Greg Marchildon and Livio Di Matteo

Canadian economists received a pleasant surprise this year: expenditure growth on public health care in Canada finally appears to be slowing down. However, it is unclear if this slowdown is the result of explicit success in sustainably bending the cost-curve or more short-term cost-cutting in response to slower economic growth or future federal health transfers.

So is it a blip on the health care horizon or the beginning of a trend?

This past week, Saskatchewan Premier Brad Wall took to Twitter to ask the question: “Is it time to allow people to pay for their own private MRIs in Saskatchewan like they can do in Alberta?” This came after a radio show in which he’d received a call from a patient who’s been waiting three months for an MRI — one of many Saskatchewan patients who are, understandably, frustrated by long waits for essential imaging services.

These wait times are a real problem. For that reason, we should be very wary of false solutions, and look first to evidence before rhetoric takes over.

On June 18, 2012, I joined dozens of health care providers and concerned citizens in Saskatoon for the 1^st National Day of Action against the cuts to the Interim Federal Health (IFH) program, which then offered health coverage to refugees in Canada.

Health providers in scrubs and lab coats, sporting stethoscopes and placards with slogans, marched in similar demonstrations across the country. I remember being struck then by the fact that 50 years earlier in Saskatoon, doctors had gone on strike in opposition to the introduction of universal health insurance. Now here was a movement of physicians and other health professionals taking to the streets to defend universal care for the most vulnerable. 

Social factors play a significant role in determining whether we will be healthy or ill. Our health care is but one element of what makes the biggest difference in health outcomes. This has been understood for centuries, and empirically validated in recent decades with study after study demonstrating health inequalities between wealthy and disadvantaged populations. 

Yet political conversations about health still tend to fall into familiar traps. When we talk about health we return by reflex to doctors and nurses, hospitals and pharmacies. And when we talk about politics — the field of endeavour with the greatest impact on what determines health outcomes — a narrow and economistic outlook seems to trump any attempts to address those social determinants.

I attended the annual meeting of the Canadian Medical Association (CMA) as a representative of Canadian Doctors for Medicare last year. The meeting was not at all what I'd expected. 

The CMA, as a professional association representing doctors, has often been seen — fairly or unfairly ­— as working primarily for the interests of the physicians it represents with patients and health equity appearing at times to be an afterthought. This impression was particularly prevalent during the presidencies of Brian Day (2007-8) and Robert Ouellet, (2008-9), both vocal advocates for privatization (and owners of private, for-profit health care facilities) who used their tenure to advocate for greater private payment for essential health services. 

Last year the Metcalf Foundation released a report on working poverty in Toronto. It found that 113,000 people were living in working poverty in the Toronto region in 2005, a 42% increase from 2000. The report's findings indicate that people living in working poverty most commonly work in sales and service occupations; work comparable hours and weeks as the rest of the working population; are over-represented by immigrants; and are only slightly less-educated than the rest of the working age population.

If you woke up this morning and put your feet on the floor in Moosenee, Iona, Bella Coola or Longlac, then the chances are that your health is poorer than if you were greeting the day in any major Canadian city. Overall, rural folk have lower life expectancy, more injury, chronic disease and mental health concerns, higher rates of smoking, alcoholism and drug misuse and poorer perceptions of their own mental and physical health than Canadian urban dwellers. There are inequalities in health outcomes between rural and urban residents, as well as among other subpopulation groups in Canada. I argue for a more nuanced look at the unfairness of  inequalities and what we can do collectively to find ways to address them. 

The Canadian North, which includes the Yukon, Northwest Territories, Nunavut, Nunavik, Labrador, and Nunatsiavut, is a vast region rich in Indigenous cultures, pristine landscapes and waterways, natural resources, and increasingly diverse communities. It is also a region known for having the highest rates of chronic housing need in Canada. Across the North, where more than half the population is Inuit (including Inuvialuit), First Nations (including Innu), or Métis, there is chronic housing need (lack of affordability, inadequacy, unsuitability, unavailability) and lower rates of home ownership than in the southern provinces. The 2006 census found home ownership in Nunavut and the Northwest Territories to be 22.7 and 52.9 per cent, respectively, compared to 71 per cent in Ontario or 73 per cent in Alberta. In most small, northern communities in Canada, social housing is the main, if not only, option, with very few opportunities for home ownership. Limited opportunities for home ownership are compounded by the high rates of unemployment in many small, northern settlements.