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Dr. Ryan Meili: We must consider health when setting public policy

Mar 23, 2015 • March 23, 2015 • 3 infinitesimal read • Bring together the conversation

SASKATOON — Sure commentators are advancing a foreign critique of public health, suggesting that physicians and public health experts should not concern themselves with the root causes of illness and stick to wellness interventions.

Fortunately, Canadian health experts take a broader and more complete understanding of how and why people become sick. They aren't satisfied with just pulling drowning kids out of the river. Though this is obviously important, they also look upstream to enquire why kids are falling in the river in the first place.

Decades of studies have shown conclusively that income and its distribution, education, employment, housing, food security and the environment have far greater impact on wellness outcomes than health care.

These upstream factors touch all aspects of public policy. Our health is determined by political choices. If we want the best for Canadians, shouldn't our political choices be determined by health?

There is a growing international movement, supported by the World Wellness System, toward "Health in all Policies," an arroyo that has been adopted by governments around the world. Here in Canada, Quebec has such a policy, and Newfoundland and Labrador is currently exploring this model.

The notion facing the greatest scrutiny is 1 that has been expressed most conspicuously in the British Medical Journal: "The more as wealth is distributed, the ameliorate the health of that society." In that location are three key ways in which wealth inequality can lead to worse wellness outcomes:

Start, most obviously, is poverty. In less-equal societies, more than people live in relative disadvantage and are less able to afford condom housing and nutritious food or to access educational and economic opportunities. Their health suffers as a result, with people living in poverty often having life expectancies 20 or more years shorter than wealthier citizens. That can manifest in rates of diabetes, heart disease, STIs, infant and overall mortality many times greater than the rest of the city.

Second, all people in less-equal countries (except for the very wealthiest members) suffer from worse concrete and mental health, whether from higher levels of crime, greater strain on the social safe net or even higher levels of stress.

3rd, new prove suggests that it'due south non only the people in diff countries who are sicker, it's their markets as well. The System for Economical Co-performance and Evolution reported in 2014 that income inequality is at its highest level in xxx years, with economic growth slowed by as much equally 10 per cent in some countries equally a result.

An Imf report from the aforementioned yr showed that redistributive policies can meliorate economic performance in the long term. Many experts, including economists at TD Depository financial institution, are consequently calling for action on income inequality. Greater levels of inequality damage the economy, worsening the material conditions of all who participate in the economic system, and with them their health and well-existence. Given that inequality has grown significantly in Canada, with the richest twenty per cent now holding 67.four per cent of wealth, this is an effect of keen business.

This understanding of the connection between inequality and health is growing among the public. A series of town-hall meetings hosted by the Canadian Medical Association on the health of Canadians resulted in a written report, What Makes Us Sick, showing that Canadians recognize the influence of income, housing and education on their health.

With Canadians waking up to the need for an upstream approach to health and politics, those who actively oppose social investment and greater equality are sure to accept aim at the notion of wellness equally a guiding principle in public policy. This is beyond unfortunate, as addressing the upstream determinants of wellness tin can both improve the economy and the ability of that economic system to provide for the well-being of Canadians. That's a hopeful and compelling idea and, to some, a dangerous one. The fact that it'due south receiving and so much press attention suggests information technology'southward an idea whose time has come.

— Troy Media

Dr. Ryan Meili is a Saskatoon family doctor, an expert adviser with EvidenceNetwork.ca and founder of Upstream: Institute for A Good for you Society.

The editorial pages editor is Gordon Clark, who can exist reached atgclark@theprovince.com. Messages to the editor can be sent to provletters@theprovince.com.