History of Canada's HC system → general overview

Question 1

20th Century → HC industry - development? (Canada)

Answer 1

more cures & treatments developed for more ailments than in all of human history

• development of surgical techniques, pharmaceuticals, medical equipment → saved millions of lives
• for many years, CDN HC system ranked among the best in the world

but over time, CDN society changed & HC system changed with ti

Question 2

Modern CDN Medical System

• Began?
• Growth/Decline?

Answer 2

Began & grew during post-WW2 (with post-war economic boom from 50s-70s)

• left-wing gov → initiated welfare state (medicare = major part of WS)
• HC system initially run by state on non-profit basis

Decline in 70s → bc of recession, economic change but mostly political change

• mid-70s → politics swung to right-wing
• late 70s/early 80s → rise of new-right led by Mulroney’s conservatives
  
  • introduced new policies → public HC cutbacks & increased HC privatization
    
    • policy continued by Liberals (90s) & Harper’s conservatives today

Question 3

Canada is not only country that has increasingly privatized HC

Answer 3

Since 80s, increasing globalization (basically global privatization)

• means corps taking over from state in every area of economy all around world

US has privatized far more than Canada

Every country in Western World hsa privatizated to some extent

Question 4

Q: How far will privatization go before pendulum of politics swings back towards left & see reintroduction of state into HC?

Answer 4

History teaches us political pendulum swings back & forth

→ so present right-wing trend won’t last forever but will continue for some time yet

Question 5

Privatization has created problems for Western HC

Answer 5

pushed modern HC in particular direction → led to major problems over long-term

Question 6

Approach to Medicine

Traditional vs. Modern

Answer 6

Traditional

• modern medicine focused on (4) types of HC (4 C’s)
• 2 provided by men & 2 by women →traditional division of labor
  
  • Cooking - Nutrition
  • Cleaning - Sanitation
  • Cuts - Surgery
  • Chemicals - Pharmaceuticals

Modern → in recent years, HC system redirected to 4 M’s (gone too far in this direction)

• HC system has become too:
  
  • Male-dominated
  • Military
  • Mechanical
  • Monetarized

Question 7

Expand on Modern Approach to HC system (4 M’s)

Answer 7

**Male-domination ** = link that ties 4 Ms together

• military, machines & money – all areas dominated by men
• Inevitably, when men took over HC → these areas became important

Every since witch-hunts killed medicine women → Modern Med has been male-dominated

Question 8

How did this modern approach to male medicine change after WW2

Answer 8

More women getting higher education

from 60s onwards → more female doctors

• Nurses also raised their qualifications

60s/70s →women gained larger voice in HC system

Question 9

After Witch-Hunts → Male-dominated HC system

After WW2 → women gained large voice in HC system (more female docs, nurses raised qualifications etc.)

In 80s?

Answer 9

change in gov policy → brought in new hospital admins from private sector

• almost all men
• steadily reduced influence of both doctors & nurses
• reoriented HC system to be more concerned with money

Male-domination continues in HC → patriarchal HC system for most part

Nurses continue to be under-valued, over-supervised & over-worked

Question 10

Male Approach to HC (i.e. TQM)

• characteristics?

Answer 10

over emphasizes short-term cures

under emphasizes long-term care

compartmentalizes health problems & then provides quick fix

• instead of looking at health as lifelong process (holistic approach)
• no one person in hospital to look at health of patient as a whole

Question 11

In order to provide a more balanced, holistic & caring approach to HC..?

Answer 11

Need more female-centered HC system

→ HC system run the way it used to be by HC professionals of whom majority are women

• NOT run by male managers who know all about money but nothing about HC

Need HC system that appreciates work provided by nurses & other female caregivers

• & that supports extending work into community through new health centres/services

Men → CURES Women → CARE

Question 12

To bring CARE back into HealthCARE…

Answer 12

need to give women greater voice in how HC system is run

Question 13

Military aspect of Modern HC

Answer 13

If you look at history →military has traditionally been main source of male medicine

• most of human history → HC in tribes&agricultural villages → provided by medicine women
• sewing soldiers up = men’s work
  
  • means that modern surgery evolved from needs of battlefield
    
    • scalpel → evolved from sword/dagger
      *

Question 14

How have aspects of Modern HC evolved from military?

