By Christeen Jesse
L-P Specialty Products
The induction of Medicare into Saskatchewan law 50 years ago has done more than just provide affordable health care - it has also placed importance on the values of equality and democracy.
"We have seen a real establishment of an ethic and understanding that people should be treated if they're sick - regardless of how much money they make and of where they are in society," said Ryan Meili, a family physician in Saskatoon and the head of the Division of Social Accountability at the College of Medicine at the University of Saskatchewan. "I think that's a really positive thing to have been developed here and it effects the way we see lots of areas of social investment."
Meili, who wrote the recently-published book A Healthy Society: How a Focus on Health Can Revive Canadian Democracy, recognizes the province's past accolades in health care, but says as society evolves, Medicare needs to change with it.
"We're very much in the second stage of Medicare and need to move beyond just doctors and hospitals to looking at what really keeps us healthy and makes us sick."
"There are definitely areas where we have moved forward - but I think it would be pretty widely accepted that we haven't really gone beyond treatment - we're mostly still dealing with people after they are sick, rather than looking at 'How do we actually organize our society in a way that fewer people get sick'?"
After 50 years of developing the Medicare model, Saskatchewan is now at a pivotal point - faced with moving beyond health care that focuses on short-term treatment of immediate cases. Looking beyond just the immune system and into the causes of poor long-term health is the next logical step for the province, says Meili
He suggests that in order to achieve that, people must understand how social determinants like income, education and employment affect personal health.
"It's all connected. We have the idea that we can just deal with our bodies once they are sick, but in our society, that's far too narrow of a view," he said.
Factors like housing, nutrition and social support also need to be taken into consideration.
"If you look at where health care dollars go, we spend a lot more on people who are at the lower end of the economic scale. We don't have actual primary care services available in an equitable fashion, so people wind up in a hospital, in the emergency room and where things are most expensive. So number one, it's looking at addressing things like poverty, where people are living, the circumstances where people get sick; and number two, it's addressing health equity - making sure that we provide more services for the people who need them most, rather than the way it is right now."
Roy Romano, former premier of Saskatchewan, also recognizes the importance of taking these factors into consideration for the future. He is quoted in the foreword of A Healthy Society saying: "The impact of the social determinants of health is well known to government and to health care organizations. The major challenge in us lies in turning this understanding into concrete actions that have an impact on individual Canadians and communities."
With a proud past, Saskatchewan is embarking on the next 50 years with a strong foundation. Future government leaders and health care professionals have the task of addressing the current issues with the system, while continuing to build on the successes of its past. If Tommy Douglas's original visions of equality and unanimous access to health care are kept alive, Medicare has a bright future to come.
"On July 1, 1962, we had doctors taking to the streets going on strike against the provision of universal health care. On June 18, 2012, we had a national day of action across the country with doctors taking to the streets protesting cuts to refugee health, saying that we need to provide universal health care, and we need to address health equity in the services we provide. So that, to me, says there has been a cultural shift within the health care providing professions, and that gives me hope," said Meili.
"And hopefully that continues - [Saskatchewan] having people working in the system having a desire for social change and who are willing to spark a conversation that will help us move beyond treatment to better health care."