Though not a cynic by nature, I sometimes view events with a jaundiced eye. I’ve been a member of the nursing profession for 46 years, having worked in several acute care areas and the community, as well as nursing education. When I read the June 1 article on the Canadian Medical Association’s (CMA) effort to solicit input from the public on how socioeconomic issues affect their health, I was skeptical.
Forty years ago, the seminal work of the Lalonde Report: A New Perspective on the Health of Canadians, established a framework for governments, health agencies and health professionals to create health policies addressing issues such as inadequate housing, unemployment, poor education and other problems related to the social determinants of health. In the next decade, Minister Jake Epp and others created another report, Achieving Health for All, in preparation for the 1986 World Health Organization meeting in Ottawa, which produced the Ottawa Charter. Other studies and reports, including those produced by the CMA in recent years, addressed questions of effectiveness, sustainability and equitable treatment in the health system.
My point is that evidence and acceptance of the list of social determinants of health have been well established since the early 1970s. Public health policies have been based on the determinants of health for many years. I must emphasize that the definition of health is more complex than “absence of disease”; by the WHO definition, it’s a “complete state of physical, mental and social well-being.” What is the purpose of the CMA’s national dialogue with the public? I also doubt the effectiveness of town hall meetings which often lose focus because there is no clear agenda or people come with their own agenda.
Only by engaging committed stakeholders in the discussion can solutions be found. The process needs to include members of the public, leaders of the community, professionals who work with individuals and communities, and particularly government members, in order to find workable solutions. Solutions require action and resources, a responsibility of governments at all levels, and perhaps co-operation and participation of private partners.
I commend the CMA for taking the initiative, but the process doesn’t seem to have much substance. A report will be written and likely languish on some bureaucrat’s desk. Is this an exercise in PR for the medical profession? Perhaps the CMA has been troubled by the attention being paid, in the media, to the medical errors resulting in death or disability. A headline on the cover of one national magazine, from April 2012, read, “why 24,000 Canadians will die this year because of medical error.”