Toornto Star, May 16, 2003
Romanow connects the dots
Carol Goar

Soap dispensers and paper towels suddenly appeared in the washrooms of hundreds
of Toronto public schools this spring.
It took the SARS outbreak to convince school board officials that cutting back
on basic sanitation wasn't the right way to save money.
In some high schools, it had been years since kids had been able to wash their
hands properly. The hot water didn't work. The dryers were broken. Soap and
towels were unheard of.
"Things are better now," said Bill Young, health and safety specialist for CUPE
4400, which represents the 12,000 non-teaching staff working for the Toronto
District School Board. He is doubtful that the improvements will last.
Soap isn't usually part of the health-care debate in Canada. Neither are
nutrition, green space or decent housing.
Roy Romanow is trying to change that. Having completed his 18-month review of
medicare, the former commissioner is now broadening his scope to encompass the
root causes of poor health.
He calls it "connecting the dots."
Governments don't like hearing about the link between poverty and illness;
homelessness and infection; pollution and disease. They prefer to put neat
boundaries around the health-care system. They want voters to think that
high-profile investments in hospitals, medical schools and diagnostic equipment
will make up for cuts in social programs, environmental safeguards and
low-income housing.
But, as Romanow told an Ottawa audience last week, "a health-care system



? even
the best health-care system in the world ? will only be one of the ingredients
that determine whether your life will be long, short, healthy or sick, full of
fulfillment or empty with despair."
The single most important determinant of an individual's health, he pointed out,
is the family into which he or she is born.
If a child is lucky enough to have affluent, nurturing parents who can give him
or her a strong start, a comfortable home and a good education, he or she is
likely to have a long, healthy life.
If a child grows up in a poor home ? or no home ? with irregular meals and a
struggling single parent, he or she is likely to be sick more often and die
sooner.
"Hopelessness kills and hopefulness with opportunity is a prescription for good
health," Romanow said.
He then laid out an ambitious six-point plan to move from treating illness to
building a healthy, resilient society:
Governments must make a concerted attempt to narrow the growing gap between rich
and poor. A large, vibrant middle class is the best guarantee of a healthy
population.
Investing in children must become a national priority. If a child spends his or
her first six years in a healthy, stimulating environment, he or she will be
well-equipped to handle life's ups and downs.
Employers must rethink the rigid workplace hierarchies that trap millions of
Canadians in dull, unrewarding jobs. One of the best ways to improve people's
health is to give them some control over their lives.
Policymakers must address the shortage of affordable housing. Crowded hostels
and substandard rooming houses are breeding places for infection and disease.
Degradation of the environment must be treated as a serious health hazard.
Contaminants in the air, water supply and food chain can cause everything from
birth defects to cancer.
Citizens must reach out to one another to build strong, inclusive
neighbourhoods. People who are involved in the life of their communities are
much less prone to ennui and illness.
Like others before him, Romanow argued that investing in people before they get
sick would cost less and have a bigger payoff, in the long run, than pouring
money into hospitals, pills and treatments.
Unfortunately, the logic of this proposition has always eluded politicians. They
like cutting ribbons and handing over cheques better than preventing health
problems that are likely to occur long after they have left office.
Bureaucrats are similarly blinkered. Their gaze seldom extends beyond their own
department. That means that health, early learning, housing, smog reduction and
income distribution are rarely discussed in the same room.
"If we really want Canadians to be the healthiest people in the world, it's not
enough that we think outside of the box," Romanow said. "We have to get rid of
the boxes altogether."
It usually takes a crisis to make that happen.
The SARS outbreak, for example, forced different levels of government and
competing bureaucracies to work together. It made preventative health care ?
from soap in schools to compensation for workers in voluntary quarantine ? look
like a bargain. It pulled people together as neighbours and fellow citizens.
But such lessons quickly fade.
It is cheaper to leave the soap dispensers empty than teach good hygiene. It is
easier to treat diseases than tackle societal problems. It is safer for
politicians to focus on individual dots than look at the big picture.