Every day, people living with cardiovascular disease account for approximately 550 visits to emergency departments across Ontario.

Emergency department overcrowding is often discussed as a problem of staffing shortages, hospital capacity and patient flow. Those issues matter. But another challenge is hiding in plain sight: chronic disease.

Millions of Ontarians live with diabetes, asthma, cardiovascular disease and kidney disease, and advances in healthcare mean many are living longer with these conditions than ever before. While this is a significant achievement, it also contributes to growing pressure on emergency departments, hospitals and the healthcare system as a whole.

This wasn’t the case 65 years ago when Ontario’s healthcare system was largely designed around acute illness and injury. Hospitals were built to treat patients for short periods before they recovered and returned home. It was not designed to manage the needs of millions of people living for years or even decades with chronic disease.

Now consider these projections for 2040, just 14 years away, from a 2024 study by the University of Toronto’s Dalla Lana School of Public Health in conjunction with the Ontario Hospital Association:

3.1 million Ontario adults will be living with major illness – an increase of 72% from 1.8 million in 2020 and more than triple the 960,000 in 2002.

Approximately one in every four Ontario adults over the age of 30 will be living with a major illness requiring significant care. This is double the figure of approximately one in eight individuals living with a major illness in 2002.

Major chronic illnesses will be affecting more than 10% of the younger population (aged 30 to 64), up from 5.7% in 2002.

We are already feeling the impact of so many Ontarians living with serious chronic diseases in every aspect of our health system, but particularly in our emergency rooms (ERs) because that’s where patients must turn when they have no other immediate option to receive care. Cardiovascular disease is responsible for more than 200,000 ER visits annually. There were 28,000 ER visits for asthma alone in 2022-23.

Issues related to unmanaged chronic diseases also contribute significantly to medical situations that do require ED care and resources, but which could be lessened dramatically by appropriate care for the underlying disease. Diabetes, which has been diagnosed in 11% or 1.7 million Ontarians,contributes to 28% of kidney failure requiring dialysis,30% of strokes, and 40% of heart attacks.

Behind these statistics are real people. Someone may arrive in an emergency department experiencing a heart attack, but the underlying risk factors that contributed to that event, such as high cholesterol, high blood pressure or diabetes, may have been developing for years. An appointment may not have been available. Early symptoms may have gone unrecognized. The right care may simply have been out of reach when it was needed. These are points where the health system can intervene before a manageable condition becomes a medical emergency.

Reducing pressure on Ontario’s emergency departments requires changing how we prevent, detect and manage chronic disease.

That means acting earlier: timely screening to identify disease and risk factors, access to a regular care team, appropriate treatment and follow-up as conditions change. These interventions can help people stay healthier for longer and reduce the likelihood of serious complications.

Ontario cannot build, staff or expand enough emergency departments to solve this challenge on its own. If we want shorter wait times, healthier patients and a more sustainable healthcare system, we must do more to prevent, detect and manage chronic disease before people arrive at the hospital.

Emergency department pressures do not begin in emergency departments. They begin upstream.

Act earlier. Improve outcomes. Strengthen Ontario's health system.

Life Sciences Ontario, Health Charities Coalition of Canada, Diabetes Canada, The Kidney Foundation of Canada, Asthma Canada and HeartLife Foundation have developed a series of evidence-based policy modules focused on diabetes, cardiovascular disease, chronic kidney disease and asthma. Together, they outline practical opportunities to improve prevention, screening, diagnosis and care.

Explore the full chronic disease strategy at

https://lifesciencesontario.ca/ontario-chronic-disease-strategy/

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