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.

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.

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.

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.

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.

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.