Transcript: Redefining Health | Mar 04, 2019

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a blue suit, white shirt, and spotted blue tie.

A caption on screen reads "Redifining health. @spaikin, @theagenda."

Steve says WE CALL IT A HEALTH
CARE SYSTEM, BUT IN EFFECT, IT'S
REALLY MORE OF A SICKNESS
TREATMENT SYSTEM.
AND WE SPEND MORE THAN
60 BILLION DOLLARS A YEAR ON IT IN THE
PROVINCE OF ONTARIO.
COULD WE BE SPENDING THAT MONEY
MORE INTELLIGENTLY?
SHOULD WE BE CONSIDERING WHAT
CONSTITUTES A HEALTHY SOCIETY
DIFFERENTLY?
DR. ALEX JADAD SAYS YES TO BOTH.
HE'S 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, AND HE
JOINS US NOW FOR MORE.

Alex is in his early fifties, balding, with a stubble. He's wearing a gray suit and a black sweater.

Steve continues GREAT TO HAVE YOU IN THAT CHAIR.

Alex says IT'S A PLEASURE TO BE HERE.

Steve says WHY DON'T WE START
WITH SOMETHING VERY SIMPLE.
WHAT DO YOU MEAN BY HEALTH?

The caption changes to "Alex Jadad. University of Toronto."

Then, it changes again to "More than sickness management."

Alex says THAT'S THE KEY.
HEALTH IS USUALLY CONSIDERED,
AND THIS IS THE WHO DEFINITION,
THE WORLD HEALTH ORGANIZATION
DEFINITION FROM 1948 AS A STATE
OF COMPLETE PHYSICAL, MENTAL,
AND SOCIAL WELL-BEING.
IF WE SAY HOLD ON A SECOND.
WHO CAN HAVE COMPLETE PHYSICAL,
MENTAL, AND SOCIAL WELL-BEING?
THE ANSWER IS PRETTY MUCH
NOBODY.

Steve says NOBODY WE KNOW, RIGHT.

Alex says SO IN 2008, A GROUP OF PEOPLE
BECAME PRETTY AWARE THAT THAT
WAS THE CASE AND SPENT THREE
YEARS HAVING A GLOBAL
CONVERSATION, AND AT THE END OF
THAT PERIOD, WE WOULD LIKE TO
PROPOSE THE FOLLOWING: TO
CONSIDER HEALTH AS AN ABILITY.
THE ABILITY THAT WE, PEOPLE,
HAVE, AS INDIVIDUALS OR
COMMUNITIES, TO ADAPT AND MANAGE
THE INEVITABLE PHYSICAL, MENTAL,
OR SOCIAL CHALLENGES WE FACE
THROUGHOUT OUR LIFE.
IT'S AN ABILITY.

Steve says HOW IS THAT
SIGNIFICANTLY DIFFERENT FROM THE
WORLD HEALTH ORGANIZATION...

The caption changes to "Alex Jadad. Dalla Lana School of Public Health."

Alex says FIRST OF ALL, IT MAKES IT
POSSIBLE FOR ANY OF US TO
EXPERIENCE GOOD HEALTH, EVEN
WHEN WE HAVE DISEASES OR WHEN WE
ARE ILL.
IT ALSO ALLOWS US TO IMAGINE A
WORLD IN WHICH WE COULD LEARN TO
BE HEALTHY.

The caption changes to "Alex Jadad, @alexjadad."

Alex continues IT ALSO OPENS THE DOOR FOR US TO
CONSIDER HEALTH MORE AS A TEAM
ENDEAVOUR, NOT AS SOMETHING THAT
A DOCTOR WOULD HAVE TO DECIDE IF
IT IS PRESENT OR NOT OR
SOMETHING THAT WOULD REQUIRE A
MEDICINE, IN PARTICULAR, AS THE
SOLUTION, WHEN IT IS NOT PRESENT.

The caption changes to "Connect with us: Twitter: @theagenda; Facebook, agendaconnect@tvo.org, Instagram."

Steve says OKAY.
LET ME MAKE SURE I UNDERSTAND
THIS THEN.
IF YOUR DEFINITION OF HEALTH IS
THE ABILITY TO ADAPT AND MANAGE
TO THE INEVITABLE CHANGES AND
PROBLEMS THAT WE HAVE IN LIFE,
THEN SOMEBODY WHO IS FIGHTING
CANCER COULD BE CONSIDERED
HEALTHY AND THEY'RE ADAPTING TO
THOSE CHANGES AND DIFFICULTIES...

