What is discouraging is that we have been down this path before with respect to how we deal with the health of our citizens. Well over 100 years ago, the city healthy movement emphasized the need for improved water and sewer systems, the eradication of slums, and the provision of more open space and a variety of social programs – all designed to prevent illness. But as the 20th century advanced powerful diagnostic and therapeutic tools such as x-rays, antibiotics, and effective anaesthesia appeared in medicine. Better health became equated – in the minds of the public and their political leaders – with doctors and hospitals. Emphasis on prevention programs (and financial support for them) declined to the point that now only about 5% of the health budget in Canada is actually spent on prevention. Our health care system is actually a sickness care system.
Many of the programs that would help to keep a population healthy have faced cutbacks from budget-conscious governments. A particularly heinous consequence of this approach has been all too evident in recent months as the COVID-19 pandemic has swept across this country, with more than 80% of its victims being residents of various types of seniors’ facility. Many of the older buildings had fatal design flaws, with up to four residents in the same room (divided only by curtains) and sharing the same washroom. Many were understaffed and most of those staff were very poorly paid, and often worked at two or three jobs, contributing to the spread of the virus. Government inspections had been drastically curtailed in Ontario, with most of them done – inexplicably – by telephone. Whatever savings were generated by “running a tight ship” and cutting back of government support for such facilities, have been far exceeded by the staggering costs of the shutdown of our economy – not to mention the disgrace of having our senior citizens left to die in such conditions, without even having the comfort of members of their own families because of the COVID lockdown.
Focus on Fire Prevention, not Firefighting
Before we despair entirely, there is another way and it has been followed, for the most part, with respect to the operation of fire departments. Originally, their purpose was to fight fires and their effectiveness was measured by how quickly they responded to fires and how successful they were in minimizing loss of life and property damage. Gradually the emphasis shifted to fire prevention. Improvements were made to construction standards with, for example, fire walls added to limit the spread of a fire. Fire safety programs were introduced and public education was stressed. We began to appreciate that the effectiveness of a fire department was reflected in how few fires it had to fight!
Might we hope that we will finally learn to shift resources to address the underlying causes of problems that we face rather than waiting until we must expend those resources on dealing with the consequences of our neglect?