Answer 14

Modern Surgery → evolved from battlefield needs

• Scalpel → evolved from sword/dagger

When Military evolved from using swords to using guns

• male med profession also evolved → invented hypodermic (needle)
  
  • needle to shoot things into patients
• Pharm industry provided ammunition for doc’s hypodermic → drugs

As Medical profession has moved from focus on battle wounds to disease
→ has for most part, continued to think in military terms

• disease is seen as invading enemy/army that must be killed

Question 15

Similarities b/w Military & Modern Medicine (male-dominated)

Answer 15

Modern Surgery

• scalpel → sword/dagger

Guns → hypodermic

Ammunition → drugs

Disease → invading army/enemy

Antibiotics → chemical killers (that kill disease to cure body)

Question 16

Basic Approach to Military Medicine

Answer 16

Kill disease → Cure body

Question 17

Problem with Military Medicine’s approach to HC

Answer 17

Strategy works well in short-term but creates problem in long-term

over long-term → diseases evolve/adapt to chemical killers

• become more strong/powerful/deadly
• reaching point where these virulent disease are resistance to most antibiotics
• speeding up process of evolution
  
  • STIs - gonorhea, syphilis → HIV/AIDS

Question 18

To fight off these stronger/more virulent microorganisms…

What do we need to do?

Problem with this?

Answer 18

Make stronger drugs

There is limit to how lethal drugs can be before they start to harm/kill people as well as disease

• have already passed point of diminishing returns
• more drugs on market have adverse side-effects

Question 19

Military Model of Waging War on Disease

Problem?

Alternative?

Answer 19

can only go so far before becoming self-defeating

need to adopt more ecological understanding of disease

• understands that human body is part of global ecosystem & it is an ecoystem in itself

Rather than killing, should modify/tailor microorganisms to our needs → help us be healthier

• Genetic Modification

Question 20

ecological understanding of disease

Answer 20

body part of global ecosystem & an ecosystem in itself

→ Body = host to 100s of microorganisms

• provides ecological niche (living space)

need alternative approach that utilizes symbiosis

• modify microrgs to become symbiotes
  
  • accept them in benign form & fill body with ones that make us healthier

Question 21

Example of this Alternative Ecological Approach

Answer 21

Few years ago in Ottawa, research began on developing oncolytic viruses → attack cancer

• instead of chemo/radiation, shot injects virus that eats cancer → developing virus to help us

Question 22

Genetic Modification

Answer 22

Will be next major technological breakthrough of 21th C
-will change society as much as comp revolution did in 20th C

Power to genetically modify & tailor microorganisms to our needs will be within our grasp within this century

Question 23

Q: How wisely will we use this power of genetic modification?

Answer 23

If we continue military approach → create long-term problems → deterioration of health

If we use it to modify microorgs to become benign symbiotes will improve health

Question 24

Modern medical system has become too MECHANICAL

• PROs?

Answer 24

machinery has become major part of modern HC

• many benefits, saved & improved many lives

At root of modern medicine → mechanical model of body

• permitted specialization & localized treatment of med problems
• Valid model up to certain point

Question 25

Modern medical system has become too MECHANICAL

• CONs?

Answer 25

human being is more than just a biological machine → has mind, feelings & rights that need to be respected by HC system

Since 80s, intro of factory-style management

• trying to increasingly mechanize HC process
• humans cant be standardized
• limits to what machines can do →cannot provide care
  
  • buying more machines only increases corp profits

Question 26

Modern medical system has become too MECHANICAL

• Solution?

Answer 26

need to re-individualize/re-humanize/customize HC

• give docs/nurses more latitude/freedom/resources to do so
• HC system spending more&more money on machinery

→ better spent on more docs/nurses (have shortage)

Question 27

HC System is too focused on MONEY

(HC has become too monetarized)

Answer 27

introduced by privatization

for-profit HC institutions provide inferior quality/quantity of care

Profit motive → forces business to focus on short-term

• In HC, means cutting costs & quick fixes
• long-term side-effects

Example: ON NHs → private l-t HC facilities need to be forced by gov/laws to provide even minimally adequate care

Question 28

Monetarized Aspect of Modern HC

• Alternative?

Answer 28

non-profit HC - does opposite of for-profit

i.e. Homes for the Aged, Meals on Wheels

• helps ppl not be institutionalized & live normal lives
• good for patients but bad for profits
• help ppl in short-term → less strain on HC system in l-t

Question 29

Quotes → relating to HC

• John Lennon
• Bible (2)

Answer 29

In the end, the love you take is equal to the love you make

• easy to forget HC is ultimately labor of love
• caring for sick/frail ppl is literally act of love

“Greater love hath no man than he who lays down his life for his brother”

• true for men → still male military mindset
• defines love in terms of short-term heroic gesture

Greater love has no women than she who dedicates her life to caring for others

• women define love in more lasting terms

Question 30

What do these (3) quotes tell us about the problem of money in HC?

Answer 30

The ultimate problem with putting money into HC

Once you reduce HC to money → love & care gone & we all suffer