Alex says YES.
OVER THE YEARS WE HAVE
ACCUMULATED DATA FROM OVER
2 MILLION PEOPLE IN 116
COUNTRIES AND WE HAVE ABOUT
1,000 PIECES OF INFORMATION THAT
HAS BEEN COLLECTED, AND WE HAVE
OVER 4,000 PUBLICATIONS OF
RESEARCH THAT FOCUS ON WHAT IS
KNOWN AS SELF-REPORTED HEALTH,
WHEN WE ASK PEOPLE HOW HEALTHY
THEY FEEL.
VERY INTERESTING THINGS HAPPEN.
AND ONE OF THEM IS THAT
TWO-THIRDS OF PEOPLE LIVING WITH
CANCER, WHEN THEY ARE ASKED A
KEY QUESTION THAT I WOULD LIKE
TO ASK THOSE WHO ARE WATCHING US
NOW, IN GENERAL, HOW WOULD YOU
RATE YOUR OWN HEALTH?
WOULD IT BE POOR, FAIR, GOOD,
VERY GOOD, OR EXCELLENT?
60 PERCENT OR MORE OF PEOPLE
WITH CANCER, IN THIS CASE
INCURABLE CANCER, AND THEY KNOW
THAT THEIR CANCER CANNOT BE
TREATED, WOULD SAY, "MY HEALTH
IS GOOD, VERY GOOD, OR
EXCELLENT."

Steve says 60 percent.

Alex says MORE THAN 60 percent.

Steve says BECAUSE THEY ARE
THINKING OF HEALTH IN THIS NEW
WAY AS OPPOSED TO THE OLD?

Alex says BECAUSE THEY ARE JUDGING HOW
THEY FEEL.

Steve says TO THAT END, THEN,
AS I SAID OFF THE TOP, WE SPEND
60 BILLION DOLLARS A YEAR ON THE HEALTH
CARE SYSTEM IN THE PROVINCE OF
ONTARIO.
WHAT PERCENTAGE OF THAT MONEY DO
YOU THINK IS ACTUALLY SPENT
ACCORDING TO THIS NEW DEFINITION
OF HEALTH?

Alex says ON THAT DEFINITION I WOULD
LIKE TO CALL IT... IT'S
SOMETHING THAT IS EVOLVING.
THE DEFINITION IS MUCH MORE A
FIXED THING THAT WE EXPECT
EVERYBODY TO ACCEPT.
THIS IS AN EFFORT TO TRANSLATE
INTO WORDS SOMETHING THAT WE
KNOW IS VERY DIFFICULT TO
CAPTURE PERFECTLY.
SO THE ANSWER IS LIKELY TO BE
MOST OF IT.
AND WE HAVE DATA FROM OTHER
PARTS OF THE WORLD THAT HAVE
TRIED TO DO THINGS A LITTLE
DIFFERENTLY, INDICATING THAT WE
COULD DO THINGS IN AN ENTIRELY
DIFFERENT WAY AND MAKE THE MOST
OF THE RESOURCES WE HAVE
AVAILABLE.
SO THE ANSWER WE WOULD BE ABLE
TO OBTAIN IF WE DECIDED TO GIVE
OURSELVES PERMISSION TO TRY TO
LOOK AT HEALTH, YOU SEE,
DIFFERENTLY.

The caption changes to "Watch us anytime: tvo.org, Twitter: @theagenda, Facebook Live."

Steve says LET'S TALK ABOUT
COLOMBIA, THE COUNTRY OF YOUR
BIRTH.
WE'RE GRATEFUL THAT YOU DECIDED
TO LEAVE COLOMBIA AND COME TO
CANADA BECAUSE YOU'RE DOING SOME
FASCINATING THINGS HERE.
DO THEY TACKLE ISSUES AROUND
HEALTH DIFFERENTLY IN COLOMBIA
FROM THE WAY WE DO HERE?

Alex says WELL, AT LEAST A NETWORK IN
COLOMBIA THAT IS SERVING OVER
1.3 MILLION PEOPLE.

Steve says AND HOW ARE THEY
DOING IT DIFFERENTLY?

Alex says WELL, IN ABOUT... WELL, IN
THE YEAR 2015 OR SO, AN
ORGANIZATION THAT ACTS AS THE
CUSTODIAN OF THE RESOURCES THAT
THE COUNTRY INVESTS IN THE
HEALTH OF THE POPULATION, WHICH
IS ABOUT 500 U.S. PER YEAR,
WHICH IS EQUIVALENT TO ABOUT
1,000 CANADIAN WHEN WE TAKE
INTO ACCOUNT THE PURCHASING
POWER.
BY THE WAY, THERE'S ABOUT
ONE-FOURTH OR ONE-FIFTH OF WHAT
WE SPEND...

