Health more than Health Care

• Many pressing issues have been calling for attention these days – the unprecedented increase in mortality rates among white Americans, the Black Lives Matter movement and the upending of the Republican Party. At the root of many of these issues are complex sociological reasons. For example, there is good reason to believe that the rising mortality among white Americans is related to the declining economic fortunes of white working-class men over the past four decades. But how is the general public to understand these issues? And how are they to know how best to respond to such concerns?
  Read the article ‘Should writing for the public count toward tenure?‘ by Amy Schalet
• When the Sisters of St. Joseph’s founded St. Michael’s Hospital, it was to care for the sick and the poor — which shows that even in 1892, income and health went hand-in-hand. Read the full article by Geoff Koehler here.
• Our efforts to combat poverty are often based on a misconception: that the poor must pull themselves up out of the mire. But a revolutionary new theory looks at the cognitive effects of living in poverty. What does the relentless struggle to make ends meet do to people?  Read the full article by Rutger Bregman here.
• Being poor can actually shorten your life. A new tool is helping doctors query patients about their physical and financial health.  Read the full article printed in the April issue of the United Church Observer by Susan Peters.
• Listen to the latest Freakonomics Radio episode with Evelyn Forget called “Is the World Ready for a Guaranteed Basic Income?” A lot of full-time jobs in the modern economy simply don’t pay a living wage. And even those jobs may be obliterated by new technologies. What’s to be done so that financially vulnerable people aren’t just crushed? It may finally be time for an idea that economists have promoted for decades: a guaranteed basic income.
• A “Poverty Tool,” created by Dr. Gary Bloch with non-profit partners across the country, lays out a three step approach for front line doctors, nurses and other health workers to deal with poverty.  The steps are simple: ask everyone about their income, learn about how poverty impacts patients’ health and connect patients with key income benefits programs and community resources already available.  The critical message to health providers?  Helping patients reduce their poverty is part of their work as health practitioners.
• Trudy Lieberman‘s interview with Eduardo Porter who writes the New York Times column, “Economic Scene”. His column which “explores the world’s most urgent economic challenges” per its tag line—stands out for its smart blending of wonky data, academic research, and insights into how real people live and respond to the remedies intended to improve their lot. Read Trudy’s interview with Porter here.
• Federal Liberals invited a leading expert on guaranteed annual income to make the case at pre-budget hearings for a major overhaul of Canada’s social safety net. Read the full article by Bill Curry in the Globe and Mail.
• The stunning — and expanding — gap in life expectancy between the rich and the poor. Read the full article by Max Ehrenfreund in The Washington Post.
• Canada’s former policy of forcibly removing aboriginal children from their families for schooling “can best be described as ‘cultural genocide.’ ” Read the full article written by Ian Austen for the New York Times.
• What if our healthcare system kept us healthy? Rebecca Onie asks audacious questions: What if waiting rooms were a place to improve daily health care? What if doctors could prescribe food, housing and heat in the winter? At TEDMED she describes Health Leads, an organization that does just that — and does it by building a volunteer base as elite and dedicated as a college sports team.
• Doctors at St. Michael’s hospital launch project to address root causes of poor health. Do health and wealth go together? These doctors in Toronto think so, and have launched an innovative project to address the root causes of poor health.
• The Canadian Institute for Health Information (CIHI) has published a recent 2014 report, Population Health and Health Care: Exploring a Population Health Approach in Health System Planning and Decision-Making. The report showcases the perspectives of health system leaders across Canada who have made demonstrable progress in adopting a population health approach in their work. An example is The Ottawa Inner City Health (OICH), a community-based program aimed at improving the health of chronically homeless people through improved access to care.
• Statistics guru Hans Rosling debunks myths about the so-called “developing world”. In his 2006 TED talk, The best stats you’ve ever seen, Hans presents interesting global health data.
• In Canada, Aboriginal poverty rates are many times higher than for other Canadians. TVO explores the dark past, difficult present and hopeful future of the issue through a shareable Aboriginal poverty infographic.
• The National Film Board of Canada presents an interactive web documentary about mental health and homelessness that examines the Mental Health Commission of Canada’s At Home pilot project. The Canadian At Home project was a four-year, coast-to-coast, randomized controlled trial which sought to give people with mental illness a home before focusing on treatment and services. In the five Canadian cities, over 1,000 homeless people with mental illness received a home while a control group did not. 
