Archive for the 'Health & Society' Category

Mirror, Mirror

The American healthcare system is a mirror, reflecting the basic characteristics of America. To the extent this is true, it will take more than a new metaphor or a new frame to change our healthcare system. It will take a fundamental change in America itself, or at least in our perception of ourselves. George J. Annas, Worst Case Bioethics.

Some unsurprising results are published in the 2010 update of Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally: European countries lead the way with the best overall health care system performance but not with greatest amount of health expenditures per capita, while America protected the rear flank with the greatest expenditures and worst performance.

What I find surprising, however, is Canada’s performance. According to the report, Canada is second-last in overall rankings, followed closely by the United States. Furthermore, in a number of categories, such as effectiveness and timeliness of care, Canada comes in last place. On a positive note, Canada ranks second in having Long, Healthy, Productive Lives.

I was recently challenged to think about the factors that may contribute to America’s fractured health care system. My response — though brief and limited to 300 characters — is as follows (borrowed the second paragraph concept from Annas):

Among many factors that contribute to the discrepancy between America’s health expenditure per capita, quality of care, and quality of life, one which is of significance is the lack of collective will to address social inequities and guarantee health as a right.

Also, American health care is wasteful, technologically driven, individualistic, and death-denying. An better system would focus more on “upstream” factors such as the social determinants of health.

What about Canada? That’s a question worth thinking about.

Not long ago I became aware of the differences between health care reform and health system reform.

On a side note, I registered myself today as an organ donor. Can you imagine how many people die while waiting for organ transplants?

Abortion, Economics, Politicians, Science, and Humanism

Re: Abortion and The Economy Comes Before Democracy

Kudos for the thought-provoking posts!

I agree with your opinion on abortion. A supporting example would be the case of severe birth defects resulting from products such as Thalidomide. With timely ultrasound screening and detection, it would be unethical to continue the developmental process of the embryo, knowing that the child and parents would suffer physically and emotionally at great cost to the family and society.

Speaking of economics, the topic of your previous post… I must admit that I know very little about this subject, but I’m troubled and disheartened by the fact that introductory economics teaches that “it is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own self-interest”. Frankly, I find such a point of view rather selfish, my reason being that other academic fields in which I have studied, such as Sociology and Public Health, advocate a drastically different perspective, one that aims to reduce inequities for the benefit of the majority.

I believe that much social phenomena cannot be solely viewed through a cost-benefit analysis or profit-maximising perspective. For example, in economics, protection of and benefits to workers (e.g., the union), concerns for the environment, measures to ensure safety, etc., are regarded as extra, undesirable costs. I don’t mean to bash economics; some experts in the field are doing meaningful work addressing poverty and inequity: http://www.sfu.ca/~pendakur/

Sorry, I can’t help but comment on your statement that all “politicians need to know economics”. In my opinion, and in my opinion only, politicians should be, first and foremost, human, as opposed to egocentric, profit-driven psychopaths — please excuse my language. Not that degrees in economics and other related fields, such as business and law, are bad — look no further than Stephen Harper and Tony Clement, an economist and a lawyer, respectively (not to mention good ‘ol dubya, who has an MBA from Harvard Business School). My concern is that there lacks a focus on two things in certain modern-day politicians : 1) humanism, 2) science. A perfect illustration would be the absence of basic understanding of and support for the well-researched and evidence-based practice of harm reduction (e.g., InSite) by our Conservative government, whose leader, Harper, is an economist. This demonstrated lack of humanism is largely due to a strongly biased ideology (one which identifies with self interest and profit) and an under-appreciation for science.

David Suzuki mentioned in his autobiography that we need more politicians who are trained as scientists. I agree and would like to add that our leaders of today and tomorrow must combine having a healthy dose of scientific scepticism with a sociological imagination which says “no” to statements like “things are the way they are and cannot be changed”.

“What are we if we don’t try to help others? We are nothing – nothing at all” – Henry Marsh

Who Owns Health?

I would like the discuss the following two questions. Who owns health? Why did Saskatchewan lead the way in universal health care in North America?

On a hiking trip yesterday, a companion and I had a thought-provoking discussion on the private ownership of our health care system, an idea which I strongly and passionately oppose. In his opinion, everything — I kid you not! — should be privatised, including rivers and the air. I wanted to see how far he would go with such a belief system, so I asked him about his thoughts on health care. The following passages contain a short summary of our heated discussion. I was frightened by its implications: I hope such firmly held beliefs of privatisation and deregulation are not reflective of significant portions of youths of my generation; I am hopeful that there is growing consciousness among us, the citizens of today and tomorrow.

My worthy opponent argued that our health care system should be completely privatised, which would lead to decreased costs and increased quality of patient care. I was completely baffled. I did not get his logic. Tell me more. How would costs go down? For whom would the quality of care increase?