Steve says I WAS GOING TO SAY,
A FRACTION OF WHAT WE SPEND.

Alex says SO IN THE YEAR OF 2015, THE
LEADERS OF THAT ORGANIZATION
SAID WE ARE GOING BANKRUPT.
WE NEED TO DO THINGS
DIFFERENTLY.
AND THEY HAD ABOUT 35
ORGANIZATIONS ENGAGED IN
PROVIDING SERVICES TO THE
POPULATION.
1.3 MILLION PEOPLE OR SO.
AND THEY SAID WE EITHER KEEP
DOING THE SAME, AND WE KNOW WHAT
THE OUTCOME IS GOING TO BE,
WE'RE GOING TO BE BANKRUPT, OR
WE ADD INCREMENTAL CHANGES IN
THE WAY IN WHICH WE DO THINGS,
OR WE GO ALL IN AND TRY TO DO
THINGS DIFFERENTLY.
THEY DECIDED TO DO THINGS
DIFFERENTLY.

Steve says LIKE HOW?

Alex says THE FIRST THING THAT I THINK
IS ESSENTIAL TO UNDERSTAND IS
TRUST.
WHAT THEY NOTICED AT THE TIME IS
THAT THEY WERE IN A STATE OF A
MEXICAN STANDOFF.

Steve says AMONG WHOM?

Alex says EVERYBODY.
NOBODY TRUSTED ANYBODY.
EVERYBODY POINTING THEIR GUNS AT
EACH OTHER AND STUCK.
THEY COULDN'T MOVE.

Steve says SO DOCTORS AGAINST
NURSES AGAINST DRUG COMPANIES...

The caption changes to "Connect with us: Twitter: @theagenda; Facebook, agendaconnect@tvo.org, Instagram."

Alex says INSTITUTIONS, AGAINST THE
GOVERNMENT, THE INSURERS, THE
PROVIDERS OF MEDICAL
EQUIPMENT... EVERYBODY, AND
SECOND-GUESSING AND THE AMOUNT
OF PAPERWORK THAT THEY HAD TO
PUT IN PLACE WAS INCREDIBLE AND
IT WAS PARALYZING.
THEY SAID LET'S TALK, LET'S
TALK.
SO 36 ORGANIZATIONS GOT TOGETHER
AND THEY SAID, WHAT WOULD IT
TAKE FOR US TO TRUST EACH OTHER
AND TO GET UNSTUCK?

Steve says WHAT WAS THE ANSWER?

Alex says WELL, THEY SAID WE NEED TO
ENGAGE IN COLLABORATIVE
LEADERSHIP AND WE NEED TO BE
OPEN AS TO WHAT IS MAKING OUR
LIFE SO MISERABLE.
EVERYBODY WAS FEELING TERRIBLE.
SO THEY SAID, OKAY, LET'S GIVE
OURSELVES THE BENEFIT OF THE
DOUBT.
ONCE THEY MADE THAT DECISION,
THEY SAID, OKAY, HOW WOULD WE
OPERATE IF WE TRUSTED EACH
OTHER?
AND THEY CREATED A MODEL THAT
TOOK INTO ACCOUNT THEIR
DIFFERENT INCENTIVES AND
ACKNOWLEDGED THEIR SOURCES OF
CONCERN, AND THREE YEARS LATER,
THAT MODEL, THAT PUTS THE PERSON
AND THE FAMILY AT THE HEAD, EACH
PERSON HAS A FAMILY TEAM THAT IS
FOCUSED ON THEIR HEALTH, THEY
HAVE AMBULATORY FACILITIES THAT
SUPPORT THOSE HEALTH TEAMS AND
THE PEOPLE.
PATIENTS AND THEIR FAMILIES OR
MEMBERS OF THE COMMUNITY HAVE
ACCESS TO THEIR ENTIRE HEALTH
RECORDS THROUGH THEIR MOBILE
PHONES.
THEY CAN ASK FOR APPOINTMENTS
DIRECTLY.
THEY CAN FIRE THEIR PROVIDER AND
CHANGE INSURANCE COMPANIES
ALMOST INSTANTLY ONLINE.

Steve says OKAY.
THAT'S THE COLOMBIAN EXAMPLE...

