by Jane Philpott
SIGNAL
2024/$34.95/296 pp.
“Health is not the only thing but it is the mother of everything.” With her understanding of an old West African proverb, Jane Philpott imparts a lifetime of lessons learned as a family doctor, politician, mother and person of faith. Through vivid storytelling and sharing her personal and professional experiences, Philpott engages the reader intellectually and emotionally to understand what is needed to create a healthier Canada.
Canada’s healthcare system was built on the principle of equity—guaranteeing those who live in this country universal access to publicly funded medical care based on need, rather than ability to pay. Yet it is falling short on delivering on many of these promises. More than six million Canadians don’t have a family doctor, those who have one are unable to obtain timely access, and private clinics are taking hold in many provinces, undermining the public system.
A former federal minister of health, Philpott proposes a four-part prescription for Canada’s ailing health system. First, she articulates a bold and clear vision to improve health service delivery through universal access to primary care services for every Canadian. Analogous to every child having universal access to K–12 public education, Philpott recommends a system in which every person living in Canada will be guaranteed access to a primary care provider—a family physician or nurse practitioner. As the foundation of a well-functioning health system, Canadians’ “primary care home” will include a team of other professionals such as physiotherapists, social workers and mental health counsellors to provide services customized to local needs.
Studies show that countries with strong primary care systems produce better health outcomes at lower cost and have increased accessibility and equity. However, access to health care is a necessary but not sufficient condition in achieving health. The concept of health extends beyond the physical realm to include mental, spiritual and social well-being and requires the cultivation of hope, purpose, meaning and a sense of belonging. Philpott illustrates the importance of each of these concepts using touching personal stories, evidence from research studies and examples of existing community programs.
No discussion about health is complete without an exploration of the social determinants of health—the conditions in which people live, work and play. Adequate housing, income, education and employment are examples of social determinants that can create conditions for optimal health. As Philpott writes, “Attention to the social determinants of health matters because these issues are the building blocks of a peaceful and productive society.”
Politicians and governance systems play a key role in both the design and the delivery of health, and in providing access to those “building blocks.” In the final section of the book, Philpott turns her attention to the political determinants of health. From her past experiences as a federal minister, she provides critical insights into why the current way of doing politics is preventing Canadians from achieving health for all. Drawing on her knowledge and experience in medical education, she outlines a number of skills, knowledge and attitudes that are transferable from the world of medicine to that of public office. While it may be a bitter pill for politicians to swallow, they would be well advised to heed the constructive solutions she offers as a path forward: engage in professional development, increase capacity for collaboration and firmly commit to equity.
Health for all may sound like a lofty goal, but in a democratic, well-resourced country such as Canada it can certainly be achieved through political will, investment and decisive action, especially if we, the electorate, demand it.
Vamini Selvanandan is a family physician and public health practitioner in Alberta.
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