Thursday, August 16, 2012

Physicians take healthier approach

AUGUST 16, 2012 

Physicians must become stronger advocates for health equity, says incoming CMA President Dr. Anna Reid, an emergency room physician in Yellowknife, Northwest Territories.

Just a few short years ago, the Canadian Medical Association's leadership launched a series of direct challenges to Canada's universal public health-care system. Two CMA presidents known for their involvement in private service delivery used the national profile associated with the organization to pitch their business model. And CMA members came within an eyelash of voting for health care to be at least in part patient-funded.

But the effort of one faction within the CMA to shift our health-care system toward a profit-based model didn't do much to sway public opinion or reshape the delivery of health care. (Yes, we've continued to see privatization by stealth - but not at any greater pace than was already under way.) Instead, it was met by the founding of Canadian Doctors for Medicare, who made it abundantly clear that the CMA couldn't claim a professional consensus to dismantle our prized national health-care system.

Now, the CMA looks to have changed direction entirely. And there's reason for optimism that Canada's medical profession is headed down a much more viable path.

In 2011, the CMA (along with the Canadian Nurses Association) unveiled a set of principles to guide health-care transformation that speak in no uncertain terms about the need to address the corrosive effect of inequality. In keeping with those principles, the CMA has pushed the federal government to include health impact assessments as part of its policy development process.

And at a national council meeting this week in Yellowknife, the CMA turned its discussion for the first time toward the social determinants of health. Rather than limiting its focus to the delivery of care, the CMA recognized that medical practice is only one of many factors in overall health outcomes. And it emphasized that physicians need to be aware and active in addressing broader social issues ranging from climate change to housing to the treatment of marginalized groups in order to improve health outcomes.

So what does the change of focus from one of Canada's most prominent medical voices mean for our broader political debate?

On one view, the CMA could hardly have picked a worse time to adopt a more socially conscious position when it comes to the receptiveness of governments. Stephen Harper's Conservatives have entirely abandoned health care and social programs as anything but an ATM for the provinces - and even there, the federal government is going out of its way to direct money where it's needed least. And at the moment, few provincial governments have both the inclination to pursue social goods and the resources to invest in them.

But some of the political barriers standing in the way of a broader view of health might start to crumble in the near future, whether through a renewed Ontario minority government or through an expected change in government in British Columbia. So a message based on health equity and the social deter-minants of health might be nicely timed to inform decision-makers on the cusp of developing and implementing long-term policy goals.

Moreover, unlike the CMA's previous advocacy for privatization, its argument to consider the social determinants of health should be relatively non-controversial within the medical community. (At least I wouldn't expect to see a Doctors with Blinders countermovement within the profession.)

At the very least, then, we should see the CMA's focus on health equity result in a strong professional front. And if Canadians recognize the significance of our medical community uniting to speak to the need for greater social action, then the CMA's new direction could play a part in transforming more than just our health-care system.

Fingas is a Regina lawyer, blogger and freelance political commentator who has written about provincial and national issues from a progressive NDP perspective since 2005. His column appears every Thursday. You can read more from Fingas at

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