Alex says AND, AND, AND, THE BEAUTY IS
THAT THREE YEARS LATER... IF YOU
ALLOW ME... I ISSUED A CHALLENGE
TO THEM AND I MUST EMPHASIZE
THAT A KEY THING THAT THEY DID
WAS TO BRING THE BEST EXAMPLES
FROM AROUND THE WORLD ON HOW TO
CREATE HEALTH.
THREE YEARS LATER, A GROUP OF
PEOPLE ISSUED A CHALLENGE TO
THEM.
WE SAID TO THEM, WHAT IF YOU
CONSIDERED YOURSELF EQUIVALENT
TO A COUNTRY?
YOU HAVE 1.3 MILLION PEOPLE.
THAT IS BIGGER THAN ESTONIA,
LUXEMBOURG, OKAY, OR ICELAND,
WHICH ARE MEMBERS OF THE OECD,
AND WHAT IF WE ASSESSED YOU WITH
THE SAME INDICATORS THAT WE USE
TO JUDGE THE PERFORMANCE OF
ENTIRE COUNTRIES IN TERMS OF THE
HEALTH CARE SYSTEM?
NUMBER ONE ON FIVE INDICATORS,
AND ONE OF THEM, WHICH IS
SELF-REPORTED HEALTH, NUMBER ONE
IN THE WORLD, OKAY?
CLOSE TO 90 PERCENT OF THESE
1.3 MILLION PEOPLE EXPERIENCED
POSITIVE HEALTH.
THEY FEEL HEALTHY.
AND MANY OF THEM HAVE MULTIPLE
CHRONIC DISEASES, CANCER, THEY
MAY BE DYING, ET CETERA.

Steve says BUT THEY THINK OF
HEALTH IN THIS NEW WAY AND THEY
LIKE MORE NOW WHAT THEY SEE...

Alex says BECAUSE IT'S HOW TO ENABLE ME
AND MY FAMILY TO COPE WITH WHAT
LIFE IS PRESENTING.

Steve says OKAY.
IF YOU HAD TO ASK THE SAME
QUESTION ABOUT ALL THE DIFFERENT
STAKEHOLDERS IN THE ONTARIO
HEALTH CARE SYSTEM, THE DOCTORS,
THE NURSES, THE ORDERLIES, THE
DRUG COMPANIES, THE GOVERNMENT,
THE PATIENTS, PATIENT ADVOCATES,
HOME CARE... THE LIST IS
ENDLESS... HOW MUCH TRUST IS IN
OUR SYSTEM RIGHT NOW?

Alex says I THINK WE ARE IN A VERY
SIMILAR SITUATION TO WHAT WAS
THE CASE IN COLOMBIA.
WE HAVE ANOTHER MEXICAN STANDOFF
HERE.
AND THE KEY QUESTION IS: ARE WE
WILLING TO GIVE OURSELVES
PERMISSION TO BELIEVE THAT WE
CAN EXPERIENCE A DIFFERENT
REALITY?
AND INSTEAD OF BEING FIXED IN A
MODE WHICH IS VERY VALID AND IT
COMES FROM THE EVIDENCE-BASED
WORLD AND ALL THAT, WHICH IS
SEEING IS BELIEVING, WHAT IF WE
FLIPPED IT AND SAID BELIEVING IS
SEEING.
OKAY?
BECAUSE WE HAVE NOW EVIDENCE, WE
HAVE DATA, WE HAVE EXPERIENCES
THAT ARE READY...

Steve says THESE ARE STUDIES.

Alex says WE HAVE NOW GROUPS,
ESPECIALLY THIS GROUP IN
COLOMBIA THAT BENEFITED FROM SO
MANY OTHERS WILLING TO PAY
FORWARD.

Steve says WELL, LET'S... OKAY.
LET'S SEE WHAT THIS ACTUALLY
COULD LOOK LIKE AS THE RUBBER
HITS THE ROAD IN THE PROVINCE OF
ONTARIO.
DOCTORS ARE THE GATEKEEPERS OF
HEALTH CARE IN THE PROVINCE,
FAMILY DOCTORS.
SO IF SOMEBODY WATCHING THIS
RIGHT NOW WERE TO GO TO THEIR
FAMILY DOCTOR AND IF WE CONSIDER
HEALTH IN THE DIFFERENT WAY THAT
YOU WANT US TO THINK ABOUT
HEALTH, HOW WOULD THAT ENTRY
POINT, HOW WOULD THAT FIRST
ENCOUNTER WITH A DOCTOR CHANGE
BETWEEN PATIENT AND DOCTOR?

