Dennnis, I enjoyed your editorial.

Do you beleive that the large amounts we spend on health care (40%+ of
government spending) reduces Canadian's ability to deal appropriately with
important determinants of health such as income, working conditions, housing,
food, education, chhild development and employment?

If so do you think we all have a responsibility to indicate our distaste with
the unfocused, and ever-increasing spending on health care?

Over 10 years ago the F/P/T Deputies ("When Less is Better") unanimously
committed to make waiting times public and to measure and report the effect of
system changes on health outcomes. The lack of such information makes it
difficult for all of us to make appropriate personal and political choices and
means that it will remain difficult for all of us to understand what is
acheived by additional health care spending.

Best wishes
David Zitner

Quoting Dennis Raphael <[log in to unmask]>:

> Rearranging Deckchairs on the Titanic:
> Premiers Promote Lifestyles as their Policies Create Disease and Misery
>
> Dennis Raphael, Ph.D.
>
> Our Premiers all assure us that they are concerned with maintaining the
> health of Canadians and assuring the sustainability of the health care
> system. Health Canada and Canadian Public Health Association statements and
> documents argue that the means of accomplishing these worthy goals is to
> promote population health by focusing on the determinants of health such as
> income, working conditions, housing, food availability, education, and
> heakthy child development. Yet, the Premiers shower us with exhortations to
> improve our lifestyles and make healthy choices.  They do so at the same
> time that their policies maintain very high levels of child poverty and
> they reduce the social and other services that keep us healthy.  It is
> difficult to believe that these developments are unrelated. The Premiers
> weaken the determinants of Canadians' health,  and they then divert
> attention from these activities by blaming Canadians for their own healthy
> problems by promoting lifestyle explanations for disease.
>
> It is increasingly clear that how a society produces and distributes
> societal resources among its population are the prime determinants of
> population health.  These links become clearer as evidence accumulates of
> how societal factors such as income distribution, employment conditions,
> and availability of social and health services are the primary determinants
> of population health. Health is an important priority for Canadians, but
> policymakers rarely consider these health determinants and the political
> and economic forces that shape their quality.
>
> For 30 years Health Canada and Canadian Public Health documents have
> highlighted the role of healthy public policy in supporting health and
> preventing disease. And data is now available that indicates that the forms
> that public policies take are an important determinant itself of any number
> of health determinants. However, Canada is increasingly looking like the US
> and UK in its approach to public policy. These nations have the lowest
> expenditures on health care and the lowest coverage of health costs by
> public medical care. Wages are low, and income inequalities and poverty
> rates are the greatest.  Similar patterns are seen when the US, Canada, and
> Sweden are compared on a number of health determinants (income
> distribution, wages, support for families and children) and health
> indicators such as infant mortality and childhood death from injuries.
> Sweden fares the best, US the worse, and Canada comes up the middle. And it
> is clear that Canadian public policy is moving more and more towards the US
> model. These issues -- not healthy lifestyles --are the primary threats to
> health and the sustainability of the health care system and should be the
> concern of policymakers.  Why is this not the case?
>
> Our governments -- and our Premiers -- are implementing neo-liberal
> policies that emphasize the "market" as the arbiter of societal values and
> resource allocations. Unfortunately, these political and economic policies
> foster income and wealth inequalities, weaken social infrastructure,
> threaten employment security and working conditions and make life difficult
> for families and children. The neo-liberal emphasis on reducing income and
> corporate taxes benefits the wealthy and creates increasing social and
> economic inequality.  Changing all the lifestyles in the world will
> accomplish little in light of the health efffects of such policies.
>
> The best means of promoting health therefore involves Canadians being
> informed as to the primary determinants of health in a society.  They can
> then consider -- and attempt to influence -- the political and economic
> forces that influence these determinants. Rather than being told to improve
> their lifestyles, Canadians need to reflect upon the kind of society in
> which they wish to live and work. Who will help bell this cat?
>
> Dennis Raphael is associate professor of health policy and management at
> York University in Toronto and the editor of "Social Determinants of
> Health: Canadian Perspectives" published by Canadian Scholars Press.
>
> Dennis Raphael, 416-465-7455
>
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David Zitner M.D.
Director Medical Informatics
Dalhousie University Faculty of Medicine
5849 University Avenue #2L 16
Halifax, Nova Scotia  B3H 4H7
902-494-3802 Fax 902-494-1642
Admin Support:  Deirdre Harvey
[log in to unmask], 902-494-2234

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