Canadian health care system goes under the microscope

York University health researchers have joined forces with other leading academics to publish a critical examination of health and health care in Canada, released earlier this week. The book is the first to consider the health of Canadians and the organization of the health care system from four distinct perspectives: epidemiology, sociology, political economy and human rights.

Staying Alive: Critical Perspectives on Health, Illness, and Health Care, is co-edited by York Professors Dennis Raphael and Marcia Rioux, and Toba Bryant, who is a post-doctoral fellow at St. Michael’s Hospital’s Centre for Research in Inner City Health. Raphael and Rioux are professors in York’s Atkinson School of Health Policy and Management, which becomes part of the University’s new Faculty of Health when it launches in July 2006.

Right: Marcia Rioux

“The key issues surrounding the health of Canadians and the health care system have been largely neglected due to the narrow focus of much health research,” says Raphael. “This book is our answer to that.”

While attention has been placed on diseases, risk factors and treatments, Raphael says health researchers must examine how societal structures influence opportunities for good health.

“The primary determinants of health are the availability of income and affordability of quality housing and food. These determinants are shaped by government decisions that reflect prevailing political ideologies, and these ideologies also shape the organization and delivery of health care services,” says Raphael.

Left: Dennis Raphael

Epidemiology links living conditions to disease and sociological approaches show how the organization of society influences health and health care. In addition, the volume adds perspectives that consider how political and economic forces shape these issues. And importantly, the book places health and health care as basic human rights and examines whether Canada has met its commitments to uphold these human rights. Within these frameworks, issues of a special focus are the private-versus-public debate, the evolution of Canada’s health care system, and the roles social security and the social safety net play in shaping Canadians’ health.

“It doesn’t make any sense to study narrow aspects of health and disease without considering the sociological and political context,” Raphael says. “It’s a bit like a jigsaw puzzle. You have to bring together all these areas in order to find sustainable solutions.” Of particular importance is how the thrust towards privatization of public resources is shaping both the health of Canadians and the organization of the health care system.

York professors weigh in on health care issues from a variety of perspectives. Joel Lexchin shows how the regulation of the drug industry in Canada has been weakened by the turning over of these duties to the private sector. Marcia Rioux considers how views of disability shape how people with disabilities and illness are treated by service systems. Pat Armstrong considers how women’s health is influenced by the organization of the health care system. Georgina Feldberg considers the history of the health care system and Mary Wiktorowicz analyzes recent reforms in Canada’s and other nations’ health care systems.

The volume showcases York’s interdisciplinary focus on health research — the mandate of the new Faculty of Health, which brings together health researchers from a range of disciplines: kinesiology and health science, health policy and management, nursing and psychology.