It's that time of year. The holiday season, when people seem to be divided over embracing the joy of the season or counting down the days until January 2 with clenched teeth. I admit I am in the latter camp. While I accept that many lovely things happen for people at this time of year, my eye is drawn more to the less-spoken-of underbelly -- the slogans of goodwill that obscure the social inequality so many people face.
A friend was telling me the other day about a rule at her family gatherings, "no politics or religion." They are a particularly polarized bunch, so this rule must be strictly enforced to create any semblance of harmony. But I would guess that most holiday gatherings aren't quite so disciplined. And on that note, this holiday column focuses on the two most enduring myths about health care that may come up around holiday tables: the idea that public health care "costs too much"; and the fictitious, damaging, policy-influencing notion of an "obesity epidemic."
I have a holiday story about the first myth. It was the late 1990s. I was an undergrad and anyone who knew me at the time can confirm that I was a little bit, well, mouthy. OK, very mouthy. Sitting down to dinner, a relative informed me that the problem with our health-care system was that too many people went to emergency rooms when all they needed was a "Band-Aid." It was shortly after Conrad Black founded the National Post and the arguments coming out of my relative's mouth seemed to be extracted verbatim from its pages. I should specify that this relative is an otherwise warm and kind person, so in my memory of this conversation I patiently explained that this was not the case. And even if there were examples of people going to emergency departments for "non-urgent" medical problems, this was a crisis of access to primary care and adequate housing. (I confess that I was probably more impatient and louder than I remember.) Her rejoinder? That privatization would solve everything. That the public purse cannot afford the spiralling costs of medicare.
So a decade and a half later, it is more than a little bit satisfying to see Ontario auditor general Bonnie Lysyk's report on Ontario spending. Public-private partnerships, which include building hospitals and other health-care infrastructure, have cost Ontario $8 billion more than publicly funded projects would have. The extra costs? Private financing and "borrowing costs." Lysyk says, unequivocally, "About $6.5 billion of this is due to higher private-sector financing costs." And perhaps this information will be lobbed back at you as simply about building hospitals with little relevance to health-care delivery. For this part of the argument, I direct you to Ontario's failing experiment with private health care in last month's column on private clinics.
As Michael Rachlis points out, the costs to be worried about are not from medicare itself, but from increasing drug costs and other health services not offered within the public system. He argues that despite alarmist rhetoric, medicare costs remain stable and sustainable. Publicly delivered health care in publicly built hospitals is the most cost-effective option (not to mention the only way we can work toward a more equitable and just society).
And if any of this gets especially heated and you're feeling especially cheeky, just whip out your smartphone and play Canadian doctor Danielle Martin's excellent deposition on medicare to the U.S. Senate.
The myth of the 'obesity epidemic'
The second myth is more insidious. Discussions of calorie-counts, fat-content, diets and weight loss dominate mealtimes in many homes, especially during holidays. This common approach to our bodies and health is so ubiquitous that when media starts reporting that "the obesity epidemic" is costing "us" trillions (more than terrorism!), too many people accept such statements uncritically.
There are so many things wrong with this math. We should start with the dubious science that attempts to use body weight as a health metric at all. In this summary of "obesity skeptics" Michael Gard and Jan Wright's work it is pointed out that epidemiologists have failed to make the case. Weight loss does not guarantee better health outcomes and dieting can actually have a negative impact on overall health. In addition to this critical perspective, is the stark truth that blaming people for their health status and shaming them about their physical appearance is not only offensive, but also offers a very convenient way to shift emphasis away from the social and political factors that have a much greater effect on our health. In Canada, the top six determinants of health include income, social status, education, working conditions and physical and social environments.
We don't need diet tips. We need guaranteed incomes and safe housing. We need social infrastructure that values people as people. A team of doctors at St. Michael's hospital in Toronto have launched a project that approaches health this way. The team is finding that supporting people through concrete initiatives aimed at improving incomes and job security improves the health of their patients. And, I would argue, it does so far more effectively than the traditional methods employed by doctors who lecture us about lifestyle choices.
This type of social justice initiative chips away at my cynicism about holiday cheer. It's the kind of thing that reminds me that after December 22, the days will become brighter and longer. If we can shift the health-care conversation to generosity about the lives people live, the bodies we inhabit and how we treat one another when we're at our worst, perhaps in years to come all of our holidays will be a little bit happier.
Julie Devaney is a health, patient and disability activist based in Toronto. Her rabble column, "Health Breakdown," is an accessible, jargon-free take on the politics behind current health-care stories. You can find her on Twitter: @juliedevaney
Photo: poppet with a camera/flickr
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