As we are in an election year in Quebec, we will be able to witness various statements from candidates who will tell us that they will solve problems thanks to their brand new ideas. Admittedly, the Minister of Health and Social Services, Christian Dubé, has just published a plan to reform the health system, but this remains essentially based on structures. Moreover, there is a lot of talk about curative care and so little about prevention.
For their part, the Québec Solidaire candidate, Dr. Mélissa Généreux, explained that she would “immediately hire nearly 2,000 professionals in the public network to put an end to the ‘appalling’ waiting lists for mental health”, if she were to take power, next October, as if the neurologist Lionel Carmant, Minister for Health and Social Services, had not already tried to implement such measures since taking office!
I could be wrong, but it is not as simple as that to help citizens in need when we know that Quebec has the largest number of psychologists of all the Canadian provinces. On one hand, I doubt they will close their professional offices, as many have left the clinical institutions in which they began their careers. On the other hand, mental health is based on many determinants and it is to be feared that as long as the lifestyle habits of citizens do not change, the mental health problem will only become more complicated.
In fact, two avenues should be considered to reduce the waiting list of physically and mentally ill individuals: (1) experts must learn to collaborate by creating a respectful and non-corporate dialogue to encourage an integrative vision of healthcare, while (2) it is urgent to encourage health in all its spheres, both curative and preventive, to encourage the various avenues in terms of healthy lifestyles. This is how, after a flashback on my reflective journey, I am talking to you about the importance of encouraging an integrative understanding in regards to our health.
I have always been interested in the meaning of health. In my early teens, I was both fascinated and shocked to see the amount of medication my grandparents took every day.
You should know that, in Belgium, there is a rate of one doctor per 249 inhabitants, where we have gone from 1/487 to 1/408 in the last 10 years in Quebec and from 1/467 to 1/414 in all of Canada. In addition, medical costs are, in Belgium, split into three. The patient pays 33% of the consultation costs, while their health insurance and the State share the rest of the bill. In short, there are fewer difficulties in meeting a doctor in Belgium than in Quebec if the person has some leeway to pay their share.
This is how my grandmother was proud to tell us that if a doctor refused to prescribe her medicine, she would see another one, then another, then another…until she was able to receive a prescription. For her, a good doctor was one who prescribed medicine to relieve one problem or another. So, she had a tray, 3 feet by 2 feet, full of medicine boxes, half of which were for her and half for my grandfather.
To me, that didn’t make sense. And I promised myself to do everything not to fall into this trap. Not that I don’t adhere to medicine per se, but I believe that we have become far too affected by three phenomena: (a) dependence on biotechnology with protocols supported by published quantitative data (obscuring at the same time the wealth of unpublished studies, because the conclusions are disturbing), (b) the belief that the administrative structure prevails over human relationships and the uniqueness of each individual, and (c) an overly reductionist vision of the factors contributing to health.
I extensively explored the first phenomenon in my research note published in 2001 with Charlène Bélanger, when we had spent two years reflecting on the issues affecting health research and the challenges posed by the promiscuity between universities and the pharmaceutical industry. Following my postdoctoral work carried out in a political ethics laboratory to document several phenomena affecting the regulation of the behavior of decision-makers in the face of biotechnologies, I published an essay in 2010 which shed light, illustrating the risks for the common good and health of individuals.
HUGE ADMINISTRATIVE STRUCTURES
The second phenomenon is based on the complexity of administrative structures that have become sprawling and their lack of adaptability in the face of changing realities on the ground. The health crisis has just demonstrated how urgent it is to find organizations that are smaller, more adaptive and closer to patients. While I have no doubt as to the good intensions of the vast majority of those involved, it is to be feared that the megastructures put in place by successive Liberal governments have only complicated the lives of individuals (patients, professionals of health and managers), which could have benefited the lobbies of the various fields of health.
In May 2020, Danièle McCann, then Quebec’s Minister of Health and Social Services, said – during a press briefing with Prime Minister François Legault and Director of Public Health Horatio Arruda – that it was not only the curve of the sick that she hoped to flatten, but also the administrative pyramid of the hospital centers, that is to say that she hoped to reduce the number of people in the offices (management) for the benefit of more people on the field (clinic). All in all, she wanted health professionals to regain care functions, rather than performing administrative tasks.
