It surprises most people to know that about one in 200 Canadians is detained or incarcerated in jail or prison every year, and that the average length of stay in these facilities is only a few weeks. Time spent in jail or prison can serve as an opportunity to improve health. But achieving this goal will require a change in attitudes about health care in custody and reforming health care in correctional facilities.
Recently, I was fortunate to attend the Global Symposium on the Role of Physicians and National Medical Associations in Addressing Health Equity and the Social Determinants of Health held in London, England. I sat down with Dr. Simpson to explore the stories, the evidence and the politics that come into play when doctors are actors for social change.
Saskatchewan is among a number of regions in Canada, such as Manitoba and even our nation's capital, currently experiencing alarming spikes in the spread of HIV. B.C. has an impressive track record for slowing the spread of HIV/AIDs in the province. The B.C. Centre created a Treatment as Prevention strategy which provides widespread access to HIV testing, care, support and treatment. Keys to the strategy's success have been political commitment, programmatic focus, ongoing innovation coupled with monitoring and evaluation, appropriate resourcing and free services (including fully free antiretroviral therapy (ART)).
There has been a dramatic increase in the number of Canadians living with obesity over the past few decades and it is often cited as a risk factor for other chronic health conditions including type 2 diabetes, hypertension, cardiovascular disease and some forms of cancer. This means that obesity is frequently a hot topic in the news. But media stories often miss the mark when it comes to informing Canadians about the complex factors that lead to obesity.
Last fall when I visited Canada, I met a Toronto doctor named Gary Bloch who has developed a poverty tool for medical practitioners. Bloch's idea was to zoom in on the social determinants of health -- food, housing, transportation -- all poverty markers linked to bad health and poor health outcomes.
The evidence for the link between factors determined by social policy and health outcomes is crystal clear. Decades of studies have demonstrated that income and its distribution, education, employment, housing, food security and the wider environment have far greater impact than health care in influencing our health.
This isn't just an American problem. Hundreds of thousands of Canadian children are growing up without enough. Low-income children, especially minorities and aboriginals, are growing up at an increased risk of preventable diseases -- diseases both classically medical and mental health related that arise as a result of their early living conditions and will affect us all. These numbers don't simply represent difficult childhoods; they mark a huge group of Canadians who are growing up without the supportive environments they need to develop into healthy adults.
Andrea Horwath wants things to 'Make Sense,' Tim Hudak 'Wants a Million Jobs,' and Kathleen Wynne has 'A Plan for Ontario.' One can't expect too much from platform titles, but none of the policy books display a focus on improving the health of Ontarians via bettering their social conditions as a primary driver. This leaves it up to the voters to read between the lines.
Last month, it was reported that an Edmonton woman was badly beaten by her spouse. Though the attack put her in the hospital, the police offered a silver lining by stating that her unborn baby, at least, wasn't harmed. Sadly, this claim underestimates the profound effect severe stress can have on children's development in their first years of life, including while they're still in the womb.
In a recent study researchers called doctors' offices in Toronto while playing the role of a person looking for a family physician. Doctors' offices were 58 per cent more likely to offer an appointment if the caller mentioned that he or she had a high-status job than if he or she mentioned receiving welfare.
What would you think if your doctor handed you a prescription that recommended filing your tax returns or applying for food or income benefit programs instead of the usual medicines for high blood pressure or diabetes? You'd probably say the physician was nuts. Tax refunds? Food? What do they have to do with making you healthier?
Living in poverty is not just an economic and political issue, but fundamentally an issue of human health. Income is the strongest determinant of health. How much you make is more important than what you eat, how much you exercise, or even your genetic make-up. A recent series of articles in the Ontario Medical Review highlights the fact that poverty is a medical problem, and healthcare providers are seeing the impacts on the front lines. We know that people on social assistance have a suicide rate 18 times higher than those in the highest income bracket. Something needs to be done.
The gap between rich and poor in Canada is growing. What is indisputable to those of us working in the health care sector is its effect on health of Canadians. Health is a concern common to all, regardless of political affiliation, and does not exist in isolation from this growing problem. Evidence continues to mount that rising income inequality is contributing to the deterioration of the health of all people in Canada, regardless of their income level. As a family doctor who sees the impacts of public policies on the front lines, I find myself nodding in agreement to calls to action. The time for leadership on this issue has come.
The Canadian Medical Association's 145th annual meeting is taking place this week. The mantra of the meeting is health equity, and Sir Michael Marmot, the white knight of social determinants, undoubtedly provides the human and scholarly element the issue of inequality deserves. There may be no better person to articulate Canada's barriers to better health outcomes.