A healthy choice

I want to talk about Mike Murphy this a.m. but a couple of housekeeping comments first.

1. I thought it was telling that Premier Graham (Premier Shawn?) went out of his way in his first speech as Premier to say there will be ‘unpopular’ decisions made during his time in office. To a lot of people this may sound like the same old boilerplate but I think the Lord Tories were terrified of making tough, unpopular decisions. They would set up commissions and do studies ad nauseum (forestry, electoral reform, etc.) and then take forever to act.

2. Greg Byrne as Minister of BNB. I think this shows right away the importance the Premier is placing on economic development. He’s got a big job ahead of him. New Brunswick has really slipped in this area over the past few years (read the 953 previous blogs here).

Now, on to Murphy.

While Joan MacAlpine has never darkened the door of my house in her riding and while I have never met former Premier Lord, I have indeed met Mr. Murphy. I had lunch with him last year after he read my blog. I found him to be bright and tuned into the issues but more than that I got the sense he really wanted relevance as a politician. That he wanted to leave his mark on provincial politics.

Now he has his chance.

The health portfolio is the largest and second most challenging in government (in my opinion, economic development is the most challenging, but I digress).

It is also a portfolio that chews up and spits out Ministers (like Furlong and Robichaud who both retired after 3-4 years of running it). Despite massive spending in health over the past seven years (you remember 75% of all new money was the mantra), we still have serious challenges and with the aging population this will only become more exacerbated.

So a little free advice for the Minister on his first full day in office.

Wellness
It’s common knowledge that New Brunswickers score at the bottom of the list among provinces on just about every negative health indicator including diabetes, smoking, obesity, lack of exercise, poor eating habits, excessive alcohol and even the highest levels of prescription drug use. Somehow, we have to re-tune the discussion towards healthy living. This is hard because it costs upfront and the ‘payback’ isn’t seen until later but having a healthy population goes to quality of life and self esteem. It must be pursued with vigor. In fact, if the Minister could make serious inroads in this area over 5-6 years, that would be a great legacy. There are already a number of models being used in places like Miramichi (Mango). But the leadership must come from the top. Scour the globe for best practices and implement them here. Use partners and channels to promote wellness – this is everybody’s business. I was in the office of Enterprise Greater Moncton last week and there is a ‘walking challenge’ program – everyone has a pedometer and there are rewards for use.

Innovation
I have said this before but it is well worth repeating. New Brunswick was the first or second province in Canada in the early 1990s to implement tele-care (against considerable resistance I might add). There were other attempted innovations (some failed, grant you). I haven’t seen much since then. We are among the slowest users of nurse practitioners, electronic health records, remote diagnostics, pharmacy drug monitoring, etc. etc. etc. despite the record levels of investment. We need to get back to thinking in terms of innovative health care activities. Using more community health centres, using more technology, being creative. Again, leadership comes from the top.

Urban/Rural
New Brunswick has the second most rural population in Canada and among the most rural populations in North America. We are one of a very small group out of the 60 provinces and states in North America that doesn’t have one ‘dominant’ city. This poses significant challenges but I would think opportunities. New Brunswick should be a world leader in the delivery of rural health care.

Health care financing
After the Chaoulli decision last year in Quebec on private health care, New Brunswick was only one of two provinces that said they would emphatically not look at other methods for health care delivery. I thought this was a cynical and even deceitful position to take. New Brunswickers already have either the highest or second highest level of spending on health care out-of-pocket of any province in Canada. It is hypocritical for the government not to be clear with the people about this while acting like some great champion of public health care. We have the worst public drug coverage program in Canada. I am not saying that using private clinics is the way to go but I think we have to have a serious look at what BC is doing, what Quebec is doing, etc. Just to make grand pronouncements about our commitment to public health care is cheating New Brunswickers.

Communications
I think that a considerable amount of effort needs to be expended to educate New Brunswickers about health care. This has a ‘wellness’ element but I think it is even broader than that. People need to know that at the current rate of increase, the health care system will be completely unsustainable in a very short time. They need to know that we are getting more sick on average than previous generations. In fact, despite quantum increases in acute health care and management, some experts are suggesting that the average life span of New Brunswickers will actually start to drop. This is one of the next battles that needs to be fought. New Brunswickers – particularly Monctonian who are among the least active in Canada among urban centres – need to get serious about healthy eating, exercise and healthy living. We need to understand the cost of health care. The government needs to be clear – not these canned propaganda pieces that the Tories sent around every year telling us how great things were and how lovely – we need the truth. When we make gains, celebrate them! But at all times, the truth must be communicated clearly. It’s the only way over time the citizenry of New Brunswick will start to get serious about their health.

