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Second Opinion

Untreated social ills make for higher medical costs
GLOBE and MAIL
ANDRE PICARD

Many of us revel in thinking of Canada as a great place to live, a
generous, caring country with a well-woven social safety net that protects
the sick and poor from harm.

But that feel-good image is largely a myth, according to Monique Bégin, the
respected former minister of health and welfare.

While we have a generous medical care system, Canada's welfare system is
parsimonious at best, she told delegates to the recent annual meeting of
the Canadian Public Health Association.

More striking still is her proposed solution. "Rebalancing of the health
budget is what is needed," Dr. Bégin said.

In other words, let's spend less money on health care and more on keeping
the population healthy.

How do you do that? By tackling what renowned social scientist Sir Michael
Marmot calls the "causes of the causes of poor health" -- the social
determinants of health.

Dr. Bégin, unlike so many of today's politicians, is bold enough to say
that, in Canada, we spend too much money on dealing with the proximate
causes of disease -- $142-billion in health spending in 2005 -- and far too
little on tackling the root causes of illness in much of the population --
a lack of adequate income, poor housing, inequality, hopelessness.

Welfare is in her vocabulary and it's not a dirty word, as it is in most
mainstream political circles.

A recent report from the United Nations Committee on Economic, Social and
Cultural Rights underscored just how frayed Canada's social safety net has
become. It became a central talking point at the CPHA conference where
delegates heard, among other things:

Minimum wage (which varies by province) is inadequate, to the point where
one-third of full-time workers can't make ends meet.

Only about one-third of people who are unemployed are actually eligible for
employment insurance.

Almost 40 per cent of all jobs are part-time or seasonal.

There are 1.2 million poor children in Canada, and nearly 320,000 of them
rely on food banks for their daily bread.

Welfare rates (which vary by province) provide income that is about half
the poverty rate.

Our social programs have perverse disincentives, such as those that require
people to quit their jobs and go on welfare to get catastrophic drug
coverage.

There is shocking poverty among native peoples; not surprisingly, their
health is abysmal.

Child care is inadequate almost everywhere but Quebec.

There is an army of unpaid caregivers that has virtually no official help.

Social housing is virtually non-existent.

In Canada, only 17.8 per cent of public expenditures are on social programs
other than health; in Sweden, by contrast, that figure is 36.8 per cent.
According to the Organization for Economic Co-operation and Development, 21
European countries spend more on social programs than Canada, including
Poland and the Slovak Republic. Not coincidentally, all those countries
spend less than Canada on health.

The lesson we should be taking from European countries is that one of the
most effective health interventions is income redistribution.

Money is the best drug we have. And, paradoxically, providing people with a
decent income is probably cheaper than treating the illnesses of poverty,
which tend to be expensive conditions such as diabetes, heart disease and
cancer.

Notably absent from the lists of Canada's welfare shortcomings are seniors.
The poverty rate in the over-65 age group is 5 per cent in Canada, compared
with 20 per cent in the United States.

Our elderly are among the best off in the Western World because we made a
determined effort to improve their lot with programs such as the Guaranteed
Income Supplement and progressive tax measures.

This demonstrates that where there is political will, we can tackle social
inequalities.

But look at what we do with children. Ottawa provides poor parents with the
Canada Child Benefit and the National Child Benefit Supplement.

But most provinces negate that measure by clawing back -- reducing
provincial welfare payments by an offsetting amount, or through taxation.

Poverty in children has a life-long reach. Poor children will grow up to be
unhealthy adults.

Dr. Bégin, who is currently serving on the World Health Organization
Commission on the Social Determinants of Health, said the message that
social justice is good for our collective health and that the speed at
which we perform hip replacements is not the most pressing health problem
in this country is a tough sell.

Baby boomers are distinguishing themselves as the most selfish generation
to have ever walked the face of the Earth. We love our health care (which
is more accurately described as sickness care) and, increasingly, we hate
welfare.

Yet it is a false dichotomy and a false economy. We can pay now with decent
social programs or pay later with increased health costs.

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