Because We Can!
Sustainability through health promotion and disease prevention

Angelique Berg
Executive Director
Canadian Orthopaedic Foundation

Dr. Kevin Orrell, Chair of the Canadian Orthopaedic Foundation, has witnessed first-hand the impact that social-marketing campaigns can have on population health. "When I first started as an orthopaedic surgeon 19 years ago," he recalls, "it was not unusual to see victims of motor vehicle accidents where alcohol was involved. Over last Christmas season at the Cape Breton Regional Health Care Complex in Sydney, NS, where he's chief of orthopaedic surgery, Orrell doesn't recall "seeing anybody who was involved in that kind of accident. It's quite incredible."

The impact of the mantra, "If you drink, don't drive" is proof positive that with time and persistence, people can change their attitudes toward harmful behaviours that were once socially tolerated. Remember when everybody smoked everywhere - even in hospitals?

Orrell references these precedents as he describes Because You Can, the Foundation's new social-marketing strategy that aims to reduce future demand for orthopaedic surgery by 50% within 20 years: "The idea of prevention in orthopaedics is exciting. Orthopaedics in Canada today is a very busy specialty, reacting to people who have already entered the system. It's what's on the horizon that's ominous - the rate of hip and knee replacements is rising faster than the population is aging, obesity rates are rising, the numbers of surgeons per population is shrinking. We're hard pressed to meet current demand, never mind what's yet to enter the system. If we start now to reduce that future demand by half, we might have a shot at achieving sustainable care. The supply side is equally critical, but it's not enough to address supply alone."

Dr. Kevin Orrell

Isn't that trying to put himself and his colleagues out of work? "We'll never achieve that," says Orrell, "and that's not our objective. There will always be injuries and diseases into which we are born or develop through no fault of our own. But perhaps it's possible to have a manageable case load. The goal of every orthopaedic surgeon is to keep people active, functioning, productive. Promoting MSK health enables that as much as operating - by doing those things together within our scope of practice, we're helping to fix the patient and fix the system."

There's no question that the Foundation has set an ambitious goal for Because You Can - "Best to aim high," says Orrell, "we need to capture the attention of health policy makers and the imaginations of those who can help us to achieve the goal" - but the magnitude of the task can only be truly appreciated when you consider that in 2003-2004 there were nearly 195,000 injury-related acute-care hospitalizations. And since today's injuries often show up as tomorrow's end-stage arthritis, many of those 2003-2004 patients will come back into the health care system to be "fixed" a second time - never mind other injuries treated in GPs offices, or not at all.

While reducing injuries is an all-important goal, Because You Can takes an integrated approach, also promoting such determinants as nutrition and physical activity with plans for targeted programmes for children, teens, adults and seniors. The name itself was inspired by a slogan from Hip Hip Hooray: "Walk with us, because you can!" The Because You Can message is a rousing call to intrinsic ability, to embrace life and its possibilities, and to rise off the couch and get moving.

"We are facing an obesity epidemic," says Orrell. "As orthopaedic surgeons, we see the difficulties that Canadians are having because of this disease. We see kids who are headed in a very bad direction. What I like about the strategy is that it includes the child. If we teach the next generation how to build and keep musculoskeletal health then we've helped them to avoid things we're currently treating."

The Foundation intends to act as a catalyst, prompting consensus around the strategy's goal. The COA Board of Directors has given its endorsement, and a presentation to Health Canada officials "was an easy sell," says Orrell. "They were very interested in our intention to work with other groups, which is unusual for a charity. We want to work with other organizations who will bring novel approaches to the strategy from their own areas of expertise." While the Foundation is already working to plan an awareness campaign in year one, within two years, its goal is to have the federal and provincial ministries of health on side, preferably with the assistance of the provincial orthopaedic associations, and like-minded interest groups.

Another milestone is to hold a stakeholders' conference that brings together professional associations, health charities, patient groups, government officials, and, critical to ratifying the programme's goal, MSK researchers. Such a coalition usually paves the way for closer government cooperation and even greater public exposure to key messages.

In the early phase, says Orrell, fund-raising will be key to accelerate its progress. Among other strategies, Hip Hip Hooray will serve as an engine of change: "Hip Hip Hooray gives us the financial means to develop the supporting programmes, so we need the involvement of COA members. The prevention approach broadens the appeal of Hip Hip Hooray - from traditionally arthroplasty surgeons and patients, to all subspecialties, and upstream to people before they enter the health care system." Certainly, the open-ended challenge embodied in Because You Can opens up all kinds of possibilities for attracting people and donations - everything from skateboarding competitions to golf tournaments to dancing with the stars.

Because You Can calls positively and hopefully to one's own ability and potential. Orrell notes, however, that its purpose is of the utmost seriousness: "Given the number of surgeons in Canada, if things don't change, if demand isn't significantly reduced, we will be faced with an ever more intractable problem of delays in delivering service. If we succeed in changing behaviours, we'll enable more sustainable orthopaedic care. A fringe benefit is that orthopaedic surgeons might see patients who are fitter, better prepared for surgery, achieve better outcomes and recover more quickly. That's job satisfaction."

 

Make your gift ... Because You Can. The Canadian Orthopaedic Foundation has turned attention to stemming future demand to help enable sustainable orthopaedic care. Because You Can is a wide public awareness and education strategy that aims to insert to the collective consciousness the importance of good musculoskeletal health for a lifetime of overall health and mobility. Your gift will help the development of targeted programmes to foster a new generation of Canadians with healthy bones and joints through making good decisions about nutrition, activity, fitness and injury prevention. With health promotion and disease prevention reducing demand, and improvements to delivery of care to augment supply, it is possible to achieve sustainable orthopaedic care for all Canadians. Make your gift by phone at 1-800-461-3639 x 4, or on-line at http://www.canorth.org/ > Donate.