Some of the need for acute care would be reduced if we paid more attention to providing the right care at the right time for the many people living with one or more chronic diseases. The numbers are growing daily and will only swell as the population ages: 2 million Canadians with diabetes, 1 in 4 women and 1 in 8 men living with osteoporosis – add those numbers to cardiovascular diseases and respiratory illnesses, and almost all adult Canadians are affected by chronic disease, directly or as a caregiver. According to the Chronic Disease Prevention Alliance of Canada, chronic diseases are the leading cause of avoidable illness, health care system utilization and premature deaths.

Risk factors for chronic diseases are well known and many are open to alteration; many of the diseases share some common risk factors so a population health approach has the potential for notable impact over time. But it takes time and investment in both health promotion and disease prevention -- and it is not sexy. Two-thirds of Canadians have at least one modifiable risk factor for chronic disease (CDPAC). That fact, coupled with the lack of attention to the determinants of health (employment, education, income, social support), mean that we risk a tsunami of chronic disease, one that will, if not attended, overwhelm the existing acute care system and provide its own answer to the original question on the purchase of health services.