New book examines how health policy is influenced by politics and economics

Health-care policy, like public policy, is influenced by political, social and economic forces, says York sociology Professor Toba Bryant in her upcoming book An Introduction to Health Policy. The effect of those influences, including the dominant neo-liberal political ideology in Canada, is felt through fewer health-care dollars, a focus on individual responsibility for health and a trend toward privatization.

In An Introduction to Health Policy, Bryant looks at what shapes health-care policy and health-related policy in Canada, key developments and influences, how it is implemented, the effects of international developments in economic and public policy, globalization, free trade agreements and market forces. Bryant also discusses how health-care policy is viewed through different lenses, how it is delivered, the outcomes and the effect of federal legislation from 1958 to the present. She then critically compares Canada’s system to others, including the United States, Sweden, the UK and Cuba.

An Introduction to Health Policy will be launched on Thursday, Feb. 19, from 5:30 to 7pm at the Riverdale Public Library, 370 Broadview Ave. at Gerrard Street in Toronto.

Bryant argues that health policy is affected by ideology just as much, if not more than public policy. She says today’s current neo-liberalism, a market ideology that considers the market the best way to allocate economic and social resources in society, has had dire effects on health policy in Canada. It has influenced the diminishing role of government in health care and, in turn, has led to health care being parcelled out as commodities and viewed as a way to make money for foreign and private health-care providers, says Bryant. A neo-liberal ideology is not conducive to providing the best health policies or care, she says. Instead, it opens the door to the market forces of globalization.

In addition, market strategies designed to lower government expenditures and ostensibly to save the public health-care system, have led to more public-private partnerships and user fees. Bryant argues private health care is not cost-efficient and studies have shown the service provided is often inferior to that of a public health-care system with worse outcomes. Canada’s single-payer system, where one administration is responsible for processing payments for health-care services, is more cost-effective and provides higher quality of care.

Left: Toba Bryant

“The shift to market-oriented health care has driven the emphasis on individual responsibility for health. Governments frequently invoke the lifestyle and individual responsibility message to justify governments’ reduced role in social provision,” says Bryant. This leads to individuals being encouraged to exercise, eat right, limit alcohol intake and avoid smoking as a way to look after their own health. It’s what Bryant calls a professionally-driven, top-down approach to health and ignores the social determinants of health, such as income, employment security, housing and education. Research has already linked income level to health. “I think we need to look at the kind of society we want in Canada. We need to look at how we can help the most vulnerable in our society,” says Bryant. “We have been seen as a caring society, but I think that’s changing now.”

Continued fighting between levels of government about who is going to pay for rising health-care costs only exacerbates the ongoing problem of how to deliver the best health care to the most people, says Bryant. It also leads to further emphasis on privatization of health care as a way to stem the flow of cash and cut wait times. But Bryant says privatization will not relieve the pressure on the public system or lead to shorter wait times for specialists. It will lure physicians away from the public system making wait times just as long if not longer and will limit access to health care by the more vulnerable, low-income populations.

Bryant calls Canada a liberal welfare state, where the government’s goal is to minimize government intervention. But this creates formidable ideological and societal barriers to developing and implementing health and health-related public policy. Bryant suggests working with political and social movements in support of health as a way to break down the barriers and to maintain the public health-care system and to support Canadians’ health by providing quality social determinants of health such as decent income, affordable housing and secure and well-paying employment. These determinants can be assured through active public policy.

What is needed is better management of health-care resources. Fighting between federal and provincial institutions over financing has blocked productive ideas on how to change, improve and sustain medicare in this country. “The two levels of government must uphold the promises made in the health accords (signed in 2000, 2003 and 2004) if medicare is to survive the current debate,” says Bryant. The 2004 accord promised $41.3 billion in new federal transfers to the provinces and territories over 10 years. In addition, governments need to pursue prevention in its health-care mandate, an idea that is consistent with a social determinants of health approach and a key to the sustainability of the health-care system.

“It will require a whole shift in ideology. People need to become more engaged and recognize that they have the power to bring about political change,” says Bryant, co-editor of Staying Alive: Critical Perspectives on Health, Illness and Health Care. She was also a contributor to Social Determinants of Health: Canadian Perspectives.

Copies of An Introduction to Health Policy will be available at the launch. The book can also be ordered through the Canadian Scholars’ Press Inc. Web site.

By Sandra McLean, YFile writer