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Sometimes you need to look back before you can move forward. André Chagnon, keynote speaker at McGill's February 9 roundtable discussion, "For Quebec's Good Health: Vision, Education and Action," referred to the groundbreaking 1974 Lalonde Report on health for Canadians. The report by the then-Minister of National Health and Welfare stressed that a good standard of living is essential to good health. André Chagnon, president of the Fondation Lucie et André Chagnon, agrees and said his foundation focuses on prevention of illness. He proposed strategies to combat disease and promote health in Quebec.
Chagnon made connections between poverty and illness, saying that children from poor families have a higher rate of health problems.
He added that chronic diseases are the leading cause of death in Quebec, pointing out that while treating these diseases is costly, many such as cardiovascular disease or obesity are preventable.
Information from Statistics Canada shows that the benefits of economic growth have not filtered down to everyone, stated Chagnon. The numbers of poor households have remained the same over the last 20 years despite economic growth. He said that a lack of education is also linked with poverty, saying that families who are poor have a much higher rate of school dropouts than the Quebec average.
Many projects have shown that effective and early intervention in children's lives help them become better learners, so "the foundation has decided to focus on preventing poverty and disease by taking action when children are very young." He said intervening during early childhood leads to a much higher projected return on the investment and avoids many health problems further down the road.
The foundation focuses on developing community projects, promoting an integrated approach to disease prevention and health in the workplace as part of efforts to create healthier individuals. Chagnon expressed his hope that "Quebec society will invest more in the early stimulation of children to enable them to do well in school. By investing early, we will ensure that our children receive a better education and, consequently, earn higher incomes in the future, which means less poverty and a Quebec in good health."
Roundtable participants Laurette Dubé, scientific director of the McGill Initiative in Integrative Health Management, Dean of Medicine Abraham Fuks and Alain Poirier, assistant deputy minister of the Quebec Ministry of Health, all made short presentations before the floor was opened for questions. The discussion was moderated by Jody Heymann, policy director at the Harvard Center for Society and Health, and soon-to-be McGill professor of medicine and arts.
Dean Fuks said the government has funded the treatment of disease rather than its prevention because that's what the public asked for. "We are the victims of our own success," he said. For instance, using antibiotics to treat infection results in quick and visible effects, whereas the benefits of preventative care take longer to become apparent. "The diseases we face today are different, such as diabetes, arthritis and high blood pressure. We need a different model."
Fuks talked of the importance of scholarly investigation, such as that by McGill researchers Michael Meaney, Moshe Szyf and Ian Weaver on the impact of how rat pups are weaned. Pups that were licked and groomed a lot by their mothers grew into less stressed and less fearful adult rats. "This shows that environment can affect our genes and which ones are turned 'on' or 'off'," added Fuks. Their research also showed that drugs can influence this effect, "raising the possibility that drugs may be used preventively rather than defensively."
Fuks also said that genotype is shaped by early environment, so we need to shift from asking about a person's disease to also looking at their genotype and environment.
In her presentation, Dubé underscored the importance of professionals in management and health care working together. With limited resources, there are difficult trade-offs between care and prevention at both the governmental level and in healthcare practices. "I believe that integrating health care and prevention is likely to put such difficult trade-offs on the agenda sooner, and possibly help us address them more effectively.
"We need to train a new breed of professional and have prevention and care management all integrated within a single mind."
Poirier said that a public health policy requires commitment from all levels of government and community. "If you believe in a public health policy it's not the responsibility only of the health minister - it should be a responsibility at the level of Charest, and at all government levels, such as the ministers of Education, of Revenue and of Family." He announced that an upcoming report from the minister of Health will include many common solutions to health problems. "We have to invest in prevention."
Dubé closed the presentations by urging everyone to "create a social epidemic of prevention" so that healthy lifestyles are supported and valued by government, education, community, business, media, individuals and families.
During the question period, one audience member suggested that investing in education should take place at all levels. While Poirier agreed on the importance of education, he pointed out that it is not the only factor: a poor environment in early childhood can lead to developmental delays. Chagnon added that the foundation's projects, such as "Québec en forme," increase the chances of participating children completing high school.
A local doctor in the audience stated that if prevention and health are important, does the upcoming report Poirier mentioned suggest penalizing those who contribute to the obesity epidemic? Another person asked Poirier if there could be additional taxes for businesses who add sugar to food.
Poirier said that while tobacco is harmful to everyone, food is not, and the option of taxing bad food would have to be publicly discussed.
All roundtable participants, no matter their background, agreed that raising awareness of such issues and engaging in public discussions is key for the future of Quebec's healthcare.