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.

T1-60

In reply to Ishmael http://cmatalks.blogspot.com/2010/12/t1-3.html

yes, you have very good points. A lot of them however cannot be addressed by the CMA. Unless of course they recommend a reduction in Health funding to allow an increase in other relevant areas for health status that do not include clinicians or medical services.

Your list: Some are educational policies, others are social programing, then there is food/corporate taxation and environmental policy. Right now we do not appear to have the political will irequired to provide this shift in funding or policy. For example, David Butler-Jones (Public Health Agency) submitted a report last year to the federal government endorsing the social determinants of health- it did not see the light of day. Why? Politically unpalatable.

I think you are bang on for the path to a sustainable society and with it a sustainable health care system due to reduced usage. It is a matter of convincing politicians to implement the financial shift of funding from health care to other important areas that also influence health status. I say shifting as health care consumes the lion's share of funding in all provinces. We have a finite amount of resources and most other departments have had reductions due to increased spending for health care.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-60

T1-3

This is a troublesome road to go down, because it cements and increases the role that large pharma has on our health care system.

It is critically important for everybody to understand that large pharma has no interest in making being healthy; the financial incentives in this system encourage drugs to be created that manage symptoms of illnesses, without actually curing the underlying problem. If the treatment has another side effect that requires further treatment, that's even better from a corporate financial bottom line POV.

Research into true cures need to be publicly funded without corporate interference so as to make sure they are as widely available as possible. Natural treatments that are easily accessible to all should be researched first, as opposed to artificial and expensive pharma drugs.

The most important part of any observation/revamp/examination of the health care system is keeping people healthy in the place, not treating them with drugs when they start to get unwell.

And there are so many, many things that need to be addressed in our society in order to keep people healthy:
- encourage physical fitness through proper urban planning and creating walkable communities, largely serviced by superb public transit and alternatives like biking and cycling
- discourage the ingestion of unhealthy food-like products through financial incentives (the more a food is processed and has unhealthy salt, sugars, chemicals added to it, the larger the tax on it - these taxes could be used to subsidize healthy, unprocessed foods)
- hard limits on the garbage they add to food like salt, fructose, refined sugar, etc
- improved nutritional teaching in schools, including preparation of healthy meals
- full support for physical fitness in schools, with lots of after-school sports, gym, etc.
- only serving healthy options in schools.
- adopting a precautionary approach when it comes to chemicals, pollution, radiation in our environment - if the company can't prove it's safe, then it shouldn't be used/ingested.
- helping people understand that health does not start with a pill, and how important it is to control what we take into our bodies and the effect that it has.
- teaching parents how important nutrition is for children in every aspect of their life. I see so many parents giving their kids complete junk as lunch and snacks, not having any idea how much damage they're doing to their children.
- ensuring companies that create huge social costs, like cancer and obesity, pay the price and that we don't subsidize them at the cost of the average person's health.
- changing the way doctors treat patients in order to give them enough time to holistically understand someone's health picture and help them get healthy, and identify potential issues at the earliest possible time. Right now, 7 minutes per patient visit, one at a time, only perpetuates a system of treatment with drugs, and having serious illnesses routinely missed until they become quite serious.

These types of changes will have a more profound and lasting effect on our society, at an overall lower cost, than lining the pockets of big pharma for expensive illness treatments for problems that other industries, and our own collective ignorance, have created.

The bottom line is that we have a finite amount of resources. I would greatly prefer to invest those in the front line of keeping people healthy, rather than at the back end where big pharma has a goal of keeping people not quite sick enough to die, and on as many medications as possible.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-3