Health more than Health Care

Health Is More Than Healthcare

What’s the Issue?

Canada spent over $180 billion dollars on healthcare in 2009. So why don’t all Canadians have similar chances of having a long healthy life?

It is critical than everyone can see a doctor when they are sick and everyone needs to be able to access preventive care easily―things like screening for cancer and heart disease. But Canadians also need to stop thinking of health as something to get at the doctor’s office.

Health starts in families, schools and communities, in the air we breathe and the water we drink. The more the problem of health is seen this way, the more opportunities there are to improve it. The conditions at home and at work have a big impact on our health, long before we see a doctor.

Simply put, the brain is an environmentally sensitive organ. It requires specific sensory input at particular times in order to develop pathways. The richer the stimulation, the richer the resulting connections. Children in nurturing environments develop more neural pathways, synapses and dendrites. Further, the stress hormone cortisol (produced in situations of neglect, fear, and deprivation) damages several parts of the brain, including the major site of memory and learning. The wiring of bad pathways can, without intervention, stay with a child throughout life.

Not being able to afford the basics, cycles of violence and abuse, and poor education take their toll on young bodies and young minds. The effects of stressful adverse experiences can take years to show themselves, but when they do, they often show up as disease. At risk children become at risk adults who carry mental illness, disability, and premature death with them into adulthood.

Current models of health promotion, disease prevention, and health policy focus on promoting healthy behaviours and trying to change damaging behaviours in adults. Mounting scientific evidence suggests the effects of these strategies may be limited. It’s time to expand the way Canadians think about health to include how to keep it, not just how to get it back.

Evidence

Please be advised that the ‘Canadian Index of Wellbeing’ was released in October 2011 by the Honourable Roy Romanow and Honourable Monique Bégin. The CIW is a composite measure of wellbeing using many indicators from eight interconnected categories or domains. Whereas the GDP has been measuring the economic status of Canada, the CIW now complements this as a composite measure that looks much more broadly at the ‘wellbeing’ of Canada. The report, video and infographic are available at http://www.ciw.ca/ <http://www.ciw.ca>.

Penny Sutcliffe, MD, MHSc, FRCPC shares a recent video developed by the Sudbury & District Health Unit as part of their ongoing public health efforts to improve health equity: Let’s start a conversation about health…and not talk about health care at all.

http://www.sdhu.com/content/healthy_living/doc.asp?folder=3225&parent=3225&lang=0&doc=11749 (note that the flash version currently has better resolution)

Let’s start a conversation about health…and not talk about health care at all is a five minute video highlighting that HEALTH is about much more than access to medical care. It highlights that everyone has different opportunities for health, largely influenced by their social and economic conditions. Using this broad view of health, the video describes actions that various non-health sectors can take. It encourages everyone – teachers, builders, dads, nurses, business women, students, politicians… to start a conversation about health… and not talk about health care at all. Dr. Sutcliffe would be very pleased to hear your feedback at startaconversation@sdhu.com

Webinar: Looking Upstream: How Income, Education and Racial Inequalities Shape Health. On April 26th, the Robert Wood Johnson Foundation hosted a webinar on the effects that income, education and race have on health.

How does Canada fare on actual health outcomes relative to its neighbour to the south? “Quite well” according to the Conference Board of Canada. The Conference Board argues “improving the health status of Canadians requires improving social and economic conditions, educating the population to reduce risks of chronic diseases (for example, by limiting tobacco and alcohol consumption and by being physically active), and enhancing the quality and safety of health care.”

The Bayview medical clinic in San Francisco is developing a new kind of pediatric medicine, focusing on childhood trauma as a medical issue. Dr. Burke, clinic founder, argues that childhood trauma has a strong impact on adult health. See the March 2011 New Yorker article by Paul Tough which reviews the Adverse Childhood Experience study and describes the powerful relationship between poverty, child development and health.

If anything the gaps in health status across income groups are widening, not narrowing, and this is not because of poor access to healthcare. The universal Canadian system does a good job of delivering healthcare to those who need it and who can benefit from it, but there is more to being healthy than healthcare. Manitoba Centre for Health Policy researchers looked at the distribution of disease, death and the use of preventive healthcare across income groups in Manitoba. They found that the growing gap in income was accompanied by profound and growing gaps in health.

Improving the health of Canadians requires we approach health and its determinants in a more thoughtful manner than has been the case to date. Mikkonen and Raphael’s Social Determinants of Health: The Canadian Facts considers 14 factors that affect health including income and income distribution, education, unemployment and job security, employment and working conditions, early childhood development, food insecurity, housing, social exclusion, social safety network, health services, aboriginal status, gender, race and disability. The publication outlines why they are important and how Canada is doing in addressing them.

It turns out there’s much more to our well-being than genes, behaviors and medical care. The social, economic, and physical environments in which we are born, live and work profoundly affect our longevity and health―as much as smoking, diet and exercise. This is a story about health, but it’s not about doctors or drugs. It’s about why some of us get sicker more often and die sooner and what causes us to fall ill in the first place. This series by Public Broadcasting Service in the U.S , UNNATURAL CAUSES, criss-crosses the country investigating the stories and findings that are shaking up conventional notions about what makes us healthy or sick.

Researchers in the US estimate that over the period 1996 through 2002 medical advances saved a maximum of 178,193 lives. They also estimated how many lives would have been saved if mortality rates among US adults with an inadequate education had been the same as rates among adults with 1 or more years of college. Changing US society to eliminate deaths associated with disparities in education would have saved 1,369,335 lives during the same period, a ratio of 8 to 1.

Unless governments change their approach to addressing the needs of poorer and socially disadvantaged Canadians, we are destined to continue to spend a large amount of dollars on our healthcare system. Governments must expand their approach to health promotion in order to tackle the major societal factors that lead to poor health and to take pressure off healthcare budgets.

Recommended reading on Healthcare Costs/Spending from the Canadian Institute for Health Information (CIHI)

From the Health Council of Canada:
- Understanding and Improving Aboriginal Maternal and Child Health in Canada. Aboriginal Canadians have significantly worse health and more challenging living conditions than the rest of the population. With a much younger demographic and a higher birth rate than the non-Aboriginal population, the Health Council of Canada set out to learn about programs and strategies that have the potential to reduce these unacceptable health disparities.

See more recommended reading from the Health Council of Canada:

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