Alex says I'M A PHYSICIAN.
I'M GOING TO GIVE YOU MY OWN
EXAMPLE.

Steve says GREAT, OKAY.

Alex says BUT, AGAIN, BELIEVING IS
SEEING.
AND THIS IS NOT SCIENCE FICTION,
BY THE WAY.
SO INSTEAD OF SAYING, WHAT'S
YOUR PROBLEM, STEVE?
WHICH IS WHAT I AM TRAINED TO
DO.
WHAT IF WE ASKED: STEVE, IN
GENERAL, HOW WOULD YOU CONSIDER
YOUR HEALTH NOW?
IS IT POOR, FAIR, GOOD, VERY
GOOD, OR EXCELLENT?
WHAT WOULD YOU SAY TO ME?

Steve says VERY GOOD.

Alex says I WOULD SAY BRAVO.
WHY DO YOU THINK YOUR HEALTH IS
VERY GOOD?

Steve says WELL, I FEEL FINE.

Alex says OKAY.

Steve says EXERCISING.

Alex says MM-HMM.

Steve says NO SIGNIFICANT
HEALTH CHALLENGES OR DISEASES
THAT I KNOW OF.

Alex says TERRIFIC.
WHAT DO YOU THINK WE COULD DO,
INCLUDING THOSE PEOPLE VERY
CLOSE TO YOU, TO ENSURE THAT YOU
CONTINUE TO FEEL LIKE THAT, OR
EVEN GO TO EXCELLENT?
WHAT IS PREVENTING YOU FROM
SAYING EXCELLENT?
AND YOU SAID VERY GOOD.
YOU SEE, IT'S A VERY DIFFERENT
KIND OF ENGAGEMENT.

Steve says I SEE.

Alex says AND THEN, AS A PHYSICIAN, IF
YOU HAPPEN TO HAVE HIGH BLOOD
PRESSURE OR HIGH SUGAR LEVELS,
ALL THESE MECHANICAL CHEMICAL
THINGS OR YOU HAVE ARTHRITIS, I
WOULD SAY, HEY, IF WE WANT TO
KEEP THIS SITUATION OR EVEN GET
YOU TO EXCELLENT, WE... YOU SEE,
IT IS NOT YOU OR ME, IT IS A WE
THING... WE NEED TO TAKE INTO
ACCOUNT THESE FIGURES THAT WE
ENCOUNTER THAT ARE RISK FACTORS
FOR YOU NOT TO FEEL SO WELL.
SO HOW CAN WE, YOU SEE, WORK
TOGETHER TO ACHIEVE THAT?
IT CHANGES THE PICTURE COMPLETELY.

Steve says WELL, YOU'RE LESS OF
A MEDICAL DOCTOR IN THOSE
CIRCUMSTANCES AND YOU'RE MORE OF
A, LIKE A LIFE COACH, I GUESS.

Alex says I'M A COMPANION.
YOU CAN CALL ME COMPANION.
AND WE BECOME, YOU SEE,
COLLABORATORS.
WE BECOME PARTNERS.

Steve says DO WE THEREFORE HAVE
TO CHANGE THE WAY DOCTORS ARE
TRAINED, THE WAY NURSES ARE
TRAINED TO DO ALL THIS?

The caption changes to "The gatekeepers."

Alex says NOT NECESSARILY, NOT
NECESSARILY.
AGAIN, IT'S A MATTER OF
NOTICING, NOTICING THAT THERE IS
SLIGHTLY DIFFERENT AND YET...
OKAY... A VERY FUNDAMENTAL
DIFFERENCE WITH APPROACHING
THINGS FROM A DIFFERENT
PERSPECTIVE VERSUS APPROACHING
IT FROM A HEALTH PERSPECTIVE.

Steve says WE DO HAVE A SYSTEM
RIGHT NOW THAT SEEMS TO WANT TO
MEDICALIZE AND FIND A
PHARMACOLOGICAL SOLUTION TO MOST
OF THE PROBLEMS THAT WE HAVE.
SO LET'S DO THIS EXAMPLE.
A GUY GOES TO A DOCTOR.
A GUY GOES TO DR. JADAD AND SAYS I'M FEELING DEPRESSED.
I DON'T KNOW WHY BUT I'M FEELING
DEPRESSED.
CONTINUE THE CONVERSATION.

Alex says THE FIRST QUESTION WOULD BE,
HOW DO YOU PERCEIVE YOUR HEALTH?
AND THE PERSON WOULD SAY POOR OR FAIR.

Steve says LOUSY.

