We often teach our systems planners and policymakers the mantra that an ounce of prevention is worth a pound of cure. It is easier to provide affordable housing options for those in need rather than respond to a crises of homelessness when it arrives. Provinces that create new jobs to support an aging population will be more productive than those who are left scrambling when large numbers of baby boomers retire or need assistance with various forms of dementia. And so it goes.
When thinking about our populations' health, however - we have, until recently, done a rather poor job of adhering to the messages that we preach. Wait times for MRI's or hip replacements, access to state of the art surgical equipment, physician and nurse shortages, exploding pharmaceutical costs - All important issues, but so consumed are we with notions of "care," or the options available once people are already sick, that we forget how powerful a force improving our general overall health status' can be in keeping all these other issues in check. While healthcare demands at least 50% of some provincial budgets and there are no shortage of reports on how overburdened and inefficient our system is at risk of becoming - rarely (with the exception of education) has the "determinants of health" earned aggressive post-election action from a new government in my (not that) young life. A "determinant" in this context is a broad societal issue that has been shown to be a strong predictor of a population's health status. Examples would include poverty & housing, gender equity, globalisation & migration, the environment, education, and access to reproductive health and early child development strategies, for example. Improvements in these areas are highly correlated with better health outcomes, improved worker productivity, and reductions in healthcare usage/wait times/costs.
So what have we been waiting for? Well, political will as is usually the case with proactive solutions, has often been the limiting factor. As one of their more successful efforts, the WHO has a commission on the social determinants of health made up of influential international figures who have been quite effective at leaning on several governments to get real about these things. And it couldn't come at a better time. In response to the release of a major study on the impact of neighbourhood & living conditions on Type 2 Diabetes, for example, a prominent Ontario health official (in 2007) publicly commented along the lines of being too consumed with caring for people already with Diabetes that it is limited how much investment we can make to strategically prevent new cases. Type 2 Diabetes costs the Canadian economy over $13 Billion annually, and he is right to be concerned with preventing the costlier problems, which occur when a poorly managed case of diabetes results in complications such as stroke, kidney failure, amputations, blindness, etc. What is missing, however, is that many of the behavioural and lifestyle changes required to prevent these complications are the very same one's which would help prevent people from acquiring the disease in the first place. This is an area where a holistic upstream approach can help prevent both the disease in some and the complications in others, resulting in a tremendous potential for downstream savings in both lives and money. It was unfortunate to hear someone in his position appearing so short sighted on this issue.
But as I have indicated, there remains hope on multiple fronts. Strong public education became the defining issue of the 2007 provincial election in Ontario. Outside of unpopular wars, the environment has skyrocketed to the top of the agenda in most developed nations. With the notable exception of some marginalized populations, most pregnant woman can access quality reproductive health care, and most parents can access effective early child development training and support. Gender equity is an interesting issue - where Canada had a solid run of progress, rates of improvement in this area have somewhat stalled. I once had a conversation with a former cabinet minister under Trudeau who mentioned that a prerequisite for an issue to be taken up at cabinet during those years, was that it had to include a statement on what impact said legislation/policy/program option would have on gender. This rule applied to all cabinet ministers and it forced the highest levels of government to think about gender when developing ideas both large and small. Now one might question whether Harper & Co have implemented a similar prerequisite, but the idea is simple enough that it could realistically be adopted by a wide range of decision making bodies.
Of all the determinants, however, action to reduce the poverty burden is arguably the most exciting area for Ontario. An important election promise with a strong commitment from Premier McGuinty, Child & Youth Minister Deb Matthews has been put in charge of the powerful new Poverty Committee. With broad membership across most ministries, this committee has been tasked with setting clear poverty reduction targets and working through a plan to achieve serious action. This level of inter-governmental cooperation is well over due, as effective action on most of the determinants requires a concerted effort from all of the non-MOHLTC ministries. After all, one might argue that the key to controlling escalating costs and an overburdened health ministry, is to do everything else better.