He reasoned that costs would go down because the government would no longer hold a monopoly on health care, which would ensure market competition and reduced costs. I was confused. I still did not understand. Explain more, I asked, especially with regards to how this competitive process would occur. He elaborated by saying that the current system of medical education is excessive — again, I kid you not — and unnecessarily long. I was rather amused listening to such a statement, especially since the claim came from someone whose field of studies relates more closely to the dealings of Goldman Sachs than to genuine love for human kind. Please, continue and humour me. By deregulating medical education, he proceeded to argue, it would not take so long to train medical professionals and a free-market competition would emerge since better trained doctors would have the right to charge more while the not-so-well-trained ones would have to charge less . WHAT?!?! I don’t blame him for failing to understand how the system works. I then explained to him the rigours and purpose of post-graduate training such as residency.

Here comes the frightening part of the story. For whom would the quality of care increase, I asked. For everyone, he answered. That did not make sense to me, so I presented the following scenario him:

There are two people in this story: persons A and B. Person A is a white, male business executive who earns $100,000 per year. Person B is an Aboriginal single mother who raises two kids while carrying the burden of diabetes and working three part-time jobs. One day, both persons A and B get into a car accident and require life-saving surgery. My question to you is: would both person A and person B receive the same quality of care in a privatised health care system?

I did not get a satisfying answer. After pressuring him two more times with the same question, I was told that “charities serve an important function and can be effective if properly utilised”. I informed him that no, persons A and B would not get the same quality of care if the health care system were privatised, and that it would be the rich who would benefit from paying for more sophisticated and rapid medical services while the poor suffer. To my utter astonishment, he attempted to retort that because person A is making a greater contribution to society, person A deserves better care! How can one justify such a statement? The weak, poor, vulnerable, and most marginalised members of society deserve more support and attention than the political-economic elites. Had my worthy opponent read about the social determinants of health, he would have realised that addressing the root of the problem — improving subsidised housing, early childhood education, health literacy, just to name a few — and offering efficacious and timely health care services to disadvantaged populations would decrease inequity in our society, which would be beneficial for society as a whole.

Because my companion claimed that privatising the health care system would reduce costs and ultimately improve services, I proposed the following question:

Why then, don’t we also privatise the fire department and police force?

Contrary to his other beliefs, he said that we should not privatise these organisations. Why not, I asked. He thought about it for a minute or two. Then, he replied that these organisations should not be privatised because they protect our private property. I could hardly believe what I was hearing. Were you saying, sir, that protecting our private property is more important than protecting our health? Yes, he replied.

I recently finished a book titled Steps on the Road to Medicare: Why Saskatchewan Led the Way (2002) by C. Stuart Houston. The book concludes as follows:

Medicare got its start in Saskatchewan because, as in the biblical parable, the seeds fell on fertile ground. The thinly populated, relatively poor province of Saskatchewan consistently led all of Canada in public health innovations and legislation, including twenty-nine firsts. Many of these were firsts for North America, not merely Canada… But why Saskatchewan?

In a province without a large city, there were few rich people or powerful corporations. Rarely did people have surplus cash, but there was an abundance of good will, of trust in one another, of a willingness to help each other, and of a sense that lives could be improved through communal effort… Mutual co-operation among pioneer settlers was more the rule than exception; it was better to do things together than separately…

Saskatchewan residents had a strong sense of justice and fairness. Honesty was the rule. A high priority was given to health matters by the public, especially by farm women… the co-operative spirit of the predominately rural Saskatchewan people… had been developed to a higher and more practical degree than in any other jurisdiction in North America.

The advances made in Saskatchewan required two ingredients: the co-operative spirit, as described above, and the individuals whose passion and direction became the catalyst… The people of Saskatchewan were, to use today’s term, proactive. Whether bureaucrat, politician, or scientist, each leader saw a need, gathered the evidence necessary for an informed decision, and then acted expeditiously… Nearly immediate response by government was then more the rule than the exception… These were simple times, without red tape. The time was right.

Familiar Topics?

I have completed a year-long, 6-credit Biopsychology course and had an opportunity to further examine the sketchy topic of sleep. It’s amazing how critical thinking goes hand-in-hand with so many aspects of biopsych and neuroscience, especially if we consider how counter-intuitive many of these topics are. Take sleep, for example. We know so little about it! We may not need so much of it after all. And hunger: much of the sensation is a conditioned effect. In terms of biopsychological theories of drugs and addiction, it’s fascinating how many factors contribute to tolerance, dependence, and pleasure. Check out this post from my instructor: http://stevenjbarnes.com/node/40

Sleep is quite sketchy. That’s right.

I must admit that I could have been not entirely correct about many of my earlier sleep-related claims. It’s rather funny now to look back at some of those posts.

For example, stress is a potential confound in many of the earlier studies in which the harmful effects of sleep deprivation were observed (e.g., jobs associated with low SES, stressful conditions of animal models, etc.). Also, studies failed to note that a decrease in sleep time is associated with increased sleep efficiency. The list goes on.

Contrary to popular believe, we don’t need that much sleep after all. This post may seem quite unsubstantiated, but I’d like to elaborate shortly.

Doors to Death of the Aged

Below is a quotation from Sherwin Nuland’s How We Die:

There is no way to deter old age from its grim duty, but a life of accomplishment makes up in quality for what it cannot add in quantity.