Alex says POOR OR FAIR.
WE HAVE DATA THAT SUGGESTS THAT
YOUR MORTALITY WOULD BE TWICE
COMPARED WITH PEOPLE LIKE YOU
WHO WOULD NOT SAY POOR OR FAIR.
THAT'S SOMETHING CRUCIAL.
WE DON'T KNOW YET WHY.
OKAY?
BUT THOSE WHO SAY "MY HEALTH IS
POOR OR FAIR" ARE AT AN
INCREASED RISK OF DYING SOONER
THAN THOSE WHO SAY GOOD, VERY
GOOD, OR EXCELLENT.
AND WHY?
I FEEL SAD.
THE PERSON WOULD NOT SAY I'M
DEPRESSED.
USUALLY DEPRESSION IS A LABEL I
WOULD GIVE YOU.

Steve says SO THEY WOULD SAY I
FEEL SAD.

Alex says I FEEL SAD.
AND I WOULD SAY, WHAT DO YOU
THINK IS THE MAIN REASON FOR
THAT?

Steve says LONELINESS.

Alex says BINGO.
ONE OF THE BIGGEST CHALLENGES WE
ARE FACING AS A SOCIETY NOW.
SO UNDER NORMAL CIRCUMSTANCES,
YOU HAVE A FEW MINUTES AVAILABLE
TO INTERACT WITH THIS PERSON
BECAUSE WE ARE IN A PRODUCTION,
THE HEALTH CARE SYSTEM HAS
BECOME LIKE INDUSTRIAL... I LIKE
TO CALL IT A FRANCHISE OF
INEFFICIENT REPAIR SHOPS, OKAY?
THEN I DON'T HAVE A LOT OF TIME.
YOU'RE FEELING SAD, DEPRESSION,
I WILL GIVE YOU A PILL, GO.
I WRITE A PRESCRIPTION AND OFF
YOU GO.
A LOT OF PHYSICIANS KNOW THAT
THEY COULD AND THEY SHOULD BE
GOING DEEPER INTO IT, AND I
THINK THAT THERE WILL NOT BE
RESISTANCE TO A NEW SET OF
CONDITIONS THAT WOULD ALLOW US
TO CONNECT MORE DEEPLY.
YOU SAID, I'M LONELY.
I SAY, OKAY, OKAY, OKAY.
IS THERE ANYTHING THAT TICKLES
YOUR SOUL ESPECIALLY?

Steve says ANYTHING THAT
TICKLES MY SOUL?

Alex says WHAT GIVES YOU THE BIGGEST
SMILE.
THINK OF THE THREE TO FIVE
HAPPIEST MOMENTS IN YOUR LIFE.
WHAT DO THEY HAVE IN COMMON?
I WOULD GO WITH THE PERSON TO
IDENTIFY SOURCES OF JOY AND SAY,
HMM, WHAT IF WE DO SOMETHING
ABOUT THAT?
IN SOME CASES, THOUGH, THERE IS
DEPRESSION, AND THERE IS EITHER
A CHEMICAL OR HORMONAL IMBALANCE
AND ALL THAT.
I KNOW THAT.
AS A PHYSICIAN I HAVE TOOLS THAT
WOULD ALLOW ME TO JUDGE WHETHER
THIS IS SOMETHING THAT
LONELINESS CAN EXPLAIN OR
SOMETHING THAT IS MUCH MORE
DIFFICULT TO HANDLE, A MEDICAL
ISSUE.
BUT WHAT I WOULD EMPHASIZE AT
THIS POINT, STEVE, IS THAT WE
HAVE AN OPPORTUNITY, IF WE LOOK
AT THINGS THROUGH A HEALTH LENS
TO STOP TRYING TO GIVE MEDICAL
ANSWERS TO SOCIAL AND TO
EMOTIONAL PROBLEMS, WHICH IS ONE
OF THE BIG CHALLENGES WE ARE
FACING AS A SYSTEM.

Steve says SO ONE OF THE WAYS...

Alex says I WOULD CONNECT YOU WITH
VOLUNTEERING OPPORTUNITIES.

Steve says THAT'S WHAT I WAS
JUST GOING TO SAY.

Alex says I WOULD ENABLE YOU TO
RECOGNIZE THAT YOU HAVE BEEN
ESTRANGED FROM YOUR KIDS AND YOU
MAY HAVE SOMETHING THAT YOU LIKE
AND THERE ARE SOME GROUPS THAT
ARE DEVOTING TIME... YOU HAVE A
HOBBY OR YOU HAVE THE POTENTIAL
TO TURN WHAT TICKLES YOUR SOUL
INTO SOMETHING THAT INVOLVES
OTHER PEOPLE.

