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- Page navigation anchor for RE: The mirage of universality: Canada’s failure to act on social policy and health careRE: The mirage of universality: Canada’s failure to act on social policy and health care
The CMAJ editorial, published on the 3rd February 2020, is an interesting read1, but its main ideas need further clarification. The very first sentence expresses one such idea: "Canadians pride themselves on the fairness of their society and their health care system, yet disturbing inequities persist in both."
Indeed, the vast majority of Canadian voters like their public health care system. This general approbation, however, apparently ends at gallop point because its meaning is not always conveyed at federal and provincial elections because Canadians often elect politicians who are known adversaries of the universal health care system.
Second, no such thing as 'Canadian health policy' exists in the country because provincial and territorial governments are responsible for formulating and executing health policy. Medicare (the Canada Health Act, 1984) is not a single national plan; it is a conglomeration of health plans of ten provincial and three territorial governments. The federal government only ensures uniformity in these regional plans by contributing cash under stipulated conditions and guarantees compliance through monitoring.
Third, the authors compare Canada's performance with other developed democratic countries, which could provide the wrong signal unless the data are carefully interpreted. For example, the editorial cites Papanicolas, Woskie and Jha (2018).2 This article compares health spending in selected high...
Show MoreCompeting Interests: None declared. - Page navigation anchor for Right diagnosis, wrong interventionsRight diagnosis, wrong interventions
Boozary and Laupacis are absolutely right on the problem: Canada is undoubtedly beset by significant disparities in health status. (1) My desire to respond, however, arose after my review of their proposed solutions, including a final rhetorical question and belief that the status quo has been inaction.
Throughout the commentary, most notable in its absence was any mention of the work of public health agencies. Working at all three levels of government, these agencies are mandated to use data and evidence to protect, promote, and optimize health through shaping determinants, contexts, and conditions in the jurisdiction they serve. Working with community partners, often apart from healthcare, these agencies bring a health perspective in calling for, designing, implementing, and evaluating various social policies and programs. This includes many of the initiatives described in the commentary’s sixth paragraph, including the basic income pilot. (2)
Granted, one common misconception is that public health is part of the healthcare system. This arises from history and various structural factors in Canada which sees public health agencies receive funding from healthcare service pots. In many provinces, this has also lumped public health together with healthcare services like hospitals and clinics. The reality is that while healthcare is undoubtedly an important partner for public health, the two sectors do not often share a common goal.
The goal of public he...
Show MoreCompeting Interests: None declared. - Page navigation anchor for The universal cost of povertyThe universal cost of poverty
Unfortunately, policy makers are still defiant of the shown facts that equitable social policy could reduce health care cost (as well as social spending) and improve peoples' health. The Yukon government commissioned a study on the cost of poverty in 2009/10, which I authored. The study was never released and acted upon but the findings were clear: eliminating poverty will lower the burden of the public purse as well as the private economy substantially...
Competing Interests: None declared. - Page navigation anchor for RE: social policy and healthcareRE: social policy and healthcare
Innovative solutions for disadvantaged and remote populations are desperately needed. We have the IT but it's not being mobilized effectively. FaceTime rather than physical presence must be established and widespread and adoption could save millions of dollars not to mention reducing CO2 emissions.
Competing Interests: None declared.