Perspective: The Fundamental Conditions for Health

The World Health Organization defines health as being “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”. Does this sound like a concept you’re familiar with? How often have you felt in your interactions with our health care system, that this is the model our system adheres to? I worked for 11 years as a Medical Radiation Technologist before going back to school to become a Chiropractic Doctor. I am intimately familiar with how our health care system works, not only as a health care worker and doctor, but also as a brother to a sister who has had more than her share of surgeries and hospitalizations. Time and again I see and hear the frustrations of my patients as they attempt to navigate through the labyrinthian overwhelming corridors of our health care system. Worse – hearing stories from people who are unable to even access the specialized or even basic care that they need. None of you need reminding, I am sure of the countless promises and problems we have heard over the years about ER wait times, surgical delays and cancellations, cut-backs, closures, lack of funding, and shortages of doctors. Our system is sick, and needs help.

Now before I go on, let me be clear: I think Canada’s healthcare system is a better alternative to the pay-for-care insurance system to the south. Privatization has its own set of problems. There are 49 million people in the US without any insurance. The same numbers are inadequately insured. Despite that shortfall, the US spends more dollars per capita on health care and has worse outcomes in areas such as lifespan and infant mortality. Having lived in the US and having friends and family there, I have seen first-hand the shortcomings of a business-based health care system. It’s a system where patients can’t retire because if they do, they won’t be able to afford their medications or insurance. It’s a system where if you get sick with an illness that isn’t listed in your insurance policy, you’re still going to have to pay for your treatment and care (even if you’re already paying thousands of dollars a year for your insurance). It’s a system where in 2007, according to a recent Harvard Medical School research study published in the American Journal of Medicine, nearly 1 million people declared bankruptcy because of medical bills (75% of these families had health insurance). So don’t get me wrong, I think we’re on the right track in this country, our system just needs a little medicine of its own (or maybe a little adjustment!). As well, as you read further it may seem like I am against taking medications for illness or pain. I am not. I do believe that there is a time and a place for pharmaceuticals and that in many ways these drugs have improved the outcome and quality of life for multitudes of people. What I do have a problem with however is an over-reliance on drugs that merely attempt to abate symptoms without getting to the root cause of the health problem, which as you will see is sometimes not completely rooted in the physical realm.

One of the failures of our system has been its narrow focus when it comes to treatment of the patient. All too often the patient is looked at as simply an organism that needs something replaced, removed, renewed, rehabbed, or retired. The health problem itself is assessed but not necessarily the impact it has had on the rest of the organism – You! On top of the pain or dysfunction we experience, we often find it challenging to accept that maybe we feel our bodies have let us down or maybe that we have to actually address issues surrounding our own mortality. We are more than just flesh and bone, we have spirit, emotion, attitudes, hopes, fears, dreams, and if we stop to think about it, probably a fairly well defined idea of how we expect our lives to play out health-wise.

When we are faced with an illness or injury, it is more than just that body part or system that suffers. It is the person as a whole that suffers because every aspect of who we are as a person is attached to that illness in some way. Pain, fatigue, immobility, and disability have the potential to produce mental, emotional and spiritual suffering as well.

In the realm of chiropractic care, depression and stress are often associated with low back pain and disability. I could prescribe every exercise in the book, but if we don’t address the stress and depression issues, and make the appropriate referrals to practitioners who can help the patient deal with those issues, it will be very difficult, if not impossible to see the patient regain their health. And yet these aspects of our health are so often ignored by our health care system. Fortunately there are some people within the system – nurses, doctors, technologists, even porters and janitors – who see the patient as an amazing, multifaceted, complex beautiful mosaic of body, mind and spirit and perform their jobs in a way that meets the needs of the patient on every level.

But the system itself is not set up or managed in a way that allows this to happen very often. How can a medical practitioner who has to see a patient every 5 or 7 minutes possibly be able to address the needs of a patient who has just received a diagnosis of cancer? How can they possibly have the time to reassure a patient whose diagnosis is still undetermined after months of illness? I am sure if you asked them most practitioners would cite a need to have more time to spend with each patient as being one of the issues most needed to be addressed. Looking at it another way as we gain more and more insight into the most minute, inner-workings of the body through amazing breakthroughs in medical technology, we begin to see the patient and illness in smaller and smaller pieces instead of dialing out to see the larger and larger pieces of the whole that make us all wonderfully and beautifully individual; a view that would clearly reflect the definition of health according to the World Health Organization.

