PREVENTION VS TREATMENT
March 2012The Honourable Dalton McGuinty
Premier of Ontario
Legislative Building, Queen's Park
21 March 2012
Dear Mr. McGuinty,
Mr. Don Drummond's report on a streamlined health care system, overlooked the importance for a review of the existing Health Protection and Promotion Act and of the need for amendments to the provincial Medical Officer of Health position, and subsequently to the emphasis of Prevention vs Treatment. (Promotion is not Prevention.)
A lamentable omission in Mr. Drummond's recently released report on economic and fiscal challenges was the myopic view on the prevention of illness, which if not prioritized, will counteract the finite improved costs. If the government had applied innovative and long-term solutions to healthcare, political realities would not be trumping economics at present. Numerous studies point out that prevention reduces healthcare costs, yet, we do not prevent illness; we treat it. Mr. Drummond's recommendations only touch the surface of solutions for preventing illness.
Management of the system, promotion of healthy lifestyle, the suppression of symptoms, and remedial treatment neither imply nor incorporate prevention of illnesses effected by environmental and socioeconomic determinants. Pollution: a key contributor to chronic disease, has been left to political interests or to inappropriately called “preventative measures”. Environmental carcinogens can not be averted by life-style changes. Jogging in a smog laden environment does not improve, but exacerbates cardiovascular disease. Asthmatics and migraineurs will not prevent afflictions by remaining indoors, since air toxics are bio-accumulative and their synergistic effect is ever more powerful.
When evaluating environmental economic feasibility, it would be erroneous to simply estimate the profitability of environmental policies, without computing the cost of damage. According to the National Illness Cost of Air Pollution study, 2008, the total economic damages costs of air pollution in Ontario will be $4,318,500 billion in 2015 (constant 2006 dollars). Obesity alone, costs $2.5 billion/year. The total costs of cancer: $7 billion 2011-12. Direct expenditures of asthma: $24.9 billion. Mental illness and addictions, cost Ontario's economy $34 billion. The impact of air pollution on health and the economy will increase over time. Absenteeism and poor health of the workforce will add to the costs. To date, the government has spent $44.7 billion in 2010-11 on healthcare and an estimated over $46 billion in 2011-12. Yet, only 3% of expenditures are dedicated to prevention; whereas, the benefit-cost ratio of prevention is $4-5 dollars for every $1 invested. This is a costly and ineffective management of healthcare.
There has been no responsibility and no long-term goals to act on the environmentally and economically sustainable proposals which have been submitted to the government the past two decades. Government allegiance has been entrusted to industry at the expense of social and health factors that determine health outcomes.
Health Protection is defined as Prevention, but the limited powers and restrictions imposed upon the CMO by the governments, have been counterproductive to the Health Protection and Promotion Act , and inadequate to protect Public Health proactively.
The Chief Medical Officer's mandate should be:
Prevention with leadership and vision will be the essential solution to alleviating health costs, and the time to act is the present.