Barbara Sibbald is editor of News and Humanities at CMAJ, and author of the recently published collection of short stories, “The Museum of Possibilities“
Health policy pundits should look to André Picard’s new book for a dose of common sense on some of Canada’s most urgent health issues. Picard, as most Canadians know, is the long-time health columnist for The Globe and Mail. The book, Matters of Life and Death: Public Health Issues in Canada (Douglas & McIntyre), is the best-of those columns over the past 15 years, updated and conveniently packaged under 14 topic headings like opioid use, medical assistance in dying, cancer, marijuana, indigenous health and infectious disease. Most importantly Picard delves into medicare itself. Canadians spent $228-billion in 2016 on health care: Do we get value for our money? Is it sustainable? Picard not only asks the right questions, he provides some very credible answers.
And that should come as no surprise. Since 1987, Picard has written 8000 articles and 800 columns for the Globe. The Canadian Public Health Association named Picard Canada’s first “Public Health Hero”. He knows health care in Canada. Full stop. And he has a gift for connecting the dots.
Hospitals are the biggest single expense in Canada’s health system, accounting for $66 billion in 2016. Picard points out some obvious ways to reduce this expenditure. Childbirth is the number one cause of hospitalization in Canada: Why is childbirth treated like an illness? And what about all those so-called alternative level of care patients? Those people who live in hospital because they have nowhere else to go? In Nova Scotia, a third of beds are for filled with these people. One patient lived in hospital for ten years, at a cost of $1000 a day.
“Wait times in emergency rooms are a direct result of the alternative level of care,” he said at his recent book launch in Ottawa. It’s a traffic jam because the wards are full of these patients. “They are there because we didn’t plan for an aging population 25 years ago,” he said.
The health system was designed in the 1950s and ‘60s for a young, acute patient. “Now we have [a need for] chronic care and we have to turn the system on its head and make primary care the focus. That’s a structural, engineering problem that we should have addressed 25 years ago. We’ve failed to change.”
“We don’t have a medicare problem,” Picard said, “we have an administrative and engineering problem.”
As the title implies, the book makes an informed and passionate argument for public health, including the social determinants of health. “Medicine fixes you once you are broken. We don’t pay enough attention to keeping healthy,” Picard said. “We don’t have a front door to our [health care] system, we only have an emergency door.”
You can’t be healthy, for example, without adequate housing. One in seven adults still smokes. There’s an epidemic of obesity. Loneliness feeds ill health. And Indigenous people live, on average, 10-15 fewer years than others in Canada, which is a “sickening disgrace,” writes Picard. Rather than imposing “outside programs that fail,” we might look within the Indigenous populations in 600 communities and learn from the many that are succeeding.
In his book, Picard writes that health policy and health politics matter as much as medicine. “I don’t write about medicine. I write about health policy. I make that distinction.”
An historic example is the tainted blood scandal — the worst public-health disaster in Canada history when 2400 people were infected with HIV/AIDS, and another 20 000 or so with hepatitis C. Investigative articles in the Globe eventually led to a public inquiry and compensation of nearly $5 billion, but it took years.
“We journalists are guilty of the same ‘crime’ as the main players in the blood system … a failure to inform the public,” Picard recounts in the book. “Like them, we have excuses, but collectively our mistakes have cost hundreds, maybe thousands, of people their lives. There can be no excuse for that. We cannot be forgiven. But we can learn from our failures by never repeating them again.”
Picard’s call to action was heeded by some. “Today, the good health reporting is better than it’s ever been, but the bad health reporting is worse than it’s ever been,” he writes. Faults include ‘cute’ trumping ‘meaningful’, simplistic coverage, jingoism, short-sightedness, ill-prepared health journalists lack of skepticism, kowtowing and little coverage of health policy. “Often, seemingly banal issues turn out to be matters of life and death,” he writes.
I would agree, but I think the fault lies less with the journalists than with those controlling the purse strings: publishers, boards of directors and the like who have gutted news rooms across Canada.
In this respect, the book is as much a wake-up call to health media and journalists, as it is to health policy makers. And wakeup calls to both are warranted.
The answer to whether or not our system is sustainable is YES. With the right changes. A good place to learn where to begin is by reading this insightful book. You won’t find the nitty gritty of solutions — after all, these are 700 word columns — but you will find a compass.
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