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
© 2002 Guelph Mercury. All rights reserved.
Doc.: 20020206GU0037
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