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Change life circumstances and lifestyles will follow

A version of this commentary appeared in the Halifax Chronicle Herald, the Vancouver Province and the Cape Breton Post

Social policies can create the conditions for good healthIn a recent media article, Nova Scotia’s Health Minister, Leo Glavine, floated the idea that people should have to demonstrate healthy lifestyles before accessing our health care system, much like a bank assesses a customer for a loan. Sadly, this is not a new idea, but has been floated by others pundits and politicos over the years, often couched in the language of practicality and common sense. Health care is a privilege to be earned, not a right, they lobby.

Health care just for the healthy, in other words. Here’s why such an idea would fail  for all of us.

Not only would restricted health care access be unkind, it would be unwise, as this kind of barrier would result in people presenting later and sicker to hospital, incurring higher system costs  costs that would inevitably be borne by Canadian taxpayers.

We are relieved that Mr. Glavine quickly recognized that a system based on the kind of pre-approval requested for bank loans would be inhumane. But why float the idea in the first place?

Our public health care system is there to help address inequality in our society by providing equal access to care for all  not to shame the sick. Our entire population’s health declines as inequity increases  even in a wealthy country like Canada.

Of course, it would be better for all people in Canada to eat healthy food, stop smoking and exercise more  as a doctor, I absolutely recommend those actions. However, it’s often easier said than done. I also see first-hand exactly why it’s difficult for many of my patients to make healthy choices.

It’s difficult for some patients to afford the pharmaceuticals that keep their diabetes under control when they are already forced to choose between rent or putting food on the table.

It’s difficult for some patients to buy nutritious foods  or it’s hard to find the time to cook when they’re working multiple part-time jobs. It’s hard to give up smoking when everyone in your family smokes and you’ve been addicted since you were 14 years old.

We don’t need the health police, and we don’t need a health bank. We don’t need “get tough” messages about personal responsibility if we’re not going to support better personal choices.

What does the evidence say? 

We know, for example, that anti-smoking programs had no effect when we wagged our fingers at smokers  but they had great effect when we used integrated strategies in public education, primary care and public health.

What we need is a health care system that’s based on need, not ability to pay. But we also need social policies that create the conditions for good health. 

The evidence also shows us that lifestyle choices such as decreasing smoking, exercise and good diet increase proportionally to an individual’s social and economic status. In other words, improving lifestyles is more about improving inequality within a society, and less about criticizing people for poor choices.

There’s no point in singling out those individuals who are “dependent” on our health care system. In truth, we are all dependent on our health care system to take care of us when we are ill or injured. And it’s a value we share in Canada, to take care of each other through our health care system.

In fact, our health care system is an important tool we have to combat inequality in our society, by providing equal access to care for all.

Medicare lets people get their health back without the added burden of financial ruin, preventing a spiral into poorer health and poverty  which affects society as a whole. 

We need to think beyond simplistic prevention messages and reactive health care. We need to include serious efforts to reduce poverty, provide affordable, quality housing, and work to overcome systemic marginalization and discrimination.

It’s a basic principle of health: if you treat the symptoms and not the underlying condition, your patient won’t get better.

It’s time to stop pointing the finger at individuals, and look instead toward policies that recognize the evidence and create the conditions for Canadians to make healthier choices.

Dr. Ryan Meili is an advisor with EvidenceNetwork.ca, a medical doctor, and the author of A Healthy Society.

March 2014

See the two posters, 1 and 2 based on this commentary

This work is licensed under a Creative Commons Attribution 4.0 International License.