Personally, I have led a life of immense privilege—a stable family home, no significant trauma, financially secure, supported to achieve my educational goals, safe clean places to be outside as a child. I was born lucky. Perhaps a few different twists and turns in my journey and I would be living a different life. Unemployed? Uneducated? Unable to support my kids? Living on the streets? Dead at 40?
Why does someone with a social profile like mine maintain relative health while someone with a less-fortunate profile experiences poor health? Dr. Ryan Meili’s A Healthy Society examines this kind of discrepancy in health outcomes, and finds that the causes of poor health can be tracked back, in large part, to the social determinants of health—income level, housing, education, social networks and gender. In the medical system, we know that the role these factors play in health is more impactful than healthcare, which is really only symptom management for poor health. Dr. Meili takes this a step further and argues that these are fundamentally political problems—with political solutions.
Updated and expanded from a first edition, published in 2012, A Healthy Society now includes chapters on poverty, food security and climate change. Thought-provoking and highly readable, it weaves together the vision of a young politician—Meili was elected leader of the Saskatchewan NDP in March 2018—and the advocacy of a good physician who has worked in rural and urban Saskatchewan and in Africa. Through a series of patient stories, Dr. Meili gives a human perspective on the issues. We meet Maxine, a 22-year-old woman who struggled with a cocaine addiction and lived on the streets until—weakened by her HIV status—she eventually succumbed to pneumonia. Among others, we also meet Jessica, an 8-year-old struggling at school, whose family moved three times in one year in a highly unstable housing situation.
Drawing on these snapshots of a doctor’s practice, the book demonstrates the impact of the social determinants of health and offers insight into solutions that could be enacted if only the political will could be garnered and sustained. The lack of political will is galling. A Healthy Society is peppered with examples of promising Canadian programs and policies that were not quite launched, not continued or simply not evaluated, and so the positive impact they might have had is unknown.
There is no lack of science to demonstrate that when the underlying social determinants of health are addressed, society as well as individuals benefit. As Dr. Meili argues, the solutions are largely political—we need policies and legislation that place the social determinants of health at the forefront. This kind of action transcends political stripe. One example explored in the book, which sadly has not gained momentum in Alberta, is the adoption of “health in all policies,” which means that, as a matter of expectation in the policy process, health effects would be considered in all government policies. This would be a concrete way to align health goals within other social policies.
Investing in helping people stay healthy makes far more sense than paying for expensive healthcare later. As Dr. Meili writes: “Work to create a healthy society, a more equal society, a fairer society and you will have a safer society.” While it would not be cost-neutral at first, it could be within a generation. What is needed, and what the book leaves up to policy-makers (and perhaps another edition), is action—the concrete steps that are needed to move Canadian society forward. With Dr. Meili’s jump into politics, we can hope he lights the way.
—Dr. Fiona Clement directs the Health Technology Assessment Unit at the O’Brien Institute of Public Health, University of Calgary.