4HP colleages -

May I take a minute of your time, and a few of your brain cells?

Below you will find an editorial I wrote for the Nov. 25 edition of Import,
a free e-newsletter I publish weekly for folks in the health and human
services sector. The gist of the editorial is that the Romanow Report helps
give us a national strategy for health care, but there has been no similar
process to develop a national strategy for determinants of health.

If you are of a mind to share your thoughts, may I ask two questions:

1.  Is there any national process underway, with both credibility and
influence, that is addressing the determinants of health as a national
priority (or could easily address them) that I just don't know about?

2.  Does the idea of a national strategy make sense in the first place, or
is it best to just keep plugging away from the bottom, or is there another
option?

3.  If there is no process addressing determinants of health as a national
priority, are you aware of (or can you suggest) tactics to move us, as a
nation, toward such a strategy?

 I ask these questions because I plan to keep returning to the determinants
theme in the newsletter, but I could use the wisdom of those with more
experienced minds - as well as fresher, newer minds - before I get wildly
out of my depth.

I apologize in advance if these seem like "duh" questions with obvious
answers.

Thanks for considering this request...
John Butler
Markham Ontario

.......................................

IN MY HUMBLE OPINION: GETTING PAST ROMANOW

I will be glad when Commissioner Roy Romanow issues his final report. Then,
the debate that has been simmering for years among our political
jurisdictions will be overt and fractious. At least the battle lines will be
drawn for all to see, and our political jurisdictions have a chance to prove
their mettle by finding agreement after the inevitable first round of
posturing. It is likely that Romanow will argue for maintenance of a
publicly funded system. He will also likely argue for more federal funding -
but for a system as it ought to be rather than as it is (uncoordinated,
bureaucratized, dominated by professional pressure groups, and slanted
against populations most at risk of ill health). Romanow may well propose an
expansion of medicare into pharmacare and home care.

Provinces (once bitten, twice shy) will resist unless expansions are
accompanied by ironclad federal guarantees to fund the expansions. Some
provinces will still yammer on about the private sector as a potential major
new player, but most will not. The idea of user fees will largely and
rightly be discarded as irrelevant silliness.

But important though medicare reform is, it is not the crux of our society's
health problems. Romanow, if he follows past patterns in major reform
reports, will acknowledge, as we all do, that the determinants of health go
well beyond the health care system, and that addressing health means
addressing all the other social elements - the economy, education, housing,
the environment, and on and on - that make the biggest difference to our
health. But again, if he follows past patterns he will say "We really must
do something about these determinants of health", without proposing a
detailed national blueprint addressing the determinants of health.

Ever since Canada's Lalonde Report was released to international acclaim in
1974, Canada and other nations have paid a good deal of lip service to
coordination of societal engines so they produce health and well-being
rather than misery. And there has been good work done - witness, for
instance, the rise of the population health paradigm, and the growth of the
healthy communities movement, an international groundswell in which
Canadians - particularly Trevor Hancock - took a lead.
But by and large governments have done little to act in accord with the
belief that economic and social justice yield health. They seldom integrate
their own internal operations across social and economic fields. Their
departments remain separate grumpy hippopotami, unlikely or unable to
cooperate on the creation of health.

Maybe after Romanow's work is done - and after the post-Romanow squabbling
has abated - we can get back to pushing our governments (through the ballot
box, through lobbying, through creative community action that governments
are expected to match) in the direction of integrated approaches to health
and well-being.

John Butler, The Agora Group

FROM THE QUOTES VAULT

"But if men cannot live on bread alone, still less can they do so on
disinfectants."
          Alfred North Whitehead

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