A Healthy Society: How a Focus on Health Can Revive Canadian Democracy, Updated and Expanded Edition

by Ryan Meili

A Healthy Society offers a new approach to politics – and a new approach to building a healthier world. Dr. Meili argues that health delivery too often focuses on treatment of immediate causes and ignores fundamental conditions that lead to poor health, such as income, education, employment, housing, and environment. This updated edition explores the positive steps that have been taken since publication of the first edition, and includes expanded discussions of basic income, poverty reduction strategies, innovative housing polices, carbon pricing, and the role of health professionals in working for health equity. This book breaks important ground, showing us how a focus on health can change Canadian politics for the better.

Genres: Nonfiction

248 pages, Paperback

Published December 1, 2017

Reviews

[Justin · Rating 4 out of 5]

I read the original edition of A Healthy Society when it was published more than 5 years ago, and it made a great impression on me. It’s clear and concise messaging and compassionate tone played a significant role in what I suppose you could call my political awakening. A lot has happened between then and now, both in terms of my own experiences and in the political realm, but with the author again vying for leadership of a provincial political party I was intrigued to see a new edition and was eager to assess if and how Ryan Meili’s outlook has changed, and how it stands up several years after its initial publication. To jump ahead, I’ve given the book 4 stars now, compared to the 5 I gave the 2012 edition; this is mostly a reflection of the impact the book had on me when I first read it. I think it has stood up very well, and that in fact the new edition improves on the original. It’s still a must read offering an inspiring vision of a different way of doing politics, with a number of concrete suggestions that could make a big difference in the local context of Saskatchewan.

The central theme of the book is the importance of the social determinants of health (SDOH) in health outcomes, and how the SDOH need to factor more prominently into public policy. Specifically, Meili proposes using health outcomes as a meaningful measure of political progress, with the SDOH offering an analytical tool to create evidence-based policy aimed at improving health outcomes across society, with a significant focus on health equity. Key to this proposal is the importance of equality; Meili admits that he borrows heavily from Richard Wilkinson and Kate Pickett’s The Spirit Level to demonstrate that increasing inequality has an overall deleterious effect on the SDOH and health outcomes. The idea of health forming a key political objective undoubtedly offers some intriguing possibilities for re-thinking public policy and the exploration of the SDOH will be enlightening for many, though these ideas have certainly broken more into the mainstream since the book was first published and many won’t be encountering them for the first time here.

All in all, it’s a very convincing case, but it clearly comes from a social democratic position that will put many conservatives (big and small C alike) on the defensive. Meili talks fairly directly about progressive taxation and the redistribution of wealth, but often frames such discussions in terms of overall economic outcomes. A central theme throughout the book is the idea that economics ought to be considered a means to the end of better health for everyone in society; he argues that achieving better health outcomes necessitates smart economic policy, which will lead to growth but depend on diversification, but that we must not confuse economic growth as the goal in itself. It seems as if it should be an obvious point, but it’s one that policy makers should clearly reflect upon. In any case, many will no doubt have trouble seeing past redistributive proposals, but hopefully some of stories in the book will force readers to step outside of themselves to consider the bigger picture. Meili is also too dismissive of many who might be sceptical of the state, either its role or its very existence, but he’s pretty clear about where he’s coming from and that his interest lies in working within and reforming the political system.

Interwoven throughout the book, particularly in exploring the various SDOH such as income, education, housing, environment, and access to health services, among others, are stories of patients or communities Meili has worked with in his time as a medical practitioner. Such stories really help to illustrate the points, and the book might have benefitted from even more of them, and maybe some from other contexts where the SDOH do play a more prominent role in shaping public policy. But the stories that are included liven up the material and offer clear examples of why change is needed and what kinds of changes can make the biggest and most immediate differences. After reading through the book again, the possibilities for building a healthier society do seem endless and exciting.

Meili wrote the first edition while running for leadership of the Saskatchewan NDP; beyond the general themes mentioned above, the book offered some provocative suggestions like creating a new provincial crown corporation dedicated to the production of pharmaceuticals and the creation of citizens’ councils to advise government policy. I was disappointed when he lost that leadership contest by an astonishingly narrow margin of 44 votes. Meili is again running for leadership of a party badly in need of reform, and based on the progress of the conversation around the SDOH since he first published A Healthy Society, perhaps the timing is ripe for this kind of movement. The ideas still come across as smart and timely, and it would be very interesting to see how they played out if given the opportunity. Though I have my doubts about how effectively the current political system can be reformed, I do think this book offers some novel and innovative ideas and that turning the system towards a focus on health could make a big difference. That makes this worth a close reading, whether or not you’re from Saskatchewan – its relevance stretches beyond provincial borders, and if you’re not from here then hey, you might learn some things about the place too! This new edition offers a few new ideas and lots of new evidence and polish to make it a worthy update.

[Murray Unger · Rating 5 out of 5]

This book focuses on many ideas that could serve to advance the lives of so many. It is an excellent introduction to, and fairly thorough examination of, the concept of the social determinants of health.

[Abbey Blais · Rating 4 out of 5]

randomly remembered I read this in first year for a health class. it’s a four star, idk what else to say