Health and health care

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This article was published 30/03/2024 (857 days ago), so information in it may no longer be current.

Health is more than health care. Think about it.

Is going to the doctor what makes you healthy? Or is living in a comfortable and safe home? Being valued in a job you like? Enjoying food with family and friends? Having fun being active? Of course, we need access to health care services when we are sick or hurt. But it takes more than illness-care to maximize individual health and well-being.

Now expand that thinking to a community or ‘population’ level, and you meet the concept of “determinants of health.” That’s how public health folks describe the social conditions that influence how healthy groups of people are likely to be. Social determinants of health are things like how much money you have, your education, whether you have a job and how safe it is, where you live, if you have enough food, your early childhood experiences, if you feel like you belong, and if there’s peace around you. And access to health care services too. The basic building blocks for opportunity and health that everyone has a right to. It makes sense that being as healthy as possible is pretty impossible when living without a safe, appropriate home, enough money or food, or with oppression and discrimination. It not only makes sense, but it’s also measurable.

When looking at health relative to socioeconomic status, income is often used as an overall measure of determinants of health given how influential it is over other determinants such as food, housing, and education. For pretty much every health statistic imaginable, people living with lower income experience higher rates of illness and injury.

According to the Manitoba Centre for Health Policy’s most recent RHA Indicator Atlas, people in the lowest income group are twice as likely to die prematurely (before age 75) as compared to those in the highest. Sadly, the same thing goes for infant and child mortality — twice as high in the lowest income group. There was also a strong connection found between income and many conditions like diabetes, hypertension, arthritis, and heart attacks. Hospital days for acute care among adults in the lowest income level is double the hospital days among those in the highest, with a gradient noted across all income levels. Roughly calculated, over a quarter of all hospital days could be avoided if all people in Manitoba experienced the same conditions and access to determinants of health as people with the highest incomes.

Having huge gaps in health across population groups is unjust and unacceptable. It is also expensive. And it’s fixable — if we have the social and political will. Allowing poverty to continue is a policy decision. Allowing poverty and the socioeconomic gradient to undermine the health of Manitobans is a policy decision. People matter and we can do better.

So, when we talk about fixing health care, let’s not forget about fixing health. If we close inequitable gaps in health, we not only improve lives across our whole province, but we also slow the flow of people into emergency departments and into hospital beds. Besides investing in needed health care workers and health services, we also need to invest in the determinants of health.

How can we close the gaps? What would that take? All government departments would need to understand and factor in how health is affected by their decision-making. We would all need to acknowledge that investing in social and affordable housing is investing in health; investing in early learning and childcare is investing in health; investing in guaranteed livable basic income, education and job training, public transit, decolonization and so on… is investing in health. Seeing policy decisions this way is called a Health in All Policy approach which prioritizes coordinated action on the social determinants of health to actually improve health and close gaps.

We know what you are probably thinking — how can we afford this when we need to invest in fixing a broken health-care system? Let’s be real: not fixing health is expensive. We are paying big time for the impacts of poverty in health care right now. And not only health care — add up the impacts of poverty on the justice system, child welfare system, education system and more. Rather than continuing to pay for poverty downstream, let’s invest upstream — lifting people in Manitoba out of poverty, improving the economy, and reducing demands on the health-care system at the same time.

So how do we want to see taxpayer’s money spent in the upcoming budget? Fixing a broken health-care system? Yes. But importantly, also investing in the social determinants of health to fix health. Because health is more than health care.

Sande Harlos is president, and Nicole Herpai, secretary, of the Manitoba Public Health Association.