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Armstrong Wasting Away The Undermining of Canadian Health Care Notes.docx

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McGill University
Political Science
POLI 321
Fillippo Sabetti

Armstrong: Wasting Away- The Undermining of Canadian Healthcare - Health is determined by social, physical, and psychological environments, interacting with biological factors - WHO defined health as “a state of complete physical, mental, and social well- being and not merely in the absence of disease and infirmity” - Health is determined by 5 factors: social environments, physical environments, psychological environments, productivity and wealth, and health care 1. Social Environments - Social relations and social support are critical to health - Comfort and support provided to people undergoing treatment can not only speed recovery but can also make a difference in whether or not recovery happens at all - The kind of social support people want and need varies with their cultural origins. Cultural sensitivity is thus important to providing care, given that familiar practices are especially supportive in stressful situations - The most vital ingredient in social support is a sense of security - Improving the health of the population depends above all on achieving the lowest possible rate of unemployment. Unemployment contributes significantly to premature cardiovascular deaths in particular. Involuntary job loss also increases rates of suicide, depression, and substance abuse - The lifespan and health of a person in linked to his or her location in the job hierarchy and to associated factors such as degree of authority, freedom to make decisions and level of social support in the workplace. Health is affected by the stress related demands of the job. 2. Physical Environments - Nutritional food, clean water, clean hands, and clean air are essential to good health - Healthy physical environments are even more critical to those who are ill because their immune system is weaker 3. Psychological Environments - There is growing evidence that mental health influences physical well-being - Psychoneuroimmunology, an emerging field, may go a long way to explaining a biological pathway linking social and environmental factors with the performance of the immune system, and hence the health status of people - Mental states are even more important when the immune system is weakened by surgery or disease 4. Productivity and Wealth - Both secure employment and secure income are important to health - Greater wealth is associated with greater health; poorer and middle income people seem to be more vulnerable than the wealthy to a variety of illnesses - Hence, when socio-economic disparities are narrowed, population health status improves 5. Health Care (medicines, practices, etc) Government Responsibilities - Governments must provide adequate health and social measures not only because citizens have a right to heath but also because the promotion of health is critical to the attainment of peace and security - The traditional focus of our health care system is the curing of illness and not the prevention of disease- this should be changed. Increased spending on hospitals, equipment or health care will not necessarily improve health status - To the extent that prevention has become the focus, resources have been shifted from health care itself. A paradoxical effect of this has been to reinforce the cuts- and-chemical approach to care. Squeezed health care budgets mean shorter hospital stays and home care visits, which in turn mean less attention to issues of health education and social support - Little in the various government reports encouraged governments to reform care within the system in ways that reflect concern about the determinants of health. Instead, the reforms being put into practice usually serve to emphasize the dominant medical model of health Basic Assumptions of Canadian Health Care Delivery - Canadian health care is centered on and dominated by allopathic medicine. This is a system focused on penetration of the body physically by surgery and chemically by drugs- but this is just one of many ways to deal with illness and disability - Allopathic medicine (what we see as regular medicine) is based on a set of assumptions, which are reflected in the structure and relations of the health care system. Assumption 1: The Determinants of Illness are Primarily Biological - In allopathic medicine, mind and body are defined as separate with diagnosis of illness or disability focused on discovering a specific injury, germ or cancerous cell that causes the problem. - Psychological problems are reduced to biology and typically treated with drugs - Little attention is paid to the interaction of mind and body, as it is assumed there are different causes for the problems in each - If a physical cause cannot be identified, the complaint will be dismissed as “all in the head” - This assumption of biological causes impacts the doctor-patient relationship. With identifiable causes in mind, doctors only spend a very limited time with patients to determine the problem. A prescription can be offered or tests ordered immediately. Walk-in clinics become possible when it is assumed that there is a readily identifiable cause that requires lie knowledge about the person as an individual. Assumption 2: The Engineering Model of the Body - Modern medicine assumes that the body works much like any other machine. It is made up of a series of parts that can be fixed. This allows for specialization in allopathic medicine. - This engineering model of the body, combined with the assumption of specific causes, also makes possible a fee-for-service system to determine doctors’ pay. - Fee-for-service is very similar to piecework payments in manufacturing, where workers are paid for each component made. In our health care system, most doctors’ fees are based on the specific part treated or task done, rather than on the basis of the number of people treated or the amount of time worked Assumption 3: Health Care is Primarily about Curing Illness or Disability - Central to modern medicine is the notion of intervention to bring about cure - Drugs and surgery are used to cure the diagnosed illness or injury. The purpose is to return the patients to “normal” - This curative approach, combined with the engineering model of the body, provides a basis for establishing acute-care hospitals that focus primarily on fixing a specific part as quickly as possible - Psychological support before and after treatment, feeding, bathing and talking with the patient are seen as non-medical tasks - Management techniques developed in industry are transferred to health care on the assumption that fixing a care part is not much different from fixing a car part Assumption 4: Medicine is Scientific - Allopathic medicine is scientific medicine - Scientific medicine taught that each disease has a single well-defined cause, and that the control of the disease could be best achieved by attacking the causative organism or by correcting the function of the diseased part of the body. Science determines cause, effect, and cure - Clinical care pathways, with the message that there is one best way to diagnose and to treat, have become more prevalent. It is assumed that all patients with the same problem will display similar symptoms, will follow basically the same pattern of disease development, and will take very similar times for treatment and recovery. It is therefore possible to determine formulas to determine the times for patient cures and discharge. Assumption 5: The Doctor as Authority and Expert - It is assumed that patients lack the necessary knowledge and often the necessary will to follow appropriate procedures. It is also assumed that doctors’ superior knowledge means that only they can know what procedures can be safely delegated to others within the system. - Doctors’ power over both patients and the system is necessary and desirable because health care is about fixing body parts based on expert knowledge of scientifically established procedures, and only doctors have this knowledge. Challenging the Assumptions Challenge 1: Doctors’ Authority and Expertise - As early as the 18 century, a group of medical practitioners tried to gain dominance by pressuring the state to give them the exclusive right to practise
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