Thursday, November 12, 2009

The best health care in the world

The world rages over health care: who has the best and who has the worst?
The United States, say its advocates, has “the best health care system the world has ever known” (Senator Richard Shelby, cited by Nicholas D. Kristoff in New York Times, November 5, 2009). American critics argue to the contrary. They point to their country’s dismal health statistics: 31st in world standing for life expectancy; 37th in infant mortality; 34th in maternal mortality; dead last among 19 countries in avoiding preventable deaths; to cite only a few.
In Canada, nearly 90 percent believe that what we call our health care is better than what Americans have, but critics find incidences of hospital and surgical waiting times, and call it flawed. A medical insurance company promises escape from what it terms “Canada’s broken health care,” and immediate access to the very best medical facilities in the United States. All it takes are payments of healthy premiums.
You would not guess it from the boiling-temperature of the debate, but the best health care in the world is easy to find. It resides in each of us.
The debate supposedly about health care is not about health care at all; it is a debate about medical care. Medical care is about treating you when you are sick. Health care, to my mind, is about things that help keep you from getting sick — exercise, diet, lifestyle choices, and psychological aspects. No one in the misnomered health care debate is talking about diet, exercise, lifestyles, stress or mental attitude. The debate is about hospitals, pharmaceuticals, surgical operations, waiting times, and access. While the medical profession constantly urges us to take better care of our health—too often crying in the wilderness— that is not what is being debated.
Ostensibly both medical care and those other aspects that affect our health fall under the rubric of “health care,” and there is a rationale for that. But lumping both aspects under the same term raises problems. It confuses the debate. It tends to focus too much reliance on fixing ills and not enough on staying healthy. And it obscures responsibilities.
Medical care is primarily a responsibility of medical professionals, but taking care of our health is a responsibility that ultimately falls on each of us. All levels of government have a responsibility in promoting and facilitating good health care, while the medical fraternity; such health organizations as those for heart, lung, diabetes; and physiotherapists, exercise physiologists and fitness trainers, also play crucial roles. Their efforts are in vain if we fail individually to become our own best health caretakers. The most miraculous medical care will not keep us well if we ruin our own health.
The care of our health inescapably starts and sticks with each of us. Advice, assistance and facilities have never been as available or as good. The best health care in the world resides within each of us when we grasp the opportunities and responsibility.
And yet, health care is in sickbay. The data confirm it.
Diabetes is one indicator. Primarily because of obesity and lack of exercise, diabetes is “fast becoming the epidemic of the 21st century,” according to The International Diabetes Federation. Some two million Canadians now have diabetes, and the number is expected to jump to three million by 2020. “The number of people with type 2 diabetes is increasing dramatically because of Canada’s aging population, rising obesity rates, increasing sedentary lifestyle, and higher risk for diabetes for Aboriginal people and new Canadians,” says a report from the Conference Board of Canada .
Kids are a particular concern. The number of overweight and obese kids aged 2 to 17 years jumped from 15 percent in 1979 to 26 percent in 2004, according to Statistics Canada. Some believe it’s worse than that, since the data were collected on a self-reported basis, and no one likes to admit that they are fat. “Extrapolating for self-reported and measured data,” Canada’s Public Health Agency estimated that one-quarter of adult Canadians were obese in 2007 . Add to that those who are overweight, and probably more than half of us carry too much fat.
The reason kids are fat is plain: they don’t eat well, and they don’t exercise enough.
Only half the kids aged 4 to 18 eat enough vegetables and fruit to meet the minimum requirement of Canada’s Food Guide; just one quarter eat enough grain products, and more than one quarter eat French fries two or more times a week (
With TV, electronic games and computers, Canadian kids spend much more “screen time” than physically active time. Fewer than one in eight meet the recommended 90 minutes per day of physical activity, according to the 2009 Report Card from Active Healthy Kids Canada. But 90 percent spend more than 120 minutes on screen time, and many spend nearly six hours per day. Two thirds live within a reasonable distance to walk or bicycle to school, but less than half do. At school, the trend, apparently, is to reduce physical education and even recess time so as to increase instruction time.
Even the ancient Greeks—who gave us democracy, the foundations of much of our science and society, and the first Olympic games 2,786 years ago—knew better than that. They knew that active bodies promoted bright minds. At Athens, the school curriculum had three divisions: writing, music, and gymnastics. Every schoolboy learned to swim, run, ride bareback, and played such sports as rowing, handball and lacrosse. The Athenian diet was plain and simple, life was Spartan, and citizens (who were a minority) tended to live long.
For a couple of hundred years or so, every generation of Canadians and Americans has lived longer than its parents, thanks to the never-ending-advances in medical science. But now, improvements in medical science might no longer be able to keep pace with declining health care. A warning has been sounded by Dr. Kellie Leitch, Health Canada Advisor on Healthy Children and Youth:
“Given the prevalence of childhood obesity, and its contribution to many diseases, this is the first generation that may not live as long as their parents. Obesity is now having a huge impact which was not foreseen 10 years ago.”
Well-meaning efforts to promote healthy, active lifestyles too often seem undone by big business — supported by government — with its cornucopia of unhealthy foods and endless profusion of un-active activities. We have become less like athletic Athens and more like decadent Rome, where affluent citizens were growing fatter and flabbier in their unprecedented prosperity.
Such thoughts came to mind on a glorious sunny Sunday in October as I hiked along a mid-section of the Victoria Railway Trail that stretches from my town of Lindsay, Ontario, almost 60 miles north to Haliburton. A volunteer organization, Trails for Health actively promotes its beneficial use for walking and bicycling. But hikers and bikers must now controversially share the trail with motor vehicles, specifically all-terrain vehicles (ATVs) and, in winter, snowmobiles.
I hiked along a nine-mile, sandy section of the trail that Sunday, from Burnt River to Kinmount and back. Including time for taking photos, I was on the trail some six-and-half hours during my 18-mile walk. I did not meet one other walker, and only two bikers. I met at least 30 people riding along on their ATVs. The appeal by commercial interests for such un-activities seems to have rolled over the best efforts of Trails for Health and others. It’s an indictment of our commercially-driven, indolent society. We have what in reality, if not in name, is universal medical care, but we lack effective, universal health care.
Medical care continues to make enormous strides, the best health care in the world resides within each of us, but for our society as a whole, health care is sick. The data confirm it.

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