Efficiency
In most provinces, a population of 750,000 people would warrant one or two regional health authorities at most. All of British Columbia has two. We have eight. I realize the politics of this but I think some serious consideration should be given to either collapsing some of these or at least finding ways to share administration and overhead costs.

I don’t know why New Brunswickers have this pathological need for smallness. We have no large cities, we have 15 regional economic development agencies. We have eight regional health authorities. There is some advantage to scale, folks. 15 regional economic development agencies! One per 50,000 population! What’s next? Our own personal economic developer? One per city block?

But I digress.

That’s it. Good luck to the Minister and the new government.

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0 Responses to A healthy choice

  1. Anonymous says:

    This should have been mentioned during the campaign as the liberals already have a platform.

    As far as one of Mango’s tenets, ‘taking responsibility for one’s health’, well, isn’t paying the highest out of pocket cost for drugs doing exactly that?

    If you’re fat or obese or don’t exercise and out of shape-you’re going to pay for it. I think everybody already knows that, if they don’t, that level of stupidity deserves it. I know people who don’t even second guess their doctor even though you can easily get online and read the clinical trials and FDA applications and independant studies (and lawsuits). If you want to deal with that, get geezers online and searching. Again, if you don’t know about resources…..

    The guy from Mango is a joke. If you’re so stupid that you ‘feel bad all the time, don’t exercise, are overweight’, well, lets just say it is SO ironic that drug addicts are constantly blamed for their own problems and told to deal with it. For fat stupid sick people we roll out the red carpet and have programs that tell them what they already know (hey, where are all you conservatives out there when we need ya!)

    The one place that its a big deal is in education, where we give schools free reign and cutbacks to put pop and candy machines in. We give them chocolate milk and have no recreational facilities for them unless its organized sports, which usually results in the worst exercise (in minor hockey you’re lucky if you get rink time twice a week, and only a third of that time are you on the ice)

    Where you can actually DO something of value is two places where people have NO power:

    1. Schools. Open up the bureaucracy and get MASSIVE physical education. Why more parents aren’t demanding this is beyond me. Even the liberals are only proposing a modest amount. Get some emphasis away from team sports and into individual sports, this has been proven to be where kids actually continue to exercise after high school. Hell, I haven’t put on a pair of skates in twenty years but I have three pairs of cross country skiis.

    2. The Workplace. People dont’ even associate health with the workplace, which is utterly ridiculous. Do you have any idea how many people are on workmans comp at any time? Workplace accidents are the leading cause of illness, injury and death. In ontario two people DIE every week. In Canada more people die from industry accidents than in Great Britain, a country ten times our population.

    In any other place this would be constant national news, its like starvation in some countries with the number of people who die, yet we don’t hear word one about it. Because, well, who owns all the papers again? Its far more interesting to talk about homicidal murderers far away than a guy who fell off a roof down the road.

    But again, these things only get done with a push. THe liberals are pushing some modest changes, certianly nothing of the order mentioned by Campbell, and none mentioned here. I have friends from other provinces and countries who talk about how much of their education was spent outside. In Norway they have outside classrooms even in winter. Here, well, I guess the fear is “they might become interested in the outside and we’re trying to cut it down”

    But that’s up to LOCAL school boards and provincial bureaucrats, so get active with parents to lobby some changes.

    If YOU want to have an effect, there are lots of volunteer opportunities, meals on wheels is a good place to start. Most cities and towns have programs where you can meet with elderly people-while there get them outside.

    Again, only losers expect their government to do everything. Anybody thought about an organization designed to get seniors or close to seniors (even better) online and looking at their health statistics?

  2. Anonymous says:

    Actually, David, the “Wellness” portfolio is under the new premier, not Murphy.

  3. David Campbell says:

    That’s a good point but I don’t think it matters much. Health still has to be alot more about healthy and the Minister of Health should be pushing healthy.

  4. Freddy Beach says:

    How about starting with some of the things? How about not having to wait for three weeks to get a piece of snail mail telling me when to go in for a blood test? Giving clinics access to an electronic scheduling system (if things like blood tests indeed need to be scheduled) give me an appointment on the spot when the test is prescribed would save paper, toner, stamps and time and the salary of whoever has to print and mail these appointments.

    I agree with DC’s points. Wellness and efficiency are the most important things to focus on.