No alarms and no surprises

Earlier, we exclusively reported many of the conversation on health findings are similar to those of the 1991 British Columbia Royal Commission on Health Care and Costs. But that doesn't surprise University of British Columbia professor Bob Evans, one of the royal commission's six members. In an interview with Public Eye, Dr. Evans - who allowed he hadn't yet read the conversation's summary of input - explained, "The issues and the responses people want have been around for a long time. But the system just doesn't respond...Andre-Pierre Contandriopoulos in Quebec wrote a paper on this 15 or 20 years ago called A System Held Hostage. And that seemed to capture the idea that you can't somehow get a hold of the levers of change."

So do you find that troubling? "Well, I'm used to it," responded the healthcare economist, who called the conversation a waste of the government's time. "I've been in this game a long time. So doesn't trouble me anymore. But it should. And it should trouble us a lot because what is happening is, when you can't make the changes that people want and that would make things better, you get the crackpot schemes. Well, not crackpot schemes, you get the kind of malcious schemes that say, 'Let's just privatize the thing and get on with moving the burdens down onto the users and increasing the income opportunities for the private sector.' When you block real reforms, then you provide more pressure and opportunity for the things that aren't really reforms."

Moreover, Dr. Evans said one of the conversation's principal findings - that British Columbians want more health promotion and disease prevention programs - might not do much to actually improve the healthcare system. "I think the public are significantly over-optimistic about the prospects for prevention," he said. "It's certainly true that lifestyles are quite connected with patterns of illness. But to go out and say, 'We're going to tell you not to smoke' - well, we've done that. And it worked as far as it worked. And that's about it. It's really much more difficult and much more important to get at what leads people into those lifestyles. You don't choose to say, 'I'm not going to worry about lung cancer or I'm not going to worry about heart disease.' Certainly, there is an increase in obesity among children. This is not a matter of a personal choice to be fat."

"If you look across Canada there are substantial variation in obesity and overweight rates with Vancouver being down near the bottom. We're actually pretty healthy. And central cities looking a lot better than suburbs and rural areas. And you say why? Well, my daughter lives in Coquitlam. Where do they walk to? Nowhere. They drive. If you live in downtown Vancouver or, bless us, out in Point Grey like as I do there are any number of places to walk to. We have constructed a built environment which encourages obesity to say nothing of the whole fast food process and increased stress on working families and increasingly restricted non-work time," continued Dr. Evans.

"So what do you expect the poor devils to do? They get in their cars and they drive to Macdonalds and then they go to work. So to say it's a matter of lifestyle choice is, on one level, true. People do choose what they eat and so on. But how did they come to make those choices in the first place?"

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