{"id":3635,"date":"2013-09-30T11:45:12","date_gmt":"2013-09-30T15:45:12","guid":{"rendered":"http:\/\/www.cachc.ca\/?p=3635"},"modified":"2014-01-05T14:38:57","modified_gmt":"2014-01-05T19:38:57","slug":"health-cares-real-iceberg","status":"publish","type":"post","link":"https:\/\/www.cachc.ca\/fr\/health-cares-real-iceberg\/","title":{"rendered":"Health Care’s Real Iceberg"},"content":{"rendered":"

\"\"A Medicare@50 blog post by:
\n<\/em><\/span>Russ Ford<\/span> (@RussJamesFord<\/a>) \u2013 Executive Director
\n<\/span><\/em>LAMP Community Health Centre (Toronto ON)<\/span><\/em><\/p>\n

Ryan Meili does not wear a beret. In fact, I doubt he even owns a Che tee-shirt. He does not\u00a0 emphatically wave his arms while speaking. Some revolutionary?!\u00a0<\/span>Ryan Meili does<\/em> wear a suit, speaks softly and is a doctor from Saskatoon. With no political experience he ran for the leadership of the Saskatchewan NDP, the province’s natural governing party and finished second. His campaign was based on the social determinants of health. Yes, some revolutionary.<\/span><\/p>\n

Dr. Meili is the founder of a new organization called<\/span>\u00a0Upstream: Institute for a Healthy Society<\/a><\/strong>, <\/em>launched on September 27 at the national Community Health Centres conference — Medicare@50 —<\/span> in Saskatoon<\/span>.\u00a0The purpose of Upstream is to\u00a0change the way you and I think about health care. \u00a0He uses an analogy of a river to\u00a0explain it:<\/span><\/p>\n

\u00ab\u00a0One day you are on the bank of a river and you see a child drowning.\u00a0 You\u00a0jump in and save the child. Soon another\u00a0child comes down the river, whom\u00a0you also save, and the more you save the more that come down the river. Eventually\u00a0you go up the river to see why so many children are falling in the water.\u00a0\u00bb<\/span><\/p>\n

Applying that analogy to our health system the obvious question is: why do we continue to direct all our efforts at treating people rather than spending some resources on trying to figure out why they got sick in the first place?<\/span><\/p>\n

Seems to make sense, but we do not do it. The current direction in Ontario, for example, is to see if we can address the needs of those that use the services the most. The belief is that if the care received by these people was better managed it would result in savings to the system.<\/span><\/p>\n

While there is certainly nothing wrong\u00a0 with trying to spend your resources in a more efficient manner, it is an example of short-term, downstream thinking.\u00a0 It is an approach an economist would prescribe, not a healthcare provider. It is just like pulling the child from the river.<\/span><\/p>\n

Upstream thinking is about redirecting the emphasis from treatment to the causes of ill\u00a0health. To use a clich\u00e9, it is a paradigm shift.<\/span><\/p>\n

So what are the causes of ill health? Well for that we go to that leftist\u00a0organization the Canadian institute for Health Information. They concluded that the five\u00a0leading causes of ill health are:<\/span><\/p>\n

    \n
  1. poverty<\/span><\/li>\n
  2. lack of education<\/span><\/li>\n
  3. lack of social support\u00a0networks<\/span><\/li>\n
  4. employment and working conditions<\/span><\/li>\n
  5. early childhood development<\/span><\/li>\n<\/ol>\n

    The holy trinity of health promotion — \u00a0\u00ab\u00a0don’t smoke\u00a0\u00bb, \u00a0\u00ab\u00a0get some exercise\u00a0\u00bb and \u00ab\u00a0watch your weight\u00a0\u00bb do not appear on the list. Yet, the majority of the meager dollars we put into health promotion stress these narrow lifestyle issues.<\/span><\/p>\n

    The truth is that it is much easier to get someone to stop smoking than it is to get them out of poverty. It is much easier to give a person a pill for high blood pressure than to teach them to read.\u00a0 But like our \u00ab\u00a0tough on crime agenda\u00a0\u00bb it is totally useless.\u00a0 I doubt there is anyone who does not know by now the perils of smoking and there is not much more we can do to discourage it, but we still pump money into anti-smoking programs.<\/span><\/p>\n

    As a doctor, Meili is trained to go by evidence not hunches or gut feelings. So what is his evidence?<\/span><\/p>\n

