Why is there so little focus on preventing health problems before they hit our creaking hospital system? It would seem like a more common sense approach but the amount of money poured into Ireland’s acute care has long dwarfed what is made available for disease prevention.
Dr Louis Francescutti, president of the Canadian Medical Association and a global campaigner for disease prevention, was in Dublin last week to encourage Irish doctors to lift their eyes from the bedside and look at health more politically.
His theory is that there needs to be a new focus on preventing people from getting ill in the first place, rather than just treating disease.
It all sounded a little thin during an interview on Newstalk where fellow guest and GP Ciara Kelly was exasperated by his habit of saying "well, that's simple . . ." when asked to suggest solutions to complex health problems.
But the following day he delivered a challenging, well-received lecture, "Getting Rid of the Patient", to a room full of doctors at the Royal College of Physicians.
Priority
The factors with the strongest influence on health lie outside the hospital system, and yet they are rarely given priority.
Healthcare contributes about 25 per cent of your health, with the remaining 75 per cent coming from social and lifestyle factors – did you get a good education, do you have adequate housing, a job you enjoy, enough income to buy good food, a loving family and supportive partner?
To focus on these issues, a much broader "vision" would be needed within the medical community. Speaking to The Irish Times after his lecture, Francescutti conceded that a difficult shift is needed for disease prevention to improve, particularly as medics are already stretched to the limit within the troubled HSE.
“It is hard to move that agenda forward because you have to deal with things like poverty, homelessness and education that lie in the political realm. But it is incredibly important for physicians to get involved at the decision-making level.
“Politicians are looking for the profession to provide solutions. Otherwise changes are not going to happen.”
Half of all the diseases seen in Irish hospitals are the result of just three risk factors – smoking, inactivity and poor nutrition. Despite the massive burden they place on the health system, very little is being done to tackle these issues.
Illness is increasingly behavioural-based and the medical profession, perhaps more comfortable treating infectious disease, is not adapting quickly enough.
“For example, there is little training given to medical students about addressing the causes of the obesity problem swamping Irish hospitals.
“In 2013 we need to ask why we have Generation XXL coming down the line and develop skills to change people’s behaviours,” says Francescutti.
“Physicians could be real leaders if they say ‘we are really good at treating heart attacks but if the majority of heart attacks are caused by inactivity, smoking and poor nutrition, why don’t we go upstream and solve it before it happens?’ but they need to be given the skills to do that.”
He had strong views on the recent junior doctors’ strike, saying other countries are not subjecting their young colleagues to the punishing hours commonplace in Ireland.
And here, as in many other countries, doctors need to stop complaining about the health system and instead focus their energy on fixing it.
“If you have a dysfunctional system, I hate to say this but you are part of the problem. When you hear the consultant bitch about the system on a constant basis, what does that teach our [junior doctors]?”
The most interesting part of his lecture was when he asked Irish doctors to do more to respond to the needs of society, particularly at the national level where there is scope for them to become involved in public advocacy on health issues.
Politically involved
Medical students in Canada are actively encouraged to become politically involved and during their first year of study they are put through a "physician advocacy leaders" programme where experienced doctors mentor them on advocacy techniques.
Francescutti has been liaising with legislators on health issues for years, and was behind a range of public safety initiatives, including the Alberta Coalition for Cellphone Free Driving which he founded after seeing terrible injuries caused by careless driving come through his emergency room.
At the individual level, he says doctors can help by being sensitive to the economic realities that impact access to healthcare.
“Most physicians are paid very well so it is hard to understand the pressures of going to a bank machine and not being able to get money out.
“You also have to think; can your patients come to the office during your working hours if they have three part-time jobs to keep their family going? When you write a prescription, can they afford it?
“Make sure you are aware of all the resources within your community that you can refer your patient to, social welfare or respite programmes.”
Asked whether referring patients to social welfare is a physician’s responsibility, he is adamant that it is and that the nature of medicine is changing.
“It is their job. Those days of saying it’s not my job are over. It is about meeting the needs of society.”
