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|Philip Astles |
Senior Research Associate
Health Innovation, Policy and Evaluation
Given the focus of our health care system on treating disease and injury, it should be called the “health restoration” system. Our highly trained clinical professionals do a fantastic job of mending our bodies when they are compromised by disease, accidents, and/or the ravages of time (sadly, our minds might not receive as much attention as they should). These professionals have, at their disposal, ingenious technologies provided by the pharmaceutical and medical devices industries to ply their skills and knowledge effectively. This set up does a pretty good job of helping us to recover when our body is sick. This health restoration process is obviously not only good for the individual, but also for the economy (e.g., a recent CBoC report estimates that each dollar spent on a drug returns two dollars in regained productivity and other benefits).
However, it can be argued that maintaining health, rather than restoring health, could bring even greater societal benefits. With the notable exception of vaccinations, the majority of the time, effort, and money in the health sector is spent on helping us regain the health we have lost. Maintaining the health we already have has been sorely neglected.
In a recent TED book, Rishi Manchanda argues that doctors should look beyond treating symptoms and try to tackle the root causes of health problems. Designing a system that would give health professionals the time, space, and power to do this would be revolutionary. However, it seems to me that this still only goes one step further than the current situation, albeit an important and difficult one. The final step would be for the health care system to get more involved in caring for the health we have.
Current spending on public and preventative health is woeful. There is evidence that preventing disease lowers health care costs and increases productivity. This would make increased spending on public and preventative health a key piece to the puzzle of creating a sustainable health system.
For example, it has been reported that in the U.S., annual health care costs are $2,000 higher for smokers, $1,400 higher for people who are obese, and $6,600 higher for those who have diabetes, than for non-smokers, people who are not obese, or people who do not have diabetes.1 But the fact is that most of us eat terribly, don’t exercise enough, and live in a stressful environment. In our recent provincial health care benchmarking report, we pointed out that lifestyle factors are associated with the prevalence of ill health. Hardly a revolutionary finding, but one that should be used as an indication that if we want our health system to keep us healthy, it has to influence these factors.
An infographic posted by the Canadian Medical Association neatly summarizes how important social determinants are for health. These socio-economic factors shape the lifestyle we choose and the environment we live in. (Read CBoC Chief Economist Glen Hodgson’s argument for directly changing socio-economic factors through guaranteed annual income.) Our health system and health experts could be more involved in policy and decisions related to these socio-economic determinants of health. And some of the current health care spending could go toward changing (or nudging as my colleague Jeannette Lye might say) these socio-economic factors and lifestyle choices to a direction that would prevent people from getting sick.
Acting on these ideas, more areas of government policy would support the maintenance of health. And, the efforts of the health system would be better balanced between health promotion and restoring health that was lost. Let’s design a system that helps prevent us from getting broken in the first place rather than just maintaining a system that just fixes us after the fact.