Hot! 40-year-old health report was prescient about today’s challenges

TheGlobeandMail.com – News/Politics/Politics Insider
Apr. 11 2014.   André Picard

“Good health is the bedrock on which social progress is built. A nation of healthy people can do those things that make life worthwhile, and as the level of health increases so does the potential for happiness.”

Those are the opening words of the report titled A New Perspective on the Health of Canadians.

That was April 1974, exactly 40 years ago.

The now-legendary document, commonly referred to as the Lalonde Report (after then-minister of health and welfare Marc Lalonde), marked a dramatic shift in thinking.

While making medical treatment available is important, the report stressed that the real impact on health comes from social and economic factors, what are now called the socio-economic determinants of health – income, education, housing, the physical environment, discrimination, gender and so on. The report was one of the first to talk in detail about the importance of lifestyle, and the need for public health promotion and prevention.

Mr. Lalonde (and the backroom forces behind the report, the deputy minister of health and welfare Maurice LeClair and the department’s head of long-term planning Hubert Laframboise) included a detailed “Health Promotion Strategy” that featured 74 recommendations that were forward-looking and eerily prescient. Here is a sampling:

  • Tackle the issue of mental illness “with a sense of urgency”;
  • Launch public health campaigns on smoking and sexually-transmitted infections (venereal diseases in the vernacular of the time);
  • “Make life more interesting for the aged”;
  • Promote increased physical activity for Canadians by investing in public facilities like hiking trails, bicycle paths and skating rinks;
  • Impose much stronger regulation on the nutritional content of food, including caloric counts and nutritional data;
  • Stronger regulation of “health hazards due to air, water, food, noise and soil pollution,” what we today call environmental issues;
  • Focus on “mission-oriented” health research, meaning studies that will result in practical changes;
  • Providing incentives to Canadians for maintaining good health, while expanding access to services covered under medicare;
  • Invest more in community-based health services, particularly nurses, social workers, health educators and teachers;
  • Offer homecare to the chronically ill and aged so they can remain in the community;
  • Improve access and quality of drug information so physicians can make “more effective and objective use of drugs”;
  • Develop health and social programs “according to economic levels served,” meaning more emphasis on the poor;
  • Establish goals for specific reductions in the incidence of major causes of mortality and morbidity, specifically cardiovascular disease and motor vehicle crashes;
  • Set national standards for both the “mental and physical care systems” so patients know exactly what they can expect;
  • Make a commitment to the health goals of the World Health Organization.

While the Lalonde report does not say a lot specifically about income, we need to remember that there was a companion report, published a few months earlier, A Working Paper on Social Security in Canada, which addressed this issue in detail and which, among other things, examined the notion of a guaranteed annual income.

Remember this was 1974.

It’s worth noting, at least in passing, that the Lalonde report got virtually no media attention when it was released, just as it is getting no media attention (present company excluded) on its 40th anniversary.

Yet it had a dramatic impact on health systems around the world; Nordic countries, in particular, embraced the Lalonde report and its philosophy, and their health and welfare system are better for it.

Yet, in Canada, the Lalonde report could be published today and be current. That’s because we’ve implemented so few of its recommendations, except around the margins.

In Canadian health care, we are still discussing the same issues today as in 1974. We are still making the same recommendations today as 1974.

In 1974, we spent $10-billion on health care; in 2014, we will spend in excess of $211-billion.

We have spent, in those ensuing 40 years, approximately $1.8-trillion (with a T) on health care in Canada, and about 2 per cent of that has gone to prevention.

If anything, our health care system is more oriented toward sickness care than ever before. We chant a constant refrain, demanding “more, more, more” of the same.

Despite some token bon mots about the importance of addressing the socio-economic determinants of health, we have yet to heed Mr. Lalonde’s warning that the “traditional view of equating the level of health in Canada with the availability of physicians and hospitals is inadequate.”

Nor have we yet digested or acted upon his sage advice: “The health-care system is only one of many ways of maintaining and improving health. Of equal or greater importance is…raising the general standard of living, important sanitary measures for protecting public health, and advances in medical science.”

In the past 40 years we have improved the standard of living, but inequalities and disparities are staggering. We continue to spend on sickness care but we have savaged many social programs and made our tax system far less progressive.

The result: The rich are getting richer, the poor are getting poorer, and the comfortable, healthy middle class is disappearing.

Are we, as a society, any healthier in 2014 than we were in 1974?

Perhaps it’s time for a New Perspective on the Health of Canadians? Or at least a new appreciation for an old and wise perspective.

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  4. 40-Year-Old Health Report Was Prescient About Today’s Challenges
    As a social work student, one of the first things we learn about is the 12 Socio-economic Determinants Of Health. I did not know that they were part of the recommendation that was written 40 years ago. These 12 determinants have come to be so neatly defined for us to identify the issues troubling our country, individuals and communities. These assist us with those who need our assistance, by giving us tools to better identify and examine a clients needs. For example: a better social environment, better access to a healthier environment, and access to health care to name a few. As Canadian we take health care for granted, we feel or believe Medicare will always be there. It may be in jeopardy. Perhaps if the Liberal Federal Gov’t in 1974 would have seriously considered these recommendations, we too could be more of a Socialist state like Sweden and not a Neo-liberal ideological country.
    Many political parties have used bits and pieces of Lalonde’s recommendations, picking on the dusty remains of this very valid, and still timely piece of health promotion strategy to their benefit, trying to make themselves look benevolent. Meanwhile, taxes go up and Medicare gets clawed back, which endangers our working, poor because they have to make the decision to buy groceries or pay to get their eyes examined. Or pay their child’s daycare or get their necessary prescription filled. As you can see we already have a two-tier healthcare system, which marginalizes those who don’t have a secondary source of health insurance after Medicare. The Conservative/Liberal capitalists want us to pay more taxes and still get fewer services. It’s time for our Health Care Policies to change for the better, and we have an oldie but a goodie of a recommendation that fits the bill.

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