“Let’s have a conversation about health…and not talk about healthcare at all.” Sudbury District
Health Unit.
Health is determined by many factors. Any discussion about healthcare should take health into
account. But when we want to talk about health, why is the default always healthcare?
As strange as it sounds, most of our discussions about healthcare ignore health. Really. Most of
the healthcare talk is about access to healthcare services including wait times, expansion of
healthcare services (or fighting their contraction), financial funding for healthcare and federal-
provincial relationships for funding.
But none of this is really about health. Its all about healthcare (indeed healthcare economics) –
how to make sick people better, how to fund those efforts, and what funding does or can cover.
Sadly, preventing people from getting sick in the first place doesn’t seem to be prominent on this
election radar. Developing healthy communities and healthy populations – which can save billions
of dollars annually – reduces stress and demand on the healthcare system enormously, enables a
massive and fair expansion of services especially for disadvantages groups, and makes people,
communities and nations happier and more satisfied with life in general. Let me ask you this:
Would you prefer a monstrous healthcare system that can make your cancer, diabetes or heart
attack manageable, or a society where cancers, diabetes and heart attacks are far less likely in the
first place?
Clearly we need a healthcare system that can manage disease, but we’re only going to achieve
that if the burden of disease is first reduced. Which begs the obvious question:
why aren’t we talking about health more during this federal election?
Most chronic disease is preventable: 95% of all cancers are non-hereditary; 80% of premature
heart disease and stroke is preventable; and 90% of type-2 diabetes is completely avoidable. Most
of our chronic diseases are associated with conditions that society imposes and for which
individuals have little to no control over. Disease, and ergo healthcare, are clearly political. But
if we would rather prevent illness in the first place, we have to remember that health, too, is
unambiguously highly political.
So why aren’t we talking about health this election?
Sure, healthcare is important now that we’ve set ourselves up to require so much of it. Being able
to see your doctor without being charged is a good start. But what if you can’t afford to follow
your doctors orders? What if you can’t afford the medications prescribed, or to be able to take
some time off of work, or be able to rest or get enough sleep, nutrition or fresh air to get better?
You’re simply unlikely to get better, or to live a happy life. One in five Canadians are not able to
take their medications as prescribed by their doctor.
Canada needs a National Pharmacare plan, something both the Green Party and NDP have proposed in their policy platforms this election. The Green Party goes so far as to quote from a 2015 spring study by Steve Morgan and Danielle Martin demonstrating that universal drug coverage would save over $7 billion dollars in private and public spending, with little or no increase to government budgets. The Green Party uses this fact to reveal the enormous system flexibility available to then fairly redistribute wealth and pay for what Canadians value – such as a Guaranteed Livable Income, free tuition, student debt forgiveness, a renewable energy future, a cleaner environment, adaptation to climate change, protecting Canada Post, re-investing in our national media broadcaster, improving First Nations communities, and implementing a National Seniors Strategy. The Liberal fallback, fraught with barriers and limits, is on individual decision making to create the infamous invisible hand of society in a market-driven healthcare system to justify avoiding the discussion on health. The Conservatives? As in all discussions that matter, MIA on health – apparently they cut and ran from this debate too.
Everyone knows getting out of bed on the wrong side, sets a day up to be terrible. Well, the same
thing goes for setting our children up for life with their early life experiences. Without good
education, a caring family and friends, secure shelter, healthy food and safe recreational
opportunities, children are set up for an unhealthy life from the moment they arrive.
An affordable national childcare system can support fair early child development for all Canadian
children, and set children up for the best opportunities in life. And for those of you still
mesmerised by the economic argument? Every dollar invested in early childhood education
returns three dollars back to the economy.
Good stable income is essential to eliminate poverty, reduce stress and give people and families
what they need for a healthy life. A Canadian job plan, income and disability support mechanisms,
and a Guaranteed Livable Income are all important to eliminate poverty, reduce stress, and
provide people with the freedom to choose their needs and healthy lifestyles.
Housing is important to a healthy life too. Housing provides the key properties that determine
material environments in which people are able to carry out their lives. Housing also provides a
platform for self-identity and self-expression. Housing can also have a serious ripple effect: when
people have to pay a disproportionate amount of their income on housing, they will have less
available money to spend on other health and well-being enhancing expenses and opportunities.
