Late last week, the federal and provincial ministers of health met to discuss future health spending, with an eye on replacing the current federal and provincial accord, which expires in 2014.
Demographics are often cited as a major future cost for our health care system. That makes sense: people in their 60s and 70s need new hips and knees far more than those in their 20s and 30s. Today, under 14 per cent of the population is 65 or older, yet the elderly account for 44 per cent of health spending. With aging demographics, the pressure on government budgets will be greater.
But in our focus on aging demographics and spending, we are missing another major cost driver: poor health.
Here's the paradox in modern health care: medicine has never been better, but we seem to be getting collectively less healthy.
Last week, the OECD released its annual report on health for its 34 member nations. The data -- effectively inside baseball for policy wonks -- was lightly covered in the news. But a careful look at the numbers underscores the above paradox.
In terms of medicine, the news is good.
Since 1980, deaths by ischemic heart disease and stroke are down -- way down.
And the good news continues. Consider cancer.
For women diagnosed with breast cancer in 2004, the five-year survival rate was 84 per cent. That's up, and up big, since 1997, from 79 per cent for those diagnosed. Canada, for the record, outperformed the OECD average, at 87 per cent.
Not surprisingly, with so much advancement in medicine, Canadians live longer than ever. Since 1960, life expectancy has grown 9.4 years.
But, alas, the health news isn't all good.
Obesity rates continue to rise dramatically. Roughly a third of the American population is obese.
University of California Professor Richard McKenzie attempts to explain this phenomenon in his new book, HEAVY! The Surprising Reasons America is the Land of the Free - and the Home of the Fat. The average American now weighs 26 pounds more than he or she did in 1960.
Summarizing his book for the Daily Beast, McKenzie notes how the weight gain has changed the country:
[Americans'] added tonnage equals the weight of 120,000 tractor-trailer trucks that, if put end-to-end, would stretch from Los Angeles to at least St. Louis, or 34 million 1960-equivalent adults.
These images of weight gain make it easy to understand why Americans began buying large SUVs in the 1980s, why rescue squads and hospitals have started using reinforced gurneys, why stadium and concert halls have had to widen their seats, and why Disney had to upgrade the carrying capacity of the boats in its hugely popular Small World ride--because it's no longer a small world.
The reason? From reductions in tariffs to women's liberation, he argues that many factors made America, well, heavy -- though he sees one general trend: weight is linked to greater economic freedom. America is fat, in other words, because she is free.
But a quick look at the OECD data shows how myopic McKenzie view is. Yes, American obesity rates soar. But, alas, the world is fat.
The OECD numbers yield slightly different results than other studies. A Canadian paper, for instance, pegged the percentage of obese Canadians at one in four -- hardly American levels, but roughly double the percentage of a quarter century ago, and among the heaviest of the Western world.
At their meeting, the ministers of health spoke about childhood obesity. "It's not the next epidemic, it's the present epidemic," said Quebec Minister of Health Yves Bolduc, a medical doctor.
But besides a press conference and general agreement on the problem, the ministers of health committed to little.
What's to be done? There are no easy answers. That said, here are a few ideas.
Back to basics. We need to emphasize physical education in our schools. Children are spending too much time playing sports on their PS3, and not enough time playing sports in the real world.
Let's stop promoting and subsidizing bad food. Agricultural subsidies and regulations shouldn't use taxpayers money for unhealthy foods or to overprice healthy ones (think dairy).
Finally, let's recognize the obvious: incentives matter. In the British experiment Pounds for Pounds, people received compensation for losing weight. No surprise here: many did.
In the coming years, we'll need to carefully re-examine how we pay for our health care system. Some argue for more robust government funding; others see a larger role for the private sector. But all should agree that the best reform is to keep people out of the health-care system by having a healthier population. And that, alas, has nothing to do with a new federal-provincial accord, and everything to do with addressing our obesity epidemic.