In Canada, we recently held an election at the Federal level (January 23rd, 2006). The election was called in late 2005 when the Liberal minority government fell. On election day, Canadians voted and received a Conservative minority government. While the overall result was not surprising, some of the details were (and continue to be) quite interesting:
– Continued polarization and regionalization of voters;
– Decreased support for the Bloc Quebecois (separatist party) in Quebec;
– Increased support for the NDP;
– No Conservative seats won in the major metropolitan areas (Toronto, Vancouver, Montreal), but strong support in rural ridings.
Okay, so what does this have to do with health or with ehealth? Based on these results, I think there are lessons that can be learned. Remember that health care (in Canada at least) is a socio-political creation. As such, health care often reflects the (changing) values and priorities of the general population. In my opinion, to ignore the election results would be somewhat short-sighted. So, here are the lessons:
1. One-size does not fit all
Not that two minority governments indicates a “trend”, but I’m not convinced that majority governments are the default position any longer. I actually think that minority governments will be the norm in the future, particularly if we look to some of the results and trends in Europe. In Canada (and in other parts of the world), we see a splintering/polarization of interests that is reflected in the voting patterns of different regions and areas. We seem to have a form of entrenched regionalism in Canada, and this situation is not likely to go away any time soon.
In the ehealth world, the parallel would be to try and create a single system that meets everyone’s needs. Given the regional differences and interests, a single solution is probably difficult and unlikely to succeed. I heard a presentation by Holly Witteman on a similar topic that has some interesting similarity (scroll down to the middle). Sure, Holly was talking about the individual level, but I think the concept can be applied successfully to the macro-level where the provinces (or regions) are the individuals that have needs for customization.
This idea that one-size doesn’t fit all brings me to my next observation and lesson.
2. Cooperation, consensus, and collaboration
Well, in a minority government cooperation, consensus, and collaboration is the name of the game. To get anything done, minority governments must compromise to get everyone’s support. Maybe it’s time health care starts to do the same (at all levels). That probably means that each group must recognize that we are all in this together and are only part of the solution – not the entire solution.
3. Urban/Rural divide
As mentioned in the introduction, the Conservative party was very strong in the rural ridings, but failed to win any in the major metropolitan areas. Does this sound at all familiar to health care? Basically, we see significant differences between the needs of urban and rural areas. Not only are the areas culturally different, but they are different in terms of the specific needs and pressures.
Maybe it’s time that we, as a group of researchers, developers, and managers, take a good look at addressing this division between the cities and rural communities. Last year, I wondered what role ehealth could play in addressing some of the rural needs. More needs to be done. The election results in Canada (and in the US) seem to point out that life, culture, needs, and thinking in the cities is vastly different from the rural areas. Unless we want to see a further fracturing of society and even health care services, we need to address this division. For rural health organizations, some have difficulty maintaining safe and clean buildings to house patients. Developing an ehealth infrastructure is not a priority when you have difficulty meeting the basic needs.
4. Find the best solution not the easiest
I’ve heard that minority governments often are the most effective forms of government because the needs of more people are met because of process involved (compromise, collaboration, and consensus) to get a bill passed. In a similar vein, I think that in health care, we need to focus on developing and implementing the best solutions – not the easiest. In all honesty, I’m not sure what “best” looks like or how to get it. But, I know that the easiest solution usually isn’t the right one. To use a political example, it’s easy to say that the solution to the economic problems we face in Canada is to “cut taxes” – is that necessarily the best or the right one? Or, in order to address wait times, we need to offer more “private” options. Again, it’s easier to offer private options, but is that the best one or the right one, especially when considering lesson #5 (see below)?
5. Build for the future
Finally, unlike most political groups that focus on short-term results (i.e., get elected again), we need to focus on building strategies and solutions that will meet today’s needs without sacrificing the future. As my supervisor Alex Jadad often says in his presentations (paraphrase) – we need to build the health care system that meets our children’s needs and expectations not ours. A recent article in the Globe and Mail by Stephanie Nolan titled “Millenium Man” (Saturday, March 11, 2006, Page F4 – sorry, there’s no free electronic version) profiled Professor Jeffrey Sachs. Sachs argues that the reason why Africa is in such dire straits is because they sacrifice the resources they have to meet the bare necessities to survive, thus leaving no resources to build a future. Are we doing this in health care, here in Canada?
For more information about the 2006 Federal Election, you can visit either the Wikipedia entry on the Canadian Federal Election 2006 or the official results from Elections Canada (Elections Canada doesn’t seem to have a dedicated area for the 2006 election just yet. I think they leave the most recent election results on the main page until a new election is called).