How one Ontario doctor is rethinking health care — and how we define health

By Steve Paikin - Published on January 22, 2019
Dr. Alex Jadad
In 2008, Alex Jadad received the Order of Congress from his native Colombia — equivalent to the Order of Canada. (Andrew Wallace/CP)

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Alex Jadad describes himself as a “cheerful pessimist.” Spend a few hours with him, and it’s easy to see why. His nature is to be optimistic — he wants to change the world for the better. But the scope of the challenge sometimes gets to him.

That’s why he decided to spend some time with me over the past couple of months, explaining how — having surveyed millions of people worldwide — he’d like to revolutionize health care in Ontario. But Jadad isn’t just talking about improving the health-care system — which, as a medical doctor and patient, he’s all too familiar with. No, that’s too modest a goal. He wants to completely reinvent how we perceive what it means to be healthy, and then figure out how to get there.

Jadad, 55, is a faculty member at the University of Toronto’s Dalla Lana School of Public Health and the director of its Institute for Global Health Equity and Innovation. Twenty years ago, he was named one of Canada’s Top 40 Under 40. In 2008, he received the Order of Congress from his native Colombia (equivalent to the Order of Canada).

Over the course of two conversations, Jadad told me about his work, his thoughts on health care in Ontario, and what it means to be healthy.

Steve Paikin: Let’s start with the absolute basics: What do you mean by “health?”

Alex Jadad: This is an important and wonderful question, because one of the things I discovered when I was a patient at Toronto General Hospital, diagnosed with possibly having cancer, is that I could be healthy even if I had cancer. The World Health Organization defines being healthy as having complete mental, physical, and social well-being. I want to shift that definition. To me, being healthy means having the ability to manage life’s challenges. Whatever strengthens your ability to adapt to X, Y, and Z — and how you perceive your health — constitutes being healthy. That’s why I felt healthy, even as I was a possible cancer patient. [Jadad eventually got a clean bill of health, in the more traditional sense.]

SP: In which case, what can we do to increase our ability to manage life’s challenges?

AJ: Okay, here’s what I’ve learned: I was part of a three-year study of 2 million people in 116 countries. It was called the Health of Humanity Project. We asked people, “How healthy do you feel?” This is a different question than what most doctors will ask you. They’ll ask about what diseases you have. We wanted to know how people rated their own health. In Colombia, we worked intensively with 3,000 people. We asked them, “If you’re healthy, what do you need to do to remain so? Or, if you don’t feel healthy, what could we do to shift you to a positive reply?” What we discovered was that less than 1 per cent of people’s needs to be healthy related to the health-care system itself.

SP: That is a stunning insight.

AJ: Yes. Our health-care system tends to have medical answers for social or mental problems. Here’s an example: a man goes to his doctor and says he feels depressed. The classic response from the health-care system is to medicalize the problem. So he probably gets prescribed an antidepressant, and away he goes. What if, instead, the doctor asked, “Why are you depressed?” Perhaps the patient answers, “Because I’m so lonely.” Then the doctor says, “Do you like to help people?” The patient might say, “Yes, I do, actually.” What if the doctor then gave the patient a list of 10 volunteer agencies and offered to connect him with whichever group interested him the most? The prescription is volunteering. It’s a totally different approach to making people feel healthier — and it’s cheaper, too.

SP: And is Colombia now taking this approach to making its people healthier?

AJ: It is. Colombia now focuses on health rather than fighting disease. The Organization for Economic Co-operation and Development recently did a survey, and Colombia came in at No. 1 on five indicators of how healthy people feel. They spend C$500 per person per year on the health-care system in Colombia. In Canada, it’s C$4,500. In the United States, it’s US$10,000. So Colombia has a population that feels healthier, at a fraction of the cost of what Canadians and Americans spend.

SP: Presumably this means every interaction with every person in the health-care system is going to have to change?

AJ: Correct. We know that if people feel unhealthy, their mortality rates double. So we have to retrain doctors and nurses to ask the right questions and listen for different answers. Here’s another example: a kid shows up at the doctor’s office with what appear to be asthmatic conditions. Rather than putting the kid on a puffer, maybe we’d visit the child’s home and discover some kind of dust in the flooring that he’s inhaling. If we changed the flooring, maybe we’d cure his breathing problems. Again, a non-medical response to a health problem.

SP: Okay, but changing the floor in that kid’s house is going to cost money that that family might not have. What can we do about that?

AJ: This is something other countries have considered. In Colombia, they have something called the Compensation Fund. In the United Kingdom, it’s called the Benefits Society. It’s a huge pool of money, funded by employers, that companies and individuals can draw upon to help solve these problems. We don’t have this in Canada. I’ll give you another example: coffee growers in Colombia were complaining of back pain. It wasn’t from picking coffee beans. It was because the roads to get to their jobs were in such bad shape, the travel was very rough. So the company tapped into the fund to buy a bus to transport the workers, and that bus could handle the bumpy roads better. The aches and pains went away. Again, a non-medical solution to a medical problem. And, again, it saves the health-care system money.

SP: Well, let’s bring it home. Is this something we could do in Ontario, where we’re spending more than $60 billion a year on the health-care system?

AJ: There are so many groups in Ontario that benefit from the status quo — everyone except the government and the public. We have a Mexican standoff in Ontario. Everyone is pointing a gun at someone else. There’s a complete lack of trust among stakeholders, and it requires real leadership and careful navigation. But, yes, we could and should do this. We can still do things.

This interview has been condensed and edited for length and clarity.

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