Media Clipping — December 5, 2002, The Coast, Halifax

In sickness and in health

Romanow Report ignores what makes Canadians sick

By Erica Butler

It's one of the biggest, most widespread criticisms of the Romanow Report so far: sustainability. While Roy Romanow mentions the word throughout his 356 page report, there's not much in there aimed at making our health care system more affordable over the long term.

That's why Ron Colman wants people to look beyond "The Future of Health Care In Canada," and start thinking about getting healthier. Colman, director of GPI Atlantic, a non-profit research group dedicated to measuring sustainable development, says Romanow has produced "a very powerful and first rate report on one of three burning health questions, and that's how to treat people who are sick. The other two are how do you improve the health of Canadians, and how do you curb spiraling health care costs?"

The cost of health care in Canada has grown faster than the economy for the last 20 years, reaching 9.4 percent of our GDP in 2001. It's the kind of number that makes a Romanow fan like Colman sound a heck of a lot like some familiar Romanow critics.

"It's not that the Canadian Alliance is wrong when they raise the questions where is the money going to come from and who's going to pay for this," says Colman. "That's a valid question. What the Canadian Alliance is not saying is: what are the creative ways to reduce the burden? The question we have to ask is how do we reduce the demand for medical care? How do we actually improve the health of Canadians?"

Which brings us to what actually makes Canadians sick. According to Colman, the main indicator of sickness in Canada is, well, money. Or, more precisely, how much of it we make. "I'm not making this up," says Colman. "This is from Health Canada. They actually say that poverty is the most reliable predictor of poor health." Sure enough, he's right. In their Second Report on the Health of Canadians, Health Canada put income and social status at the top of their list of key determinants of health, followed by social support networks, education, and employment and working conditions. Personal health practices are listed at number seven.

It's no stretch of the imagination to figure that poverty would contribute to sickness. If people can't afford good food and warm shelter, their health is bound to suffer. But Health Canada says this link stays true all the way up the ladder of social and financial status. A British study found that the health of civil servants increased with each level on the job hierarchy-those one step down from the top had heart disease rates four times higher than those at the top. Another study found that high income mothers in Manitoba, on average, gave birth to higher birthweight babies than their equally well-fed, middle income counterparts. (Low birthweights are associated with health problems throughout life.)

According to Health Canada, "the degree of control people have over life circumstances, particularly stressful situations" seems to be a key influence on health. Another is inequality. In "Toward a Healthy Future (1999)," Health Canada points to increasing evidence that the gap between the rich and the poor, which increased dramatically in Canada in the '90s, affects the health of society as a whole.

"We looked at Nova Scotia," says Colman. "We found that people with low incomes have a far higher rate of physician use than people with higher incomes. We worked out that if everyone had the same health status as people with higher incomes we would be saving $27.5 million every year. And the same is true with education. People who haven't completed high school have a far higher rate of physician use in Nova Scotia. We found that if everyone had the health status of those with university degrees, we would be saving $42 million in excess physician costs per year."

Colman also compared the cardiovascular and heart health of poor, middle and high income Nova Scotians, and found that 200 deaths from heart disease per year, along with $124 million in annual health care costs, are directly attributable to poverty.

The big worry is that increased spending on treatment will take money away from other social services like education and affordable housing, which will in turn increase health problems. "If we can't afford [social services] because we put all our money into treating the sick, then it's a dog that's chasing its own tail."

But turn it around, and there are savings to be had. "It's not just theoretical to say that you could actually reduce medical costs. You can," says Colman, citing a study in the US that gave nutritional supplements to low income women, infants and children. "They found that there's $3 in health care savings for every $1 invested in the program."

There are other success stories. Twenty years ago Finland had the worst rate of cardiovascular disease in the world, and so it undertook a national campaign to improve cardio health, including nutritional education programs, physical activity programs, even warning labels on foods with high salt content. "It was dramatically successful," says Colman. "Their rate of death from cardiovascular disease dropped by 73 percent."

In Canada we seem to be moving backwards. In 2000, Health Canada pulled its funding for the country's well-known ParticipAction program. The 30-year-old fitness promotion program was costing the whole country a whopping $1.4 million. Last week, Halifax city council turned down an opportunity to join smoke-free cities like Ottawa, Victoria and Fredericton by rejecting a ban on smoking in public places. On the other hand, higher taxes, larger warning labels and a general increase in smoking bans across the country resulted in a dramatic decrease in Canada's tobacco consumption last year. And Nova Scotia has just announced a partial ban scheduled for January.

"We actually know what to do," says Colman. "The report is a great prescription for improving the treatment of Canadians who are sick. A real RX," he says. "All of that's important. Treating people who are sick is one of the three essential parts of health policy." However, adds Colman, "the next revolution has got to be dealing with the determinants of sickness. That's the real direction Canada has to go. That's the next big revolution."

Copyright © 2002, The Coast