This wishful thinking is not new. I had the opportunity to discuss it a few times with the person I consider to be my political mentor, Dr. Jean Rochon. I also contributed to the preparation of our intervention, within Force Jeunesse, at the Clair Commission. I also participated in the Romanow Commission on the Future of Healthcare in Canada. Above all, I put together the files and participated in the three parliamentary committees for Quebec drug insurance.
If I go over the first two, you should know that the third was piloted by the Minister of Health and Social Services at the time, namely François Legault. It looked at various problems, including the chronic deficit observed since the creation of the hybrid public/private system. The efficiency of Force Jeunesse was based on the fact that we were young professionals who met regularly to analyze societal problems, documented the phenomena with multidisciplinary visions, then produced a note, an opinion or a brief to be submitted to the political leaders of all parties. We therefore discussed with the government, but also with the opposition to make them aware of the blind spots in bills or the issues targeted by parliamentary committees, when these situations put the younger generations at risk.
This is how, in 2001, we identified the origin of the “financial hole” in public insurance. After our hearing, RAMQ actuaries came to question us in more detail about our analysis. I will always remember the interjection of one of them: “well, explain to us what we haven’t understood yet! In fact, the plurality of professional functions of the members of our group of volunteers had made it possible to identify a scheme favorable to private insurers.
Within the group, everyone had their responsibilities. For my part, I had to meet, on the sidelines of the commission, the Liberal MP who acted as a health critic to present our analysis to her. She replied “but we can never change the situation, it is our electorate that is at stake! In fact, Pauline Marois, who took over the ministry in March of 2001, did not change anything, nor did the Liberals who were elected in 2003.
This is a file that we then followed less within Force Jeunesse. We were busy with other societal topics. The president, Martin Koskinen, was recruited as an adviser to François Legault who became the finance minister. It was Jean-François Roberge who became president of Force Jeunesse, while I had the pleasure of being its vice-president. Thus, I continued my voluntary work on the reform of the Law of Standards, including the thorny problem of orphan clauses (reduction of wages for young employees in favor of older ones) and psychological harassment in the workplace, supported by my mentor, Jean Rochon.
THE TWELVE TASKS OF ASTERIX
It is clear that, twenty years later, things have changed very little. Collectively, we still face big challenges. To shed light on the subject, Katia Gagnon and Ariane Lacourcière have just signed an excellent file which they have entitled “The six works of Christian Dubé” to define the possible solutions that could solve the structural problems within the healthcare system. We knew them, but these have largely been brought to light by the consequences of the health and political crisis that has been overwhelming us for more than two years.
To do this, they go back to the various major reorganizations of our public system since the “Rochon Report” (1988) through the various commissions that were orchestrated to try to improve access to healthcare for people who are sick or experience loss of autonomy. They analyze six projects, presenting what should have been done and what was actually put in place:
- Acquire a strong first line,
- Increase home care for seniors,
- Decentralize the network,
- Implement activity-based funding,
- Computerize the health network,
- Rely more on the private sector.
Their analyzes thus present the evolution of the visions proposed during the commissions, but also how they were concretely implemented, without forgetting to describe the challenges which have become more complex from decade to decade.
However, I propose six other projects for reflection and transformation of our way of managing Health in a broader sense:
- Decompartmentalize the understanding of health and question the hegemony of certain corporations, sometimes far too influenced by pharmaceutical lobbies and university necessities;
- Question the protocols proposed by the National Institute of Excellence in Health and Social Services, which are equally influenced by pharmaceutical lobbies and university necessities, to bring out curative, but also preventive strategies, based on multidisciplinary practices;
- Fund multidisciplinary research based on mixed-type research protocols (neo-phenomenological research protocols);
- Put in place public strategies that encourage concrete action on all the determinants of health, including aspects that arise from poverty, while encouraging health tax deductions for all preventive and curative practices;
- Identify the environmental factors that affect, or even alter, health in a broader sense, but above all, the physiological aspects, in order to put in place specific policies to reduce the risks generated by an identified nuisance;
- Teach, from elementary school, healthy lifestyle habits that promote balanced health in the different spheres of life (physical, mental, social and environmental).
These six other projects are based on an integrative vision of health which can only be put in place when corporatism fades away in favor of respectful collaboration and better knowledge of the different practices in promoting health. As a priority, it would be valuable if we worked more on the factors encouraging health than on the necessities to counter disease! Not that the second should be denied, but that if fewer people get sick, care can be more easily provided to those who need it.
Article originally published on www.joelmonzee.com
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