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The result is that we have the same uneven access, the issue the CDR was supposed to resolve. Hopefully, the issues of inequality in access to care and in treatment will not persist after the new cancer strategy is in place. The other issue is funding. Britain has spent the equivalent of $4-billion over five years on improving cancer care. In Canada, Ottawa has provided $260-million in seed money to identify what needs to be done differently, but it will be up to the provinces to find the money to implement improvements. For example, if the new CPAC (Canadian Partnership Against Cancer) decides there should be a national screening program for colorectal cancer, what happens if some provinces balk at the cost? There is not doubt that federal-provincial-territorial issues will be a challenge in cancer care, as they are throughout the health system.
Cryin Outloud, Canada: Mr. Picard, how much do we know about the polluted environment and the poor quality of the food we are eating being a cause for cancers?
I mean, we can now purchase salmonella, botulism, meat with syringes, E. coli, genetically altered foods that are not required to be labelled, etc., right in our grocery stores. I'm finding this very distressing and we DO KNOW that stress causes cancer!
André Picard: Cancers (there are about 200 different types) have their roots in a combination of genetic and environmental causes. With few exceptions such as smoking and exposure to radiation or asbestos - it is difficult to pinpoint the exact cause of cancer. There is no doubt that our lifestyle, and our diet in particular, plays a role in a number of cancers. A diet high in fibre, for example, lowers the risk of colorectal cancer. Chronic exposure to h. pylori increases the risk of stomach cancer. But it is difficult to point to specific foods, good or bad, that can cause or prevent cancer. A lot of associations have been identified, but these interactions are complex.
Sylvia Ralphs-Thibodeau, Ottawa: Can you tell me more about the "nurse navigator" pilot projects in Canada? Thanks.
André Picard: Unfortunately, I do not know a lot about nurse-navigator projects in this country. Canada is the land of pilot projects there are hundreds, if not thousands, of good initiatives underway at any given time, and it is difficult to keep track of them. But I do promise that we will be writing about nurse-navigator initiatives in The Globe in the near future.
John Penturn, Toronto: This article covers much of what needs to be covered, especially giving some sense of what Canada would have to do to emulate England. What is utterly inexplicable is, having read on numerous occasions in The Globe (over many years) how France is rated the number one health system in the world by the World Health Organization, and how it's done for less money than we spend, why has there never been an article on what it would take to emulate them?
André Picard: The reason Britain was chosen was because it has a system that, on the ground, is similar to Canada. It is also, without a doubt, the country that has acted the most forcefully on dealing with cancer. We also considered Australia, New Zealand and France, but none of their cancer strategies are as advanced or as sweeping as the one in Britain.
Personally, I have written a number of stories about the French health system and why it has been identified as the #1 health system in the world. (That crown has recently gone to the United Arab Emirates.) Without getting into the arguments of policy analysts on whether the World Health Organization uses the proper measures for determining what qualifies as the "best," it needs to be pointed out that France scored very high marks because the system puts a lot of emphasis on choice and speed. There is virtually no waiting for care in France whether it is for cancer care or any other health issue. To do so, they have tremendous over-capacity. (Canada, on the other hand, has a certain amount of rationing, which is more cost-efficient.) For example, there are twice as many cancer specialists in France as in Britain countries of about the same size. So why is French health care not tremendously more expensive? Because health professionals in France are paid significantly less than their counterparts in Britain and Canada.
And France has extensive user fees, which Canada does not. In other words, there are trade-offs in every system.