http://www.embassymag.ca/html/index.php?display=story&full_path=/2006/february/8/bennet/

Embassy, February 8th, 2006
FEATURE
By Dr. Carolyn Bennet
Health and Health Care: Understanding the Difference
Some of the most poignant images from 2005 had to be the faces of those
victims caught in the devastation of Hurricane Katrina and the children of
Kashechewan, Ontario. In the wake of the distant disasters like the tsunami
and the earthquakes in Kashmir, there was something terribly wrong with
these images from two of the world's most prosperous countries.

I remember looking at the footage on the news on Sept. 9, of the lanes of
cars leaving New Orleans, sometimes with only one person in them. I
remember asking the television set, 'Where are the buses?' Then, days
later, we saw the images of parking lots with school buses up to their
fenders in water. I remember the faces of the people left behind in the
Superdome, the city's most vulnerable, some with mental illnesses, but most
just poor and without hope in their lives.

Throughout that time, the rhetoric of so many speeches kept bugging me: "a
prosperity that leaves no one behind, a tide that raises all boats." The
graphic pictures had presented a geographic reality. It was no longer a
metaphor: the most vulnerable people had literally been left behind and
many had paid with their lives.

Commentators were asking how there can be a pursuit of happiness without a
profound commitment to social justice.

In Canada, the November front-page photos of the children of the
Kashechewan native reserve made all Canadians face the shameful reality of
the health status of our aboriginal people.

There can be no discussion of the sustainability of our cherished health
care system without an understanding of the difference between health and
health care. We must aspire for more of the former and less demand for the
latter.

No amount of MRI machines nor gamma knives can fix the basic error of
focussing upon a goal of the best possible repair shop in a sickness care
system, instead of Tommy Douglas' important challenge: "Let's not forget
that the ultimate goal of Medicare must be to keep people well rather than
just patching them up when they get sick."

For over 10 years as Minister of National Health and Welfare, Paul Martin
Sr., understood that it took both "Government health services will bring
returns not only in human happiness, but in productivity and wealth, which
will more than offset the dollars expended. Our country must move steadily
toward the goal of social justice."

In fact, in 1974, the federal government's White Paper, A New Perspective
on the Health of Canadians (Lalonde Report), proposed that changes in
lifestyles or social and physical environments would likely lead to more
improvements in health than would be achieved by spending more money on
existing health care delivery systems. Canada led the way in articulating
the required paradigm shift from solely health care to population health.

But somewhere along the way we got lost. I remember Monique Begin's first
question to then new Health Minister Allan Rock "How are you going to do
health without welfare...now that the departments have been split?"

We mistook Medicare for a service contract instead of a longer warranty. In
our pursuit of making sure that all Canadians would have what they needed
when they needed it, we neglected to understand that most of us would
prefer that we wouldn't need it at all. And now, in Canada, we face the
first generation of children that will have shorter lives than their
parents if we cannot do something about their obesity and the resulting
diabetes and complications.

We need to turn it around. We all need to learn the lessons from Katrina
and Kashechewan and listen to the important work that Monqiue Begin and
Stephen Lewis are doing with Sir Michael Marmot at the WHO Commission on
the Social Determinants of Health.

The importance of these teachable moments cannot be underestimated. In the
summer of 2003, the heat wave in France killed over 14,000 people. The
victims were mainly elderly women older than 75 years living alone. These
were preventable deaths. The French responded with a proper Heat Health
Watch Warning System and a preventive action plan for each region by summer
2004. They had learned.

Almost 10 years earlier in the 1995 heat wave in Chicago there had been
similar teachings. Eric Klinenberg's Heat Wave: A Social Autopsy of
Disaster in Chicago had outlined the telling importance of what Robert
Putnam has called social capital. In analysing the data, he found
predictable results of lower death rates in wealthier neighbourhoods. But
there was a surprising result: no deaths in the Latino community where
everyone knew one another and looked after one another. It's what Jane
Jacobs calls neighbourliness. It saves lives.

So how do we move forward? How do we take the lessons learned from
Kasheshewan, Katrina, France and Chicago and move them into coherent public
policy in which the determinants of health --poverty, violence, the
environment, shelter, equity, education, and a sense of belonging -- are
seen as essential components in achieving the sustainability of our
cherished health care system?

In Canada, we have begun that important task, by establishing with the
provinces and territories a set of aspirational health goals that can be a
tool for setting real targets and indicators that will allow us to measure
our progress on keeping Canadians well. The medical schools will take up
the challenge with an increased focus on interdisciplinary care, social
accountability, the determinants of health, and culturally sensitive care.
Our health institutions will follow the excellent lead of places like
Community Health Centres and Women's College Hospital, which understand the
need to move from hospital to community, doctors to multidisciplinary
teams, understanding the patient as a partner in their care.

And governments will have to overcome the gridlock of social justice health
issues that cross all government departments and responsibilities that
cross all jurisdictions and internationally. I am optimistic. The images of
Katrina and Kashechewan will not fade.

The Honourable Dr. Carolyn Bennett is the Liberal Member of Parliament for
St. Paul's, Ont. and is the former Minister of State for Public Health
(2003- 2006).

[log in to unmask]

-------------------
Problems/Questions? Send it to Listserv owner: [log in to unmask]


To unsubscribe, send the following message in the text section -- NOT the subject header --  to [log in to unmask]
SIGNOFF SDOH

DO NOT SEND IT BY HITTING THE REPLY BUTTON. THIS SENDS THE MESSAGE TO THE ENTIRE LISTSERV AND STILL DOES NOT REMOVE YOU.

To subscribe to the SDOH list, send the following message to [log in to unmask] in the text section, NOT in the subject header.
SUBSCRIBE SDOH yourfirstname yourlastname

To post a message to all 1000+ subscribers, send it to [log in to unmask]
Include in the Subject, its content, and location and date, if relevant.

For a list of SDOH members, send a request to [log in to unmask]

To receive messages only once a day, send the following message to [log in to unmask]
SET SDOH DIGEST

To view the SDOH archives, go to: https://listserv.yorku.ca/archives/sdoh.html