Can you imagine living where conditions are described as below third world standards, potable
water is rarely available, and occupancy is measured in people per room rather than rooms per
person per household? Well, that’s life in Canada on many First Nations. As a Canadian, this is
embarrassing, and definitely unhealthy. During this election, its also ‘out of sight out of mind’ for
most of us. On reserves, housing is a federal responsibility.
Despite these deplorable and avoidable conditions, it doesn’t mean there is no effect on all of us:
when society is unhealthy, everyone, regardless of your income level, suffers. This is one key
take-away from the Spirit Level by Michael Wilkinson and Kate Picket, and other research on the
social determinants of health. The greater the income inequalities in a society, the less healthy
everyone is, regardless of where you stand on the income ladder. In other words, simply
insulating yourself with enormous personal wealth is actually making everyone sick, including
yourself. It makes little difference how much money we throw at a healthcare system: inequality
kills.
In urban centres, if housing costs more than 30% of a households income, there’s often
insufficient money to put nutritious food on the table, pay the utilities, provide clothes for
growing children, or provide other necessary health needs. Imagine being a 14 year old going to
school in the same outfit you wore last year that is now three sizes too small. That’s a direct
health impact certain to hurt the child and work against their learning outcomes, not to mention
self esteem, unless the school body has an incredibly forthright set of values against bullying. Or
imagine the 15 year old that can’t afford a smart phone and social media? With 25% of Canadians
paying too much for housing, and unable to afford other essential health needs, Canada needs a
Canadian Housing Strategy.
The environment makes all life on this planet possible. We can’t have clean drinking water, fresh
air to breathe, or healthy food without clean and sustainable ecosystems. Climate change is
already the biggest threat to human health this century according to the World Health
Organisation. Solid political commitments with achievable goals and accountable, measurable
targets for climate change demonstrates how our political candidates care about health. When the
economy, jobs or GDP growth trump the environment, it’s a slap in the face for our health and
well-being.
Housing, education, income, a healthy environment and other supports won’t cure all our
diseases, but they’ll go a long way, make many more people happy in the process, and fairly
allocate funding in a more equitable manner across society. Only if we talk about health, and
disease prevention, can we adequately provide the necessary healthcare, pharmacare, dental care
and affordable housing, income support and child development, among others. We need to stop
funding illness care to the absurd exclusion of health. We need to start funding health.
Most of these solutions are beyond individual lifestyle choices we are often lectured about.
Simply stated, poverty doesn’t allow you to afford a healthy education, childcare, nutritious food,
or a nice house in a safe community with a healthy environment.
More simply stated: social inequality produces poverty. Inequality makes us sick. This is the
politics of health. We need a discussion about health, and stop falling prey to the manufactured
distraction of healthcare. Beyond poverty, how power and wealth is distributed within society
also has enormous implications for the health and well-being of that society.
In Canada, the lowest income quintile has three times the first time heart attack hospital
admissions as do the highest income quintile population. Since this result is directly attributable
to income rather than lifestyle health-related risk behaviours (such as smoking or alcohol),
healthcare provides, at best, a rather modest contribution to health outcomes compared to income
factors. A constant expansion of benefits and wealth to the already wealthy – in the form of tax
cuts at the expense of the majority of Canadians has made a bad situation literally deadly in
Canada. For example, between 1990 and 2005, the tax burden of the bottom 10% rose from
25.5% to 30.7%. In contrast, the top 1% of earners saw their taxes drop from 34.2% to 30.5%,
and the next highest 4% of income earners saw their taxes drop from 36.5% to 33.8% – and yes,
you read that correctly: the highest income earners paid less tax than the other 4 quintiles by
2005. This is a far cry from the 90% top tax rate in the earlier part of the last century.
In the end, elections are about our health and well-being. There are a lot of factors that
contribute to our health, and, despite its imposing nature, healthcare is only a small fraction of
what’s important to health. Individual lifestyle choice is determined by the wider social and
environmental determinants, and these are all determined by how power and wealth is shared.
These are unarguably political decisions. Ask your political candidates about health this election,
and let’s see what they say.
