Psychology's Role in Health in Canada: Reaction to Romanow and Marchildon1

By Arnett, John L.; Nicholson, Ian R. et al. | Canadian Psychology, August 2004 | Go to article overview

Psychology's Role in Health in Canada: Reaction to Romanow and Marchildon1


Arnett, John L., Nicholson, Ian R., Breault, Lorraine, Canadian Psychology


Abstract

Notwithstanding its high cost, the current Canadian health-care system provides Canadians with minimal access to publicly funded psychological services in spite of their demonstrated efficacy, comparative cost advantages, minimal risk of adverse treatment effects, and the public's preference for these services. Psychological services are now available not only for mental health problems but also for a wide range of physical health problems. A great deal of illness is preventable; population health research has illuminated the links between illness and risky individual behaviours, which are amenable to psychological intervention. These approaches have been shown to be effective in promoting health-enhancing behaviours that reduce morbidity and mortality. Nevertheless, the primary focus of the present health-care system is on the increasingly expensive detection and treatment of disease, often with expensive equipment and pharmaceuticals, rather than on the prevention of illness and health promotion. We believe that the current Canadian health-care system is not sustainable in the long run in its present form. We urge governments to act to provide Canadians with greater access to psychological services and we urge psychology education and training programs to ensure that students are adequately prepared to assume a larger role in a reformed health-care system.

The Romanow and Marchildon (2003) article highlights how the noble objective of protecting ordinary Canadians from financially ruinous hospital and medical bills, that began in Saskatchewan in 1947 and spread across Canada over the next quarter century, spawned a health-care system that now costs 10% of Canada's Gross Domestic Product (GDP) and nearly 40% of provincial government budgets. Furthermore, there is little evidence indicating that cost containment regarding the current health-care system is in sight. Minimal public funding for psychological services has been provided under this system and these services are among the first to be cut when the system is financially challenged, as we have seen in Ontario in recent years. We acknowledge Romanow and Marchildon's conclusion that as provincial governments struggle to control health spending they are unlikely to add psychologists on a fee-for-service basis to provincial health-care plans. However, in the public interest, they should act to enhance the availability of psychological services within the health-care system and ensure that further erosion of the availability of these services is stopped.

This medical-hospital system, now renamed the health-care system, remains mainly focused on illness rather than health and on diagnosis and treatment rather than on health promotion and illness prevention. Romanow and Marchildon (2003) also note thai there is increasing emphasis on pharmaceutical approaches that now constitute the second largest cost-driver to the system.

Powerful health professional organizations along with the highly influential medical and pharmaceutical industries have rendered the present system mainly biomédical in orientation and focused primarily on illness, relatively resistant to major change, and largely self-perpetuating by absorbing the bulk of research funding, thus leaving comparatively little for research oriented toward a model of health rather than illness. In spite of the Lalonde (1974) report that clearly articulated the value of the population health perspective focused around health promotion and illness prevention and shifts in federal block funding for health to the provinces in 1977 under the Established Programs Financing (EPF), the system's approach remained remarkably similar to when it was first introduced more than 55 years earlier.

From a population health perspective, it is now well recognized that a great deal of illness is preventable because it relates in significant measure to an individual's behaviour. David Satcher (1998), then U. …

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