Steve says BUT THAT'S DOCTOR
MORE AS SOCIAL WORKER, IF YOU
LIKE, OR COMPANION OR CONNECTOR
AS OPPOSED TO MEDICAL PERSON... RIGHT?

Alex says YEAH, BUT THEN WHAT IS THE
ROLE OF A PHYSICIAN?
YOU SEE, WHAT'S A ROLE OF A DOCTOR?
THE ETYMOLOGY OF THE WORD
"DOCTOR" HAS TO DO WITH
TEACHING, WITH ENABLING
LEARNING.
SO WE HAVE AN OPPORTUNITY ALSO
TO RE-THINK WHAT WE NEED BY
MEDICINE AND WHAT IS THE ROLE OF
MEDICINE IN SOCIETY.
AND I WONDERED THAT.
WHAT IS MY ROLE AS A PHYSICIAN?
HOW CAN I OFFER OPPORTUNITIES
FOR THOSE THAT HAVE THE
PRIVILEGE, YOU SEE, TO BE WITH,
TO ACHIEVE OPTIMAL HEALTH, OKAY?
AND THIS IS ONE OF THE MOST
IMPORTANT QUESTIONS NOW: WHAT IS
OUR ROLE?
AND THAT WOULD APPLY TO NURSES,
TO SOCIAL WORKERS, BECAUSE OVER
THE YEARS WE DEVELOP THOSE
LABELS, AND WE HAVEN'T STOPPED,
OKAY, TO RE-THINK OR EVEN TO
EXAMINE THEIR MEANING.

Steve says SO HERE'S THE BIG
QUESTION.
LET'S FINISH UP ON THIS BIG
QUESTION HERE.
HERE'S WHERE WE ARE.
I UNDERSTAND WHERE YOU THINK WE
NEED TO GO.
THE QUESTION IS: CAN WE GET
THERE?
BECAUSE ALL THOSE STAKEHOLDERS
IN THE HEALTH CARE SYSTEM THAT
WE'VE ALREADY TALKED ABOUT...
DOCTORS, NURSES, YOU KNOW,
PHARMA COMPANIES, ET CETERA,
ET CETERA... THEY ALL HAVE A
STAKE IN THE STATUS QUO, NOT IN
CHANGING THINGS.
SO HOW DO WE GET FROM HERE TO THERE?

The caption changes to "Embedded in the status quo?"

Alex says WELL, IN A SHORT... MY SHORT
VERSION WOULD BE TO USE ONE
WORD: CO-LEADERSHIP.
WE NEED LEADERSHIP MORE THAN
EVER.
AND LEADERSHIP IN THIS
PARTICULAR CASE WOULD INVOLVE
THE WILLINGNESS TO MAKE POSSIBLE
WHAT IS POSSIBLE, TO MAKE
VISIBLE THE INVISIBLE AND TO
REALIZE THIS MIGHT NOT BE A ZERO
SUM GAME.
THAT EVERY PLAYER CAN FULFIL
THEIR OBJECTIVES IF WE DECIDE TO
WORK TOGETHER.
AND WHAT HAPPENED IN COLOMBIA
AND WHAT HAS HAPPENED IN MANY
OTHER PLACES THAT HAD THE
EXPERIENCE OF COLOMBIA THAT THEY
DECIDED TO ALIGN THEIR
INCENTIVES TO WORK TOGETHER, TO
TRY TO OPTIMIZE HEALTH WHILE
EACH OF THE ORGANIZATIONS
INCREASED THE POSSIBILITIES OF
BEING SUSTAINABLE, WHICH IS THE
BIGGEST PROBLEM AT THE
BEGINNING.
AND NOW MORE THAN EVER, IN
ONTARIO AND IN CANADA AT LARGE,
WE HAVE AN OPPORTUNITY TO
BENEFIT FROM THE BEST
EXPERIENCES FROM AROUND THE
WORLD AND IMAGINE THE
OPPORTUNITY THAT WE HAVE BEEN SO
DIVERSE, TO INCUBATE AN EVEN
BETTER SYSTEM AND TO TURN IT
INTO OUR PRESENT FOR THE WORLD.
SO I THINK WE CAN DO IT.
THIS IS ONE OF THE MAIN REASONS
WHY I'M HERE.

Steve says BUT LEADERSHIP
REQUIRES SOMEBODY TO LEAD.

Alex says MM-HMM.

Steve says WHO IS GOING TO LEAD THIS?

