We Know How to Build a Healthier Canada. Why Don’t We Act?

An excerpt from All Together Healthy highlights the role of poverty and inequality in health outcomes.

By Andrew MacLeod 15 May 2018 |

Andrew MacLeod is The Tyee's Legislative Bureau Chief in Victoria. Find him on Twitter or reach him here.

[Editor’s note: In his new book, All Together Healthy: A Canadian Wellness Revolution, Tyee legislative bureau chief Andrew MacLeod digs deep into research, people’s experiences and lessons from other countries to offer a prescription for a healthier Canada. A key lesson, explored in this excerpt, is that the path to better health lies largely outside the current medical system.]

In August 2017, after nearly two years as health minister, Jane Philpott addressed the Canadian Medical Association’s General Council meeting in Quebec City and called on doctors to advocate for social change.

“Here’s my bottom line,” Philpott said, according to the text of the speech published on the government’s website. “For Canada to thrive, we need to improve the health of our most vulnerable people.” Philpott focused her comments on Indigenous health, the epidemic of opioid overdose deaths and youth mental wellness, which she described as linked to each other and to the social determinants of health.

“I do not believe that we can achieve a healthy population without the expertise and active engagement of Canada’s doctors,” Philpott said. “Of course doctors can’t address the needs of vulnerable people without a broad range of other health professionals and social systems. But those systems will not succeed without the participation of physicians.”

Doctors care and they have education, insight and practical wisdom, she said. “Because you are a doctor, society has granted you power and privilege, respect and responsibility. There is no better use of that power, than to advocate on behalf of those who do not have the same opportunities.”

While the speech sounded great and identified several areas where the government was spending money to deal with crises, it fell far short of committing the government to a wide-ranging plan to make Canadian society more equal. Instead of really taking broad action, Philpott was calling on doctors in the audience at the CMA meeting to advocate.

It was an all the more ironic tack to take considering the organization had itself been pressing for more action from governments since at least 2012. Here’s the CMA’s official position from its website:

“The CMA believes the social determinants of health can have a larger impact on individual and population health than the health care system. The CMA also believes that any actions to improve health and tackle health inequity must address the social determinants and their impact on daily life.”

In 2013 the CMA had led a national dialogue with town hall meetings in cities across the country. “In those town hall meetings, Canadians served notice that they expect government action to address these issues,” the website said. The resulting report, Health Care in Canada: What Makes Us Sick? included the conclusion that “Canadian society has suffered from a lack of imagination, will and leadership to address social inequities.” While there is a role for citizens, physicians and communities to help deal with the problems, it said, “Governments need to be pressured to take action.”

Out of a dozen recommendations in the report, eight were explicitly for federal, provincial or territorial governments. The other four included adopting a housing first strategy to deal with homelessness, developing a national food security program and other initiatives that would at least require government leadership, if not direct government management.

In short, the CMA had committed to pressing the government for action and had been rewarded, four years later, with a speech from the minister in charge telling them they had to advocate. The river of rhetoric was starting to look more like a lazily turning whirlpool.

When I asked Roy Romanow in the summer of 2017 how Canada had done at addressing the social determinants of health, he said, simply, “I would say we have been unsuccessful overall.” Romanow was the premier of Saskatchewan from 1991 to 2001 and the head of a Royal Commission on the Future of Health Care in Canada that in 2002 submitted to the House of Commons its report Building on Values: The Future of Health Care in Canada. The report received some criticism for paying insufficient attention to the social determinants of health, but Romanow says it was produced in 18 months with a limited mandate. The focus was on how to fix the health care system, not how to make Canadians healthier, which is another question.

Since that time Romanow has worked with the Atkinson Foundation and other groups to more directly address the underlying causes of illness. By his estimation he at one point was giving 20 speeches a year on the topic.

“I had the impression there was a generally accepted message,” he said. And yet, he added, “Nothing ever happened.” That could be dispiriting, he said. “It’s a very, very tough field in which to labour, I’ve found… I’m not sure I’ve got the will to keep pounding away at it.”

According to Romanow, the main challenge for politicians is the prevalent and mistaken view that providing robust social services isn’t really about health. “The faith in hard medicine is pretty strong,” Romanow said. “I think it comes down to the attraction that we’re steadily making progress on the illness side of things.” When Canadians talk about “health,” the perception is that what’s really important is having the latest technology or a sufficient number of hospital beds, and that drives the decisions politicians make on their behalf.

The media contributes, said Romanow, with the latest advances given glowing attention on newscasts and in newspapers. “It is exciting news to hear there’s a possibility of a breakthrough,” he said.

With the public attention there, that’s what gets the attention of the policy makers, he said, adding there are more political points to score for the politician who announces an addition for the local hospital than there are for giving any number of speeches on early childhood development or prenatal care. “That’s my assessment as a former politician.”

Romanow compared the policy options to a teeter-totter, with acute care at one end and the social determinants of health at the other. “We still seem to be focused on the acute care end of the teeter-totter,” he said. Other countries — Britain, France, Sweden and the other Nordic countries — get the balance better, he said. The United States, with the highest health care costs and the worst outcomes, gets it worse.

“It’s always the balance. There’s never enough money to go around.”

All Together Healthy: A Canadian Wellness Revolution is published by Douglas & McIntyre and available in stores and online now. Andrew MacLeod will be discussing the book as part of a Read Local panel at the Shoal Centre in Sidney, B.C., on May 24. For more information, go here.

The Victoria launch for All Together Healthy will be May 31 at 7 p.m. at the Bard & Banker, 1022 Government St.  [Tyee]

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