    If you live in the centre if Saskatoon where Meili practices, \u00a0you are living in one of the most impoverished areas in Canada.\u00a0 If you live there, the \u00a0research shows that you are fifteen times more likely to contract a sexually transmitted infection; fifteen more times likely to commit suicide; thirty-five times more likely to get Hep C and thirteen times more likely to have type-two diabetes. The infant mortality rate is three times higher and a resident of this community \u00a0is 2.5 times more likely to die within the year. The evidence is there.<\/span><\/p>\n

    So if addressing poverty and the issues that accompany it like racism would make\u00a0people healthier and reduce costs in a much more significant way, why are we not doing anything about it?<\/span><\/p>\n

    To do that we would \u00a0have to change the way we \u00ab\u00a0do politics\u00a0\u00bb and the way we think about it.<\/span><\/p>\n

    The way we currently do politics is a disservice to this country. We are more interested in scandals, especially if sex is involved. We dumb down debate to attack ads and the\u00a0issues that many face no longer seem to be relevant to our political masters. Scoring\u00a0debating points in question period seems to be what is important. Getting elected is more important than telling the truth, especially if the truth is what the polls\u00a0tell you the people do not want to hear.<\/span><\/p>\n

    So let’s change it. Meili almost became leader of the Saskatchewan NDP by not succumbing to the tired old approach. Let’s start by making evidence-based decisions and challenging those that are not based on evidence.<\/span><\/p>\n

    Take crime as an example. There is not one shred of evidence to support the \u00ab\u00a0get tough on crime agenda\u00a0\u00bb. Yet the government initiates it and the opposition parties, fearful that the public will see them as \u00ab\u00a0soft on crime\u00a0\u00bb if they oppose it, meekly accept it. Perhaps the opposition should have more faith in us and present the evidence. \u00a0It is not hard to find. It is one Google search away.<\/span><\/p>\n

    Mike Harris, former Premier of Ontario, would often say that the best social program is a job. In other words, a\u00a0strong economy will cure most if not all that ails us. He was wrong, or to be more charitable, he way out of date.<\/span><\/p>\n

    The new global economy has only increased inequity, even during times of growth. An increase in GDP historically meant that most members of society prospered.\u00a0We now know that is no longer true. A strong GDP now means nothing to the lives of most\u00a0Canadians<\/span><\/p>\n

    Many have argued that our future health care system will find itself in crisis largely\u00a0because people are living longer.\u00a0 We have moved from a system that previously addressed episodic illnesses to one that is now focussed on chronic disease management.\u00a0 But to suggest that chronic disease will be the iceberg that derails our health system is simply nonsense.<\/span><\/p>\n

    The money is there, or at least it was there until governments started cutting our taxes, especially those of corporations, literally taking billions out of the public treasury. The lost tax-cut money can easily finance those costs and there will be even money left over to buy the military all the toys it wants.<\/span><\/p>\n

    No, chronic disease will not be our undoing. Our undoing will be a failure to\u00a0acknowledge and address the fact that our new economic order is causing more and\u00a0more Canadians to be sick by creating more inequality.<\/span><\/p>\n

    The easy solution would be to enter our political parties into a rehab program in order to end their addiction to public opinion polls. Can you imagine how politics would be different if our parties stood for something, and acted on principle rather than focussed on what the polls tell them we want to hear?<\/span><\/p>\n

    Doing politics differently means starting\u00a0 to say what needs to be said.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

