Health Council Report Steps Up Criticism of Runaway Medical Spending

Thanks to New Year’s resolutions that haven’t run out of steam yet, my local gym is packed with fresh faces of people who look like they don’t normally look forward to an hour a day of sit-ups, lunges and push-ups, but feel like they have to if they want to lose a few pounds or 20.

I do my best not to look up from my exercise ball, for fear that I will feel the call to deliver a public lecture on the illusion of suffering through personal behavior modifications rather than indulging in painless changes to public health policy.

This year I’m having an especially hard time keeping my thoughts to myself because I feel like handing out a government –sponsored report I just read called Stepping it Up. The stepping doesn’t refer to sweating it out at step class, but to, as the subtitle puts it, “Moving the Focus from Health Care in Canada to a Healthier Canada.” With that unerring sense of bad timing that only health policy wonks are capable of, the report was released in mid-December, just as most people were getting ready to let loose their inner glutton.

Now is the precious interlude — just before the season of remorseful self-loathing follows the season of giving up on getting exercised by guilt – when the report, which might have been called Working Out Won’t Work, could have been released for optimal effect.

The report’s main line of argument is based on over 30 years of impeccable and irrefutable research.

But anyone who’s seen a gym floor in early January knows the report’s message is totally counter-intuitive and cannot be accepted deep down as a meaningful basis for personal and public health policy.

The gym floor in early January testifies to deeply-felt and painful grip of several levels of illusion about healthy caring for our bodies. First, people confuse looking fit with being fit, and therefore work on show muscles – biceps, quads and sixpacks, for example – rather than the health-supporting but invisible inner thighs, lower back, core and heart. Second, many people think they must force themselves to work-out, rather than play or reflect-in, moving their minds and bodies with dancercise or yoga and Pilates. Third, many seem to assume that health comes from doing certain things at certain times of the day, rather than from life itself – the reason why the stock phrase “health and well-being” is really only built into daily language as an expression of two sides of the same coin in French, as used in Quebec. Finally, almost all people, from healthfood and exercise nuts to the slothful majority, believe health comes from personal behavior or lifestyle modification, not modification of government policies that cause poor health.

Because of the depth and breadth of such understandings, politicians and the general public turn a deaf ear to reports such as Stepping It Up, despite the research which backs up its claims, despite the 2010 endorsement from ostensibly powerhouse bodies such as the cross-Canada Ministers of Health and Health Promotion, and — most remarkably – despite the doubling of Canadian government health budgets to $120 billion a year over the last decade, during a period when most people have been saying they want to cut taxes. Cutting taxes that cut spending on programs that support health turns out to cost more than any savings from tax cuts: a no-win route to saving money that we need to expose more often.

At 30 pages, the report is brief, well-written and nicely laid-out. It’s written by Health Council of Canada CEO, John Abbott, a former deputy minister of health in Newfoundland, along with outstanding health promotion author Dennis Raphael of York University. The message is short and sweet: Canadians are wasting about 24 billion a year on medicine and drugs that could be more productively spent curing such problems as dietary neglect caused by poverty. The report cites one Saskatoon study which attributes $179 million in medical spending to problems stemming from extreme poverty, and a Winnipeg study which links $62 million in yearly medical spending to heart and bone injuries linked to poverty. Another Manitoba study shows that a one per cent yearly reduction in rates of smoking, inactivity and obesity, achieved at a cost of $529 million, could yield $1.8 billion in direct (medical) and indirect (absenteeism during treatment) savings, an unbeatable return on investment of 300 per cent.

To achieve these kinds of results, the report says, there needs to be a “whole-of-government” approach to health, whereby departments responsible for transportation, environment, economic development and agriculture take population health as one of their objectives and not put the entire burden on health on medical treatment.

The report deserves to be challenged on several fronts. It separates government from society too much, and should be raising issues of “whole-of-society,” rather than the old command and control concept of “whole-of-government.”

In his less official presentations, such as a talk he gave during the spring of 2010 to Canadian dieticians, Abbott highlighted unwarranted and unexamined drug expenditures as a major element of the Canadian health budget, which, at 16.3 per cent of Canada-wide health costs in 2008 alone suggest the power of vested interests – not just the inability of government departments to collaborate — that lies behind the medical monopoly over health.

Multiple government subsidies to support calorie- and fat-intensive diets, together with the almost complete absence of support for local and sustainable fresh produce, don’t rate a mention, even though they are prime examples of governments sidestepping their own role in causing ill-health.

But as something to read while recovering from a tough workout, the report is a great start to the new year, a year in which both provincial and federal governments will likely be held to account in elections.

(adapted from NOW Magazine, January 6-12, 2011; this version includes background info for readers living outside the area reached by NOW.)

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