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In health Olympics, Canada wins no medals
Judy Gerstel
TORONTO STAR COLUMNIST JULY 6, 2001.

  With only a week to go until we discover if Toronto wins the 2008 Olympics,
it's a good time to look at who wins the health Plympics.

  While Canada doesn't even make it to the podium, Japan takes the prize. The
health Olympics' single event? The race
against death.

  The health of a nation is most often measured by life expectancy. In Japan,
men can expect to live 77.6 years and women,84.3 years. In Canada, life
expectancies are 76.2 years for men and 81.9 years for women. That puts us in
fifth place, behind France, Switzerland and Spain. The U.S. ranks 25th, behind
almost all of the world's richest countries and even a few poor ones.

  As with the real Olympics, deep pockets don't guarantee the gold medal. Canada
spends $75 billion on health services but that doesn't propel us to the front of
the pack. In fact, it doesn't even make us feel good. Despite the big spending,
writesToronto-based health analyst Sholom Glouberman, "Canadians are in a high
state of alarm about whether care will be available when they and their families
need it."

  In the health Olympics, big spending doesn't even guarantee a good showing.
With about 4 per cent of the world's people,the U.S. accounts for 42 per cent of
all spending on health care. If throwing money at health care guaranteed the
gold, the Americans would be sporting the gilded medallion. Instead, Uncle Sam
is back in the middle of the pack, plodding alongside Cuba, Sri Lanka and Costa
Rica.

  Because, it's not how much money you've got or how much you spend. It's how
you spread it around. The reason that big bucks don't make for the world's
healthiest nation, say many public health analysts, is not just the way spending
is
distributed but something more fundamental: disparity of income.

  The health of a society is determined by the size of the gap between rich and
poor, studies show. And the health of an individual is determined to a great
extent by socio-economic status, according to evidence-based research. Shrinking
that gap and raising the socio-economic status of the most vulnerable members of
society is what makes for better health andlonger life.

  However, not everyone agrees that socio-economic status should be a primary
concern for health policy makers and health professionals. Conservative American
physician Sally Satel, in her recent book PC M.D., excorciates "politically
correct medicine...the idea that injustice produces disease and political
empowerment is the cure."

  She writes that "injecting social justice into the mission of medicine diverts
attention and resources..." The subtitle of her book: "How Political Correctness
Is Corrupting Medicine."

  Satel puts her faith in the biomedical model, with its emphasis on high-tech
interventions and belief that health is the purview of health professionals.

  But within the medical establishment and in academic institutions, there are
people who are compiling potentially explosive research showing that the
socio-economic milieu - education, social support, self-efficacy, self-care - is
a major determinant of health. In contrast to Satel, these researchers also see
an expanded role for health professionals and policy makers as advocates for
improving that milieu.

  Meanwhile, here in Canada, where we pride ourselves on universal and equal
access to health care, we may be missing the point. France, which allows for the
option of private health care while also making sure that no one goes without
access to health care, ranks first in the World Health Organization (WHO) survey
of health systems.

  The survey compares responsiveness, fairness of financial contribution
(including taxes), overall level of health, how well people at different income
levels are served, and distribution of financing. Of 191 members states
belonging to the WHO, Canada ranked 30th, behind Greece, Germany, Japan, Sweden,
Spain, the United Kingdom, Switzerland and Morocco and, oh, Andorra. Italy
ranked second and the U.S. was 37th.

  If it's any comfort, our rival for the 2008 Olympics - China - ranked 144 out
of 191 in the WHO survey and wasn't even a participant in the Health Olympics
race against death.


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