Arthritis: The sleeping giant

Arthritis is the sleeping giant of Canadian healthcare. Its effects in pain, disability and shortened lifespan on one hand and its enormous social impact on the other are unprecedented. Yet arthritis is regularly dismissed as little more than aches and pains by laypeople, by legislators and even by doctors and other healthcare professionals.

But ask any one of the more than 600,000 Canadians who are disabled by arthritis if it’s just “aches and pains.” Ask any of the hundreds of families every year whose loved ones have died from complications from their disease; from side effects of their arthritis medications; or ask one of the researchers who have shown that arthritis pain is often fiercer and longer-lasting than the pain of cancer.

Then ask sufferers about arthritis, “the sleeping giant.” They’ll tell you that the condition is under-recognized, its impact under-appreciated, and research into its causes, treatment and cure drastically under-funded. And they’re right. Well, the sleeping giant is about to wake up, and it isn’t going to be pretty.

Very soon, arthritis is going to be a problem so huge it simply will not be ignored or dismissed, and we’ve already missed a opportunity we might have had to get out ahead of the coming crunch. To understand why, you have to realize that Canada’s population’s make-up — its demographic profile — is unique. We’re very fat around the middle. No other country has such a massive baby boom bulge: almost a third of our total population was born between the years 1946 and ’66. That enormous cohort of people poses special challenges for healthcare because they’re all going to grow old at about the same time, starting in 2012, when the front edge of the wave hits 65.

Right now, Canadians 65 and up represent only about 11 per cent of the total population. Statistics Canada estimates their numbers will almost double by 2021 — to about 20 per cent of the population. Since reliance on medical services increases dramatically with age, the boomer bulge is inevitably going to place a huge strain on our already creaking healthcare system. David Foot remarks in Boom, Bust & Echo, his 1996 bestseller, “if the cost of healthcare is a problem in the mid-1990s, demographics tell us that, as the saying goes, we ain’t seen nothin’ yet.”

The fact is, boomers have already begun to make their mark, simply by turning 50. The 50s are the decade when many of us experience the first signs of arthritis: By the time we hit 50, one in four of us will have begun to develop arthritis or another musculoskeletal (MSK) disorder; by age 65, it’s one of every two. So, as boomers age, the number of Canadians with arthritis will increase by more than two million people — a whopping 50 per cent increase over the current four million-plus.

Keep in mind that between now and 2022, when the first boomers turn 75, the little matter of healthcare is going to get a serious working over. Until recently, Canadians could expect to have enough caregivers. But over the next 25 years, arthritis-related disability will be roughly twice what it was in 1986, while the total adult population is only expected to increase by 30 per cent. This increase in arthritic disability will take place against a backdrop of a static number of people 16 to 45, the age group that traditionally supplies the largest share of formal and informal caregivers.

So, here’s the picture: As governments prune budgets and realign the healthcare delivery system, the range of services deemed “essential” is becoming increasingly narrow — and you can bet your bottom dollar that as time goes by, fewer legislators and administrators will deem that arthritis qualifies for many “essential services” — leaving anyone with mild or moderately severe arthritis to their own devices. If you have arthritis and think it’s hard getting help now, just wait a few years. In other words, you’re going to have to become an arthritis self-manager, shouldering some of the responsibility for your own healthcare. On the plus side this task isn’t as daunting as it may sound, and the benefits are significant. Certainly becoming more knowledgeable about your illness and treatment will leave you less anxious and better able to cope with an occasional setback. And involvement will ensure you’ll be on the alert for side effects from your medication. Merely knowing how to tell major from minor side effects — and what to do about both — strips them of their mystery and potential danger.

Don’t think that by taking charge, you’re abandoning what professional services are available to you; on the contrary, you’re going to learn to maximize their potential. It starts by becoming informed; in the following pages, we’ll suggest a few lines of advance.