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Monday, 28 May 2012

CIHI 2012 Health Indicators report released

There is an annual tradition for which we owe a debt of gratitude to MacLean’s magazine.  It is the release of the comparison indicators between health regions in Canada by the Canadian Institute of Health information. health indicators report 2012  or if the link does not work, access through the CIHI site and download for free at CIHI store 

The document does what the provinces have long feared, makes some direct comparisons combeined with celebrating the cumulative accomplishments of health improvement in the country.   Considerable focus is on the impact of the health care system on wellbeing, a calling deaths as avoidable and preventable – then listing where the system is not working. 

The actual document which compares health regions is embedded starting at page 45 – perhaps another message of how the document has impacted perceptions.  Most notably though is while there are reams of statistics, the presentation is standard geographic format and you will need to study the information before drawing any conclusions.  So much so that while regions may be marked as statistically different, you may find yourself asking if the finding is higher or lower than the national rate, and statistically testing does not appear to have been applied to provincial data – leaving the impression that perhaps there is no statistical difference when clearly there is.

And when will the health system learn that it has a huge impact on the determinants of health and that these are inappropriately called the “non-medical” determinants of health?  The document defines these as factors outside of the health system that affect health.   And yet, right up front in the document the health system is defined as "by the World Health Organization in 2000, includes “all activities whose primary purpose is to promote, restore or maintain health.” Therefore, in addition to the provision of care, the health system also includes public health activities of health promotion and disease prevention and other policy initiatives such as road and environmental safety  improvement, access to clean water, support for good nutrition and housing.”

Such inconsistencies are reflective of biases and prejudices of some of the members of the CIHI board who might be obvious when reviewing the names, but will not be shamed publically here. Thankfully the more rationale heads of the likes of Brian Postl, Vivek Goal, Corey Neudorf, and Luc Boileau who bring strong public health thinking to the table have influenced the remainder of the document. Thanks to these broad thinking directors of CIHI we have such a worthwhile document. 

The data are a major contribution to determining how well health regions and provinces are performing.  DrPHealth would welcome your interpretations of any particular section – if you don’t analyze it, don’t expect that the report will have made what is inherently obvious to you, something that others would recognize (write your piece and send to drphealth@gmail.com)   

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