HEALTH CARE? Sickness care is more like it

The Learning Curve is an occasional column written by local academics who are experts in their fields. It is open to any educator from Winnipeg's post-secondary institutions. Send 600-word submissions and a mini bio to thelearningcurve@freepress.mb.ca.

The recent controversy surrounding the efforts of sufferers of multiple sclerosis to gain access to a promising, but as yet, unproven therapy not yet available in Canada, is generating considerable debate. However, by focusing attention on the issue of offering expanded biomedical treatments to more and more people, such debates, which are foundational in a publicly funded health care system, overlook what may be a more important and as yet unanswered question: To what extent does formal biomedical health care contribute to improvements in population health?

Social scientific health researchers have shown that industrialized nations such as Canada spend an increasing percentage of their gross domestic product on formal health care, such as offering treatments for disease. In Canada the latest data show that governments spent $120.4 billion on formal health care in 2007-2008 (Canadian Institute for Health Information, 2009). Total health spending accounted for 10.1 per cent of GDP in Canada in 2007, compared with an average of 8.9 per cent across OECD countries (OECD, 2009). The United States (16.0 per cent), France (11.0 per cent), Switzerland (10.8 per cent), Germany (10.4 per cent) and Belgium (10.4 per cent) had a higher share. This places Canada fifth on the list of OECD nations in terms of health care spending per capita, with countries such as the U.S., Norway, Switzerland and Luxemburg spending more per capita. However, international comparisons also show that those countries which spend the most on formal health care do not necessarily receive proportionate returns in terms of population health status. For instance, Japan has a life expectancy of 82.6 years, ranking it first on the OECD list of countries, but it only ranks 21st in health care spending per capita. In comparison, the U.S. ranks first in health spending per capita but, with a life expectancy of 78.1, ranks 17th. At 80.7 years, Canada ranks sixth in life expectancy at birth.

What this shows is that our formal health care system is designed to care for us when we become ill, rather than to promote and protect good health. Today we have primarily a medicalized health care system focused on the acute care of sick people within institutions, such as hospitals. In our current formal health care system "health" is often equated with biophysical functioning and "health care" is all too often reduced to the provision of biomedical products and services (such as pharmaceutical drugs and surgery) by the medical profession and corporate interests. In other words, our health care system is more aptly described as a "sick care system" that treats biophysical disease, and in which physicians exercise dominance. Data show that spending on hospitals, other institutions, physicians, and prescription drugs, accounted for 66 per cent of all health expenditures in comparison with 6.6 per cent spent on public health measures (Canadian Institute for Health Information, 2009). Put another way, a tenth of what was spent on formal health care was spent on public health in Canada in 2007-2008.

Achievements of biomedicine and the quest to cure debilitating and deadly diseases such as multiple sclerosis are undeniably important. Many lives have been saved, much relief from pain and suffering given, opportunities for a fuller, more rewarding life afforded by biomedical health care. Compassionate physicians and nurses care for us when we are sick, sometimes at great costs to their own health and wellness. It cannot be denied that medicine has been a great benefit to humanity. However, there is ample evidence which shows that the contribution of biomedical health care to population health is less than commonly believed. Indeed, formal health care was not primarily responsible for much of the decline in mortality experienced over the last century. However, in spite of these facts, biomedical health care has continued to expand its boundaries, enjoying tremendous public acceptance. As a result, we debate social inequalities in the distribution and care of illness rather than the more important issue of social inequalities in the production of health.

Christopher J. Fries is a health sociologist in the department of sociology at the University of Manitoba and co-author of the forthcoming book from Oxford University Press, Canada: Pursuing Health and Wellness: Healthy Society, Healthy People.

Republished from the Winnipeg Free Press print edition June 19, 2010 ??65524