• Dr. Jino Distasio, Director of the University of Winnipeg’s Institute of Urban Studies speaks at the University of Manitoba regarding the At Home project. His presentation, the Health and Homelessness: An Experiment in Action and Policy, is available here. 
• A November 2013 report by the Health Council of Canada says that governments must make a greater effort to collaborate to improve health care for First Nations, Inuit, and Métis seniors. The report, Canada’s most vulnerable: Improving health care for First Nations, Inuit, and Métis seniors, shows they often do not receive the same level of health care as non-Aboriginal Canadians because of poor communication, collaboration, and disputes between governments about who is responsible for the care of Aboriginal people.
• The Ontario Medical Association (OMA) has produced a series of five articles examining the relationship between income and health in primary care settings. Part of the OMA’s work in this area has involved engaging physicians who frequently encounter poverty in their practice and who have witnessed, first-hand, the impact of low income on health. These articles were published in the Ontario Medical Review’s October and November 2013 issues, and are available here.
• The President and CEO of Children’s Hospital Oakland, Bertram Lubin, gave a Tedx Talk which zeroes in on poverty as a disease and the importance of addressing social determinants, not healthcare, as the road to health and well-being.
• See the Resources (Library, Online courses on the social determinants of health and more) available from the National Collaborating Centre for Determinants of Health website: http://nccdh.ca/resources/
• Mapping children’s chances (2013), paints a global picture of children’s well-being, education and family life across different countries. The maps were produced by the University of California Los Angeles’s World Policy Analysis Centre.
• Fewer people could be hospitalized for injuries resulting from suicidal and self-harming behaviour if social disparities reduced. Disparities by socio-economic status suggest where improvement  efforts can be focused.
• Health Indicators 2013. As the last in a series of 14 annual reports, Health Indicators 2013 provides an overview of the joint CIHI-Statistics Canada Health Indicators reporting project and describes CIHI’s new program of work in health system performance reporting. This publication also contains the most recently available health indicators data and features an In Focus section that highlights the expanded reporting of health indicators by socio-economic status.  See especially What’s  New In This Report?
• The Better Beginnings Better Futures project, established by the Ontario provincial government in 1991, has been able to follow children who participated in universal, holistic, community-based programs at eight centres as they progressed through the school system. Researchers found that, by the time students reached Grade 12, they had higher grades, needed fewer special education services, exercised more regularly and were less engaged in crime.
• Wellbeing Toronto, an online mapping application, is a web-based measurement tool that enables access to community economic and social wellbeing indicators across City of Toronto’s 140 neighbourhoods. It provides a number of facts and measures that allows a range of users to custom select and combine data, viewing their results instantly on a map. This tool is designed to raise awareness and understanding of the different neighbourhoods that comprise the city. It is equally a support tool for Council and staff in the development of policies and programs that require a place-based neighbourhood perspective.
• So what are health inequalities? How do government policies influence whether we improve a nation’s health or make it worse? These and other questions are tackled by Dennis Raphael in this Podsocs episode.
• See the Social Determinants of Health: The Canadian Facts a primer for the Canadian public by Juha Mikkonen and Dennis Raphael. This publication considers 14 factors that affect health including income and income distribution, education, unemployment and job security, employment and working conditions, early childhood development, food insecurity, housing, social exclusion, social safety network, health services, aboriginal status, gender, race and disability. It outlines why they are important and how Canada is doing in addressing them. See this video for a conversation with Dennis Raphael.
• Empathy, dignity, and respect: Creating cultural safety for Aboriginal people in urban health care (December 2012). This report highlights some of the barriers to Aboriginal people seeking health care services within mainstream health care settings and describes key practices that are contributing to positive change.
• Making health care delivery culturally safe for Aboriginal people in urban centres (November 26, 2012) (youtube.com). A conversation with Stl’atl’imx Elder Gerry Oleman, a Community Support Worker in Vancouver about the importance of cultural competency and creating health care environments free of racism and stereotypes.
• The town with no poverty: The health effects of a Canadian Guaranteed Annual Income Field Experiment (September 2011). A study published by Canadian Public Policy reveals that guaranteed annual income could significantly reduce health care costs by improving population health.
