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Introductions to sections of the Connexions Annual written by Ulli Diemer.
In the twentieth century we in the industrial nations witnessed a marked improvement in many of the indicators of human health. Infant mortality has been greatly reduced, life expectancy has increased significantly, many illnesses and injuries which were formerly fatal or incapacitating are now treatable. We tend to live longer, and be healthier.
This progress is largely due to advances such as public sanitation and sewage treatment, drinking water that is free of disease-causing bacteria, better nutrition, improved standards for handling food, and large-scale vaccination. Advances in medicine and pharmacology have contributed, though their contribution relative to public health measures is frequently over-stated.
These benefits have not been shared equally. In the third world, lack of food and clean drinking water kills millions. In Canada, Native peoples and the poor have worse health, less medical care, and lower life expectancies.
In the population at large, health issues continue to be a major focus of concern. Smoking — including second-hand smoke — and inappropriate diet are massive, preventable causes of ill health which reflect not only individual choices but also the effects of advertising, social pressures, and institutional policies.
Workplace health issues are among the most serious and widespread of all health problems. Canadian workers and farmers are killed or injured at work in appalling numbers. Often they are exposed to noise, dust, radiation, and dangerous chemicals, at levels far above those considered ‘acceptable’ for the population at large. Frequently they are deliberately lied to or kept in ignorance about the hazards which they face at work. (Asbestos companies, for example, knew for decades that asbestos was lethally dangerous before they admitted to their workers that the substance was in any way hazardous.) Workplace health issues are becoming a major battleground as workers fight for the right to earn a living without sacrificing their health.
Such issues frequently become struggles for power, specifically the right of workers to full knowledge of the substances they are working with, the right to have a significant say in managing work to minimize health risks, and the right to refuse unsafe work without being penalized. The emergence of such issues presents a significant opportunity for alliances to be made between unions, environmental groups, and health organizations.
Environmental health issues have similarly become the subject of widespread concern as risks become known or suspected. Air and water pollution are linked to cancer and respiratory disease. Highly toxic chemicals lace our water supplies and the fish we eat. The thinning of the ozone layer makes us more vulnerable to the carcinogenic rays of the sun. Modern farming practices leave pesticide residues in our fruit and vegetables and anti-biotics and growth hormones in our meat. Rising levels of noise cause increased stress for many.
Pharmaceuticals are another issue of concern. One problem is the widespread over-prescribing or mis-prescribing of drugs, especially to the elderly, women, and psychiatric patients. Doctors are often lamentably ill-informed about the drugs they prescribe, with most of their information about particular drugs coming from the companies that sell them. The giant multi-national drug companies aggressively pursue their market share, all too frequently by producing drugs of little value, or their own brand-name versions of another company’s already existing product.
In the third world, drug company marketing strategies have resulted in a tragic misallocation of scarce resources, and the companies continue to resist fiercely any efforts to adopt the ‘rational prescribing’ policies advocated by the World Health Organization. In Canada, the drug multi-nationals, backed by the U.S. government, were successful in pressuring the government to pass legislation drastically restricting the right of independent pharmaceutical firms to produce cheaper generic equivalents of their expensive products.
Financial issues generally are contentious in the health care system. Government spending going to health care has been increasing rapidly in many parts of Canada, yet sectors of the health care system are suffering from underfunding. One important debate revolves around how much money should be going to ‘high-tech’, hospital-oriented, doctor-driven approaches, and how much to education, prevention, home care, and other health care providers such as midwives, nurse-practitioners, and alternative healers.
Some are also looking for ways to reduce doctors’ disproportionately high share of income and power. Nurses especially have been putting their concerns forward with increasing militancy. The Patients’ Rights Association has been pressing for patients to have increased say in their own care.
With governments pursuing an agenda of budget cutbacks, it seems certain that financial pressures will increase. One way in which governments have shed expenses has been through ‘deinstitutionalization’. In theory, this means moving people from large institutions to community-based care. In practice, it has more often tended to mean dumping psychiatric patients and the disabled onto the streets with little or no support, follow-up, or care. Parents nearing retirement age find themselves forced to single-handedly shoulder the burden of caring for children with severe disabilities; children, epecially daughters and daughters-in-law, find themselves responsbile for caring for aging parents.
Another strategy has been privatization: in essence, shifting the responsibility for care of the elderly and others from publicly accountable institutions staffed by unionized workers to privately owned companies using workers paid little more than the minimum wage.
Financial considerations also directly affect the users of health care. While the existence of medicare gives Canadians a much more egalitarian health care system than Americans, financial deterrents to access exist in the form of user fees in some provinces.
AIDS in particular is raising significant ethical, economic, and political issues which relate to both health care and human rights. AIDS activists are highly critical of how the health care system has responded to the pandemic so far, and are concentrating their efforts simultaneously on political pressure, education and self-help.
A woman’s right to choose whether or not to have an abortion is still under serious attack, presenting a major challenge for pro-choice groups which advocate that women have access to safe legal abortion and reliable contraceptive information.
Many of the groups in this chapter deal with a particular pressing health issue. Others, such as those advocating a ‘healthy city’ strategy, are trying to develop a comprehensive approach to changing public policy in the many sectors which affect our health. When health is seen in its wider context, it is apparent that many of the issues identified elsewhere in this Annual are also health issues, suggesting that there are many fruitful ways in which health groups and other groups can work together.
Other Overview Articles from the Connexions Annual:
Introduction to the Connexions Annual
Introduction to the Arts, Media, Culture section of the Connexions Annual
Introduction to the Community, Urban, Housing section of the Connexions Annual
Introduction to the Development, International section of the Connexions Annual
Introduction to the Economy, Poverty, Work section of the Connexions Annual
Introduction to the Education, Children section of the Connexions Annual
Introduction to the Environment, Land Use, Rural section of the Connexions Annual
Introduction to the Human Rights, Civil Liberties section of the Connexions Annual
Introduction to the Lesbians, Gays section of the Connexions Annual
Introduction to the Native Peoples section of the Connexions Annual
Introduction to the Peace section of the Connexions Annual
Introduction to the Women section of the Connexions Annual