In my previous blog post, I talked about how I define 'health' for the purposes of conversation on this site—which, defined from my perspective, takes into account the social and economic policy decisions that impact our collective health and that ultimately reflects the value that society places on health.
Now, what about 'health care'? And why separate the two conversations? (And probably, more importantly, how does this all fit in this 'narrative' that I speak of?)
I separate the two conversations into their own distinct categories because, to me, these are two parallel conversations that, while overlap often, are slightly different when explored independently: while 'health', more generally, captures the broader impact of social and economic policies and established norms that influences the state or condition of our health, 'health care' describes the actual mechanism of care delivery that addresses our specific health concerns. For example, community health clinics allow citizens to access professional opinions of their current health status and allows for a regular connection in having one's health condition monitored. Hospitals provide needed care in emergencies and offer a space to conduct more complicated scheduled care, like surgeries or treatments for difficult diseases, like cancer. Health care can be delivered publicly, that is, though public tax dollars, or privately in a for-profit or non-profit arrangement.
Why is this conversation important? Well, I can suggest that many people see health care in the following way—when you get sick, you want someone to heal you, right? Well who, how, and—for how much—are important factors when you're making a decision to seek help for a health concern. The health 'system', and how it subsequently delivers health care services, varies by society—for example, in the United States, health systems can typically be described as private (both for-profit and non-profit) and government plays a smaller role in managing the delivery of health care services to citizens. In this system, a citizen accesses the system at a personal, out-of-pocket cost paid for per visit or through a privately managed health care insurance plan covering a specific range of services, or a wider range of services, depending on one's risk and cost preference. Conversely, in Canada, a publicly-funded health model is adopted, where society pays for health care services primarily through taxes (and to a lesser extent, small, consistent health care premiums depending on the province you live in), and these taxes fund the public delivery of health care where citizens can access most health care services at no out-of-pocket expense, but for a certain range of health care services that are deemed 'uninsured'. Know that this is a painful simplification of both models; but we'll have opportunities to 'dig' into both systems in later blog posts.
There are advantages and disadvantages to both models and models in-between—yes, some societies have adopted a blend of private and publicly-funded elements—and the advantages and disadvantages of each filter into the public space, with intense debates on the subject sometimes leading to legislative decisions that re-frame how health care is actually delivered to citizens. You may already be acutely aware of these discussions if you are in the United States and are observing public conversations that concern the Affordable Care Act and the current administration's desire to replace it. In Canada, discussions on wait-times and 'value-received-for-public-dollars spent' typically dominate public conversations on the subject.
Regardless of which health care delivery model is used, these models should be responsive and available to citizens when they need to access it. When the system is not accessible—and there can be many reasons for why that is the case—discussions focus on how to improve access in those models, sometimes through incremental changes and, at other times, through wholesale changes to how that model works—examples of which will come in later blog posts (and I'll try not to exasperate you with the minute details; there can be many facets to explore...)
So—how does this all relate to the narrative that I'm building?
Our society shapes our state of health through the social and economic decisions that it makes and related consequences it accepts that impacts our health. Whether we, as society, choose to mitigate those consequences or not, a health system that delivers accessible health care should be put in place to deal with citizen's health concerns in either case. The health care system should be designed to address health concerns regardless of whether a social and economic policy is uplifting or damaging to our health. If burning coal is raising the number of asthmatics in our community (or perhaps doing far worse), the health system needs to be there to address those health concerns. If access to that system was poor or if that system was not equipped to address a variety of health concerns, we would invariably observe a citizen population that has poor health outcomes (for example, by seeing higher rates of preventable deaths). Having a robust health care system provides a feedback mechanism to policy makers in providing them data on the state of a population's health. From that data, policy makers, and the public more generally, can make arguments or decisions to modify previously accepted or currently debated social and economic policies.
We need to have a conversation in both spheres to make sure that we are getting closer to a model of health that allows us to achieve our respective and communal health goals; if there are challenges in the one, the other, or both spheres, we may very well find ourselves further away from our vision of health for ourselves and for our society, since we need both spheres to align in order to 'raise' our collective health.
It's my hope that, with this site, we can have productive conversations together about how we can make positive changes in both spheres. And with future posts, I'll start throwing some ideas that address both spheres together and separately.
So—your mind is blown, right!? Or maybe you're reading this and thinking that you're miles (or kilometers?) ahead of me! Well let me know what you think.