A new study, released by the University of Toronto’s Dalla Lana School of Public Health, finds that millions more Ontarians will be living with chronic illness in the next 20 years. The findings have sobering implications for Ontario’s health care system, which will face significant strain and rapidly rising pressure in the next two decades. The province will face a level of demand for health services like never before. 

The study, Projected Patterns of Illness in Ontario, published in collaboration with the Ontario Hospital Association (OHA), represents the most recent comprehensive public report to quantify chronic disease and multimorbidity in the Ontario population. This study combined age and sex-specific demographic projections with historical chronic disease trends to model the burden of illness in the population in the future. 

The authors of the study project that 3.1 million adults will be living with major illness in Ontario in 2040, up from 1.8 million in 2020. Approximately one in four adults over the age of 30 will live with a major illness in 2040, requiring significant hospital care, up from approximately one in eight individuals in 2002. 

“Planning for sustainable and equitable health care that’s responsive to emerging trends requires projections of what chronic disease rates are likely to be in the future,” said Dr. Adalsteinn Brown, Dean of the Dalla Lana School of Public Health and co-author of the study. “Our projections suggest that more Ontarians will be living with major illness, and the number of cases will rise for many chronic conditions. Given these findings, it’s clear that new solutions are needed now, including significant efforts in chronic disease prevention and management.” 

In addition to more people living with major illnesses, the number of illnesses any individual will be living with will also increase significantly. The conditions expected to increase the most in number are those that increase with age, including osteoarthritis, diabetes, and cancer. Multimorbidity is also rising, which refers to the presence of two or more co-morbid chronic conditions. Multimorbidity is a major driver of demand for health services and costly for hospitals as people living with multimorbidity have unique and complex health care needs. 

Canadians are living longer, with life expectancy growing to 81.5 years as of 2020-2022. An aging population contributes significantly to the estimated increases. Underlying structural and social determinants of health and an increase in chronic disease risk factors also contribute to these estimates. 

A turning point – the need for new thinking in health care 

“As we look to the future, it’s clear that Ontario’s reached a turning point,” said Anthony Dale, President and CEO of the Ontario Hospital Association (OHA). “Ontario’s health system is already grappling with rapid population growth, increasingly complex health needs and intense pressures on existing capacity. These findings confirm that maintaining the status quo is not an option. Health care in Ontario needs an innovation revolution. Without it, the system won’t be able to cope.” 

Ontario’s health system must galvanize around the findings of this study and aggressively focus on prevention, early detection and effective treatment of chronic disease. Past successes, including reductions in chronic disease risk factors such as smoking and improved management of cardiovascular health at the population level, dramatically reduced the burden of chronic disease. 

Ontario urgently needs a long-term health services capacity plan, so the province is truly ready to meet the needs of its rapidly growing and aging population. Expanding services that support and encourage seniors to age at home, such as access to home and community support services, primary care and supportive housing, will also ensure that long-term care and hospital capacity are available for people with the most complex and serious needs. 

“Over the past several decades it is biomedical and technological innovation that has driven clinical improvements, cost savings and improved access to care in hospital settings,” said Dale. And now, artificial intelligence, gene therapy and personalized medicine are demonstrating astonishing potential. Working together and embracing innovation in all its forms, we can create a future with less disease, better treatment and universal access to care. It’s within our reach.” 

Key Facts 

• The population will grow by 36 per cent in Ontario over the next 20 years, with the largest increase happening in the 65 and older age group.

• The number of people living in Ontario aged 65 or older will grow from 2.6 million in 2020 to 4.2 million in 2040, an expansion of over 60
per cent.

• The number of people living with chronic illnesses has nearly doubled over the past 20 years from approximately 960,000 in 2002 to 1.8 million in 2020. This trend is expected to continue, reaching approximately 3.1 million people living with major illness in 2040.

• Major illnesses are expected to increase substantially in the age 30 to 64 age group of the population – or working age population, from 5.7 per cent in 2002 and 9.2 per cent in 2020 to over 10 per cent in 2040.

• An additional 5.1 million people will be living with some illness in 2040, up from 2.9 million in 2002 and 3.9
million in 2020.

• Some of the conditions expected to experience large growth in the number of cases are those typically associated with aging, such as dementia, hearing loss and osteoarthritis.