An ounce of prevention ... - Dr. Peter Zalan

Good health comes from a variety of factors. Surprisingly, most are not related to the health care system.

Our increased life expectancy has been primarily due to improved nutrition, sanitation and living conditions, plus the control of infectious diseases by means of vaccinations and antibiotics.

Only to a lesser degree is it due to improved therapy for chronic diseases. Otherwise, how could a poor country like Cuba reach a life expectancy of 79, when in Canada, it is only two years longer?

Did vaccination and improved sanitation make a big difference?

In the Boer War, fought from 1899 to 1902, British deaths from disease were five times the number of deaths from violence. In the Russo-Japanese War, 1904-1905, Japanese losses from disease were less than a quarter of the deaths from violence, because the Japanese introduced systematic vaccination and sanitation for their troops. The British had not.

Is change difficult? In 1854, an English doctor, John Snow, discovered that cases of cholera were associated with a source of drinking water contaminated by excrement. Gradually, cities began to install public sewer and water systems.

All this innovation was met initially with resistance. It was expensive and intrusive.

The United Nations published a report in September 2011 on the prevention and control of the major causes of human illness and death; namely, cardiovascular and chronic obstructive lung disease, cancer and diabetes.

These are firmly linked to tobacco use, harmful use of alcohol, unhealthy diets, and lack of physical activity. It is of double concern that the incidence of obesity, unhealthy diets and inactivity are rising among our children and youth.

In 2009, Canada spent $190 billion on health care, the single biggest sector of spending in the country. Six per cent went to fund public health and health promotion. Sixty per cent went to fund hospitals, drugs and physicians.

So here’s the puzzle. There is general agreement that preventing a disease is more satisfactory than curing it. Then why are governments investing large amounts of resources in the attempt to cure, and small amounts in the attempt to prevent?

The answer is that governments are afraid of our displeasure. The public’s expectations are very high, expecting the latest and best drugs and technologies to be available as soon as they are described on the Internet.

Disappointing those expectations means loss of votes. Trying to meet those expectations consumes energy and resources. Year after year, there is little left of either energy or resources for other initiatives.

As a society, we are not living within the truth. We blame governments, even though they reflect our values. We have not admitted that the principle of a right to certain public services without definable limits, when enacted as law, constitutes the writing of a blank check that no society can ultimately afford.

Are we willing to embrace the truth and examine our values?

Dr. Peter Zalan is president of the medical staff at Health Sciences North. His monthly column tackles issues in health care from a local perspective.

Posted by Vivian Scinto