowering healthcare costs and improving productivity.

Education is a critical first step in promoting health and wellness. Individuals, businesses, and governments all have a role in raising awareness of the importance of maintaining a healthy lifestyle. At the individual level, people need to be educated on choices they can make to promote overall wellbeing. Companies can take steps, such as offering wellness programs that provide employees with information and resources on healthy habits and lifestyle choices. They can also provide education and access to ergonomics solutions. Finally, governments can promote health and wellness through public health campaigns and education programs encouraging a healthy lifestyle.

A proactive approach to healthcare, consisting of healthy lifestyle choices and chronic condition management is integral to our overall wellbeing. It’s also important to keep in mind that healthier decision making can improve one’s quality of life as longevity increases, and ideally decrease years spent in poor health later in life. Through a sustained commitment to healthy choices and self-care, we can all take steps toward improving our quality of life.

1. ADP Canada survey conducted with Maru Public Opinion
2. Robert Half survey
3. Centers for Disease Control and Prevention
4. Organisation for Economic Co-operation and Development (OECD)
5. Harvard School of Public Health
6. American Psychiatric Association
7. Oexle N, et al.
8. Cleveland Clinic Study
9. GN Group
10. Public Health Agency of Canada
11. Statistics Canada
12. Statistics Canada
13. Public Health Agency of Canada
14. Marcel E. Salive, Multimorbidity in Older Adults, Epidemiologic Reviews, Volume 35, Issue 1, 2013, Pages 75–83
15. Sakib, M.N., Shooshtari, S., St. John, P. et al. The prevalence of multimorbidity and associations with lifestyle factors among middle-aged Canadians: an analysis of Canadian Longitudinal Study on Aging data. BMC Public Health 19, 243 (2019)
16. Ansah J & Chiu, C: Projecting the chronic disease burden among the adult population in the United States using a multi-state population model
17. National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)
18. Heart and Stroke Foundation of Canada
19. Hypertension Canada
20. Arthritis Society Canada
21. Public Health Agency of Canada
22. Canadian Cancer Statistics 2023
23. Alzheimer Society of Canada
24. Canadian Medical Association | Canada’s elder care crisis: Addressing the doubling demand
25. Conference Board of Canada | Sizing up the challenge. Meeting the demand for long-term care in Canada
26. Canadian Institute for Health Information | Pandemic experience in the long-term care sector (June 2020)
27. Family Caregivers of British Columbia | The financial impact of caregiving
28. Public Health Agency of Canada | Seniors’ Falls in Canada (Second Report) 

This material is intended as a general source of information only and should not be considered as personal and/or specific medical advice.