Barb Mildon, RN, PhD, President, Canadian Nurses Association.
Almost every discussion we have about health in Canada is fixated on how the system needs to be better, faster or cheaper – or all of the above. These discussions are of course important; but no matter what we do to achieve those improvements, Canadians won’t achieve the best health as long as our eyes remain fixed on the system alone.
Few stop to consider that 75 per cent of good health depends upon factors outside of the health-care system. These factors, known as determinants of health, include income, employment, literacy, security of housing and food. Given this fact, doesn’t it make sense for governments to take a broader view and consider incorporating health issues into all their policy decision-making? A simple example: we all hear how much obesity costs the health-care system, but if health issues were considered when governments scaled back physical education in our schools, would obesity be the ‘epidemic’ it has now become for health care?
We can see this same ripple effect if we look at all the determinants of health. Governments at every level could help Canadians become healthier, while saving money for health care, if they would consider or incorporate them into a broad spectrum of policy-making.
Consider the significant health problems facing many Aboriginal people in Canada, which are complicated by numerous social factors. Accessibility to clean water, secure housing and good food all contribute much more significantly to their health issues than the narrow range of services associated with the health-care system. As of October 31, 2012, Health Canada had 122 First Nations communities across Canada under a drinking water advisory. Some communities have been under such an advisory for years. How much would the health-care system save if the federal government considered health outcomes when developing any and all social and economic policies for Aboriginal communities?
Similarly, research indicates that low-income Canadians are more prone to poor physical and mental health. In 2010, one in four Canadian workers was considered to be low income earning, having a job paying less than $13.32 per hour. How much faster are health-care costs rising because employers aren’t required to provide workers with a living wage, one that takes into account necessary expenses: housing, food, transportation and government tax deductions?
The connection between poverty and poor health is especially apparent for older Canadians. Nearly five million Canadians are seniors – 65 and older – and 1.2 million of them are over 80. More than two-thirds of seniors are on fixed incomes. Poverty makes it hard for aging Canadians to maintain good health, often forcing them to make choices they should never have to make: between food, rent or medication. Yet the 2012 federal budget just increased the age of eligibility for seniors’ benefits. How much could we save by improving seniors’ living standards with policies that take health into consideration?
Canadians want and deserve to be healthy. Right now, what they have is a patchwork quilt of services that can’t be efficient or effective. We expect our governments to put our health first: assess the impact all policies, laws and public programs may have on Canadians’ health. Doing so will enable us to address health in a more forward-thinking way and allow us to achieve better health for the nation through a sustainable, publicly funded, not-for-profit health-care system.