Keep people healthy in the first place

[Guest guest]

[Finally! An article about prevention in Canada's national newspaper]

http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20040624/HPICARD2\

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Keep people healthy in the first place

 

By ANDRÉ PICARD

PUBLIC HEALTH REPORTER

Thursday, June 24, 2004 - Page A19

 

'Good health is the bedrock on which social progress is built. A nation of

healthy people can do those things that make life worthwhile, and as the

level of health increases so does the potential for happiness. "

 

So begins the now legendary report titled A New Perspective on the Health

of Canadians, more commonly referred to as the Lalonde Report, after then

minister of health and welfare André Lalonde.

 

When those words were written in 1974, Canadians spent less than

$10-billion annually on health care. Today, we spend in excess of $120-billion.

 

Why have costs risen inexorably for three decades? Why has this level of

spending, $3,839 per capita and rising, resulted in only marginal

improvements in health outcomes? Why does the health system of one of the

richest nations on Earth sputter from one crisis to the next?

 

One of the main reasons is that today's political leaders lack vision.

Another is that governments of all stripes have systematically failed to

heed the Lalonde Report, which was indeed a visionary document.

 

The report is considered one of the great achievements of the modern

public-health movement because it brought into the mainstream the notion of

socio-economic determinants of health. It summed up the concept like this:

" The health-care system is only one of many ways of maintaining and

improving health. Of equal or greater importance is . . . raising the

general standard of living, important sanitary measures for protecting

public health, and advances in medical science. "

 

In other words, there are a host of non-medical factors that have a

tremendous impact on our health as individuals and as a nation: Employment

(or a reasonable income), decent housing, clean water, breathable air,

healthy food, support for raising children and caring for the elderly,

having a modicum of control over one's life, good safety regulations and

health education.

 

If that protective net exists, far fewer people are going to get sick in

the first place. If those basic needs are not met, no health system,

however wealthy, is going to improve the health status of the population.

 

Yet, in Canada, we persist in thinking that good health can be ensured by

having a hospital in every community, by bolstering the number of

physicians per capita, by ensuring that no one waits for more than 30

seconds for treatment in an emergency room, and that we all have unlimited

access to the latest technological bells and whistles such as PET (positron

emission tomography) scans.

 

The Lalonde Report made clear that this obsession with an ever-expanding

illness-care system is a losing proposition. " The traditional view of

equating the level of health in Canada with the availability of physicians

and hospitals is inadequate, " the report said.

 

The Lalonde Report was also prescient on the issue of chronic diseases.

Heart disease, diabetes, cancer, lung disease and the like -- many

preventable or, at the very least, whose effects can be attenuated -- now

gobble up two in every three health dollars.

 

Not only do we do a poor job of preventing these chronic conditions, the

management of patients with chronic conditions remains poor. Many

sufferers, particularly the frail elderly, are preposterously overtreated:

They are drugged and hospitalized, when what they need is home care and

social support.

 

" For a health-care system whose essential motivation is based on curing the

sick, the treatment of the chronically ill is not very satisfying, " said

the Lalonde Report. We need to be motivated to prevent and to " care " as

much as to " cure, " it said.

 

What is eerie is just how timely and current the Lalonde Report remains

today. Canadian society has changed a lot in 30 years, but the health

system remains stuck in a bizarre time warp.

 

It's time for some progress.

 

This is not to suggest that we abandon the excellent sickness care provided

by the publicly funded health system. What the Lalonde Report recommended

in 1974 remains valid today: We need to shift resources to prevention,

health promotion and other aspects of the social safety net so that,

ultimately, there will be a healthier population and better care for those

who need it.

 

The report, sadly, noted that its message would be a hard sell in a world

fixated on short-term gain. " There is the paradox of everyone agreeing to

the importance of research and prevention, yet continuing to increase

disproportionately the amount spent on treating existing illness. "

 

Since then, Canadians have spent an eye-popping $1.65-trillion (yes,

trillion) on health care -- only about 2 per cent of the total has gone to

prevention.

 

As the Lalonde Report says, in its charmingly understated way: " It would

appear that steps need to be taken to reconcile the foregoing . .

.. " apicard