Politics as ‘medicine writ large’

Health care in Canada is in a state of crisis, and Jane Philpott, a doctor who served as federal minister of health from 2015 to 2019, has something to say about it. Part treatise on health care, part autobiography, Health for All: A Doctor’s Prescription for a Healthier Canada examines the clinical, spiritual, social and political dimensions of health and offers up solutions for what ails the health care system.

Philpott begins her book by recounting a day in Niger during one of her missions to the West African country as a volunteer with Médecins Sans Frontières. Her task that day was to screen children for severe malnutrition, sending the sickest children to the Centre de Recuperation Nutritionnelle Intensive in the city.

“During the years we lived [in Niger], I watched children die of starvation in a world that has plenty of food. Living in one of the poorest countries on earth taught me that while health is much more than health care, the people of Niger were terribly lacking in both,” she writes. “[Canada is] also far from achieving evenly distributed opportunities for people to be well.”

In part one, Philpott shifts her attention to Canada and the clinical underpinnings of health. Noting that, according to the 2023 survey OurCare, 6.5 million Canadians, or 22 per cent of the population, do not have a family doctor or nurse practitioner, she advocates for a primary care home for all.

“Simply put, we must make it a reality that every person living in Canada has a primary care home, just as every Canadian child has access to a public school,” she writes.

That home would be staffed not only by doctors and nurse practitioners but also by nurses, physiotherapists, midwives, social workers, and other health and allied health practitioners. To effect a primary care home for all, Philpott urges the federal government to implement a Canadian primary care act as a complement to the Canada Health Act.

“You set out the principles in the program criteria so Canadians know what they can expect. Commit to federal investments. Make it clear that if provinces are noncompliant, the federal contribution will be reduced or withheld.”

In part two, Philpott examines the spiritual dimensions of mental wellness — hope, belonging, meaning and purpose — which constitute the four core elements of the First Nations Mental Wellness Continuum (FNMWC) framework.

“ Health is the result of so much more than health care. If we want a healthy population, we need to invest in the upstream factors that determine wellness.”

“To be physically well, we all know that you have to have nutritious food, some exercise and regular checkups with your health care team. We also understand the social factors that are widely understood as determinants of health. . . . But until I came across the FNMWC framework, I never had a list of factors to help me understand the underpinnings of spiritual wellness.”

The social determinants of health, including education and literacy, income and social status, employment and working conditions, childhood experiences, and social supports and coping skills, are the stuff of part three. Philpott explains them by telling stories of real people.

“Health is the result of so much more than health care,” Philpott writes. “If we want a healthy population, we need to invest in the upstream factors that determine wellness.”

In part four, Philpott turns to the political dimensions of health and explains her decision to enter the political arena. “Politics is nothing but medicine writ large,” she writes. “It’s the leap from healing individuals to healing society. Politicians set the societal rules that have a profound impact on who will be well. For me, the move to politics was simply a way to improve people’s health on a grander scale.”

At times heartbreaking and at times heartwarming, Health for All: A Doctor’s Prescription for a Healthier Canada offers a detailed roadmap for resolving Canada’s health care crisis.