Whenever it meets with physicians in their environment, the QMA has observed that many of its members are committed to improving care and services on a daily basis. Great initiatives are taking shape everywhere. Some of them should even be implemented or adapted elsewhere, but for this to happen, we need to know that they exist!
If you have set up a project that deserves more visibility or if you know of members colleagues who have done so, feel free to contact QMA. We would be pleased to showcase your achievements.
The story of Dr. Ak'ingabe Guyon and her two million patients
QMA member Dr. Ak'ingabe Guyon was recently awarded the Public Health Physicians of Canada’s President’s Award, in recognition partly for her public health advocacy work. In 2015, she didn’t hesitate to take her protest straight to the National Assembly when the government slashed the budgets of regional public health teams by 33%.
As an assistant clinical professor at Université de Montréal’s École de santé publique and a consulting physician at the Direction de santé publique de Montréal, where she has worked since 2013, Dr. Guyon was unwilling to stand by and watch as the teams that keep the public health system running were dealt a crippling blow. “We don’t have any big machines, scanners or expensive drugs—our treatments depend on the partnerships and relationships we make and on the influence we have on people,” she explained. If we start sabotaging these multidisciplinary teams of doctors, epidemiologists, nutritionists, sociologists, demographers, etc., then we’ll be less well armed to win the battles that, 10 or 15 years down the line, have the potential to turn into resounding victories in the form of spectacular health outcomes.
The work done by the Centers for Disease Control and Prevention in the United States shows that 25 of the 30 years of life expectancy gained in the past 100 years are attributable to prevention, compared to only five years gained through curative treatments! “These staggering effects make prevention non-negotiable,” Dr. Guyon said, both for her personally, which is why she chose it as her speciality, but also on a population level, because of the tremendous difference it makes on people’s health.
Building up Quebec’s public health capacity
Dr. Guyon remains convinced that the 2015 cuts will continue to have negative effects for years to come. “The situation can be compared to having one-third of your body amputated. The rest of the body might continue to function and slowly heal, but it’s not without its consequences.” In her opinion, there’s no doubt that Quebec needs to start playing catch-up with the other provinces in order to build up its public health capacity.
According to the Commissaire à la santé et au bien-être, Quebec currently contributes 2.8% in funding to its public health system, compared to the Canadian average of 5.5%— far from the shining example of public health that the province once was and making it impossible to be as efficient as we should be. “We have recognized, proven solutions and interventions that actually reduce preventable deaths and diseases. But given all the cuts and disinvestment since 2011, the teams are no longer capable of delivering the dose, the dose being the team itself,” explained Dr. Guyon. In short, we have a pretty good idea of what can be done, what needs to be done, or what needs to keep being done, but it’s impossible to do it well enough.
Quebec was once the envy of the rest of Canada for its public health capacity and interventions, which were considered the most innovative in the country. However, Dr. Guyon is optimistic and hopes that in the next few years, “we’ll be able to make up ground again, to everyone’s benefit.” She was very encouraged by this fall’s election campaign. “This is a government that recognizes the benefits of public health and prevention initiatives,” she said. She also keeps several quotes from François Legault handy in case the new government starts backsliding on its public health promises.
Battling the effects of climate change and social inequality
Obviously, the need for prevention isn’t going away anytime soon. And the worst is yet to come, given the growing issues of climate change and social inequality, two issues with harmful effects on health because they cause “preventable deaths and diseases.”
Hence the importance of doctors continuing to defend health in general and public health in particular. It’s obvious to Dr. Guyon that physicians are “excellent messengers of the problems they see in their patients every day. Physicians are healers, but they’re also witnesses to the things they see on a larger scale.” This means they can attest to their patients’ problems; they’re also justified in explaining that the reason why some of their patients are sick is because what should have been done up to that point wasn’t actually done. Physicians need to commit to defending health in general—not just individual patients, but all patients—and to fight, if need be, for what their patients should be entitled to in order to improve their health. Dr. Guyon admits that physicians are tired and overworked; nevertheless, she is calling on them to speak out on this issue with democratic institutions, such as the Protecteur du Citoyen, the Auditor General, or users’ committees.
The healthcare system needs to create health, not just provide care
With two million patients on the island of Montréal, there’s nothing stopping Dr. Guyon from taking her campaign for prevention public! But how, exactly? By reminding people that they have the right to “demand that the healthcare system keep them healthy.” Treating a disease is one thing, but the healthcare network, in conjunction with all its partners in the municipal government, community organizations and society in general, should also be able to “generate health.” She also thinks it’s crucial that we showcase “the incredible successes” we can achieve through prevention, not to mention “honour the clinical prevention work done by physicians, nurses, midwives, respiratory therapists, etc.”
Public health may not be glamorous, but it works, and for it to work even better, the healthcare system needs to help healthcare professionals deliver clinical prevention, “meaning counselling, immunization, screening, and the evidence-based initiatives that generate health. It’s important for me to reinforce what my clinician colleagues are already doing in terms of clinical prevention work, and to say out loud that if they want to keep doing what they’re doing, the healthcare system needs to support them.”
What is clinical prevention?
According to the Canadian Task Force on Preventive Health Care, clinical prevention is based on four areas: immunization, screening tests, counselling, and preventive treatments, for example, prophylactic chemotherapy or treatment prescribed to the partner of someone with a sexually transmitted infection.
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