Never thought I’d ever see the day when a Conservative senator extolled Cuba’s neighbourhood clinics as a model for improving our own health care system.
But that’s exactly what occurred when the Senate Subcommittee on Population Health, chaired by Tory Wilbert Keon and Lib Lucie Pépin, took a series of pokes at politicians for their refusal to fund health beyond medicine.
The subcommittee’s reports, the fourth released in April, astoundingly offer the most radical rethinks of Canadian health policy in 40 years – likely not the kind of Senate reform Harper’s government campaigned for.
The fact is, our unrepresentative, unelected Senate, despite the Tory-dominated landscape, has pushed “health determinants” – social, economic and enviro factors – to the centre of the system’s reform. It’s an odd place for leadership to come from and a reminder that nothing much new is emanating from either NDP or Green types.
The Canadian media, the report says, “tends to overemphasize the significance of the health care system and personal lifestyles and to underemphasize the role of the socio-economic environment.”
Meaning most of what ails us is beyond our individual or our doctors’ ability to fix.
These class-analysis senators cite studies showing that social inequality and exclusion account for fully 50 per cent of illness, while genetic inheritances are responsible for 15 per cent of health outcomes, and medical treatment gets the credit for 25 per cent.
And more biting still, the subcommittee argues that current health care priorities largely ignore this fact, instead spending whatever it takes to cure illnesses that could have been avoided.
Keon and Pépin know Canada’s hospital and health system from the inside. Keon was Canada’s foremost heart surgeon from the 1970s through the 1990s, as well as CEO of Ottawa Civic Hospital. In January he led a fact-finding mission to Cuba looking at early childhood and maternal care.
Pépin was head nurse of a Montreal gynecology unit during the 1960s before leading national campaigns for family planning, birth clinics and women’s health.
The report offers studies showing that the wealthy live longer than the poor and experience less chronic illness, obesity and mental distress. Over 68 per cent of affluent males can expect to live beyond 75, but only 53.4 per cent of low-income males.
Such differences, the senators say, “are avoidable and, as such, are unjust and unacceptable.”
And the world is noticing. Canada’s standing, they point out, is slipping. We now rank 30th of 30 industrialized countries in terms of best value for health care dollars. We spend more money to achieve worse results. For all the economic resources, they say, “there is no national plan in Canada to reduce health disparities and improve overall population health status.”
Canadian governments have long had the global lead in promoting the idea of socio-economic health determinants – as well as the lead in honouring such principles in the breach rather than the observance.
Most recently, the Ontario Health Quality Council issued its 2008 report. Though “population health” is one of the council’s nine themes, there’s no reference to shifting resources to anti-poverty or food access programs.
“There’s a lot you can do to become a full partner in improving your health,” the report blathers. Adopt a healthy lifestyle, get your annual flu shot and use the College of Physicians website to find a family doctor, it recommends, taking gratuitous advice to a whole new level.
What the senators are saying is that if access to medical care is guaranteed by Medicare, the right to other health opportunities should also be equal.
It’s enough to make you give up on stereotypes when one of the country’s most archaic institutions is now in the health care avant-garde.