Years ago, I took part in the 1st Canadian Patient Forum in Toronto as a life-long severe asthmatic. A colleague from the congenital heart group shared his frustration with getting funding for projects to support his members. Repeatedly he was hitting roadblocks; he was told by one of the larger heart patient groups they were only funding prevention programs and not supporting those actually living with congenital heart defects.
He railed, “how the hell is switching from butter to Becel going to help someone actually living with congenital heart problems?”
When did it become acceptable to jettison the sick in favour of the healthy? If only it were just an unfair rhetorical question, but it’s actually been a long-running, ongoing issue.
In 1974, “ A New Perspective on the Health of Canadians”, also known as the Lalonde Report, was released. Despite its groundbreaking and broad-ranging recommendations, this seminal government position paper was narrowly interpreted by many to suggest that while our medical system was important — enviable even — it was NOT the most important determinant of collective health — not even close. What was to become a collective refocusing on social determinants of health began its glacial move to the forefront of government health policy. The over-arching importance of education, poverty mitigation and healthy lifestyle, among others, was accepted broadly as the potential saviour of our collective health, health care system and — ultimately — our economic health.
Cue neo-liberal teeth gnashing.
Coincidently, its release dovetailed nicely with the loss of political will in the on-going creation of a truly comprehensive health care system in Canada. Hospitals had been brought into our health care system, then doctors — albeit kicking and screaming. The Lalonde report seemed to signal an acceptance that we had “done enough” and the grand health care dream of Tommy Douglas (who originally intended and recommended the inclusion of more services like prescription and dental care) wheezed to a sad and bureaucratic end.
And few noticed.
However, the Lalonde report had a fatal flaw, failing to appreciate what a powerful cudgel it could be in the hands of rightist ideologues. Coupled with trickle-down economics of the Thatcher and Reagan eras, it provided governments a free hand to cut spending on the health care system. After all, if health care didn’t have much effect on health, then the responsible thing for government to do was slash it, right? From the original 50 percent federal funding for health care in the 60's, we began to see across-the-board unilateral cuts to federal health budgets, such that the share of funding from the federal government now approaches 20 percent. Thus the stage was set for health care to duke it out for funds with other social programs and prevention — with the federal government washing their hands of the whole muddle.
But here’s the problem. As with many complex decisions, we assume away reality to simplify understanding. The authors of the Lalonde Report did this by treating the entire population as one homogeneous mass. So, yes, if you look at the health of the population as a whole, the health care system will SEEM to be less important. BUT, if you split the population into healthy and chronically ill populations (45% of Canadians have been estimated to have at least one chronic illness) you get a VERY different picture.
For many chronically ill, the health care system is often the most important determinant of health. Without adequate health care it is unlikely that many could be contributing members of society, if they survived at all. The chronically healthy don’t require much from the health system, but the chronically ill desperately do.
By focusing health policy on the fallacious belief that the health care system is a minor player in its citizens’ health, eventually the chronically ill will be left holding the proverbial bag, while the healthy stay healthy.
This is the nub for those who, with their reactionary angst, impetuously blame the victim for all high health care costs. They stubbornly cling to the aphorism “an ounce of prevention is worth a pound of cure” as gospel, without considering its impact.
Yet, we live in a society that over-promotes the consumption of goods, including food. We live in a society that allows and benefits, though taxes, from tobacco. Look, I’m no fan of smokers, and while they are treated as pariahs, it IS legal. So, if we do not control these problems, what can we really expect?
Ultimately, though, we cannot lay all of the blame on preventible illness. Yes, you can prevent some cancer by not smoking, you can prevent some type 2 diabetes or heart disease by eating properly (if you can afford it). But, if you consider the burden of the three most preventable illnesses, heart disease and stroke, type 2 diabetes and cancer (warning, back-of-an-envelop math ahead), that still leaves two-thirds of the chonically ill population who suffer from conditions over which they have no control. That’s 11,0000,000 Canadians for whom prevention is moot.
But I guess the solution is obvious. Those living with a chronic illness should have been prescient enough to switch from butter to Becel™ or quit smoking in utero.