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The Connexions Annual:
Introduction to Health
In the twentieth century we in the industrial nations witnessed
a marked improvement in many of the indicators of human health.
Infant mortality has been greatly reduced, life expectancy has increased
significantly, many illnesses and injuries which were formerly fatal
or incapacitating are now treatable. We tend to live longer, and
be healthier.
This progress is largely due to advances such as public sanitation
and sewage treatment, drinking water that is free of disease–causing bacteria, better nutrition, improved standards
for handling food, and large–scale vaccination. Advances in medicine and pharmacology have contributed, though their
contribution relative to public health measures is frequently over–stated.
These benefits have not been shared equally. In the third world,
lack of food and clean drinking water kills millions. In Canada, Native peoples and the poor have worse health,
less medical care, and lower life expectancies.
In the population at large, health issues continue to be a major
focus of concern. Smoking — including second–hand smoke — and inappropriate diet are massive, preventable causes
of ill health which reflect not only individual choices but also the effects of advertising, social pressures,
and institutional policies.
Workplace health issues are among the most serious and widespread
of all health problems. Canadian workers and farmers are killed
or injured at work in appalling numbers. Often they are exposed
to noise, dust, radiation, and dangerous chemicals, at levels far
above those considered ‘acceptable’ for the population at large.
Frequently they are deliberately lied to or kept in ignorance about
the hazards which they face at work. (Asbestos companies, for example,
knew for decades that asbestos was lethally dangerous before they
admitted to their workers that the substance was in any way hazardous.) Workplace health issues are
becoming a major battleground as workers fight for the right to
earn a living without sacrificing their health.
Such issues frequently become struggles for power, specifically
the right of workers to full knowledge of the substances they are working with, the right to have a significant
say in managing work to minimize health risks, and the right to refuse unsafe work without being penalized. The
emergence of such issues presents a significant opportunity for alliances to be made between unions, environmental
groups, and health organizations.
Environmental health issues have similarly become the subject of
widespread concern as risks become known or suspected. Air and water pollution are linked to cancer and respiratory
disease. Highly toxic chemicals lace our water supplies and the
fish we eat. The thinning of the ozone layer makes us more vulnerable
to the carcinogenic rays of the sun. Modern farming practices leave
pesticide residues in our fruit and vegetables and anti–biotics
and growth hormones in our meat. Rising levels of noise cause increased
stress for many.
Pharmaceuticals are another issue of concern. One problem is the
widespread over–prescribing or mis–prescribing of drugs, especially
to the elderly, women, and psychiatric patients. Doctors are often
lamentably ill–informed about the drugs they prescribe, with most
of their information about particular drugs coming from the companies that sell them. The giant multi–national drug companies aggressively
pursue their market share, all too frequently by producing drugs of little value, or their own brand–name versions
of another company’s already existing product.
In the third world, drug company marketing strategies have resulted
in a tragic misallocation of scarce resources, and the companies continue to resist fiercely any efforts to adopt
the ‘rational prescribing’ policies advocated by the World Health
Organization. In Canada, the drug multi–nationals, backed by the
U.S. government, were successful in pressuring the government to
pass legislation drastically restricting the right of independent
pharmaceutical firms to produce cheaper generic equivalents of their
expensive products.
Financial issues generally are contentious in the health care system.
Government spending going to health care has been increasing rapidly
in many parts of Canada, yet sectors of the health care system are
suffering from underfunding. One important debate revolves around
how much money should be going to ‘high–tech’, hospital–oriented,
doctor–driven approaches, and how much to education, prevention,
home care, and other health care providers such as midwives, nurse–practitioners,
and alternative healers.
Some are also looking for ways to reduce doctors’ disproportionately
high share of income and power. Nurses especially have been putting their concerns forward with increasing
militancy. The Patients’ Rights Association has been pressing for patients to have increased say in their own care.
With governments pursuing an agenda of budget cutbacks, it seems
certain that financial pressures will increase. One way in which
governments have shed expenses has been through ‘deinstitutionalization’.
In theory, this means moving people from large institutions to community–based
care. In practice, it has more often tended to mean dumping psychiatric
patients and the disabled onto the streets with little or no support,
follow–up, or care. Parents nearing retirement age find themselves
forced to single–handedly shoulder the burden of caring for children
with severe disabilities; children, epecially daughters and daughters–in–law,
find themselves responsbile for caring for aging parents.
Another strategy has been privatization: in essence, shifting the
responsibility for care of the elderly and others from publicly
accountable institutions staffed by unionized workers to privately
owned companies using workers paid little more than the minimum
wage.
Financial considerations also directly affect the users of health
care. While the existence of medicare gives Canadians a much more egalitarian health care system than Americans,
financial deterrents to access exist in the form of user fees in
some provinces.
AIDS in particular is raising significant ethical, economic, and
political issues which relate to both health care and human rights.
AIDS activists are highly critical of how the health care system
has responded to the pandemic so far, and are concentrating their efforts simultaneously on political
pressure, education and self–help.
A woman’s right to choose whether or not to have an abortion is
still under serious attack, presenting a major challenge for pro–choice groups which advocate that women have access
to safe legal abortion and reliable contraceptive information.
Many of the groups in this chapter deal with a particular pressing
health issue. Others, such as those advocating a ‘healthy city’
strategy, are trying to develop a comprehensive approach to changing
public policy in the many sectors which affect our health. When
health is seen in its wider context, it is apparent that many of
the issues identified elsewhere in this Annual are also health issues,
suggesting that there are many fruitful ways in which health groups
and other groups can work together.
Ulli Diemer
Aussi disponible en français: L'Annuel
Connexions: Introduction à la Santé
También disponible en español: El
Anuario de Conexiones: Introducción a la Salud
Related article: Ten
Health Care Myths
Other Overview Articles from the Connexions Annual:
Introduction
to the Connexions Annual
Introduction
to the Arts, Media, Culture section of the Connexions Annual
Introduction
to the Community, Urban, Housing section of the Connexions Annual
Introduction
to the Development, International section of the Connexions Annual
Introduction
to the Economy, Poverty, Work section of the Connexions Annual
Introduction
to the Education, Children section of the Connexions Annual
Introduction
to the Environment, Land Use, Rural section of the Connexions Annual
Introduction
to the Health section of the Connexions Annual
Introduction
to the Human Rights, Civil Liberties section of the Connexions Annual
Introduction
to the Lesbians, Gays section of the Connexions Annual
Introduction
to the Native Peoples section of the Connexions Annual
Introduction
to the Peace section of the Connexions Annual
Introduction
to the Women section of the Connexions Annual
Resource
and Reading List from the Connexions Annual
Other Resources and Links:
Connexions
Online: Health Links
Ten
Health Care Myths: Understanding Canada’s Medicare Debate
Abandoning
the public interest: The hidden costs of deregulation and privatization
Contamination:
The poisonous legacy of Ontario’s environmental cutbacks
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