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?

Wednesday, November 29, 2006

Motivation, The Primary Determinant of Health

Although our Alberta Conservative leadership candidates don’t seem to want to talk much about healthcare, and Ed Stelmach didn’t even have it on his top four priorities the other day on “talk radio”, healthcare continues to take front page space on our Alberta newspapers. Today, Nov.29/06 edition of the Calgary Herald informs us of the Calgary Health Region’s intent to “construct” (not really true since someone else will “construct” and the Health Region will rent) a 75,000 square foot Health Centre in the unhealthiest part of Calgary. This clinic will replace two existing clinics that a) “aren’t adequate to meet service needs, b) “are unable to provide the unique services needed in the area” c) really doesn’t meet (our) needs. The Health Region then intends to purchase the building back from the “contractor/financer” of the building. I hope that during these times of escalating construction costs, the region has their contract nailed down, no pun intended.
The major point of my entry today is to ask the question of the Calgary Health Region: “What are these needs that are not being met and what is the plan to meet them, and at what additional cost”? Staff increases are stated to be more than 10%, and the only reasons that I can find to justify this move pertains to “life styles” and as a result, I would surmise, a shorter life expectancy. These areas have “the highest rate of smoking, smoking while pregnant, individuals that don’t meet daily nutritional needs, lowest birth rates, and highest rates of unemployment”.
Dr. Brent Friesen, the regions officer of health, said “One of the things that the Calgary Health region is doing, at the present time, is that we are partnering with other groups because the solution to a number of these problems lies outside the health system as a whole”. After pointing out that this group of people are not meeting their nutritional needs, he goes on to say “If people are on a fixed income, then they have to find the money from other areas, and most often the area they get that money from is the diet”. Well, I say “Amen” to both of those statements; but why do they not take that money from their smoking budget, bingo and entertainment budget, etc? Walking is free and gas is expensive. Now, there is a trade we could all make!
The only reference in the article I could find as to the “unique” services to be offered are “diversity and translation services for immigrants, and wellness programs to reduce smoking and obesity. Twenty new employees are planned for the center; I certainly hope they are sociologists and psychologists because this may come as a surprise to Dr. Ed. Friesen, but I suspect that there will be a low enrollment rate in his programs. Contrary to the prevailing belief in many areas at present, I do not believe that poverty and poor education, per se, are the determinants of health. Rather, they are simply the symptoms of an underlying pathology, poor motivation. I know, I know; variation in motivation is probably a normal genetic variant, similar to many other inherited characteristics, but are we as a society ignoring the important environmental factors that can assist development or potentially retard development of motivation? Some people are truly gifted athletes but never show up on the radar screen of performance; others with a fraction of the genetic ability become Olympic athletes. Some people may misconstrue the word “motivation” and combine it with the words “ambition” and “greed”. I prefer to think of it as a need for self improvement. This may mean different things to different people (the state of one’s spirituality and mind, is more important than the state of one’s body), so perhaps it is unfair to have “health measurements” as a measurement of motivation, or motivation as a determinant of health outcomes, but it is more valid than anything we are using at present.
As a farm kid I was very familiar with the expression “the cream always comes to the top”. There was something magical and intrinsic in cream, so that after a period of time, the cream would separate from the skim milk and rise to the top of the milk bottle. That does not mean that cream is necessarily better (although I think it was implied). Because it has certain characteristics, it simply differentiates itself from the milk. I truly feel that people that are motivated will differentiate themselves along the pathways that they feel are important; that they value. This certainly can be influenced by an environment of hope, the exclusion of mental illness, and a host of other environmental factors. But I have learned over the years that a host of other environmental factors can negate our motivation. Imagine my consternation when, many years ago, I moved to the city and found out that when you homogenize the milk, the cream doesn’t rise to the top anymore. Are we as a society trying too hard to homogenize the people in our society? Are we perhaps putting incentives and disincentives in the wrong place? By guaranteeing the status quo, are we feeding our fear of change and thereby taking away the hope of improvement? Or even worse, by rewarding inertia, and dwelling on the risks of moving forward and the sacrifices that would have to be made for independence and self improvement, are we neutering motivation? And what part do high taxation and inappropriate handouts have in this process? If we did a survey and asked people if they valued their health, likely 100% would say that they did. Yet, we find that only twenty percent of people will invest their time, energy, or money, in their health. Why the disparity? Do they really "value" their health, or do they feel that it is not their responsibility and are simply "entitled" to good health?
Today’s entry is not made as a condemnation of the poor, but rather as a commentary on our society as a whole. Why are our young people spending their money on cars, televisions, toys, etc, when these things depreciate by 30% a year when real estate in Alberta is going up at the rate of 30% a year? Obviously, they have different attitudes, priorities, values, etc. Is this wrong? Not necessarily, but along with it seems to be an increase in an attitude of entitlement. A recent “pink book” by a particular federal women’s group seems to epitomize this. If this is their version of “fulfillment” or “self improvement”, we are in trouble as a society.
So by all means, build and staff a medical clinic in North-East Calgary. But for heavens sake, make it a pilot project and hire sociologists to look at motivation. Throwing more money at these problems, I suspect, is simply part of the homogenization process that actually prevents the cream that is in all of us, from rising to the top.

1 Comments:

Anonymous Anonymous said...

What would it take to put foot health up in that category? Because it seems just as important to me?

4/10/13 1:49 PM  

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