This quick and enthusiastic introduction to the literature on the determinants of health, written by a young family doctor, is timely, aligning well with the current policy directions of the Canadian Medical Association.1 Dr. Ryan Meili’s passion and his ability to give a real sense of the people and places he has encountered is evident, particularly in the striking anecdotes that bring theoretical concepts to life. At one point, we are transported to a gathering under a mango tree in Tevele, Mozambique. We also travel to Brazil, and to various locales in Canada, although mostly in his Saskatoon community clinic.
The author also has a gift for memorable metaphors. Among many, he compares unchecked economic growth to cancer; to basing an economy on selling raw materials to a garage-sale economy; and he suggests that rather than run government as a business, it should be run as a family.
Meili heads the division of social accountability at the College of Medicine at the University of Saskatchewan, and is vice-chair of Canadian Doctors for Medicare. He also has a history of political activism (including a run for provincial NDP leadership) and is a physician mentor with SWITCH (Student Wellness Initiative Toward Community Health), which brings students in various health professional programs together with residents to work in “core communities” in Saskatoon. Half of the royalties from this book are being donated to SWITCH.
The volume is well written and a good read, albeit less successful as nuanced policy analysis. The author tends to assume that any reasonable person will share his passion for improving the lives of vulnerable individuals. Early in the manuscript, he argues that “we need a clear objective that will inspire people from diverse circumstances to work together for a greater good” and proposes that everyone will agree that this common objective is health. He uses this to argue for a series of progressive reforms, including potential changes to policies affecting taxes, food security, housing, criminal justice, environmental protection and climate change, education, and child care, which he justifies as evidence-based, cost-effective investments in improving the health of the population, especially the most vulnerable.
The book ends with a ringing plea for a more participatory democracy. Meili believes that people are ready for the “high road” and that they largely believe that we are all in it together. One chapter concludes with a series of sentences, in the best John Lennon tradition, imagining something better; not only imagining “a government that involves the people meaningfully in decision-making, judging every decision it makes not on short-term political gains but on the real impact on people’s health” but also imagining “elections that are truly based on whether the country has become a healthier place.”
Cynically, one might suggest that this argument constitutes health imperialism, and that people, although they emphatically want good health, might also deem other things to be important. Practically, one might suggest that there are deep, and growing, ideological differences in society, and that not everyone will necessarily agree that we have an obligation to help our neighbours. Meili appears to harbour an optimistic view of human nature and its ability to avoid selfishness and seek the common good. He stresses trying to avoid polarization and find common ground, giving as an example his own father, whose “political affiliation has always been to the right” but who is “a very good man.”
One might pick a few nits with some of the analysis, or the rather minimal referencing (although the book does note many key references), but this fascinating book is not intended to provide an academic perspective. It is intended as a stirring call to action. Given how many of his stories feature grand plans that were never implemented and unsuccessful political campaigns, Meili’s continued enthusiasm is commendable; he continues to see the glass as half full rather than half empty. His patients and students are obviously lucky to have him.
Footnotes
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Raisa Deber has published extensively on Canadian health policy; her recent publications include Case Studies in Canadian Health Policy and Management, 2nd edition, University of Toronto Press (in press), whose real-life examples were coauthored with over 120 graduates of her case studies course.