A Medicare@50 blog post by:
Russ Ford (@RussJamesFord) – Executive Director
LAMP Community Health Centre (Toronto ON)
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: Institute for a Healthy Society, launched on September 27 at the national Community Health Centres conference — Medicare@50 — in Saskatoon. The purpose of Upstream 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, whom 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 are 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 treating people 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 if the care received by these people was better managed it would 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 healthcare 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:
- poverty
- lack of education
- lack of social support networks
- employment and working conditions
- 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 stress these narrow 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 times more likely to contract a sexually transmitted infection; fifteen more times likely to 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 the tired old approach. Let’s start by making evidence-based decisions and challenging those that are not based on evidence.
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 search away.
Mike Harris, former Premier of Ontario, would often say that the best social program is 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, he 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 now 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 chronic disease 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, especially those of corporations, 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 in order to end their addiction to public opinion polls. Can you imagine how politics would be different if our parties stood for something, and 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.