COVID-19 and Canadian Health Care

canada-healthThe CBC has a new opinion piece by Dr. Anca Matei that posits that COVID-19 exposes truth of globalization – wealth does not always equal health. I’m going to examine the proposition and her reasoning.

The importance of public health in times like this cannot be denied and has never been more compelling. Yet business, as usual, continues to overshadow and undervalue it as the focus on bolstering the economy intensifies.

The importance of a health care system certainly cannot be denied. An advantage of a centrally controlled public health agency is that it can be quickly reconfigured to deal with a new threat. However, a massive economic downturn is more dangerous in the long term than the pandemic, so valuing the economy over health care doesn’t seem inappropriate.

Health and the economy are intimately intertwined, and the situation in which we find ourselves today is a direct consequence of the dance between health and the economy over the past several decades.

Health care in Canada is largely severed from the economy. Creating a social medicare system that actively prevents a separate public tier from operating means that the system has no economic incentive to be cost effective.

The neo-liberal agenda has led us to believe that economic growth will bring wellbeing to the masses, but in reality it has often simply made the rich richer and the poor poorer.

Growth at all cost is a foolish idea. Improving productivity does “raise all boats”. The rich get richer at the expense of the poor when they are able to use the power of government to bend things in their direction.

COVID-19 is a stark reminder that when push comes to shove, it is not the wealthy who will pull us through. It is our health care system: the health care workers, the hospitals that have long needed renovations, and the programs that have been chronically underfunded.

I agree that the health care system has greatly reduced the amount of death and suffering from COVID-19.

This pandemic, like all pandemics before it, will run its course. When it ends, we are going back to the older epidemics that plague our health care system: obesity, diabetes, cardiovascular disease, cancer, social inequalities, and an underfunded public health care system that often seems to take a back seat to political and economic interests.

The status quo seems likely, given that all three major parties support the Canadian medicare system.

Will [the COVID-19 pandemic] bring change to the unsatisfying trends in globalization? After the physical distancing ends, will we have the courage, as a generation, to stand up and demand that smart, informed, practical public health policy be fixed at the core of public and private economic actions?

What does “fixed at the core” mean?

In 2003, Samuel Preston gave us the Preston Curve. This showed us that life expectancy was directly proportional to GDP per capita – on average, people in wealthier countries tend to live longer than those in poorer nations – but only up to a point. After a certain GDP level, life expectancy flattened out.

Makes sense.

Preston used life expectancy as an indicator for health, but of course health is so much more than a person’s number of birthdays. Critics of the Preston Curve point to the importance of things such as literacy, nutrition, and overall public health. In addition, factors such as social justice, spirituality, and social relationships are all important to what the World Health Organization (WHO) defines in its constitution as not merely the absence of disease, but “a state of complete physical, mental and social well-being.

Life expectancy is a good metric to use. Literacy and nutrition are not measures of health. What does “overall public health” mean? Social justice, spirituality, and social relationships are not measures of health. The World Health Organization does not help its own case by producing such a fuzzy, non-scientific definition of health.

The conclusion is clear: wealth does not equal health.

No shit. However, there is a clear correlation, up to a point. Ignoring that would make you a fool.

What is the benefit of promoting an economic system of financial elitism if, in the face of an international crisis such as the one we are in now, long-term care facilities are overcrowded, hospitals do not have sufficient space to properly isolate suspected or confirmed COVID-19 patients, and physicians have to decide which severely sick patient has access to an intensive care unit bed and which does not?

Clearly only the financial elite benefit from an economic system of financial elitism. If you question the benefits of a healthy economy when there are shortages in the medical system, you are a fool. Both are important.

Without strong public health policy at the core of our social and economic systems, wealth is meaningless.

Bullshit. Wealth helps especially when public health policy is weak. Health is important, but it is not all important.

In a post-pandemic world facing the reality of a possible recession, a critical analysis of our preparedness, our response, and what it tells about societies will ensue with a vengeance. Will we be satisfied with the status quo of economic growth for the sake of growth, or will we demand economic recovery that also enables true health – that state of complete wellbeing that keeps eluding us?

Growth for the sake of growth is unsustainable. We need to turn to making our economy more efficient. Without Canada’s fossil fuel industry, we would not be able to afford the current medicare system. We need to make the medical system more affordable, and increase productivity in other sectors of the economy, if we are to move away from our reliance on a large fossil fuel based energy sector.

Will we demand that government investments in economic initiatives also translate to investments in our public health?

Will we demand that government not waste our money on things that do not give us benefit? The governments investments in the economy are very inefficient. If the government were to scrap corporate welfare for the fossil fuel industry (as Conservative leadership candidate Erin O’Toole initially promised, then backed away from), that money could instead be used to fund health care.

Or will we go back to the way we were, where politicians promise us clean air but invest in pipelines? Where much-needed hospital expansions take a back-seat to bureaucratic processes and personal interests? Where health care workers are scrutinizedbelittled and deemed dishonest – and only hailed when, already underfunded and burnt out, they show up to work every day in the middle of a pandemic?

Investing in a pipeline from Alberta to eastern Canada would allow us to use our own resources instead of importing oil from Saudi Arabia while also shipping it to Asia, thus reducing emissions due to shipping. Bureaucratic processes are part and parcel of a public health care system. Throwing more money at the public system will not make it more efficient.

As this crisis unfolds, we must ask ourselves these important questions. When it is past us, we must ask our political representatives these difficult questions and demand answers prior to casting votes. We need a paradigm shift.

I agree that change is essential. Advocating to make the public health care system the center of this change seems self-serving and unlikely to lead to success. The first step toward improving our medical system should be to largely remove any federal control. Responsibility and funding should be devolved to the provinces. Distributed, locally managed system are naturally more efficient than large, many tiered, centrally managed ones.

About jimbelton

I'm a software developer, and a writer of both fiction and non-fiction, and I blog about movies, books, and philosophy. My interest in religious philosophy and the search for the truth inspires much of my writing.
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