Healthcare challenge or health crisis? Failing to prevent preventable diseases guarantees a doctor shortage.
Residents of the Sault have a lot of challenges, not the least a failing, perhaps even collapsing, healthcare system, and substance abuse and mental health crises, along with dismal performance reducing GHG emissions and ongoing food and housing insecurity.
Experts are shifting upstream to tackle the demand side, or causes of these interconnected problems rather than only the downstream effects. This shift intends to prevent problems rather than simply treat or manage their symptoms. As they say, an ounce of prevention....
The loss of doctors and subsequent orphaning of thousands of local residents presages a serious healthcare challenge. So how should the Sault respond?
Physician recruitment and retention are important to overcome any doctor shortage, but when the Sault is competing with every other community across the country and everyone is struggling with an overburdened and admittedly under resourced healthcare system, doesn't it make a lot of sense for communities like the Sault to also do what we can to reduce demand on and for healthcare?
Besides, wouldn't the recruitment of more foreign trained doctors only expand inequalities and manufacture illness by competitively stealing foreign doctors from global hotpoints that are already experiencing severe healthcare service shortcomings?
What if we were to reduce demand on the healthcare system and solve any doctor shortage by creating healthier communities and improving the health of residents?
The numbers are compelling. For instance, more than 90% of heart disease and 95% of cancers are preventable through the social and environmental determinants of health. Traffic collisions are virtually 100% preventable since they are all caused by driver error – fatigue, distraction, impairment, speed, aggression and failure to drive for the conditions – which in turn largely result from poor road and infrastructure design (which in turn is the result of an intentional narrative and the resulting practices).
Poverty and inequality – the cause of incredible suffering, mortality, and disability life years lost – and the primary contributors to the leading causes of disease and death in Canada, is entirely a policy choice, and completely preventable. And nearly all mental illness is the result of complex interactions between genetic endowment and our social environment, and most is preventable through early and proper sustained interventions in, and support of, the social determinants of mental health.
While we can't affect our genes or choose our parents, city's can certainly contribute to the social and environmental conditions to prevent disease and illness, and promote population health. This in turn can substantially reduce demands on our healthcare system.
Crane identified how this can work in our 2019 budget submission using transportation as an example.
Shouldn't we see more than just a focus on treating the symptoms of unhealthy environments through competitive and costly (and arguably unethical) physician recruitment and retention when our health is threatened?
The key solution to our doctor shortage and healthcare challenge is to shift thinking upstream and create healthier communities and populations.
While the city is doing some upstream work, and genuinely wishes to do more, there remains considerable latitude to do much more.
As just one example, when the city plans and designs our community with roads and private automobility in mind, it establishes – as the default – a sedentary lifestyle that is polluting, costly, discriminatory, noisy, energy intensive, unfair and inequitable, divisive, harmful to our (sense of) community/participation/belonging/empowerment/place/trust, impoverishing and fundamentally unhealthy. By design. The result contributes to preventable heart disease and cancers, along with many other preventable diseases, not to mention collision-induced harms that the Speed Management Task Force is currently struggling with.
All of these impacts place very direct stress on our healthcare systems and medical professionals. Reducing these stresses would be transformative for the healthcare system, and the way we define and consider health.
Upstream thinking challenges the basis of our doctor shortage and healthcare struggles, and repositions decision makers to question the structures and practices that lead to ill health – the causes of causes – to challenge and replace the fundamental political rationalities that shape and define healthcare and health.
As someone once said, every minister is a health minister, meaning every public policy and program affects health.
Sir Michael Marmot has observed that most of the things that doctors treat are failed prevention.
Or, as the late Monique Bégin (Former Minister of National Health & Welfare, Fellow of the Royal Society of Canada and Member of WHO Commission on Social Determinants of Health) noted "What good does it do to treat people’s illnesses, to then send them back to the conditions that made them sick?"
Considering doctor shortage as a health crisis, and not only a healthcare challenge, opens a vast number of opportunities for local solutions that the city has complete control over, many that would not only cost nothing, but would pay huge dividends.