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Mar. 21, 2005. 01:00 AM

Focusing on health, not illness

CAROL GOAR

Carolyn Bennett's mission is to put health back into health care.

Somewhere along the line, she says, Canadians got so fixated on treating
illness that they lost sight of everything else that keeps a person alive
and well. Medicine became confused with health.

Bennett, a family doctor, is minister of state for public health. It is her
job to shift the focus from hospitals — which she describes as the repair
shops of the health-care system — to the hardships, hazards and bad habits
that bring people to their doors.

Those include everything from polluted air and junk food to substandard
housing and domestic violence.

Next week, Bennett will invite Canadians to help set national health goals.

The minister could easily have drafted a list herself. She could have done
it with her provincial and territorial counterparts. She could have turned
to the many academics who specialize in the "social determinants of
health." Or she could have borrowed the goals chosen by Sweden, Britain or
the United States.

But one of Bennett's objectives is to get Canadians talking about what a
healthy society looks like and how to become one.

The first half of the exercise is relatively easy. Most people agree (and
there is abundant evidence to prove) that clean air and water, a decent
standard of living, a safe place to live, a well-balanced diet, regular
exercise, good genes and a strong social support network contribute to good
health.

It is the second half of the undertaking — creating those conditions for 32
million Canadians — that poses challenges. It pits rich against poor,
environmentalists against industrialists, advocates of tax relief against
proponents of public spending, medical professionals against social
activists and various federal departments against each other.

To complicate matters further, all three levels of government provide and
pay for health services. Demand is high. Dollars are scarce.

That largely explains why politicians have promised to tackle the root
causes of poor health for years, but never found the cash or political will
to do much.

The process Bennett is poised to launch comes out of the health accord
signed by Canada's first ministers last September. They agreed: "For the
first time, governments will set goals and targets for improving the health
status of Canadians."

Since then, Bennett has been examining the ways other countries set public
health goals, trying to come up with yardsticks to measure success and
attempting to convince her cabinet colleagues that they're all responsible
for aspects of Canadians' health.

When asked what her ministry got out of last month's federal budget,
Bennett cheerfully pointed to child care, aboriginal housing, immigrant
assistance, pension increases for low-income seniors and support for Sport
Canada.

She carries around a diagram that she invented. It depicts a large
deciduous tree. Below the ground are all the hidden factors that determine
how healthy an individual will be: socio-economic status, education,
shelter, environment and genetics. Running up the trunk are the behavioural
factors that influence a person's health: eating, physical activity, drug
and alcohol use. Only in the foliage do the medical consequences of these
inputs these appear.

The chart is part of a discussion paper Bennett will distribute to
participants in the priority-setting process. It will also be available
online.

Several details of the national dialogue have yet to be worked out:

It is not clear how many health goals the minister is looking for. The
Americans identified 467. The Swedes settled on 11.

It is not clear how long the consultation process will take. If it lasts
longer than nine months, it could be cut short by an election campaign.

And it is not clear where the resources to implement the goals will come
from. That has always been the problem with health promotion. It is no
mystery that rising asthma rates are linked to smog, yet doctors keep
handing out puffers while the air gets dirtier. It is obvious that homeless
shelters are the perfect breeding ground for infectious diseases, yet
governments continue to squabble about funding for affordable housing.

Bennett can claim some modest headway. Canada got its first Chief Public
Health Officer (Dr. David Butler-Jones) on her watch. Research dollars are
going into disease and injury prevention.

But she has a lot of public education to do. Most Canadians want relief for
the sick more than help for the vulnerable.


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Carol Goar's column appears Monday, Wednesday and Friday.