 

Ottawa Charter 

The Ottawa Charter for Health Promotion (See link above) is a document that was drafted and signed as a result of a series of World Health Organization conferences (most notably in Ottawa in 1986). The Ottawa Charter states that “the fundamental conditions and resources for health include Peace, Shelter, Education, Food, Income, a Stable Ecosystem, Sustainable Resources, Social Equity, and Justice.” Wow…….wow. Take a second to let that sink in. In fact, let’s read that again:

 

The fundamental conditions and resources for health include Peace, Shelter, Education, Food, Income, a Stable Ecosystem, Sustainable Resources, Social Equity, and Justice.

How many of those “fundamental” conditions and resources can we honestly say we have here in Canada? As well it goes on to say

• “Political, economic, social, cultural, environmental, behavioural and biological factors can all favour health or be harmful to it.” (Do we have a HEALTH care system?)

• “Health promotion focuses on achieving equity in health. Health promotion action aims at reducing differences in current health status and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential.” (Heart disease is 1.5 times higher and Type 2 diabetes is 3 to 5 times higher among First Nations people and rates are increasing among the Inuit; and Tuberculosis infection rates are 8 to 10 times higher. First Nations peoples in Canada continue to be over- represented in new cases of HIV infections. Life expectancy on the reservation is 5-8 years less than it is for the general Canadian population)

• Reorienting health services also requires stronger attention to health research as well as changes in professional education and training. This must lead to a change of attitude and organization of health services which refocuses on the total needs of the individual as a whole person.

 

I am amazed that this document was written in 1986 and yet here we are 23 years later and our health care system still does not encompass wholly what this document describes as a basis for health and health care. It has been my experience many times in dealing with patients that it is this lack of assessing the whole patient as opposed to just the part that hurts or isn’t working that has prevented many from being able to regain their health. Instead they become “chronic” patients, in the process diminishing their quality of life, losing jobs, relationships, and self-respect, and having to continually access the health care system for more treatment and tests that will undoubtedly continue to fail them.

Another issue which limits our current system from being more efficient and prevents us from accessing care that may be of great benefit , is the lack of recognition and responsibility delegated to complementary health care practitioners like chiropractors, naturopathic doctors, acupuncturists and registered massage therapists.

According to the Health Council of Canada, in 2008 we spent 172 billion dollars on health care. Of that amount, 23 billion was spent on medical doctors (well worth it) but, get this, 30 billion on drugs…more than we spend on doctors! The total spending on health care is up from 79 billion in 1997 and is projected to hit 340 billion by 2019. These costs are not solely related to population growth, aging population or inflation but rather increased use of services from diagnostic tests to prescription drugs.

Low back pain, depending on whose research you read, ranks anywhere from the 5th to 2nd most common cause for a visit to the doctor’s office. Most commonly treatment for back pain in the doctor’s office is either medication or advice to rest or walk. Everyday you have literally thousands of people sitting in waiting rooms across the country, undoubtedly in an office that is already stressed to the max for a condition that could easily be dealt with by a practitioner who has studied the spine for 4 years and is better equipped to diagnose and treat the back pain, more likely without the use of costly tests or medications. Similarly you could say the same thing about naturopaths and digestive or weight issues, as well as acupuncturists and massage therapists and stress or pain complaints among a myriad of other conditions that they can treat. On top of that, all four of these health care professions teach their practitioners to identify other health conditions that may lie outside their own particular scope of practice and make the appropriate referral to the medical doctor for follow-up and treatment.

Think about the changes that could be made as far as access to treatment, and the burden taken off overworked medical practitioners, if patients were more easily and confidently triaged to care with other providers who are better equipped to deal with their issues. I am not suggesting that medical doctors no longer have a place in our health care. On the contrary. Western medicine has made incredible progress over the years in its ability to successfully diagnose and treat thousands of conditions. What I am saying is that in order to offload the burden currently placed on medical providers and our health care system, more of an effort should be made to evaluate the plethora of good peer-reviewed research and evidenced based treatments provided by complementary health providers and utilize these treatments more frequently and effectively; this can only improve the health of people across the country by giving them access to effective care early preventing conditions from becoming chronic and by limiting and preventing the over-use of expensive and often unnecessary drugs and diagnostic tests.

Lastly (really, I mean it) the lack of emphasis on prevention in health care may be the final nail in the health care coffin so to speak. Our current system is struggling. Badly. We have, over the years been socialized to think reactively about our health. Our entire health care system is a reactive one. The attitude more or less is to wait for problems to appear and then go about the business of fixing them with drugs and surgery rather than educating the public about what Health really means, identify ways to make it real and accessible to everyone, and therefore be more healthy as a country and become less dependent on the system. There are attempts at education, I realize that. But what if we took a fraction of the money spent every year on marketing drugs and used that to create realistic, accessible education programs that could be delivered in every town across the country, think about how much healthier we could be as a nation.

