What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Thursday, February 09, 2006

Determinants of Health

I really don’t mean to horn in on the “whining” domain of my one daughter (www.squiishie.blospot.com) or the domain of my other “idealistic” daughter (lannysblog.blogspot.com) but: Why is it that our “educators” are more interested in promoting their agendas than they are in encouraging the “thought process”? I related, a while back, that I had been to a “philosophers” discussion group on assisted suicide. It was clear that the professor from the U of A was a proponent of assisted suicide and discouraged opinions to the contrary. At the end of the session 95% of attendants supported assisted suicide instead of being impressed with the complexity of the issue and/or requiring time to give it thought.
Yesterday I attended a presentation at the University of Calgary by Dr. David Low, PhD, advisor to the President on public health (formerly with the University of Texas), titled: Does Education Cause Health? It became apparent from the start that this gentleman was a presenter, not to generate thought on the subject, but to formulate conclusions. His first statement “in all populations studied to date, health is not evenly distributed, but follows a gradient which is a function of social and economic advantage”. He followed this with pointing out that in the U.S., where some of the greatest variances in health markers exist, there also exists some of the greatest national variances in wealth.
Now, I agree that there is a correlation between life expectancy and the attainment of education milestones, but is it truly a “function”? (Inferring that there is a cause and effect relationship). He stressed how important the first three years of life was with regards to learning, and was obviously a strong proponent of universal day-care systems with educational components. He made the bold statement in his hand out “The most effective way to improve health of the population is to focus policies on optimizing both early child development and education to provide adequate social and cognitive development in early childhood”. Is this really the “most effective way”? Wouldn’t the effectiveness depend on the policy and the application of the policy? It became apparent as the session continued that Dr. David Low was a supporter of “wealth transfer” as a way of accomplishing this. It would seem that he felt redistributing wealth and taking away “wealth disparity” in a country would make health disparity less. I was astonished that such a simplistic approach would be entertained, much less promoted at this level of discussion.
During question period I asked if perhaps “the determinates of education” could be more important than education itself? Was education just a measure or reflection of personal and local community factors such as: differing values and priorities, conflicting interest (staying alive and putting food on the table may be more important than going to high school), motivation (putting off immediate gratification to attain long term goals, achieving excellence, etc), existing beliefs, (my grandfather felt my going to University was a waste of time and I should clear land and pick stones on a quarter section of land in Saskatchewan), and many other factors. Could these underlying factors that contribute to the attainment of education, in fact, be the same factors that contribute to good health and not education per se? Dr. Low’s response was that my question was an extremely important one but then refused to comment on it other than to say there may be some “third” theory---end of discussion.
I think ideas on health policy are only as good as their planned implementation. Do we take all the children from poor families (families at health risk now and in the future) and make them wards of the state? Do we transfer money for health and education to those groups within our society that have shown their health vulnerability? This has been the policy of our federal governments to date and certainly hasn’t helped our native populations. It seems to be failing on a national scale for the rest of the population as well. How will we ever arrive at solutions when the people who are supposed to stimulate thinking, are advocates for forgone conclusions? I think we should be looking for what constitutes hope in our disadvantaged populations and look at methodologies to address those issues. Hope, to me, will motivate, and motivation in one area spills into secondary areas. We must keep in mind while doing this, that our priorities may not be the priorities of other groups of people (as health care providers we may feel or health values are more important than family or ethnic values). Our willingness to do “good works” for the population at large should never and can never; take away our freedom of choice as an individual.
For better “thinking” on health care issues I would refer you to the following excellent articles: The Break Even Point: “When Medical Advances Are Less Important Than Improving The Fidelity With Which They Are Delivered” (http://www.medscape.com/viewarticle/519943), and “Battling Bad Behavior” (http://www.the-scientist.com/2006/2/1/51/1). These are quite detailed scientific articles for the lay person but for those of you interested in public health policy, they make an excellent “read”.


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