TTH-2

Audience Comment / Toronto Town Hall

Hi there. My name is Jeremy Petch. I live here in Toronto.

"Good Value"... (and there's alot of ways to answer that) but I'll speak right to the idea of just not treating things through the healthcare system that are better addressed elsewhere. And this is to go to the point of the social determinants of health and the importance of including that is that in many cases we treat the healthcare system has become the sort of end point for all kinds of social problems...be there lack of social housing, lack of good quality food...nutritious food... These kinds of things are ultimately dealt with in the healthcare system.

I'll use one example (who I'll refer to as "Betty") who came into TGH [editor's note: Toronto General Hospital] with abdominal pains. She was on welfare. All she could afford to eat was white rice and she came in with an abdominal blockage so severe it needed to be dealt with through a really quite radical surgery. It cost more to perform that operation than it would have cost to feed Betty good, nutritious vegetables for 20 years. Alright? We way over-payed for that.

And I think Dr. Turnbull since you work in inner-city health you probably see this all the time. (Turnbull nods agreement). That is the place. Right? We also see it on our aborginal reserves where aborginal populations have enourmous health problems and it's the social determinants of health that are really driving those.

So I think if you want to call for federal leadership one of the places the Feds can really take a strong role is in addressing the social determinants of health across the country. And that will take alot of pressure from organizations like the CMA to fight against what I've seen in federal health policy... a tendency amongst the conservative government to not recognize it. Perhaps they see the social determinants of health as Liberal wish fulfillment because they offer a rationalle for paying for programs that are traditionally liberal. But the social determinants of health are real. The epidemiology is there. And the best way to address...one of the ways to get good value from our healthcare system is to address them because it's cheaper to deal with the social determinants than to address it with expensive abdominal surgery...And whatever else. Thank-you.

Dr. Haddad responded:

Certainly on the social determinants of health... I mean I mentioned that in my statement... I run a hospital. When you look at patients that come into hospital that shouldn't be there. I see children -- the reference was to adults -- there are many, many people who use our system today that shouldn't have to use the system. So I think that the last speaker really challenges us on a national level to deal with policy around this but also the recognition that there's a direct correlation to costs in the healthcare system.

TTH-1

Audience Comment / Toronto Town Hall

My name is Michael McBain. I'd like to start just by thanking Dr. Turnbull and The Canadian Medical Association for calling on federal leadership in healthcare. We're gonna lose the system without federal leadership. We're not just a bunch of provinces. We're not just a bunch of regions. We're a country and the system is splintering because there's no guardianship -- there's no building for the future -- without federal leadership.

You're asking a really good question. We're not getting value for money and I think the 800 lb gorilla in the system is the pharmaceutical industry. Now it's interesting that nobody talks about that but that's the biggest cost driver. How can you say you're concerned about sustainability and rising costs and not address what the cost driver is -- the primary cost driver. Pharmaceuticals has gone up 73% in 10 years per capita inflation adjusted. Nothing comes near that. But worse than that we're spending 30% more than the international average on new drugs. We're not using them properly. Over prescribed. Drugs are dispensed based on marketing tactics not on evidence. Even with children! If we're concerned about children's health we should be concerned about physicians who are prescribing dangerous anti-psychotics to 2 year olds. That's a huge problem and that's a marketing problem. That's something the medical association needs to consider. This is a moral issue. Medicine's not about commercial marketing. And that's the biggest challenge in terms of value for money.

And I think the solution is a universal public pharmacare plan. Not a private plan, not a hybrid like Quebec has because Quebec's drug plan is out of control. It cannot control it's costs because it partnered with the private insurance industry. You have to have a public plan. So I think it's a very good question. I think we have to address the cost drivers and I think we're not getting value for money, particularly with new drugs.