According to a 2008 research study by the School of Health Policy and Management, at York University in Toronto, pharmaceutical industries in the US spend about 30% of their budget marketing the drugs they manufacture. Excluding direct-to-consumer advertising (TV, print ads, etc.) they estimate that with a total expenditure of US$57.5 billion and about 700 000 practicing doctors in the US, the pharmaceutical industry spent around US$61,000 in promotion per physician. As a percentage of US domestic sales of US$235.4 billion, marketing consumes 24.4% of the sales dollar versus 13.4% for Research and Development.

Take a look at these numbers reported by HealthCare BC in the posting “Healthcare by the Numbers” from BC Ministry of Health (see link):

Health Statistics

Cost of providing health services – today and tomorrow

• 42% – the percentage of total government spending that goes to health care this year

• 70% – the potential percentage of total government spending that health care could consume by 2017

 As baby boomers age, demand on the system increases

• $2,364 – average spent by the province annually per person aged 45 – 64

• $5,224 – average spent by the province annually per person aged 65 – 74

• $9,841 – average spent by the province annually per person aged 75 – 84

• $20,878 – average spent by the province annually per person aged 85 or older

• 14% – percentage of B.C. population over the age of 65 today

• 24% – percentage of B.C. population expected to be over age 65 by year 2030

• $867 million – amount spent on PharmaCare in 2005/06

• $1.04 billion – projected PharmaCare cost in 2008/09 based on current 3 – year plan

• 149.1% – percentage increase of PharmaCare expenses since 1993

• 715 – number of different drugs paid for under PharmaCare in 2005

You can see that as the population ages health care costs go up – drastically. Guess what segment of our population is 2 years away from turning 65? Guess how much of your population is composed of baby boomers? According to Pierre Fortin, a professor of economics at the Université du Québec à Montréal, and an associate of the Canadian Institute for Advanced Research this is what we will see happen over the next 10 years: “The passage of this large group of baby boomers into their golden years will push the percentage of senior citizens 65 and older from 13% of the total population in 2006 to 18% in 2020. Now a senior citizen costs on average five times more in terms of health-care costs and social services compared to a younger adult. As a result, between now and 2020, there will be a 14% increase in annual provincial spending in health care and social services, this above and beyond the already extremely rapid increase in spending over the past several years (on average 7% per year since 2000).”

So now you have to ask yourself, “Do I want to be dependent on that health care system, or do I want to invest as much of myself as I can Right Now in educating myself about health and wellness, addressing the health needs that I have now so that I can enjoy the later years of my life NOT relying on a health care system that seems doomed to collapse in its current form?”

Does this all sound gloomy? Well, sorry. But it could be that gloomy.

The good news is that we all have the tools and resources we need

to change that scenario and envision a brighter health future for everyone.

 

1. Think PREVENTION. Modify your lifestyle and habits so that they have the least negative impact possible on your health. Avoid excess relating to diet and alcohol. Get your rest. Exercise (just walk 30 min a day). Manage your stress. Laugh. Socialize. Get a pet. Drink water. Eat your fruits and veggies. Forgive. Love. Breathe.

2. You are Body. You are Mind. You are Spirit. Begin to view health as something that encompasses EVERY part of who and what you are. Health means that every facet of your being is cared for.

3. Demand the best from all of your health care providers , whether they be medical or complementary. You deserve it and that’s our job. Living in an isolated or rural area does not mean that you shouldn’t have access to the very best care. We enter our professions for the purpose of working our tails off every single day in order to help those who depend on us find answers to their health questions and assist them in creating healthier, productive and satisfying futures for themselves and their loved ones. Don’t let us let you down!

4. Advocate for the fundamental conditions and resources for health we talked about earlier. Remember what they are? Peace, Shelter, Education, Food, Income, a Stable Ecosystem, Sustainable Resources, Social Equity, and Justice. Astoundingly they don’t exist for every man woman and child in our great country. But they should. Make it happen.

5. Educate yourself about health and whatever health conditions you may have. There is an incredible amount of information available to anyone who cares to look. Sometimes it can be a little confusing, so ask us about it.

6. Consider alternative forms of health care for your health related complaints. Many of you already do – that’s why you’re reading this! But if you’ve never considered chiropractic, acupuncture, naturopathic medicine, or massage therapy, or aren’t sure how we could help you, pick up the phone! Call us and ask us any questions you may have or drop by the office just to talk. I am always happy to take the time to answer questions you may have about Chiropractic care.

The Canadian Physiotherapy Association in a position letter to the Canada Health Council regarding their “Value for Money” initiative states

“Value in healthcare happens when patients receive the right care in the right place at the right time. By removing traditional barriers to early intervention and encouraging inter-professional collaboration, innovative (multidisciplinary) health centres can reach for better outcomes at lower cost. The results are healthier living, disease prevention, prompt return to function and a reduction of the impacts of chronic disease on quality of life.”

I couldn’t agree more.

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