    A Medicare@50 blog post by: Russ Ford (@RussJamesFord) \u2013 Executive Director LAMP Community Health Centre (Toronto ON) Ryan Meili does not wear a beret. In fact, I doubt he even owns a Che tee-shirt. He does not\u00a0 emphatically wave his arms while speaking. Some revolutionary?!\u00a0Ryan Meili does wear a suit, speaks softly and is a doctor from Saskatoon. With no […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[42],"tags":[],"class_list":["post-3635","post","type-post","status-publish","format-standard","hentry","category-medicare-50"],"yoast_head":"\nHealth Care's Real Iceberg - ACCSC<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Health Care's Real Iceberg - ACCSC\" \/>\n<meta property=\"og:description\" content=\"A Medicare@50 blog post by: Russ Ford (@RussJamesFord) \u2013 Executive Director LAMP Community Health Centre (Toronto ON) Ryan Meili does not wear a beret. In fact, I doubt he even owns a Che tee-shirt. He does not\u00a0 emphatically wave his arms while speaking. Some revolutionary?!\u00a0Ryan Meili does wear a suit, speaks softly and is a doctor from Saskatoon. With no […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/\" \/>\n<meta property=\"og:site_name\" content=\"ACCSC\" \/>\n<meta property=\"article:published_time\" content=\"2013-09-30T15:45:12+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2014-01-05T19:38:57+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/www.cachc.ca\/wp-content\/uploads\/2013\/07\/Russ-Ford.jpg\" \/>\n<meta name=\"author\" content=\"CACHC\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@http:\/\/www.twitter.com\/cachc_accsc\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"CACHC\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/\"},\"author\":{\"name\":\"CACHC\",\"@id\":\"https:\/\/www.cachc.ca\/#\/schema\/person\/f7a9613a6a97d50bfc7cd08297bfba75\"},\"headline\":\"Health Care’s Real Iceberg\",\"datePublished\":\"2013-09-30T15:45:12+00:00\",\"dateModified\":\"2014-01-05T19:38:57+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/\"},\"wordCount\":1228,\"commentCount\":0,\"image\":{\"@id\":\"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/#primaryimage\"},\"thumbnailUrl\":\"http:\/\/www.cachc.ca\/wp-content\/uploads\/2013\/07\/Russ-Ford.jpg\",\"articleSection\":[\"Medicare at 50: Our Healthy Future and the Role of CHCs\"],\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/\",\"url\":\"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/\",\"name\":\"Health Care's Real Iceberg - ACCSC\",\"isPartOf\":{\"@id\":\"https:\/\/www.cachc.ca\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/#primaryimage\"},\"thumbnailUrl\":\"http:\/\/www.cachc.ca\/wp-content\/uploads\/2013\/07\/Russ-Ford.jpg\",\"datePublished\":\"2013-09-30T15:45:12+00:00\",\"dateModified\":\"2014-01-05T19:38:57+00:00\",\"author\":{\"@id\":\"https:\/\/www.cachc.ca\/#\/schema\/person\/f7a9613a6a97d50bfc7cd08297bfba75\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/#primaryimage\",\"url\":\"http:\/\/www.cachc.ca\/wp-content\/uploads\/2013\/07\/Russ-Ford.jpg\",\"contentUrl\":\"http:\/\/www.cachc.ca\/wp-content\/uploads\/2013\/07\/Russ-Ford.jpg\"},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.cachc.ca\/#website\",\"url\":\"https:\/\/www.cachc.ca\/\",\"name\":\"ACCSC\",\"description\":\"Les centres de sant\u00e9 communautaire au Canada\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.cachc.ca\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"fr-FR\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/www.cachc.ca\/#\/schema\/person\/f7a9613a6a97d50bfc7cd08297bfba75\",\"name\":\"CACHC\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/www.cachc.ca\/wp-content\/uploads\/avatars\/1\/618d3fabd6238-bpfull.png\",\"url\":\"https:\/\/www.cachc.ca\/wp-content\/uploads\/avatars\/1\/618d3fabd6238-bpfull.png\",\"contentUrl\":\"https:\/\/www.cachc.ca\/wp-content\/uploads\/avatars\/1\/618d3fabd6238-bpfull.png\",\"caption\":\"CACHC\"},\"description\":\"Communications profile and account for CACHC\",\"sameAs\":[\"http:\/\/www.cachc.ca\",\"https:\/\/x.com\/http:\/\/www.twitter.com\/cachc_accsc\"],\"url\":\"https:\/\/www.cachc.ca\/fr\/chcommunity\/participants\/cachc\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Health Care's Real Iceberg - ACCSC","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/","og_locale":"fr_FR","og_type":"article","og_title":"Health Care's Real Iceberg - ACCSC","og_description":"A Medicare@50 blog post by: Russ Ford (@RussJamesFord) \u2013 Executive Director LAMP Community Health Centre (Toronto ON) Ryan Meili does not wear a beret. In fact, I doubt he even owns a Che tee-shirt. He does not\u00a0 emphatically wave his arms while speaking. Some revolutionary?!