More health care doesn’t mean better health
There have been remarkable improvements in life expectancy over the past 100 years. The reasons are many: sanitary drinking water, pasteurized milk, safe sewage disposal, work safety, higher standards of living, better education, and cures or immunizations for many communicable diseases such as smallpox and diphtheria.
Readers may wonder why universal health care is not on this list. It would be on a longer list, but research indicates that a country's health-care system is not as important as any of the top seven reasons – in fact, it's been estimated that they are responsible for at least three-quarters of the increases in life expectancy in developed countries over the past 100 years.
How much a society spends on health care has not been found to be directly related to any health outcome tested. For example, at 17 per cent of GDP, the United States spends more (by far) on health care than any other country. And yet, its life expectancy and infant mortality rates (two common measures of population health) are just average compared with other developed countries.
What is the primary determinant of population health? There is a huge body of research that shows a strong correlation between income and life expectancy. The effect of income appears to be stronger than many other variables, such as race and education level.
It has been known for some time that the better off people are in terms of income, social status, social networks, sense of control over their lives, self-esteem and education, the healthier they are. Higher incomes are related to better health not only because wealthier people can buy more food, clothing, shelter and other necessities, but also because wealthier people have more choices and control over decisions in their lives. This sense of overall security is intrinsic to good health. Thus, security of income is just as important as the income level itself.
The counterargument – that poor health causes low economic status – does not explain the results. If we look at subgroups of workers by income level, we find that those with lower levels of income have measurably higher mortality rates over the course of the study, even if one considers only workers whose incomes rose over the same period.
There is also a strong correlation between a population's health status and the degree to which national income is equitably distributed. In other words, if a country wants to see significant improvements in its population health, the best public policy is to eliminate poverty.
This background is extremely important today, as Canada heads into an era where many social programs (including Old Age Security) will be competing with health-care delivery for limited resources. An appropriate balance between health-care spending and social-support spending is crucial.
A society that spends so much on health care that it cannot or will not spend adequately on other health-enhancing activities may actually be reducing the health of its population.
There is a threshold for useful spending on traditional health-care delivery. Beyond that threshold, overall population health may actually suffer, not only because the care itself has marginal or dubious benefit but also because less money is available to support health-enhancing activities in the general social and economic policy spheres, such as in early childhood development or income security.
It is a very real question whether it's truly beneficial, for example, to raise the age of eligibility for OAS to 67 from 65 in order to find ever more money for traditional health-care delivery.
Surprisingly, the end result could be a decrease in the overall health of our population.
Robert L. Brown is an expert adviser with EvidenceNetwork.ca and a fellow with the Canadian Institute of Actuaries.