November 19, 2014
Monika Dutt, Lawrence Loh, Michael Schwandt, Claudel P-Desrosiers, Yassen Tcholakov and Andrew Bresnahan
Monika Dutt is Medical Health Officer, Cape Breton District Health Authority and chair of Canadian Doctors for Medicare; Lawrence C. Loh, is Medical Health Officer, Fraser Health Authority; Michael Schwandt, is Deputy Medical Health Officer, Saskatoon Health Region; Claudel P-Desrosiers, Yassen Tcholakov and Andrew Bresnahan are medical students
Earlier this week, The Globe and Mail published a column asking public health officers to “focus on disease, not politics.”
The short answer is: We are very much focused on disease. It is, after all, our mandate.
As public health officers and physicians in training, we are charged with protecting the health of the Canadian people. Every day, we are confronted by dire health statistics and patient stories that demonstrate the inexorable rise of noncommunicable diseases (NCDs) in our country. Those diseases are determined primarily by social determinants of health, such as food security and the environment; their treatments and prevention measures lie outside of the hospitals’ walls.
For decades now, the top killers in Canada have been cancer, cardiovascular disease, stroke, and chronic lung disease. Given that they aren’t passed from person-to-person, as communicable diseases are, this has led to their designation as “non-communicable” by the World Health Organization. In understanding the root causes of NCDs, we understand that they develop largely in relation to where and how we live; our jobs, our access to health care; our alimentation, our social status – factors affected by social policy and thus the political process.
The gains made on infectious diseases came as much from needles as from a greater understanding of the root causes of disease transmission. This meant addressing social and economic contexts: poverty and housing conditions – it required public health to eschew short-term “band-aid” thinking to achieve longer-term benefits to health.
That success was seen in the eradication of smallpox from the face of the planet and the reduction in rate (often thousands-fold) of many former childhood scourges – measles, whooping cough, and meningitis. Today, vaccine-preventable diseases are no longer as prominent as they were in our society. Thus, although we remain committed to reducing infectious diseases, remaining tied to needles would mean not being true to our purpose.
In addressing NCDs, therefore, public health today has been tasked to work with other sectors that control these factors, such as government, community organizations, private enterprise, and school districts. In keeping people healthy, modern health systems recognize that issues like food security, income inequality, physical activity, air quality, and housing all have a tremendous impact on the health status of our populations. To ignore these linkages in the face of scientific evidence would be frankly negligent, a disservice to our communities and costly to society.
In a world of rising health-care costs, the public health field and medical community increasingly understand that forestalling future health-care demand requires us to look beyond needles and pills to the contexts we live in. To safeguard health, we must work outside of a biomedical silo, with other partners to build healthy communities and safe environments that give Canadians the opportunity to live in full health and well-being. Prevention is the cheapest form of medicine, this is also why public health practitioners who have a much greater focus on the holistic management of the health of the population choose to invest effort in it.
Data show that the least fortunate in our social hierarchy have worse health outcomes and poorer health behaviours than those who are better off. We are not interested in simply accepting this state of affairs; we know that entrenched inequities are not fixed by our biology. Changing the health status of the most indigent in our societies means that we must recognize that income inequality is an essential health problem, shaped by the society we live in. That alone gives us reason for optimism: with the right policies and programs, everyone’s health can improve, and we will collectively be better for it. Health is thus both a tool for increasing opportunities for all and an outcome of that greater equality.
Public health officers, medical students, and the physician community remain committed to protecting the health of Canadians. With a rising tide of NCDs, we have committed to extending beyond merely focusing on needles and pills to looking at the root causes of ill health among Canadians. It would, in fact, be irresponsible if we did not extend our role toward working with other sectors. Only by doing so can we truly address the root causes of disease and act on the factors that influence the health of Canadians.