In my report on the future of health care in Canada, I noted that we must set a national goal of making Canadians the healthiest people on Earth.
Our 47 recommendations for achieving a renewed health-care system will take us a long way in achieving this, but not the whole way. Even the best health-care system in the world will only be one of the ingredients that determine whether one's life will be long or short, healthy or sick, fulfilled or empty.
If every citizen had a magic wand and could bring about the things that contribute to health and well-being, the experts might suggest they consider the following wish list.
- Be rich. Rich people live longer than poor people and are healthier at every stage in life.
- Pick your parents well. Make sure they nurture your sense of identity and self-esteem and surround your with interesting stimuli. Prenatal and early childhood experiences have a powerful effect on later health and well-being.
- Graduate from high school and then go on to college or university. Health status improves with level of education.
- Don't work in a stressful, low-paid, manual job in which you have little decision-making authority or control, or are in a toxic physical environment. Poor jobs equal poor health.
- Don't lose your job and become unemployed. Unemployed people suffer from stress and isolation and can become poor - and remember what I said about being poor.
- Live in a community where you trust your neighbours and feel you belong. A civil and trusting community promotes health and life expectancy.
- Live in quality housing, but not next to a busy street, in an urban ghetto or near a polluted river. Clean air, water and soil are vital to your health, as are the human-made elements of our physical environment.
But we cannot rely on magic for our health and well-being. Because the main factors that affect health and life span are the ones that affect society as a whole, we need to depend on policies and programs that provide what is necessary to turn hope into reality for all of us.
We've known for a long time that money is the single largest determinant of health. Many are familiar with the old adage "health is wealth." That may be useful as a metaphor for what's important in life, but as far as a predictor for the future, it's quite the opposite. The reality is, that in the majority of cases, "wealth is health."
The amount of money that one has is the lead domino in a whole line of dominoes - the quality of your early childhood years, your education, the type of job you have, the kind of housing and community you live in, the type of recreation and fitness programs you have access to - all of which directly affect health.
There are many more factors that affect your health than can be cured by a medical prescription from a doctor or even a policy prescription from a health minister.
Things like lifetime access to quality, school-based physical education, accessible recreation activity, and a secure supply of healthy and affordable food are fundamental to personal well-being.
A clean and safe environment is vital. Contaminants in our air, water, food and soil can cause everything from cancer to birth defects, to respiratory illness and gastrointestinal ailments. Hospital admissions for respiratory illness climb each summer with smog levels.
Quality affordable housing is a critical part of our physical environment. People who are homeless aren't healthy. People who live in substandard, overcrowded, cold and damp housing are not healthy. If you want to find those with the worst health, go look in the worst parts of the housing stock. Or worse yet, look to the streets of our cities.
Governments need to create methods that encourage them to think and act across disciplines and departments. Policymaking in Canada often suffers from "hardening of the categories."
Finally, what we measure, counts. That's why our concept of a strong and independent Health Council is so important. The public demands and deserves clear, valid, independent information about how our health-care system is doing. And we need to measure health and well-being in the context of all of the determinants of health.
Right now, the most commonly cited measure of Canada's progress is our GDP (gross domestic product). I sometimes think that GDP must stand for gross distortion of prosperity. It certainly was not created as a measure of well-being, but it's often taken as a sign of "how we are doing" as a nation.
GDP counts all economic activity as a gain. It makes no distinction between activity that brings benefits, and activity that causes harm. Crime, pollution, accidents, sickness, natural disasters and war - all make the GDP go up simply because money is being spent on prisons, lawyers, doctors, drugs, hospitals, pollution cleanup and weapons.
This new index of well-being would be based on the full range of values that Canadians regard as important to their quality of life. It would provide solid data at the national, provincial and local level. The index and its "subindices" would be calculated and reported regularly, promoted widely, and understood easily by the public.
The good news is that Canada has many groups doing promising work in this regard. This work needs to be supported, focused, and harnessed. From workplace water coolers to government policy rooms, an index of well-being would put the accountability spotlight on the kind of progress that Canada truly needs.
Historians and health experts tell us we've had two great revolutions in the course of public health. The first was the control of infectious diseases (notwithstanding our current challenges). The second was the battle against non-communicable diseases.
The third great revolution is about moving from an illness model to all of those things that both prevent illness and promote a holistic sense of well-being. This is the kind of revolution that will ensure that Canadians are the healthiest people in the world. Roy Romanow was chairman of the Commission on the Future of Health Care in Canada.