Backward Medicine

"The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease." Thomas A. Edison Which is more effective: the prevention or the treatment of illness? Unfortunately, that question is not being asked by those who control the health care system. Today our health care system's primary function is to deliver services once illness is detected. However, the only way to sustain the health of Canadians and preserve our system of universal health care is simply to use it less, by preventing illness in the first place. Prevention is the best way to save our health care system. Government programs do exist for the early detection of illnesses. Mammograms, PSA testing for prostate indicators, and stress tests are all routine screens ordered as standard tests by most doctors. Yet, would it not make more sense to have governments contribute tax dollars to prevent such diseases from developing in the first place? As we watch incidence rates skyrocket for heart disease, diabetes, and cancer, we appear to be moving in the wrong direction. Proper nutrition, exercise, stress management, and the control of environmental toxins are the keys to controlling health care costs, but few health care dollars are being spent in these areas. Rising Health Care Costs As the battle rages on between the provinces and the federal government over health care funding, little attention is being paid to just how out-of-control the costs really are. In 2001, you, the taxpayer, funded $97.6 million for health care, up 7.2 percent from the year before. Figures across the country vary from province to province, but health care spending exceeds 40 percent of total program spending in some provinces. Nadeem Esmail, senior health policy analyst for The Fraser Institute, predicts that unless we make drastic fundamental changes, by 2040 all 10 provinces could be spending their entire provincial budgets on health care. No other country, says Esmail, spends more than Canada to maintain a universal access health care system. With baby boomers moving ever closer to retirement, the demographics are also working against our health care system. The 65-plus crowd will have grown from 14 percent of the population in 1980 to over 40 percent by the year 2040. This is especially alarming considering that those over 65 already account for almost 70 percent of total health care spending today. Curbing Obesity One area where prevention is critically needed is weight management. Obesity levels in this country are at an all-time high. In Canada, 35 percent of boys and 29 percent of girls are overweight. It has been statistically shown that 42 to 63 percent of obese school-aged children will go on to become obese adults. Along with heart disease, increased cancer risk, stroke, and hypertension, type 2 diabetes is becoming the "new normal" associated with obesity. Worldwide estimates project the number of cases of type 2 diabetes to hit 300 million by the year 2025. According to the Harvard School of Public Health more than 90 percent of these cases could be avoided or reversed through weight control, exercise, a healthy diet and by not smoking. Exercise is a major component in the prevention of obesity. Our former national fitness program, Participaction, was launched in the 1970s with funding of approximately $1 million a year. Two years ago it was cancelled after funding dwindled to just over $300,000. Maintaining, or better yet, increasing funding for programs such as Participaction would be a move in the right direction to improve the health of the nation. The majority of patients rely solely on their medical practitioners for advice and treatment. However, the average doctor receives less than seven hours of nutritional training in medical school. Furthermore, most physicians and dieticians follow Canada's Food Guide, which recommends high glycemic-index foods shown to be major contributing factors in obesity and thus type 2 diabetes. Cuts That Cost With federal funding for health care dwindling, the provinces are looking for ways to cut costs and divert funds into crisis management. In some cases, the budget cuts move us even further away from a preventive approach. Ontario took a giant step backward in 2004 by announcing the de-listing of chiropractic, physiotherapy, and optometry exams (as BC did a few years earlier). The de-listing of these services will save the Liberal budget $200 million a year. According to Ontario health minister Greg Sorbara, "In order to raise the revenues necessary for more critical services, joint replacement, cardiac surgeries, cataract surgeries, and vaccinations for young people, you have to make choices." Dean Wright, president of the Ontario Chiropractic Association called the move "short sighted," noting that 1.2 million Ontarians are kept out of pain and at work through chiropractic. An independent report released in September 2004 by Deloitte Inc., National Health Services Consulting, concluded that de-listing chiropractic alone would end up costing the province's taxpayers as much as $125 million a year extra for medical treatment. Chiropractic is just one of the many integrative disciplines, such as naturopathy, homeopathy, and acupuncture, which no longer receive adequate coverage from the government of Ontario. Time to Change Direction In July 2004 at the premiers' health care summit, a proposal was tabled asking the federal government to fund $7 billion a year for a national pharmacare program. The premiers want Ottawa to pay full costs for a full-fledged drug program which would replace all provincial plans except Quebec's. Imagine what we could accomplish if $7 billion a year was spent on preventive measures instead? Rather than simply pumping more money into advertising campaigns that have little effect on smoking habits, both federal and provincial governments could pay for smoking cessation aids such as the nicotine patch and acupuncture, which are proven to be very effective. We could revise Canada's Food Guide to make it an effective tool in educating the public about proper nutrition and weight loss. Our federal government could put physical fitness back into the school curriculum. We could develop a system where medical doctors worked in concert with experts in the fields of nutrition, weight loss, and fitness to help their patients prevent illness and maintain good health. Finally, we could empower members of the public to take charge of their own health by instituting a tax-deductible allowance for physical trainers and nutritionists. Proactive, preventive initiatives such as these will have to come from public demand as well as a decisive vision from our politicians. The benefits of improving the health of our nation through these kinds of measures could be enormous. Now is not the time to commission another study but to work diligently to reduce obesity, curb smoking, and improve cardiovascular health through physical fitness. A simple change in focus to keeping people well - may be just what the doctor ordered. The Ontario government recently received a Webby award for their website, healthyontario.com, which promotes proactive measures for a healthy lifestyle.