January 23, 2000 Toronto Star
Row flares over delay of Ontario health report
Critics link Tories' cutbacks to more illness
By Kevin Donovan
Toronto Star Staff Reporter
A groundbreaking new report reveals Ontario's north - towns
and cities north of Parry Sound - have the sickest residents in
the province, with the highest mortality rate compared to six
other provincial regions, public health researchers say.
`It's a shame that this report is being
held back. It is a waste that the public
has paid for this professional report and
it is not being made available in a timely
fashion.'
- Frances Lankin, NDP health critic
``There are some major variations in the type of illness patterns
across the province,'' said University of Toronto professor Dr.
Ian Johnson, primary author of the 200-page study, entitled
Report On The Health Status Of The Residents Of Ontario.
``One of the big things (in the report) is the discrepancy
between the health of people in the north versus the south of
Ontario,'' said another researcher, epidemiology and
bio-statistics professor Larry Chambers of McMaster
University in Hamilton.
``People in the north are disadvantaged in many ways with
health. The mortality is higher; the chronic disease rate is
higher,'' Chambers said.
The report, paid for by the provincial health ministry and
several municipal public health units, has been sitting in boxes
at the ministry since the first week of November.
This week, Ontario health ministry spokesperson Dan
Strassborgh said the report will be released in February.
He would not comment on it, except to say it was inaccurate.
The only inaccuracy Strassborgh could identify involves the
cover page. It bears a trillium, Ontario's floral emblem, which is
also a provincial government symbol. Strassborgh said the
report is being reprinted without the emblem on the cover.
But critics of the delay allege the Conservative government
barred release of the report because it finds health is determined
by the strength of the social safety net. Those same critics
accuse the Tories of weakening that net with cutbacks to
welfare and other programs.
New Democratic Party health critic Frances Lankin, whose party
has been pushing for its release, accused the Tories of
withholding a report that will prove embarrassing to their
government.
``It's a shame that this report is being held back. It is a waste
that the public has paid for this professional report and it is not
being made available in a timely fashion,'' Lankin said.
She said the government must pay more attention to the
``determinants of health,'' the factors that make people healthy
or sick.
``Our current government has abandoned this in favour of
Band-Aid solutions to the health care problem in Ontario,''
Lankin said.
No government would want to release a report ``that effectively
spanks itself,'' said Dr. Pete Sarsfield, chief medical officer for
Northwestern Ontario, based in Kenora.
``But I personally think governments should be able to prod
themselves,'' Sarsfield said.
The Star could not obtain a copy of the report but researchers
have shared some of the details.
`If you want to predict whether
somebody is going to live or die or
become ill or well, look at the
amount of income they have'
- University of Toronto professor Dennis Raphael
It was conceived by the health ministry in 1998 and ministry
officials were involved in its preparation. The primary work was
done by epidemiologists attached to public health units, the
University of Toronto and other academic institutions.
It takes what is known in the research community as a
determinants of health approach.
That's a concept used by such respected groups as the World
Health Organization (WHO).
Instead of focusing on treating illness, it advocates finding out
what makes people sick.
``Poor conditions lead to poorer health,'' the organization states
in a preamble to a 1998 report on the social determinants of
health called The Solid Facts.
``Medical care can prolong survival after some serious diseases
but the social and economic conditions that affect whether
people become ill are more important for health gains in the
population as a whole,'' the WHO document begins.
Ontario researchers based their study on the most recent
information available, a survey of 35,000 Ontario residents
conducted by Statistics Canada in 1996.
That's the year after the Progressive Conservative government
came to power.
Their research also used government information on mortality
and accident rates.
``This report also summarizes mortality and morbidity
information from different sources like hospitalization rates,
different discharge diagnoses, sexually transmitted disease and
other infectious diseases,'' Chambers said.
Researchers took this data and examined it regionally. They
make conclusions as to what factors affect health. Among them:
air quality, water quality, income, housing, nutrition, education,
exercise, smoking and drinking, and type of employment.
Workers in public health units say this report will help them on
a day-to-day basis and they would have liked to have received
it last fall.
(Public health units across Ontario are responsible for the
health of the local community. Duties include the control and
prevention of infectious disease, health programs for children
and infants, health services in schools, prevention of heart
disease and other illnesses and promotion of better nutrition
and exercise.)
One small example of how it would help: The survey asked
people whether they obtained flu shots. Sources say that in one
area, 65 per cent of people took the influenza vaccine, while in
another area 25 per cent did.
(Researchers would not identify the areas).
``This is information we needed yesterday. We need to know
where coverage is low so that we can do more health promotion
so that people, especially seniors, will know that a flu shot can
help them,'' said a public health official, who asked not to be
named.
In Toronto, U of T professor Dennis Raphael has been
advocating for the provincial government to base its health
policy on determinants of health.
``The predictors of health are basically related to social issues,''
he said.
``Sometimes they are the most obvious cases, as when you
have homelessness and poverty. If you want to predict whether
somebody is going to live or die or become ill or well, look at
the amount of income they have.''
Meanwhile at the ministry, Strassborgh was adamant about the
need to reprint the report. ``It's not our report, so it would be
inappropriate to have our logo on it.''
Chief researcher and author Johnson confirmed that the report -
prepared by academics affiliated with the Public Health
Research, Education and Development program, a network of
public health units across Ontario - is being reprinted.
``I had a picture of a trillium on the front page. I just thought it
was a symbol of Ontario. The ministry was taking it as if it was
an official ministry publication,'' Johnson said.
A draft went to the ministry in September and the final report
was delivered in November. Ministry officials told Johnson
they wanted to study the report and manage the release.
Johnson feared the research would be affected.
``If it goes through the ministry of health and comes out as their
official paper, it has to go through all the communications
review and it turns into much more of a political document.
``We didn't want that. We wanted to know what is the scientific
basis for public health services,'' Johnson said.
``I said I am not going to alter it for political purposes,'' he
added.
The ministry then told him they would not allow the release
with the trillium on the cover.
Johnson and fellow researchers agreed to the change and say it
is being reprinted.
http://www2.thestar.com/thestar/editorial/news/20000123NEW01_CI-POOR23.html
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