Creating a Real Canadian Health Service for the Next Generation By Warren Redman

Nowhere, in the weighty reports that have been funded and presented by federal and provincial governments and seldom, in all the words that have been uttered by government ministers and health service authorities, has a clear view of the hard reality facing us been uttered.

Three crucial points have been largely ignored, because to raise them would appear to be political, professional or business suicide. Firstly, we do not have a health service – we have a sickness service. The second point is that the purpose of a health service is neither asked nor answered. Thirdly, thinking in the same old box cannot provide new solutions.

The first crucial point is that we do not have a health service in Canada; we have a sickness service. This is true of pretty well any country, so we are not alone. While it may be seen as semantics to say so, this first statement is of the utmost importance to our understanding of why we are struggling, and will continue to struggle with the health of our nation. The fact is that of the billions poured into health; almost all of it is spent on dealing with people after they become sick.  If we do not change that, there is nothing that can be done to stem the tide of ever-increasing costs.

Let us for a moment say, then, that we have a sickness service. What would it look like to have a health service? A health service would be dedicated to keeping people healthy. It would provide the resources, the education, the incentives and the support within communities, schools and families to encourage individuals to take care of their health and to ensure that they receive the attention they need before conditions become chronic and before “accidents” on the road, at home or in the work place occur. Dealing with the causes of ill health rather than the results would cost far less than the current system and bring greater quality of life to Canadians. Currently we spend around $3,600 for every single person every year. Let us put $1,000 per person towards a health service. In the long term (a generation as per Paul Martin’s pledge) we would need to spend probably another $2,000 per person on the sickness service, an overall saving of $18 billion per year, diminishing rather than increasing in ensuing years.

The irony is that we do have an “underground” health service, which is hardly funded by any government. These are currently in the areas that, were they recognized and funded, would be termed a two-tier health service. Most of us pay for it privately, or through our privately paid for insurance companies. This means that only those who can currently afford it and who pay attention to and accept responsibility for their own health (a minority) actually use preventive measures. Such measures include healthy eating, appropriate physical activities and the maintenance of emotional balance (a hugely ignored area and the one in which I spend almost all of my professional life). The provision of services, activities, courses, information and other resources is there and could be vastly increased given the will and some reallocation of funding.

Some of the things that we pay for already are essential to us. I pay for my optical care and eyewear. Without glasses, I simply could not function in the same way. My wife, who has had type one diabetes since she was 11 and has always taken good care of her health, has had to pay many thousands over the years just to stay alive. We both make regular visits to our dentist, at significant cost, so that we do not succumb to the various health complications that can occur without good dental maintenance. We take care of our eating and exercise and mental health and strive to keep well balanced emotionally. Some of this costs money; others are simply about having a conscious intent to be responsible for ourselves.

The second point that has hardly emerged in all the great debates has been the key question: what is the purpose of having a health service? The reason, I suspect, that this question is left unasked and unanswered is because it could put the cat among the pigeons. Let us suppose that a health service is about quality of life for our citizens. (Others could argue it is really about creating profits for drug companies and keeping large research institutes and buildings, not to mention ranks of professions and bureaucrats in the manner to which they have become accustomed. I prefer to keep my belief that all, or at least the vast majority of those involved in the current health service, are dedicated to enhancing the quality of life of their patients.)

What actually occurs now? While hundreds of thousands of Canadians are rightly thankful for the services and the professionals who have brought them better health, saved lives or given them hope, there is an equal number who suffer at the hands of a service that cannot possibly, given its current philosophy, offer what is needed. I am not even talking about the infamous waiting times for treatment, which cannot be solved simply by throwing more money into a system that will demand ever more. I am talking about a difficult and unpalatable issue. Our attention is not focused on quality of life; it is focused on quantity. We are more concerned now with the length of life, of keeping people alive at all costs, than we are with its quality, whatever the wishes of the individual. We have adopted a moral code and a belief that has led us into an untenable and unhealthy situation.

I am nearly 65. I may have thirty years to live, maybe more. I am fine living until a hundred, as long as I am feeling good, have my faculties and am not dependent on others for my physical and mental functioning. If, tomorrow, I were to fall prey to some disease or accident that impaired me in such a way, then I want to exercise the last choice that remains to me. I wish to die feeling that I have dignity and am afforded respect by my fellow human beings. Such a choice does not appear available to me now, unless somebody breaks the law. My only option seems to be that I am forced to be kept alive, suffer unspeakable indignities until I am finally released naturally, and cost Canadians many thousands, perhaps many hundreds of thousands of dollars for the privilege.  My wife and I agree on this for each other. A health service with a human face would be one that assists people to die with dignity when the time has come. A society that is truly mature helps people to face the only inevitable thing in life; that we will all die, and that we may need help for this when the time comes. Extending life for the sake of it is both cruel and expensive. It is also currently politically and for some philosophically unacceptable, so we are stuck with both the bill and the inhumanity of the situation until we speak it out of ourselves.

The third crucial point that appears to escape the combined wisdom of all the health decision-makers right now is that by continuing to look inside the same box, we do not see what is obvious. Putting more and more money into the open sinkholes of hospitals, drugs and new technical equipment does not improve the health of our people. At the Prime Minister’s and Premiers’ conference, Alberta Health Minister Gary Mar stated two examples of where Canada Health is not serving Canadians. The first was in diabetes, the second in mental health. He referred to diabetes, (meaning I assume type 2) as becoming more prevalent and therefore more costly to treat. Mental illness too, Mr. Mar contended, is on the increase, giving considerable cause for concern.

Thinking out of the box on those two issues would bring us to the conclusion that both are preventable, and that preventing them will both improve the general health and productivity of Canadians and cost a fraction of what it costs to treat them. Current thinking leads us to the development of more drugs, the employment of more physicians and nurses, the building of more institutions and the creation of even more causes of mental illness and disease brought about because of the frustration that increased services of this nature can never keep up with the demand. 

If Canada is to have a true health service, one that will last for the next generation at least, and one that incidentally will lead the world in health care, we need to face these three key points and make the really tough decisions that will bring about the changes that are needed. Those changes are to radically increase the funding for preventive measures, while slowing down the resources put into drugs, new equipment and other reactive solutions. Such changes will be made when there is a new philosophy, a new vision and a new willingness to grasp the most difficult and contentious issue facing our federal and provincial governments at this time.

Over the past ten years in Canada, I have been able to work directly with only about 200 people, providing them with self-directed ways of enhancing their personal emotional fitness. The outcomes for almost all of those people have indicated to me the value of such an approach. Relationships that were on the edge of breakdown are stable; individuals who were in stressful and frustrating work are now feeling successful and fulfilled; people who had felt lacking in self-confidence and esteem now have more positive perceptions on themselves. While anecdotal, the heightened overall health of these people is sufficient enough evidence for me to continue this work with or without any “official” recognition. With government support, many thousands of people could benefit.

This is just one example of what could happen if we move from a sickness to a health service, define and clarify what the purpose of a health service really is in terms of life quality, and think out of the box for new ways of enhancing the health of Canadians.

Warren Redman is president of the Emotional Fitness Institute formerly called Centre for Inner Balancing and author of fifteen books, including the award winning “The 9 Steps to Emotional Fitness”. www.EFitInstitute.com

Warren Redman © 2005