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Focusing on health, not illness
The Toronto Star
Mon 21 Mar 2005
Page: A22
Section: Editorial
Byline: Carol Goar
Carolyn Bennett's mission is to put health back into health care.
Somewhere along the line, she says, Canadians got so fixated on treating illness that they lost sight of everything else that keeps a person alive and well. Medicine became confused with health.
Bennett, a family doctor, is minister of state for public health. It is her job to shift the focus from hospitals - which she describes as the repair shops of the health-care system - to the hardships, hazards and bad habits that bring people to their doors.
Those include everything from polluted air and junk food to substandard housing and domestic violence.
Next week, Bennett will invite Canadians to help set national health goals.
The minister could easily have drafted a list herself. She could have done it with her provincial and territorial counterparts. She could have turned to the many academics who specialize in the "social determinants of health." Or she could have borrowed the goals chosen by Sweden, Britain or the United States.
But one of Bennett's objectives is to get Canadians talking about what a healthy society looks like and how to become one.
The first half of the exercise is relatively easy. Most people agree (and there is abundant evidence to prove) that clean air and water, a decent standard of living, a safe place to live, a well-balanced diet, regular exercise, good genes and a strong social support network contribute to good health.
It is the second half of the undertaking - creating those conditions for 32 million Canadians - that poses challenges. It pits rich against poor, environmentalists against industrialists, advocates of tax relief against proponents of public spending, medical professionals against social activists and various federal departments against each other.
To complicate matters further, all three levels of government provide and pay for health services. Demand is high. Dollars are scarce.
That largely explains why politicians have promised to tackle the root causes of poor health for years, but never found the cash or political will to do much.
The process Bennett is poised to launch comes out of the health accord signed by Canada's first ministers last September. They agreed "For the first time, governments will set goals and targets for improving the health status of Canadians."
Since then, Bennett has been examining the ways other countries set public health goals, trying to come up with yardsticks to measure success and attempting to convince her cabinet colleagues that they're all responsible for aspects of Canadians' health.
When asked what her ministry got out of last month's federal budget, Bennett cheerfully pointed to child care, aboriginal housing, immigrant assistance, pension increases for low-income seniors and support for Sport Canada.
She carries around a diagram that she invented. It depicts a large deciduous tree. Below the ground are all the hidden factors that determine how healthy an individual will be socio-economic status, education, shelter, environment and genetics. Running up the trunk are the behavioural factors that influence a person's health eating, physical activity, drug and alcohol use. Only in the foliage do the medical consequences of these inputs these appear.
The chart is part of a discussion paper Bennett will distribute to participants in the priority-setting process. It will also be available online.
Several details of the national dialogue have yet to be worked out
It is not clear how many health goals the minister is looking for. The Americans identified 467. The Swedes settled on 11.
It is not clear how long the consultation process will take. If it lasts longer than nine months, it could be cut short by an election campaign.
And it is not clear where the resources to implement the goals will come from. That has always been the problem with health promotion. It is no mystery that rising asthma rates are linked to smog, yet doctors keep handing out puffers while the air gets dirtier. It is obvious that homeless shelters are the perfect breeding ground for infectious diseases, yet governments continue to squabble about funding for affordable housing.
Bennett can claim some modest headway. Canada got its first Chief Public Health Officer (Dr. David Butler-Jones) on her watch. Research dollars are going into disease and injury prevention.
But she has a lot of public education to do. Most Canadians want relief for the sick more than help for the vulnerable.
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