An Ounce of Prevention
While we did not set out specifically to publish an issue of Healthcare Policy/Politiques de Santé focused on population health and preventive care, the theme emerged as the papers for this issue came together. The topics covered are broad – from early childhood development to laws that restrict smoking, and maternal mental health to chronic disease prevention. Equally diverse are the approaches that our authors have brought to shed new light on the complex policy questions involved.
Reading through the papers again has caused me to reflect on the balance between prevention and cure in the health system and in health policy more generally. This central challenge plays out at the micro and macro levels across the health system and beyond, reflecting an equilibrium that evolves over time and differs from place to place.
While n=1 stories hardly make a compelling basis for health policy, even anecdotes can illuminate a broader point. For example, the contrast between the letters that I received from the Danish health system while I lived in Europe and those that I have gotten since I returned to Canada illustrate the difference in the degree to which preventive care and access to these services is embedded in the two health systems.
This was not obvious to me at first, as the initial correspondence in both cases related simply to registration processes. In Denmark, it was an envelope with my social insurance card, the key to official life in the country, including healthcare. Fast forward a couple of years, and the first communication that I received after my return to Canada was a reminder of the need to get a new health card.
From there, the paths diverge. In Denmark, the second communication arrived shortly after the first. After much hard work with the dictionary, I was able to decipher that it was a letter from the local municipality noting that I was of an age for which a pap smear was recommended but they had no record of my having had one. (Naturally, they did not have access to my Canadian records.) The letter encouraged me to have the test and offered me a variety of alternatives, in case I was not comfortable having it done by my family physician. The next correspondence also related to access to preventive care. I had been referred to my local hospital for an ophthalmological screening test and the letter gave me information about my options, including seeking care elsewhere if the wait was long.
Contrast that with the two letters that I received from my family health team in Canada. Each year since my return, they have sent me an invitation to pay for a package of services, such as notes for insurance or employers, not covered by the provincial insurance plan – prevention of a financial sort, perhaps, but hardly a systematic approach with proactive outreach for preventive care.
To help explore the balance, the authors in this issue of the journal take up the challenge of what is being done, or could or should be done, with regard to improving various aspects of population health and preventive care, based on the latest available evidence. Others review approaches for enhancing research and knowledge translation capacity. I hope that you will find food for thought on these and other issues in the pages of the journal.
About the Author(s)Jennifer Zelmer is Editor in Chief of the journal Healthcare Policy
AcknowledgmentThis editorial is from Healthcare Policy Vol. 8, No. 2. The issue will be available soon.
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