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- Page navigation anchor for RE: Fueling the culture of distrust in doctorsRE: Fueling the culture of distrust in doctors
Response to Dr. Alam, Jan 22, 2018.
The physician remuneration example was chosen because it is a classic Canadian health care funding issue. In the past, negotiators have strategically used the media to apply pressure or sway public opinion, making this an example to which CMAJ readers could relate. See, for instance, Quebec doctors recently signing an open letter protesting a pay increase.
Examples are helpful as they underline the difficult choices that have to be made before money can be reallocated between health and social portfolios. Controlling growth and reducing total expenses are two different things; no one is suggesting that we remove well-established health care services like vaccination or that physician salaries should be the one and only source for potential reallocation of tax dollars from health budgets to social services budgets. Rather, what is needed is a thoughtful comparison of the population health benefits attributable to spending on provincially-funded health care relative to the benefits generated by spending on affordable housing, social assistance, and programs designed to address food insecurity.
Competing Interests: None declared. - Page navigation anchor for Creating the conditions that allow health for all to emergeCreating the conditions that allow health for all to emerge
Dutton’s paper alludes to the complexities that determine health and disease. It has long been known that socioeconomic disadvantage is associated with poor health outcomes, which now can be explained in basic science terms – chronic HPA-axis stimulation resulting in genomic dysfunction [1]. Indeed, chronic activation of the physiological stress response is the driver for most morbidities [2].
The most important message in this paper is the fact that even very small changes to a variable in a complex system can have a very substantial impact. In this case minuscule increase in social spending results in substantial improvements in avoidable mortality and increase in life expectancy.
This type of observations challenges the very nature of health systems. Current health systems preoccupation with disease management more accurately should be described as disease management systems. If we really want a health system, the focus needs to be on all factors that impact on the emergence of health of individuals and communities – as Kerr White has shown, on a few occasions this will require the expert input by disease care [3].
It is high time to start a public discourse about the pressing need to redesign our health systems [4].
[1] Cole SW. Human Social Genomics. PLoS Genet. 2014;10(8):e1004601.
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[2] Sturmberg JP, Bennett JM, Martin CM, Picard M. ‘Multimorbidity’ as the manifestation of network disturbances. J Eval Clin Pract. 2017;23(1):199-208...Competing Interests: Foundation President of the International Society for Systems and Complexity Sciences for Health - Page navigation anchor for "Pay me now or pay me later""Pay me now or pay me later"
"Pay me now or pay me later," warned an old TV commercial for Fram oil filters. Similarly, if the public is unwilling to pay sufficient taxes to ensure a minumum level of housing, education, healthcare, and other social programs, those who are deprived of these may eventually rise up and take them - sometimes violently.
I personally witnessed this during the April 1968 Martin Luther King riots when I was a medical student at Johns Hopkins in Baltimore, Maryland.
Health outcomes as well as social stability are jeopardized in the United States. One need only look at the gated communities and high rates of murder, theft, and drug abuse.Competing Interests: None declared. - Page navigation anchor for Fueling the culture of distrust in doctorsFueling the culture of distrust in doctors
I was happy to see Dr. Dutton et al add Canadian data to the literature supporting prioritization and investment in social care. I agree that social determinants of health can have as significant an impact as health care on life expectancy — sometimes more. I also agree that using evidence to thoughtfully drive policy yields better decision-making than political agendas.
What I am disappointed by though is the authors’ need to single out negotiations for physician funding as a lack of “shared understanding that spending on social services may also improve health outcomes.” A statement like this seems totally misplaced in an otherwise well-written paper.
Physician services are indeed a significant line item in health care spending — but they tie for third with nursing services, lagging behind spending on hospitals and pharmaceuticals. So why jump on doctors? Thoughtful cost-savings should be sought out in all aspects of government spending.
Unfortunately, statements like this fuel the culture of distrust in doctors by playing on the politics of envy and division. Literature shows that fewer physicians per capita exert a negative effect on population health. Literature also shows that health care interventions like vaccines, cataract surgeries, diabetes management and angioplasties — physician-led endeavours — have also improved life expectancy.
Balancing efficiency with equity of care should be the primary goal of all health care systems — one...
Show MoreCompeting Interests: None declared.