• Royal Society of Canada Expert Panel on Early Childhood Development, Fall 2012. A report on early child development and the impact of early adverse experiences on developmental health.
• See David Williams, Harvard University, A Time for Action: the Enigma of Social Disparities in Health and How to Effectively Address Them for a great review of factors related to health status in the U.S.
• The Canadian Index of Wellbeing was released in October 2011 by the Honourable Roy Romanow and Honourable Monique Bégin. The CIW is a composite measure of wellbeing using many indicators from eight interconnected categories or domains. Whereas the GDP has been measuring the economic status of Canada, the CIW now complements this as a composite measure that looks much more broadly at the ‘wellbeing’ of Canada.
• Penny Sutcliffe, MD, MHSc, FRCPC shares a video developed by the Sudbury & District Health Unit as part of their ongoing public health efforts to improve health equity. Let’s start a conversation about health…and not talk about health care at all is a five minute video highlighting that HEALTH is about much more than access to medical care. It highlights that everyone has different opportunities for health, largely influenced by their social and economic conditions. Using this broad view of health, the video describes actions that various non-health sectors can take. It encourages everyone – teachers, builders, dads, nurses, business women, students, politicians… to start a conversation about health… and not talk about health care at all. Dr. Sutcliffe would be very pleased to hear your feedback at [email protected]
• Webinar: Looking Upstream: How Income, Education and Racial Inequalities Shape Health. In April 2011, the Robert Wood Johnson Foundation hosted a webinar on the effects that income, education and race have on health.
• How does Canada fare on actual health outcomes relative to its neighbour to the south? “Quite well” according to the Conference Board of Canada. The Conference Board argues “improving the health status of Canadians requires improving social and economic conditions, educating the population to reduce risks of chronic diseases (for example, by limiting tobacco and alcohol consumption and by being physically active), and enhancing the quality and safety of health care.”
• The Bayview medical clinic in San Francisco is developing a new kind of pediatric medicine, focusing on childhood trauma as a medical issue. Dr. Burke, clinic founder, argues that childhood trauma has a strong impact on adult health. See the March 2011 New Yorker article by Paul Tough which reviews the Adverse Childhood Experience study and describes the powerful relationship between poverty, child development and health.
• If anything the gaps in health status across income groups are widening, not narrowing, and this is not because of poor access to healthcare. The universal Canadian system does a good job of delivering healthcare to those who need it and who can benefit from it, but there is more to being healthy than healthcare. Manitoba Centre for Health Policy researchers looked at the distribution of disease, death and the use of preventive healthcare across income groups in Manitoba. They found that the growing gap in income was accompanied by profound and growing gaps in health.
• It turns out there’s much more to our well-being than genes, behaviors and medical care. The social, economic, and physical environments in which we are born, live and work profoundly affect our longevity and health―as much as smoking, diet and exercise. This is a story about health, but it’s not about doctors or drugs. It’s about why some of us get sicker more often and die sooner and what causes us to fall ill in the first place. This series by Public Broadcasting Service in the U.S , UNNATURAL CAUSES, criss-crosses the country investigating the stories and findings that are shaking up conventional notions about what makes us healthy or sick.
• Researchers in the US estimate that over the period 1996 through 2002 medical advances saved a maximum of 178,193 lives. They also estimated how many lives would have been saved if mortality rates among US adults with an inadequate education had been the same as rates among adults with 1 or more years of college. Changing US society to eliminate deaths associated with disparities in education would have saved 1,369,335 lives during the same period, a ratio of 8 to 1.
• Unless governments change their approach to addressing the needs of poorer and socially disadvantaged Canadians, we are destined to continue to spend a large amount of dollars on our healthcare system. Governments must expand their approach to health promotion in order to tackle the major societal factors that lead to poor health and to take pressure off healthcare budgets.
• Recommended reading on Healthcare Costs/Spending from the Canadian Institute for Health Information (CIHI)

From the Health Council of Canada:

• See the 2011 report Understanding and Improving Aboriginal Maternal and Child Health in Canada. Aboriginal Canadians have significantly worse health and more challenging living conditions than the rest of the population. With a much younger demographic and a higher birth rate than the non-Aboriginal population, the Health Council of Canada set out to learn about programs and strategies that have the potential to reduce these unacceptable health disparities.

• See more recommended reading from the Health Council of Canada.