Essays March 2011

Electioneering Chronic Illness

Neil Seeman

None of the critical issues in healthcare will be decided by a frenetic-paced federal election. This is because what matters today is chronic illness and its prevention; this also matters next month, and the month after that, and so forth. We’ve been talking about chronic illness in this country since the Lalonde report in 1974; everybody in Parliament pays lip service to prevention. But it’s not a political priority.

Canada used to be what consultants call a ‘thought leader’ in attacking the many facets of chronic illness. We’ve been left behind; we are not a country to boast about our preventive care.

Elections are about framing. So you’ll hear the scary-sounding word ‘coalition’ a lot from the Conservatives; Mr. Ignatieff will continue to flub on whether he wants a coalition or not. Mr. Harper will win this election, and likely a majority: whatever your opinion on the idea of minority governments, this current structure has passed its shelf life.

Canadians (with the major exception of Toronto) understand this. Mr. Harper is more popular than the polls indicate, and the polls look strong for him. There is still a bias against telling a pollster you support the Conservatives, especially if you live in Toronto. But Toronto (and Toronto media) are becoming less and less important.

I know that Stephen Harper, Michael Ignatieff, Jack Layton, Elizabeth May and Gilles Duceppe care about making Canada a healthier place to live. To say otherwise is absurd and vindictive. These individuals have committed significant personal courage to participate in public life.

There is a gross misunderstanding among many in the civil service and people who work in healthcare about how federal politics actually works. Many of the people who run this country are young, in their late twenties and early thirties. They are policy staffers for MPs, messaging consultants, and speechwriters – and partisans. It was always thus. Jean Chretien was masterful at nurturing young talent; Paul Martin was not. So-called ‘system leaders’ – and especially academics – are about 1/1000th as important as most people in healthcare think they are. I’m always bewildered at who people in the healthcare system consider to be ‘influencers’. They are almost always not among those who keynote any major healthcare conference in this country.

All of this is not meant to make readers feel disenchanted with democracy. Either you believe in democracy or you don’t. It’s imperfect. Yet hundreds of thousands of people in authoritarian regimes are risking their lives right now to taste democracy. So how do you marry democracy and chronic illness prevention? How do you ensure that good ‘evidence’ – and we all disagree on what this means – gets in the hands of those twenty-something staffers who run this country?

Forget about elections and public policy entertainment. Chronic illness already is ‘on the agenda’ as much as it ever will be. When the federal budget was released, healthcare advocacy groups did as they always have. They crowded into the halls of Parliament and gasped for airtime with any journalists willing to listen. The return on investment from such advocacy is zilch. In the business world, there is an easier approach: outcomes matter and the free market reigns.

One way to address chronic illness is to create companies that prove you can make money in it. So: invest your time in that dusty business plan of yours, not in electioneering blather.

About the Author

Longwoods essayist Neil Seeman is Director of the Health Strategy Innovation Cell at Massey College. His current book is XXL: Obesity and the Limits of Shame.



William Hill wrote:

Posted 2011/03/30 at 06:53 AM EDT

Bravo Mr. Seeman. While we have been toasting ourselves for advances in modern medicine that have resulted in us correcting disease and injury and living longer, we have forgotten the cost on the back end. Our focus on treating the here and now has caused us to abandon prevention and left us with an increasing elderly population with significant resource costly comorbidities.


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