Next week the Canadian Medical Association meets in Newfoundland. The program looks interesting, as always. The education sessions on Sunday afternoon will be on Health Care Transformation and preparing for the renegotiation of the Health Accord between the federal government and the provinces and territories in 2014.
As always, the CMA will be encouraging its members to get involved in policy and therefore the politics of health and health care. CMA President, the impressive Dr. Jeffrey Turnbull, has spent his term demonstrating his understanding of the importance of involving Canadians in the fight for the future sustainability of health care in Canada. Last week, he published the report "Voices into Action" -- evidence of the solid support Canadians have for their most cherished social program. The concerns expressed in the report are valid; in some parts of Canada the wait lists are still way too long, and too many Canadians are without a family doctor. I believe Canadians should be able to expect real strategies with hard targets to address these issues. We need Canadians to have confidence in our health care system in order to have Canadians onside as we try to truly transform the health care system into a genuine system for health.
The sustainability of our health care system will require two commitments:
1) A commitment across all government departments and all jurisdictions for policies and programs that take responsibility for the health of Canadians;
2) A commitment to an integrated and accountable health care system that spends its money wisely based on the ongoing collection of evidence for achieving better outcomes.
Many of us have fantasized about a big 'RESET' button we could push that would magically transform our system from one based upon a 'repair-shop model' into Tommy Douglas' original goal for medicare -- keeping Canadians well, not just patching them up when they get sick. From Marc Lalonde's "New Perspectives on the Health of Canadians," to "The Ottawa Charter for Health Promotion," to Monque Begin's fabulous leadership on the WHO Commission of the Social Determinants of Health, Canada has led the way in building the evidence and the theory regarding the importance of disease prevention, health promotion and the social determinants of health.
With the Kelowna Accord, Paul Martin's government tried to close the gap in health status for First Nation, Metis and Inuit people by addressing housing, education and economic issues. In the 2004 Health Accord, all governments committed to determining Health Goals for Canada with real targets and indicators.
I believe that in order to really transform the system we need citizens actively pulling for healthy public policy. We must make sure that the evidence on which the policies are based is translated into easily understandable language. There is no question that when citizens have the facts, the political will of the decision-makers to get on with putting evidence-based policies into practice suddenly materializes! When the outcomes of programs are continually measured and the results are transparent, citizens have the power necessary to insist on cost-effective and better programs.
A Systems Approach to Healthy and Effective Public Policy:
I believe that engaged citizens can drive this virtuous cycle much faster than we have been able to do to date. Increased health literacy (citizens aware of evidence of what works for their bodies and the system) and increased civic effectiveness can drive the changes necessary for true transformation in health and health care. We all want more health for ourselves and our families and would be thrilled not to need health care. We want the system to be there and work well for us should we need it, but we'd still rather not need it!
I ended up in politics because of my fight for Women's College Hospital in Toronto. I had believed that its approach of patient-centred, multidisciplinary, hospital to community care was the future and worth fighting for! I also believed that the women's health institution was leading the way on violence against women, environmental health and patient empowerment. My patients showed me the way; almost to a person they took seriously three essential roles -- empowered patient, effective advocate and engaged citizen.
This year, the CMA's Town Halls have been important in engaging Canadians. But from Jean Chretien's National Forum on Health led by Dr. McMurtry, to the work of Romanow and Kirby, Canadians have been pretty consistent in their support for our publicly-funded health care system.
On the weekend, my son brought me three documents he's found in an old desk: the Budget 2003 document "Investing in Canada's Health Care System"; The Pocket Guide to the NHS in England 2002; and the July 13, 2003 issue of The Economist folded back at page 41 at an advertisement for the Global Future Forum "Public Sector Article No.1 -- Are governments recognizing and reacting to the new 'empowered citizen'?" by Joop de Vries.
I was impressed that they seemed to fit together -- investments in health reform, the NHS handbook to show citizens how their system worked and the article in which de Vries states that "People see the world around them increasingly in their own terms" and that governments need to pay attention.
Then I found on the dining room table three more documents that Peter had found and wanted to know if he could throw away: my "Are You Ready for Romanow Quiz -- 20 Questions to Save Medicare; my speech in the House of Commons debate during the Romanow process; and the 2001 study we did with Don Lenihan and the Library of Parliament, "Measuring Quality of Life: The Use of Societal Outcomes by Parliamentarians."
It was sobering.
Enough already, the fight for Women's College Hospital was in 1989. These documents are almost a decade old. Since then how many studies, how many Commissions, how many experts concluding pretty much the same things? As the song goes, "The answer, my friend, is blowing in the wind" -- I don't think so. The answers are right in front of us!
Health Care: The Canada Health Act is sound, but we need to focus on quality care, measure the outcomes, integrate the system and we need electronic health records in order to do that properly. We need to make sure Canadians can afford their medication and are able to access quality care outside of hospitals. We need to ensure that all Canadians have access to a Family Practice Centre.
Health: Keep people well by evidence-based policies and programs on disease and injury prevention, health promotion and addressing the social determinants of health.
My memory stick is filled with presentations on transforming our health care system to a true system for health -- to the Chiefs of Ontario, the Sauder School of Business, Brenda Zimmerman's class at the Schulich School, Hospital Volunteers Association of Ontario, etc... Many presentations have slides in common, including this Canadian Institute for Advanced Research slide which is in every presentation:
And on my quiz questions, everyone gets 100 per cent!
Do we want a strong fence at the top of the cliff or the state-of-the-art fleet of ambulances and paramedics at the bottom of the cliff? Do we want clean air or puffers and respirators for all? Should governments be boasting about how much they are spending on the health care system, or the health of their populations -- leaving no one behind.
We can and must do better. Last year the Health Minister refused to attend the CMA meeting. The doctors of Canada are trying, as are the nurses, and the whole sector. They can't do this alone. The provinces and territories want a partner in Ottawa to provide the leadership that is required on this shared venture. The federal government has direct responsibility for the equivalent of the fifth biggest province -- populations with some of the worst outcomes -- aboriginal peoples, military, veterans, corrections and RCMP.
Canadians should be able to expect more. Hopefully as the CMA leads with its "Voices into Action," all those Canadians who spoke at the roundtables and many more who didn't will take seriously their roles as empowered patients, effective advocates and engaged citizens. Political will improves markedly when citizens are paying attention. Canadians are now saying that health care is their number one priority -- we need them to know the difference between health (we want more) and health care (we want to need less) and have the tools to fight for them both.