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Thursday, 21 July 2011

Economics and health - not health economics

Communities that are healthy, are economically vibrant.  Conversely those communities that are deemed economically successful tend to have residents who are healthy.

Which is the chicken? and which is the egg?

Do communities blessed with characteristics that have led to their flourishing, attract people who are healthy and have money?  The costs of living are higher.  The higher economic status of the average members means the communities can spend more on social services, plan for development that encourages healthy lifestyles, and attract more money. 

Or, can a community control the health destiny of its members by nourturring economic success?   To some extent the answer appears yes.  The caveat is that at least at a national level, it is less about economic success than it is about the relative equitable distribution of wealth.  So communities and countries that implement policies that support equity of all its members are the most successful, and tend to be overall the wealthiest.

Money begets money.  Likewise health begets health.  

Anyone who has worked in small rural areas (say less than 5000 population) will know the tenious relationship between the local economy and many factors.  Single industry communities where the industry closes result in more health problems (the most resilient communities see the opportunity and can thrive through economic diversity).   The hospital is not necessarily a protector of health, but can be the main economic driver within a community and employs often the highest paid residents.   Hospitals may well contribute to a greater inequity in the distribution of wealth in a community and that is a bad thing.

I sat through many discussions where health administrators have argued that it is not their job to stimulate economies, often resulting in closure of less efficient hospital resources and subsequent whithering of the community.   Those very decisions contributed to health reductions - not through the loss of services, but through the loss of an economic driver.   Hospitals and long term care facilities however do appear to be contributors to economic growth, more like economic stabilizers.

Saskatchewan in the late 80's closed a large slew of hospitals to the cries of disaster from those communities. The criteria for closure was an average daily census of less than 8 (or 6?) patients.   A decade or so later, and evaluation actually demonstrated that the health of residents in those communities had improved.  Partially attributed to the improved quality of care.  The communities were generally provided some buffer to the economic reduction which likely lessened the negative impact.

I recall the evaluator's presentation, that when faced with the data the communities response was "that is all well and good, but when do we get our hospital back?"

Successful communities will look to economic diversification, policy that is socially responsible and encourages socialability, planning based on the needs of the next generation, and a solid sustainable infrasture.  To do this may mean saying no to the developer after a quick buck, and possibly taking their money and running to the next town. Hard choices for politicians who need to think to the next election, not the next generation.   Look to some successful communities and see how often a visionary leader has steered the community to the future. They have the health and pocketbooks of their residents at heart.

1 comment:

  1. You brought up an important point in your example of single industry communities.

    Social resilience is dependent upon redundancy. When governments/planners seek to become efficient (shift to monoculture farming) then redundancy and resilience are lost!