Discussion about guaranteed annual incomes and other innovations for reducing poverty and associated health inequities highlighted debate during the CMA's April 23 town-hall meeting in Calgary.
The meeting, the fourth in a series of town-hall discussions being held across the country, was held in partnership with Maclean's magazine and CPAC, and attracted more than 100 people. All town halls focus on the social determinants of health - issues outside the health care system that can have a significant impact on Canadians' health.
The meeting moderator, Maclean's Vancouver Bureau Chief Ken MacQueen, pointed out that even a wealthy province such as Alberta faces variations in health outcomes related to social issues. For instance, life expectancy in Calgary is three years more than in northern areas of the province.
MacQueen said there is no magic involved - Calgary simply has more money, and as a result more secure housing, better educational outcomes and a healthier living environment. But even in Canada's second wealthiest city, said MacQueen, there are "pockets of poverty and want."
"We are the most inequitable of the provinces," said town-hall panel member Dr. Stan Houston, a professor of medicine and public health at the University of Alberta and director of the Northern Alberta HIV Program.
The other panellists were Dr. Evelyn Forget, a health economist and professor at the University of Manitoba, as well as Fred Phelps, executive director of the Canadian Association of Social Workers and Paul Wells, political editor at Maclean's.
"We have real poverty in Canada," said Houston, and it is characterized by homelessness, "food deserts," and unreliable sanitation and water supplies.
Forget agreed, noting that growing income inequity in Winnipeg is promoting different health outcomes for rich and poor. "The numbers are appalling," she said.
Wells pointed out that when incomes fall below a certain level, health inevitably suffers and this adds costs to the health care system.
Wells and Phelps both addressed recent policy decisions by the federal government to withdraw from holding the provinces accountable for health care spending by dismantling mechanisms such as the Health Council of Canada.
The provision of a guaranteed annual income was raised as a serious option for addressing the types of health inequities discussed at the meeting. As MacQueen wrote in a recent Maclean's article, a guaranteed annual income would replace the current welfare system and increase minimum income to a guaranteed level. This approach has been championed by many, such as American economist Milton Friedman and Hugh Segal, a Canadian senator.
Forget described follow-up research to an experiment conducted in Dauphin, Man., in the 1970s which had showed that the provision of even modest financial security and stability significantly reduced hospital visits when compared with comparable communities, and reduced the number of physician visits for mental health issues, accidents and injuries.
"There are a lot of fears associated with thinking big ideas," said Forget.
Houston said there are many other examples of approaches that can help eliminate health inequities, such as improved sanitation - "a no-brainer for a wealthy country such as Canada" - stop-smoking campaigns and improved nutrition. An audience member said there are many pockets of innovation in Alberta, but they have not been connected or sustained.
"Health care reform needs to be part of the equation," said Dr. Michael Giuffre, president of the Alberta Medical Association.
Echoing CMA President Anna Reid's introductory comments about why the CMA is holding the meetings, a palliative care physician stated "advocacy is at the core of what every physician has to do."
"Physicians are the natural attorneys of the poor," Houston added.
The last public consultation in the current process series will be held Montreal May 8. However, an additional town hall will be held by the CMA in St. John's June 3, and the association is encouraging people to provide input and comments at www.healthcaretransformation.ca.