Alex says WELL, THAT'S THE QUESTION I
AM IN AS ONE OF THE PEOPLE WHO
WOULD BE PREPARED TO DEVOTE A
BIG CHUNK OF LIFE TO MAKING THIS
HAPPEN AND I'M SURE THAT THERE
ARE MANY OTHER PEOPLE FROM THE
COMMUNITY, FROM THE GOVERNMENT,
FROM THE CORPORATE SECTOR, FROM
ACADEMIA WHO ARE READY TO JOIN
FORCES WITH OTHERS TO MAKE WHAT
IS POSSIBLE POSSIBLE.

Steve says THIS SOUNDS LIKE,
THOUGH, THAT... IT SOUNDS LIKE
SOMETHING THAT MIGHT GET THIS
TRUCK MOVING IS IF PREMIER FORD
WERE TO GET EVERY STAKEHOLDER IN
THE HEALTH CARE SYSTEM INTO A
ROOM AND SAY, "I'M NOT LETTING
YOU OUT OF HERE UNTIL YOU FOLKS
FIGURE OUT A BETTER WAY..."

Alex says WELL, WE HAVE BEEN INVITED TO
CREATE HEALTH TEAMS.

Steve says SO THAT'S A START.

Alex says AND NOT ONLY THAT, WHAT I
UNDERSTAND IS THAT WE HAVE A
UNIQUE OPPORTUNITY TO PROPOSE
HOW TO DO THINGS DIFFERENTLY AND
THAT THERE WILL BE SUPPORT TO
CREATE THE SPACE FOR INNOVATION,
THE SPACE TO TRY TO RELATE TO
EACH OTHER IN A COMPLETELY DIFFERENT WAY.

Steve says DOES THE
RESTRUCTURING ANNOUNCEMENT THAT
THE PROVINCE MADE LAST WEEK HELP
GET US CLOSER OR FURTHER AWAY
FROM YOUR VISION?

Alex says THE MESSAGE IS, WE WANT
PEOPLE TO WORK TOGETHER.
WE ARE PREPARED TO RELAX AND
REMOVE BARRIERS FOR A NEW
REALITY TO EMERGE.
GO.
OKAY, CREATE TEAMS.
SO LET'S CREATE TEAMS AND
LET'S... AND THIS IS NOT SCIENCE
FICTION.
THERE ARE EXAMPLES.
WE COULD RIGHT NOW HAVE A SYSTEM
THAT MAY SPEND MUCH LESS MONEY
AND ACHIEVE MUCH BETTER OUTCOMES
JUST BY PAYING ATTENTION TO WHAT
OTHERS ARE DOING.
SO WE NEED TO OVERCOME WHAT SOME
PEOPLE CALL THE LEARNING
DISABILITY IN TERMS OF WHAT IS
HAPPENING IN OTHER PARTS OF THE
WORLD THAT ARE NOT THAT FAMILIAR
TO US.
I THINK WE HAVE THE TALENT.
I THINK WE HAVE THE RESOURCES.
I THINK WE HAVE THE HISTORICAL
OPPORTUNITY TO OVERCOME SOME OF
THE TRADITIONAL BARRIERS WHICH
ARE USUALLY RELATED TO THE
INCENTIVES THAT EACH GROUP OF
STAKEHOLDERS HAVE, TO PROTECT
THE WAY IN WHICH THINGS HAVE
BEEN DONE OR THE WAY IN WHICH
THINGS HAVE BEEN UNTIL NOW.
AS OUR COLLEAGUES IN COLOMBIA
DID, THIS IS THE TIME TO SIT
DOWN AND SAY, WHAT IF?
WHAT IF WE TRIED SOMETHING
DIFFERENT?

Steve says BECAUSE BELIEVING IS SEEING.

Alex says BECAUSE BELIEVING IS SEEING.

The caption changes to "Producer: Mark Brosens, @MarkBrosens; Steve Paikin, @spaikin."

Steve says YOU'VE GIVEN US A
LOT TO THINK ABOUT.
THAT'S DR. Alex Jadad,
WHO'S A FACULTY
MEMBER AT THE U OF T'S
DALLA LANA SCHOOL OF PUBLIC
HEALTH AND DIRECTOR OF THE
INSTITUTE FOR GLOBAL HEALTH
EQUITY AND INNOVATION.
GREAT TO HAVE YOU HERE
DR. Jadad, THANKS SO MUCH.

Alex says IT WAS A PLEASURE. LET'S HOPE
WE DO THE RIGHT THING.

Watch: Redefining Health