Guelph Mercury
  Opinions, Wednesday, February 6, 2002, p. A9

  COMMUNITY EDITORIAL BOARD

  Begin health care cost reductions by reducing poverty

  Maggie Laidlaw

  Health care policy experts admit that we don't really have a health care
system, we
  have a sick care system. So what is the missing ingredient that would turn our
 system
  into one of genuine health care? Prevention. The boring part of health care,
not the sexy
  stuff that catches the headlines, like doctor shortages, and hospital
closures, and
  emergency room crises.

  Prevention has perceived problems, however. It's not immediate, so it doesn't
provide
  the instant gratification that society demands. Because it may not produce
results within
  four-year electoral mandates, it is of little interest to most politicians. As
 a result, it has
  been relegated to the status of "poor cousin" in the health care system. Any
year-end
  leftover health care money may be dribbled into the prevention envelope, but
leftover
  health care money is rare, so prevention programs are cash-starved.

  Yet investment in prevention, like investment in education, pays off in
spades. Studies
  show that every dollar invested early brings a return of $7.50 in future
savings, whether
  it's early childhood education for preschoolers or prenatal nutrition care for
  moms-to-be. Bankers understand the investment concept, but the powers-that-be
in
  health care just don't get it. Perhaps the decision-making is too
overwhelming: where to
  invest the money, when money is already scarce?

  There are many possible prevention programmes for every segment of the
population,
  from seniors at risk for osteoporosis to adults worried about heart disease to
 teens
  concerned about obesity, and everything in between.

  So where to target limited prevention resources? What is the single most
important
  indicator of poor health, an indicator whose abolition would significantly
reduce the
  pressure on our overburdened health care system? That indicator is poverty.

  At a recent public health conference I attended, I heard Dr. Dennis Raphael of
 York
  University speak about poverty and health. He presented compelling evidence
that
  poverty is the major contributor to many lifestyle diseases like cancer,
diabetes and
  heart disease.

  Take heart disease, for example. Dr. Raphael noted that, in recent
epidemiological
  studies, the one heart disease risk factor which swamps all of the others
combined,
  including smoking, high blood pressure and high cholesterol, is socio-economic
 status.
  In other words, the lower a person is on the income scale, the greater their
chances of
  dying prematurely from heart disease. This relationship holds across many
diseases,
  such that those who are wealthy simply don't get nearly as much illness as
those who
  are poor.

  This is not rocket science; senior levels of government have known it for
years. A 1986
  Health Canada document stated: "The first challenge we face is to find ways of
  reducing inequities in the health of low- versus high-income groups". A 1994
Ontario
  government report noted that "...to create health in Ontario... two sets of
responses are
  required: policies that reduce poverty and policies that reduce the effects of
 poverty".
  A 1999 Saskatchewan health department document emphasized: "...consensus is
  growing that one general factor may be particularly important, and that is
economic
  inequality....the healthiest societies are those in which there is a
relatively small gap
  between the best-off and the worst-off members".

  This knowledge should have initiated a "war on poverty" battle cry, if only to
 ease the
  burden on the health care system and reduce waiting lists for things like hip
  replacements, bypass surgery, etc. After all, the rich wait in the same lines
as the poor
  in our "equal-access-for-all" medicare system. But no, the well-to-do in our
society,
  and the governments they elect, are heeding the cry of their neo-con think
tanks -- the
  C.D. Howe and Fraser Institutes, and the Business Council on National Issues.
Rather
  than tackle the issue of poverty head on, they are pushing hard for a two-tier
 system,
  where poverty numbers grow but the wealthy don't care about long line-ups,
they will
  just pay to move to the top.

  Until governments of all stripes, at all levels, come to grips with the
growing problem of
  poverty in this country, the demands on the health care system will continue
to grow in
  an unsustainable fashion. "An ounce of prevention is worth a pound of cure" is
 never
  more true than in this current climate of overburdened health care and its
link to the
  growing gap between the rich and the poor.

  Maggie Laidlaw, a member of the Mercury's Community Editorial Board, is also a
  Guelph city councillor. Community Editorial Board contributions appear Monday,
  Wednesday and Friday.

  Illustration(s):

  Photo: Maggie Laidlaw

  Category: Editorial and Opinions
  Uniform subject(s): Diseases, therapy and prevention; Health and social
services;
  National politics and governments
  Story type(s): Opinion
  Edition: Final
  Length: Medium, 615 words





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