Speaking Out On Inequities

By Ted Bruce

CMA Town Hall Report June 2013

The health care establishment occasionally shows glimmers of awareness that the greatest contributors to health are social determinants. We even see the Canadian Medical Association speaking out about poverty in its report What Makes Us Sick.

But we still have a long way to go in debunking the notion that health is all about personal choices and genes. A good example is the comment made by Nova Scotia’s Health Minister who apparently even suggested that people should demonstrate healthy lifestyles before they can access health care. Fortunately these types of uninformed statements are being challenged as was done in this case by a leading anti-poverty physician Dr. Ryan Meili.

It is discouraging that a Health Minister can be so uninformed but it seems all too common that ideology trumps science in the discourse on health. Nonetheless, the message about the importance of addressing social determinants like poverty is slowly taking hold in the medical community. But it requires challenging those uninformed statements every time we hear them as was done by Dr. Meili.

Public health understands this issue and it is ever more important for each of us to challenge statements that will take us down the wrong path to improving the health of the population and reducing health inequities. We can’t be shy about the importance of creating a more equitable society as the path to better health.

Further reading:

Don’t lecture on lifestyles; level social playing field | Dr. Ryan Mieli | The Chronicle Herald February 28 2014

Healthcare in Canada: What Makes us Sick | Canadian Medical Association Town Hall Report | June 2013

Check out:

Upstream: http://www.thinkupstream.net/

Dr. Ryan Meili is the National Director of Upstream. The organization works with the growing body of evidence on these social determinants of health and uses that knowledge to guide recommendations for change.

Housing is a powerful determinant of health

By Ted Bruce

ACORN Canada is a civil society organization dedicated to eliminating poverty and promoting social and economic justice. The group currently has a project underway to advocate for stronger building maintenance bylaws for people living in rental accommodation in BC so that landlords are required to ensure the basic rights of tenants to a healthy and safe environment.  PHABC is assisting ACORN to collect information about the maintenance issues experienced by groups of tenants in Burnaby, New Westminster and Surrey and about the impact of living conditions on the residents. Sadly, the conditions reported on some of the rental accommodation is appalling and the response of some landlords appears to be not just inadequate but punitive to those who complain.

Mould, infestations, structural issues and even a lack of heat are just a few of the problems experienced by tenants. And one common problem identified is the uselessness of trying to take concerns to the Residential Tenancy Branch for help. This latter problem has been recently analyzed in a report by the Community Legal Assistance Society entitled On Shaky Ground  that demonstrates why so many tenants I talked to expressed a terrible sense of powerless and almost hopelessness due to the conditions of their homes and their inability to get support to resolve issues.  The dominant ethic of “smaller government” can lead to a situation where governments seem to be unable or unwilling to actively fulfil their role to protect the health and safety of citizens. Hopefully the work of ACORN will shed more light on this problem. Housing is not only a fundamental right but also a powerful determinant of health. And let us remember that one of the drivers of health is the chronic stress associated with a sense of powerlessness and hopelessness – a condition that seems more common than we may think for those living in market rental housing.

When PHABC finalizes its work with ACORN, it may be a time for a discussion about the role of public health in working to ensure basic environmental conditions affecting health in residential settings.

– Ted Bruce is the past-President of the PHABC

Ethical healthcare in British Columbia

By Ted Bruce

I read with interest the article in The Tyee by Christine Boyle and Seth Klein entitled Imagining a Moral Economy for British Columbia.

The article laid out the rationale and the potential for us to re-think economic development and base our decisions about the economy on a set of moral principles. The principles they articulate include ecological justice, equality and shared good.  The article resonated with me in part because of the work PHABC has been doing to bring attention to the Corporate Determinants of Health: see the recent commentary in the Canadian Journal of Public Health by PHABC’s Dr. John Millar.

But it also reminded me of the need for a moral foundation for the health care system.

PHABC has called for greater investment within the health care system on upstream prevention and health promotion. Similar to the “moral economy”, a health promoting system would be based on a strong set of ethical principles – those articulated by public health. The core principles of public health concern themselves with questions of equity, social justice and the distribution of health and risk. Public health recognizes that health is situated within the social, political, and economic environment and if the health care system is to be effective it must attend to the relationship between these aspects of society and the individual. In short, improvements in the health of the population and the reduction in health inequities – ostensibly the goals of the health care system – depend upon addressing poverty, racism and inequality.

In fact the current approach to health care, with its focus on treating sick individuals, is nearing collapse under the weight of an unlimited demand for more service and an attempt to respond to this demand primarily by improving efficiency of services geared to these already ill individuals. Many would say that addressing the social determinants of health is not the job of the health care system. But there is an important and under developed role for health care to focus on health promoting factors – to keep people healthy, to address health inequities through targeted programming and to show leadership to encourage and facilitate inter-sectoral actions to address the social determinants of health such as poverty.

It is time we redesigned our health care system based on the ethics or moral foundation underlying public health.

– Ted Bruce is the past-President of the PHABC.