To What Extent?

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To What Extent Should Government Control National Healthcare?

The general health of the population today must be considered one of the greatest marvels of human civilization and ingenuity. Pregnant women no longer have to dread the 10 percent risk of death at childbirth that used to be usual; a newborn in Canada today can expect to live 80 years; death related to childhood infections is now rare; the long-term outcome of childhood leukemia has changed from 85 percent mortality to 85 percent survival; patients with cataracts, osteoarthritis and heart disease benefit from surgery that was unimaginable 40 years ago; many cancer patients can now be offered substantial relief and some even long-term survival. The focus now in well-developed countries such as Canada is on personal healthcare services, but we still must keep in proper perspective the indirect societal factors that are mainly responsible for making and keeping people healthy.
I learned a salutary lesson as a young and enthusiastic surgeon, a member of the team sent from Glasgow University in 1966 to help establish the new medical school in Nairobi. At a meeting with the Kenyan minister of health, we were complaining about the lack of drugs and equipment at the hospital when he interrupted, thanked us warmly for our service and politely explained that his major priorities as health minister were schools, safe water, houses, sewers and nutrition. We did not find this very endearing at the time, but he was displaying an excellent understanding of the determinants of human health.
Living in Canada, we have high expectations for relief of ailments that in past generations were accepted as normal accompaniments of daily living and aging. The scope of these services has expanded to an extent that Justice Emmett Hall in 1964 could never have contemplated as he drafted the recommendations for Canada’s national medicare system. The federal legislation enacted two years later established a publicly funded

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