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Socio-economic factors responsible for 20% of health care spending

When CMA President Anna Reid addressed the Economic Club of Canada recently, she admitted that the speech, which focused on hunger, child poverty and similar social issues, might surprise some members of her Toronto audience.

Reid pointed out that 300,000 Canadians are homeless or "precariously housed," while another 882,000 of them visit a food bank every month. Meanwhile, Canada now ranks 11th in the UN's Human Development Index after recently spending several nears in first place.

"So what do these statistics have to do with me, a physician, when my business is health?" asked Reid. "A lot. More than anything else, it is the circumstances of one's day-to-day existence that determine whether a person is healthy or sick, and it is therefore these life circumstances, good and bad, that also frame a doctor's everyday realities."

In delivering the speech, Reid was continuing the CMA's drive to move the social determinants of health - income, education, housing, employment - higher on the health care agenda.

"According to the Public Health Agency of Canada, one in every five dollars spent on health care in Canada is attributable to socio-economic factors such as income," she explained. "Statistically, the health care system accounts for only 25% of the health outcomes of Canadians. Biology and genetics account for another 25%."

This means, said Reid, that "fully one-half" of Canadians' health status depends on their life circumstances.

Despite this, she said, there is a stronger focus on trying to fix the health care system than on dealing with the factors that lead to poor health in the first place.

As for the health care system itself, Reid said Canadians consider it "an emblem of our country's compassion and sense of fairness." However, this emblem is becoming a little shopworn: it fails to provide an adequate pharmaceutical strategy "for the millions of Canadians who aren't taking their meds because they can't afford them," it has no dementia strategy in place in the face of an aging population, and it lacks long-term care infrastructure.

Finally, little is being done to target poverty, the "overriding factor" in determining a person's health status. "Spending on health without addressing the underlying causes of poor health makes no sense," Reid said.

She reminded her business audience that Canada's health care system is a boon for businesses because of the international competitive advantage it provides.

"The business community has a vested interest in Canada's health care system," she said.

Forward any comments about this article to: cmanews@cma.ca.