The recent annual meeting of the Canadian Medical Association was remarkable for a number of reasons. Most notably, for its explicit focus on health equity and the social determinants of health. Though the link between health and factors like education, housing and income has been well-established for some time, never before has the medical association so openly acknowledged it - and they've done so with great gusto. The Yellowknife meeting featured a keynote address by Dr. Micheal Marmot, author of the seminal Whitehall Paper on social inequity and health, and marked the release of the CMA's own study linking declining income to failing health. What is equally remarkable is how far and how quickly the organization shifted from a 'pro-profit to 'pro-equity’ agenda.
From 2007 to 2009, physicians greeted BC's Dr. Brian Day and Quebec's Dr. Robert Oulette as successive CMA Presidents. Their terms marked a period in the organization's history of an equity-averse voice in health care reform. When Dr. Day assumed the organization's presidency he did so as the founder of the for-profit Cambie Surgical Centre. If that sounds familiar it’s because he's in the news again, this time for violating the Canada Health Act and continuing to do so in defiance of a court order. Under his leadership the CMA pushed for the expansion of private insurance into essential and core health service delivery despite evidence that doing so would decrease access to services, especially for the most marginalized. His successor, owner of a chain of private diagnostic centres, continued this very public advocacy for more of the same.
The fall of 2009 marked a gradual turning away from the organization’s equity-busting policies. Saskatchewan's Dr. Anne Doig, Oulette's successor, turned down the volume on an expanded role for private funding. Her successor, Ontario's Dr. Jeff Turnbull* began pushing equity to the fore. An internist by training, he is a founder of the Inner City Health Project for the homeless in Ottawa. Under his leadership the language of the organization towards both the public and physicians began to change. Evidence-based reform and quality improvement rooted in health equity gained prominence and the social determinates of health began to be discussed without reservation. PEI's Dr. John Haggie continued, pushing the federal government to take a stake in health equity and equality. He marked the end of his term last week sounding alarm bells on behalf of MDs: "[w]hat is particularly worrisome for Canada's doctors is that in a nation as prosperous as Canada, the gap between the 'haves' and 'have nots' appears to be widening."
Yellowknife’s Dr. Anna Reid, just one week into her term, is stepping in at an exciting moment in the organization's history. At a time when the problems of social inequity and income inequality are gaining support from the unlikeliest of corners, physicians have an opportunity to advocate for health and well-being in a way they have not before. With a federal government divesting itself of a stake in health care, cutting funding for its own refugees, openly hostile to groundbreaking harm reduction programs and embracing an agenda of austerity, a strong physician voice for health equity and the social determinants of health is more important now than ever.
*Full Disclosure: I campaigned on behalf of Dr. Turnbull during his campaign for CMA President.
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