In all the talk about health care sustainability we lose sight of the fact that the interventions that cost the least and are likely to have the biggest impact on population health take place outside the confines of the Ministry of Health.
Regulation has become a dirty word, made so by those who have a vested interest in making profits from activities that may not necessarily be in our best interests.
As a public we all subsidize this bad behavior in part through higher health care costs. Ottawa’s Dr. Yoni Freedhoff, for example, points out that a single serving Coca Cola bottle of our grandparents’ generation was less than a third of the size of what kids buy today at a typical vending machine or corner store. Three times the sugar, three times the calories. While I can hear the howls of freedom of choice from here, we have less freedom of choice when it comes to all of us paying the health costs related to rising rates of diabetes.
What if we were to regulate the soft drink industry to establish a standard size for a single-serving beverage? Would the wheels of industry come to a halt? Would thousands be thrown out of work? Of course not.
We don’t regulate for several reasons. For starters we keep on electing people to office who oppose the idea of government. Secondly, these same people have persuaded us that we can’t trust government. Third we have replaced our faith in government with a blind faith in business even though the root of many of our modern-day scandals is in the relationship between the two.
Rob Ford’s public defense of his boorish behavior is not that he led us as Mayor to a better Toronto – but that he saved the city money. Sadly, for too many that’s enough, even as they seethe in bumper-to-bumper traffic, can’t find affordable housing, or are confronted by the daily face of homelessness among so much wealth.
If we are really serious about building a better health system, we need to start by building a better government. One that isn’t afraid of standing up for the public interest. That may sound trite, but it is one that would require a massive change in how we think.
Any public policy decision presently requires that it be viewed through the lens of cost to government.
What if we required all decisions made by municipal, provincial and federal governments to first look at the population health impacts and report on their findings as part of the process?
The Toronto Star recently reported that Ontario households on the wait list for affordable housing have hit the highest level ever. If the politicians dealing with this question had to estimate the health effects of homelessness, substandard housing, or families paying too high a percentage of their income on housing, then dealing with this issue would likely rise in priority. It would not be a matter of whether we can afford to address the issue of affordable housing, but can we afford not to? How does the more than $800 million in backlogged repairs at Toronto Community Housing compare to annual provincial public health care bill that’s $48 billion and climbing?
There’s been a lot of attention spent recently in the United States on the concept of a living wage. It’s not a new concept – the Catholic Church, for example, has believed that workers should be paid a living wage since the early 1800s.
The argument goes that we are all subsidizing the profits of companies like Wal-Mart through social supports to people who have little choice but to work for them. Recently we reported that the not-for-profit VON paid so little to its personal support workers in Grey Bruce Counties that some of these workers had to rely on food banks to feed their children. Given the VON’s funding largely comes from government contracts, does this make any sense?
If government were to look at the issue of minimum wage through the population health lens, again, the outcome could be very different.
The Globe and Mail recently produced an excellent series on the effects of rising inequality. Inequality is not an inevitable outcome of our economic structures but the result of choices we have made over the last three decades. Instead of spending our time on a single human tragedy unfolding at Toronto City Hall, we should be focusing on solutions for the greater human tragedy that is taking place as a result of that growing inequality gap. That includes addressing the minimum wage.
International studies have shown that growing inequality has a direct cause and effect impact on rising mental illness. Remarkably, relatively poor but more equal countries are likely to have better population mental health than relatively rich countries with greater inequality.
The cost of mental illness in Canada is staggering. Measured just on its impact to the workplace, it’s estimated that mental illness costs us $20 billion annually.
We’ve consumed so much energy on the squandering of $1 billion on cancelled gas plants in Ontario. It is therefore curious that we remain silent about inaction on mental illness and its root causes despite the fact that is costing us 20 times the gas plants each and every year.
If there is one way we could kick-start change, it would be by asking that one question: what is the impact of this decision on population health?