\u00a0Ryan Meili does wear a suit, speaks softly and is a doctor from Saskatoon. With no […]","og_url":"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/","og_site_name":"ACCSC","article_published_time":"2013-09-30T15:45:12+00:00","article_modified_time":"2014-01-05T19:38:57+00:00","og_image":[{"url":"http:\/\/www.cachc.ca\/wp-content\/uploads\/2013\/07\/Russ-Ford.jpg","type":"","width":"","height":""}],"author":"CACHC","twitter_card":"summary_large_image","twitter_creator":"@http:\/\/www.twitter.com\/cachc_accsc","twitter_misc":{"\u00c9crit par":"CACHC","Dur\u00e9e de lecture estim\u00e9e":"6 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/#article","isPartOf":{"@id":"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/"},"author":{"name":"CACHC","@id":"https:\/\/www.cachc.ca\/#\/schema\/person\/f7a9613a6a97d50bfc7cd08297bfba75"},"headline":"Health Care’s Real Iceberg","datePublished":"2013-09-30T15:45:12+00:00","dateModified":"2014-01-05T19:38:57+00:00","mainEntityOfPage":{"@id":"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/"},"wordCount":1228,"commentCount":0,"image":{"@id":"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/#primaryimage"},"thumbnailUrl":"http:\/\/www.cachc.ca\/wp-content\/uploads\/2013\/07\/Russ-Ford.jpg","articleSection":["Medicare at 50: Our Healthy Future and the Role of CHCs"],"inLanguage":"fr-FR","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/www.cachc.ca\/health-cares-real-iceberg\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/","url":"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/","name":"Health Care's Real Iceberg - ACCSC","isPartOf":{"@id":"https:\/\/www.cachc.ca\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/#primaryimage"},"image":{"@id":"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/#primaryimage"},"thumbnailUrl":"http:\/\/www.cachc.ca\/wp-content\/uploads\/2013\/07\/Russ-Ford.jpg","datePublished":"2013-09-30T15:45:12+00:00","dateModified":"2014-01-05T19:38:57+00:00","author":{"@id":"https:\/\/www.cachc.ca\/#\/schema\/person\/f7a9613a6a97d50bfc7cd08297bfba75"},"inLanguage":"fr-FR","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.cachc.ca\/health-cares-real-iceberg\/"]}]},{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/www.cachc.ca\/health-cares-real-iceberg\/#primaryimage","url":"http:\/\/www.cachc.ca\/wp-content\/uploads\/2013\/07\/Russ-Ford.jpg","contentUrl":"http:\/\/www.cachc.ca\/wp-content\/uploads\/2013\/07\/Russ-Ford.jpg"},{"@type":"WebSite","@id":"https:\/\/www.cachc.ca\/#website","url":"https:\/\/www.cachc.ca\/","name":"ACCSC","description":"Les centres de sant\u00e9 communautaire au Canada","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.cachc.ca\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"fr-FR"},{"@type":"Person","@id":"https:\/\/www.cachc.ca\/#\/schema\/person\/f7a9613a6a97d50bfc7cd08297bfba75","name":"CACHC","image":{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/www.cachc.ca\/wp-content\/uploads\/avatars\/1\/618d3fabd6238-bpfull.png","url":"https:\/\/www.cachc.ca\/wp-content\/uploads\/avatars\/1\/618d3fabd6238-bpfull.png","contentUrl":"https:\/\/www.cachc.ca\/wp-content\/uploads\/avatars\/1\/618d3fabd6238-bpfull.png","caption":"CACHC"},"description":"Communications profile and account for CACHC","sameAs":["http:\/\/www.cachc.ca","https:\/\/x.com\/http:\/\/www.twitter.com\/cachc_accsc"],"url":"https:\/\/www.cachc.ca\/fr\/chcommunity\/participants\/cachc\/"}]}},"_links":{"self":[{"href":"https:\/\/www.cachc.ca\/fr\/wp-json\/wp\/v2\/posts\/3635","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.cachc.ca\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.cachc.ca\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.cachc.ca\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.cachc.ca\/fr\/wp-json\/wp\/v2\/comments?post=3635"}],"version-history":[{"count":0,"href":"https:\/\/www.cachc.ca\/fr\/wp-json\/wp\/v2\/posts\/3635\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.cachc.ca\/fr\/wp-json\/wp\/v2\/media?parent=3635"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.cachc.ca\/fr\/wp-json\/wp\/v2\/categories?post=3635"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.cachc.ca\/fr\/wp-json\/wp\/v2\/tags?post=3635"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}