More than a pill

Community Action, April 18, 2005

More than 30 years ago, Marc Lalonde, Minister of National Health and Welfare at the time, issued: A New Perspective on the Health of Canadians. This paper was a remarkable contribution to our thinking about health policy and programs. Well received, it went through several reprintings and more than 150,000 copies were distributed.

At the time, only a few health experts and thoughtful politicians worried about the rising expenditures for health care. In 1974, Canadians spent about $10 billion on health care, about $2,200 per person per year. (Today's spending is over $120 billion and more than $3,800 per person per year.) Lalonde and others recognized that increased spending on health services no longer brought commensurate improvements in longevity and living conditions. We were spending more and getting less.

The essential idea of the Lalonde paper is: The healthcare system is only one of many ways of maintaining and improving health. Of equal or greater importance is raising the general standard of living, improving sanitary measures for protecting public health, and implementing appropriate advances in medical science. The emphasis was placed on the social, economic and environmental factors that affect the way we live because there was growing concern at the time with heart disease, diabetes, mental health, obesity and other conditions that were being influenced by changes in life style.

The paper stimulated discussion and thinking about health policy and programs. But aside from the intellectual impact, the actual implementation of the ideas was limited. Federal and provincial governments took modest steps to expand their spending for health education. Even with the limited funding some health promotions have brought dramatic results, most notably the anti-smoking campaigns. In 1974, most Canadian adults were smokers; today, less than 25% still smoke and the campaign continues.

We fondly remember the ParticipAction program that utilized advertising and marketing techniques to promote healthy living. Like advertisers everywhere, they exaggerated and chided us that a 60 year old Swede could outrun, outski or outswim a 30 year old Canadian. It was amusing and much discussed but it wasn't true. However, it did encourage many Canadians to take up fitness activities and a healthier lifestyle. This program unfortunately, no longer exists.

The Lalonde report also pointed to the importance of housing and working conditions. Since then, housing programs have been reduced and homelessness has risen, accompanied by a rise in TB and other infectious diseases among the homeless, diseases that were in decline 30 years ago. Laws on labour standards are under constant attack in the belief that lesser conditions will make us more competitive in the global markets, without detriment here at home.

For more than a decade we have seen a series of cuts to every program that might impact on the healthy life style. We have reduced every form of recreation and informal education that helps to make healthy living worthwhile and we've relegated them to the "frills" category.

Health education and promotion is the least costly effort we can make to advance healthy living. Yet the major form of health education today comes to us via television advertising. Drug companies teach us that some new and more expensive drug will provide near miraculous results, when in most cases the improvement, if any, is slightly better than the older, less costly version. The ads urge us to "discuss" the medication with our physicians. This advertising is hardly about our health. It serves to pressure doctors to prescribe any drug that "will do no harm" even if it does no good. It also puts pressure on the provincial drug plans to include the new drug even though a dependable generic drug is available. The result: drug costs are the fastest rising item of our health care system.

We are doing a fair amount to reform delivery of health care. We reorganized our hospitals, expanded home care, introduced new techniques and technologies and are in the arduous process of changing to a more efficient method of paying health care providers. Yet the stresses on the health care system continue. More money is constantly called for.

As the Lalonde report pointed out in 1974, the cure for our health care system is not to be found only in the system itself. The answers are to be found in the economic, political and Social environment in which the health care system operates. This is what we need to emphasize as we budget and plan for the needs of our community.

--L.K.