Russ Ford's Blog

Health Care's Real Iceberg



Ryan Meili does not wear a beret. In fact  I doubt he  even owns  a Che tee shirt. He does not  emphatically wave his arms while speaking. Some revolutionary
 
Ryan Meili does wear a suit, speaks softly and is a doctor from Saskatoon. With no political experience he ran for the leadership of the Saskatchewan NDP, the province's natural governing party  and finished second.   His campaign was based on the social determinants of health.  Yes, some revolutionary.
 
Dr. Meili is the founder of a new organization called Upstream and its purpose is to change the way you and I think about health care.   He uses an analogy of a river to explain it.
 
One day you are on the bank of a river and you see a child drowning.  You
jump in and save the child. Soon another child comes down the river which
you also save and the more you save the more that come down the river. Eventually you go up the river to see why so many children and falling in the water.
 
Applying that analogy to our health system the obvious question is why do we continue to direct all  our  efforts at treatment  rather than spending some resources on trying to figure out why they got sick in the first place.
 
Seems to make sense but we do not do it. The current direction in Ontario for example,  is to see if we can address the needs of those that use the services the most. The belief is that some of the care received by these people was properly  managed it  result in savings to the system.
 
While there is certainly nothing wrong  with trying to spend your resources in a more efficient manner, it is an example of short term,  downstream thinking.  It is  an approach an economist would prescribe, not a health care provider. It is just like pulling the child from the river.
 
Upstream thinking is about redirecting the emphasis from treatment to the causes of ill health. To use a cliché, it is a paradigm shift.
 
So what are the causes of ill health? Well for that we go to that leftist
organization the Canadian institute for Health Information. They concluded that the five leading causes of ill health are 1) poverty 2) lack of education 3) lack of social support networks 4) employment and working conditions and 5) early childhood development
 
The holy trinity of health promotion,  don't smoke,  get some exercise and watch your weight do not appear on the list yet the majority of the meager dollars we put into health promotion stresses these lifestyle issues..
 
The truth is that it is much easier to get someone to stop smoking than it is to get them out of poverty. It is much easier to give a person a pill for high blood pressure than to teach them to read.  But like our "tough on crime agenda" it is totally useless.  I doubt there is anyone  who does not know by now the perils of smoking and there is not much more we can do to discourage it, but we still pump money into anti smoking programs.
 
As a doctor Meili  is trained to go by evidence not hunches or gut feelings. So what is his evidence?
 
If you live in the centre if Saskatoon  where Meili practices,  you are living in one of the most impoverished areas in Canada.  If you live there the  research shows that you are fifteen more times likely to contract a sexually transmitted infection; fifteen more times likely at commit suicide;  thirty five times more likely to get hep  C and  thirteen times more likely to have type two diabetes. The infant mortality rate is three times higher and a resident of this community  is 2.5 times more likely to die within the year. The evidence is there.
 
So if addressing poverty and the issues that accompany it like racism would make people healthier and reduce costs in a much more significant way,   why are we not doing anything about it?
 
To do that we would  have to change the way we do politics and the way we think about it.
 
The way we currently do politics is a disservice to this country. We are more interested in scandals especially if sex is involved, we dumb down debate to attack ads and the issues that many face no longer seem to be relevant to our political masters. Scoring debating points in question period seems to be what is important. Getting elected  is more important than telling the truth especially if the truth is what the polls tell you the people do not want to hear
 
So let's change it. Meili almost became leader of the Saskatchewan NDP by not succumbing to that approach. Let's start by making evidence based decisions and challenging those that are not.
 
Take crime as an example. There is not one shred of evidence to support the get  tough on crime agenda. Yet the government initiates it and the opposition parties fearful that the public will see them as soft on crime if they oppose it, meekly accept it. Perhaps the opposition should have more faith in us and present the evidence.  It  is not hard to find.  It is one Google  away.
 
Mike Harris would often say that the best social program was a job. In other words a strong economy will cure most if not all that ails us. He was wrong or to be more charitable, way out of date.
 
The new global economy has only increased inequity even during times of growth. An increase in GDP  historically meant that most members of society prospered.

We know that is no longer true. A strong GDP now means nothing to the lives of most Canadians

Many have argued that our future health care system will find itself in crisis largely because people are living longer.  We have moved from a  system that previously addressed episodic illnesses to one that is now focussed on  chronic disease management.  But to suggest that this will be the iceberg that derails our health system is simply nonsense.
 
The money is there or at least it was there until governments started cutting our taxes literally taking billions out of the public treasury. The lost tax cut money can easily finance those costs and there will be even money left over to buy the military all the toys it wants.
 
No chronic disease will not be our  undoing. Our undoing will be a failure to
acknowledge and address the fact that our new economic order is causing more and more Canadians to be sick by creating more inequality.
 
The easy solution would be to enter our political parties into a rehab program to end their addiction to public opinion polls. Can you imagine how politics would be different if our parties stood for something, acted on principle rather than focussed on what the polls tell them we want to hear.
 
Doing politics differently  means starting  to  say what needs to be said.

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