by Cameron Smith

A comparison sometimes brings a point home with the abruptness of a door thrown open. The latest annual report of the B.C. Provincial Health Officer does just that in a special section on women’s health.

Poor health among women, it says, is linked to poverty and unjust distribution of income as strongly as lung cancer is linked to smoking.

When you pause to take that sentence apart, you find it saying that poor health among women is (a) primarily a social issue, (b) it is a social issue of epidemic proportions, and, (c) many women require medical care because social policies are destroying their health (and failure to deal with poverty is, in itself, a social policy).

That’s pretty strong stuff, and it comes from Dr. John Millar, the provincial health officer, a man with an amiable insistence on probing for the links to illness.

His previous report covering 1994 carried these far-reaching statements:
◊ ``To make any real improvements and to make any impact on reducing disparities in health, we must address the most powerful influences on health: adequacy of income and employment, education, housing, early childhood care, sense of control, social supports, and the creation of communities free of violence, crime, abuse, and discrimination.’’
◊          ``Many studies demonstrate that the more equitable the distribution of wealth, the healthier the population. In other words, while the total amount of money in a society is important, it is more important that available income be shared equitably among the population.’’
◊          ``In 1987, the most recent year for which international figures are available, 45 per cent of single parent households in Canada were classified as living in poverty; the comparable figure for Sweden was 5.5 per cent.’’

Millar was hired three years ago to become British Columbia’s first provincial watchdog over health. Part of his mandate is to develop a set of provincial health goals and a series of benchmarks against which progress can be measured. Once developed, they will be submitted to the B.C. Cabinet for consideration.

In short, here we have a man taking a far-reaching and fairly radical approach to health, who is going to have a significant impact on policies in British Columbia and possibly, by example, across the rest of Canada.

How broad is his vision? ``Well,’’ he says, ``when you start talking about the determinants of health, the subject becomes so broad it’s almost inappropriate to call it health. I’d rather call it a sustainability framework.’’

When he talks about sustainability, he talks about all the connections that support various parts of society, how those parts support each other, and how they, in turn encourage good health. For instance, he talks about how important a vibrant economy is to living and working conditions, how important they are to health and, coming full circle, how essential a properly functioning ecosystem is to a stable economy.

He talks about how important to both physical and psychological health are strong communities in which people have a sense of cohesion and mutual support, and where they have control over public issues. And how such communities contribute to widespread economic vitality.

His thrust is more toward what keeps people healthy than toward how to cure them once they’re sick. There’s lots of data on the sickness model, he points out, but very little on the wellness model. So one of the tasks he faces in developing benchmarks for the province is to collect data on what keeps people healthy. ``And surveys of that kind can be expensive,’’ he says.

One focus of his attention is the health care system itself.  ``It has never been very accountable.’’ Where is it ineffective, he is asking? Where is it wasting money ``or even actually harmful? ``If money is not being well spent, we have a huge opportunity to redirect priorities.’’

Already he is deeply engaged in the studies for his 1996 report. It’s going to be exclusively on child health, he says. ``This is a huge issue: the extreme importance of early childhood.’’ Out of it, as with his three earlier reports, will come data for his set of provincial goals and benchmarks.

How I wish some of the other provinces were following Millar’s lead and his perception of sustainability.