Over 1.5 million Canadians are living with acquired brain injury, stemming from traumatic impact, stroke, suffocation and other conditions. Bill C-277 — an Act to establish a national strategy on brain injuries — aims to implement much-needed long-term treatment and equitable support.
Traumatic brain injury (TBI) may appear to be a non-discriminating event: something that could affect anyone. However, this is not entirely correct for two reasons.
The first reason is the profound long-term impact of TBI on a patient’s life, despite the perception of the incident causing the injury as a momentary event. People living with a brain injury are diverse and unique and the health trends that follow are clearly life-long and complex. For instance, the 10-year long Manitoba Traumatic Brain Injury study revealed that a brain impact increased the 10-year patient mortality, regardless of the injury severity.
Long-term, chronic effects
The impact of the brain injury on a patient’s mental health, work productivity and cognitive capacity can also be life-changing. Impaired healing of the brain and/or disruption of normal blood circulation function may underlie secondary brain conditions, including epilepsy, depression and cognitive decline.
Lasting brain injury could contribute to two- to three-fold higher odds of suicidality and drug use in adolescents, as apparent from studies conducted among Ontario secondary school students.
For these reasons, TBI is increasingly viewed as a chronic condition that needs continued support, rather than a one-time event. In a joint position paper with Canadian Traumatic Brain Injury Research Consortium, CEO of Brain Injury Canada Michelle McDonald and a contributor to this story, explains:
“Unlike a broken bone or a torn ligament, a moderate to severe TBI is not a one-time injury with a linear recovery; rather, it is a chronic neurological condition leading to significant life-long disability.”
TBI intersects with adversity
The second reason TBI is not always a non-discriminating event is the way it intersects with adverse circumstances. TBI can happen to anyone, but a person’s long-term quality of life, income, health and resilience can be influenced by their unique life experiences, access to treatment, psychosocial support and access to community resources. Some individuals may be at a disadvantage due to the barriers and challenges in accessing treatment and support.
For example, among individuals without a place to live, roughly half report experiencing a TBI in their lifetime. The status of houselessness has a significant role in increasing the life-long risk of brain injury. The figures are similar for imprisoned individuals, with around 50 per cent of males and 40 per cent of females having been affected by TBI.
People living in socioeconomically underserved areas could also be at a higher risk of TBI, as well as more likely to develop long-term complications. This could partly be explained by historical systemic barriers to health that some individuals faced in the past, as well as stigmatization of TBI. Therefore, TBI can trigger a vicious cycle of health problems creating socioeconomic barriers that then contribute to a higher risk of recurrent injury.
The time is ripe for an action plan that would make the voices of people living with brain injury heard and provide the clinicians with evidence-based and unified guidelines on TBI management.
Need for a national strategy
Currently, in many instances, brain injury is commonly treated as a single event with most of the treatment focused on minimizing immediate symptoms. There is a need for a unifying national strategy that could address the void that exists in long-term management of brain injury and break the barriers to better health. People living with brain injury and their families have shown inspiring resilience, championing awareness of acquired brain injury and encouraging the government to act.
Alistair MacGregor, MP for Cowichan-Malahat-Langford, B.C., sponsored a Private Members Bill C-277 — An Act to establish a national strategy on brain injuries in partnership with Brain Injury Canada, CGB Centre for Traumatic Life Losses; the BC Brain Injury Association; and the Cowichan Brain Injury Society.
Bill C-277 would direct the minister of health — in consultation with representatives of the provincial governments responsible for health, Indigenous groups and relevant stakeholders (including individuals and families living with the effects of brain injury) — to develop a national strategy to support and improve brain injury awareness, prevention and treatment as well as the rehabilitation and recovery of individuals living with brain injury.
At the bill’s second reading on June 12, the vote in the House of Commons passed with unanimous support. McDonald of Brain Injury Canada called the vote a milestone marking a significant breakthrough for brain injury and the millions of Canadian families lacking essential supports and services. While there is still much work ahead, the brain injury community remains dedicated to the implementation of a national strategy.
Unified and equitable support
While the novel strategy will require significant initial investment to implement, it may play a significant role in reducing long-term economic expenses, such as the cost of TBI working-age disability, expected to reach $8.2 billion by 2031.
Bill C-277 could provide physicians with improved tools for preventing complications in populations at risk, dismantling the vicious cycle of marginalization leading to higher injury risk and vice versa. It could serve as the basis for government co-operation with international partners to implement a unifying world-wide policy of TBI surveillance, such as exists for infectious diseases and other chronic conditions.
Should this Act come into force, the minister of health will be given a year to develop a report on the strategy for Parliament, after which it will take an even longer time to refine and implement it in partnership with the provinces. Yet, one thing is clear: It is a step in the right direction towards unified and equitable support strategy stemming from the unique stories and experiences of people living with brain injury.
Michelle McDonald, CEO of Brain Injury Canada, contributed to this story.