PUBLICATION The StarPhoenix (Saskatoon)
DATE Fri 22 Oct 2004
SECTION/CATEGORY Forum
PAGE NUMBER A11
BYLINE Dr. Cory Neudorf
HEADLINE: Health costs hurting battle against poverty
The following is the opinion of the writer, Saskatoon's chief
medical health officer.
The relationship between poverty and health is an issue that needs
attention in Saskatoon.
Health status reports from Saskatoon and from the Canadian
Population Health Initiative, as well as many research
publications, all show that poor socio-economic status leads to
poor health.
No matter what measure is used, it is clear that people who are
poor suffer more from poor health.
For example, lower income groups have lower life expectancy and
higher rates of most diseases. Chronic diseases (arthritis,
rheumatism, diabetes, heart problems, cancer and hypertension) are
twice as common for Aboriginal persons, but most of this
difference is related to the lower average income experienced by
this group.
And infant mortality is higher in the low- income neighbourhoods.
Disability is more common among people with low incomes (32 per
cent for men, 28 per cent for women) than people with high incomes
(12 per cent of men and 16 per cent for women).
Lower income groups tend to have higher rates of smoking and
certain other negative health behaviours.
The research that highlights the linkages between poverty and
health is growing and we should be proud that Canada is playing a
lead role internationally in studying these linkages and proposing
potential solutions.
But, while the relationship between poverty and health is becoming
ever clearer, the questions it raises for resource allocation and
revenue generation are complex, fraught with ideological debates
and lend themselves to conflict and public controversy.
This is an important debate to have so we can work through the
complexities.
We must move beyond the "crisis" in health care and begin building
healthy communities to correct these health inequities. To do this
we should think more seriously about progressive tax policies that
provide the needed resources to support a good quality of life for
everyone.
The public also needs to consider the implications of our demands
on the health system.
For example, we already enjoy good access to high tech diagnostic
and treatment services and waiting times are being managed at a
safe level.
The costs of adding more expensive equipment to further reduce
wait times may speed the system up for a short while, but at what
cost? Less services in prevention? Less money for education or
social services?
How much will further improvement in this area affect the overall
health of our population, or reduce costs compared to investments
in other areas of society?
Many new drugs that are being developed are primarily enhancements
of old drugs, with fewer side effects, but at increased cost. How
much does funding these new drugs contribute to further improving
the health of our community?
Also, there is a great deal of local public attention focused on
surgical waiting lists and the quality of care at emergency rooms.
While we need to ensure waiting lists for surgery don't get too
long and that we continue to have safe care in emergency wards,
this must be balanced with waiting lists for social housing,
prevention programming and lineups at food banks.
The number of requests to the Saskatoon food bank rose by almost
12 per cent between 2002 and 2003.
If we supported the well being of our communities, we would
consider progressive tax policies and a resource allocation system
focused on dealing with the other growing waiting lists.
Such a shift in approach requires a change in what society asks
its governments to fund.
Evidence from certain European countries shows that where wealth
is distributed more equitably, the health gap between the rich and
poor is smaller and overall population health is better.
The fact that we have as much inequity as we do is inexcusable and
unnecessary in a country like Canada. It is a matter of choices.
Poverty makes me sick -- because poverty makes those experiencing
it sick.
To have healthy communities we need to deal with the inequities.
We need to break from some of the old patterns that have been
established and use more creative approaches to ensure there is a
balance between health system resources allocated to prevention
and population health with that allotted to treatment and
diagnostic services.
We have to ensure health system costs don't overwhelm our ability
to fund the other "health" services -- such as social services,
education, and employment. Until government feels that the public
is demanding this balanced approach to funding, the current
pattern will not change.
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