ABSTRACT

A Practical Model for Voluntary Work Time Reduction

When we measure progress according to economic growth rates, sickness contributes far more to the economy than health, because it produces more spending on doctors, hospitals and drugs, all of which contribute to the Gross Domestic Product (GDP). Because the GDP is widely misused as a measure of well being and prosperity, sickness is perversely counted as a sign of progress, sending misleading signals to policy makers. Indeed, 98% of what we call "health care" expenditures are actually "disease treatment" costs, with only a tiny proportion invested in health promotion and disease prevention.

By contrast, the Genuine Progress Index measures progress according to how healthy people are. Health Canada has identified twelve main determinants of health, including education, income, employment status, physical environment, gender, personal lifestyle, social supports, and healthy child development. Improvements in these determinants of health make the GPI go up, because they improve population health.

This approach is critical from the perspective of practical cost-effective policy making. With health care in crisis throughout the country, investment in the determinants of health and in a healthier population can reduce long-term costs far more effectively than a single-minded focus on disease treatment.

This portrait of women's health in Atlantic Canada was prepared for the Maritime Centre of Excellence for Women's Health, and presented to health officials in the four Atlantic provinces. It looks at trends in health determinants to suggest ways policy makers can work to improve population health in general and women's health in particular. The study notes that these determinants are highly interactive, so that a strategic investment in one is likely to produce improvements in others and wide-ranging health benefits.

Poverty and income inequality are among the most reliable predictors of poor health. On an hourly basis, the study reports that women earn only 81% of male wages, and nearly one in five Atlantic Canadian women live below the low-income cut-off. More than 70% of single mothers and their children in Newfoundland and Nova Scotia live in poverty, and child poverty rates have increased across the country. Just as concerted public policy has dramatically reduced poverty rates among seniors, the study suggests that improving social supports for single mothers is one of the most cost-effective strategic investments governments can make to reduce long-term health costs.

The study also examines trends in mental health, psychological well being and stress, and notes that hospital patient days for mental disorders in Canada exceed the combined total for cardiovascular disease, cancers, injuries and nervous system disorders combined. Though mental illness is extremely costly, studies show stress levels rising, and a direct relationship between poverty and low levels of psychological well being. The study notes that the alarming increase in smoking rates among teenage girls (38% in Nova Scotia and Newfoundland) appears to be directly related to rising stress levels in that group.