This column is an opinion by Dr. Anca Matei, an obstetrician and gynecologist, and Department Head of Surgery at Valley Regional Hospital in Kentville, N.S. She is pursuing a Master’s degree in Global Health Policy at the London School of Hygiene and Tropical Medicine. For more information about CBC’s Opinion section, please see the FAQ.
The importance of public health in times like this cannot be denied and has never been more compelling. Yet business, as usual, continues to overshadow and undervalue it as the focus on bolstering the economy intensifies.
Health and the economy are intimately intertwined, and the situation in which we find ourselves today is a direct consequence of the dance between health and the economy over the past several decades.
COVID-19 is a stark reminder that when push comes to shove, it is not the wealthy who will pull us through. It is our health care system: the health care workers, the hospitals that have long needed renovations, and the programs that have been chronically underfunded.
As a physician, I am deeply immersed in the front line response to COVID-19. Between preparedness activities, which range from meetings – with department heads, perioperative, maternal and neonatal health committees, with nurses, with Infection Control – to simulations, webinars, online courses, and patient care, I look around and reflect on the larger implications of what we are experiencing now.
This pandemic, like all pandemics before it, will run its course. When it ends, we are going back to the older epidemics that plague our health care system: obesity, diabetes, cardiovascular disease, cancer, social inequalities, and an underfunded public health care system that often seems to take a back seat to political and economic interests.
I can’t help but wonder if the COVID-19 pandemic will be a turning point in public health policy.
Will this bring change to the unsatisfying trends in globalization? After the physical distancing ends, will we have the courage, as a generation, to stand up and demand that smart, informed, practical public health policy be fixed at the core of public and private economic actions?
In 2003, Samuel Preston gave us the Preston Curve. This showed us that life expectancy was directly proportional to GDP per capita – on average, people in wealthier countries tend to live longer than those in poorer nations – but only up to a point. After a certain GDP level, life expectancy flattened out.
Preston used life expectancy as an indicator for health, but of course health is so much more than a person’s number of birthdays. Critics of the Preston Curve point to the importance of things such as literacy, nutrition, and overall public health. In addition, factors such as social justice, spirituality, and social relationships are all important to what the World Health Organization (WHO) defines in its constitution as not merely the absence of disease, but “a state of complete physical, mental and social well-being.“
The conclusion is clear: wealth does not equal health.
COVID-19 is a tragic reminder of this.
Developed countries such as Italy, France, Spain and the U.S. have been devastated by the extent and death toll of COVID-19. Health care workers everywhere have suffered high infection rates, and essential supplies such as ventilators and personal protective equipment have been in short supply. In Canada, large and small hospitals alike have been concerned about their ability to cope with a surge of COVID-19 patients while maintaining essential services for the rest.
What is the benefit of promoting an economic system of financial elitism if, in the face of an international crisis such as the one we are in now, long-term care facilities are overcrowded, hospitals do not have sufficient space to properly isolate suspected or confirmed COVID-19 patients, and physicians have to decide which severely sick patient has access to an intensive care unit bed and which does not?
Without strong public health policy at the core of our social and economic systems, wealth is meaningless.
In a post-pandemic world facing the reality of a possible recession, a critical analysis of our preparedness, our response, and what it tells about societies will ensue with a vengeance. Will we be satisfied with the status quo of economic growth for the sake of growth, or will we demand economic recovery that also enables true health – that state of complete wellbeing that keeps eluding us?
Will we demand that government investments in economic initiatives also translate to investments in our public health?
Or will we go back to the way we were, where politicians promise us clean air but invest in pipelines? Where much-needed hospital expansions take a back-seat to bureaucratic processes and personal interests? Where health care workers are scrutinized, belittled and deemed dishonest – and only hailed when, already underfunded and burnt out, they show up to work every day in the middle of a pandemic?
As this crisis unfolds, we must ask ourselves these important questions.
When it is past us, we must ask our political representatives these difficult questions and demand answers prior to casting votes. We need a paradigm shift.