Medicalization and Health Care in Canada

• Medicalization


  The process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment
• Foucault on Medicalization


  • Madness and sexuality were first subject to the moral model, and later the medical model
  • The Medical Gaze
• Suicide is the leading cause of death among young people (15-24)
• Suicide


  While often thought of as individual, it is intimately connected with the social (think Durkheim)
• Participatory action research in community affected by youth suicide


  Contrary to adult and media opinion, youth in the project said that social relationships were key to understanding their mental health
• Canada's health care system

  • Complex system where provinces and territories are responsible for their own health care systems
  • Federal funding provided to provinces/territories
  • Indigenous people on reserve are federally funded, while off-reserve are provincial
  • Canada only publicly funds services that are deemed "medically necessary"
  • Public: hospitals, physicians, nurse practitioners
  • Private: dental, vision, complementary services
  • Mixed: prescriptions, home care, mental health
• Challenges and barriers of a universal health care system

  • Long wait times for services presents a challenge
  • Need to develop a more equitable system to prevent a privatized system from being imposed
  • Supply of physicians is concentrated in urban centres; even in cities, access is stratified by SES
  • Immigrants face specific barriers to care
  • Indigenous people are among the most disadvantaged in terms of access
• Chaoulli v Quebec (AG) [2005] 1 S.C.R. 791, 2005 SCC 35
• Chaoulli v Quebec (AG) [2005] 1 S.C.R. 791, 2005 SCC 35

  1. Is it unconstitutional according to the Quebec Charter of Rights and Freedom and the Canadian Charter of Rights and Freedom to prevent privately funded health care services to patients given that the alternative is to be subjected to delays in the public system for access services?

  2. 4 to 3 ruling that the Quebec prohibitions on private health and hospital insurance are inconsistent with the Quebec Charter of Rights and Freedom

  3. 3 to 3 tie ruling on the question of the Canadian Charter, so the Chaoulli decision does not apply to any other province

  4. Could the same be found in other parts of Canada?
• Cambie Surgeries Corporation v. British Columbia (AG), 2022 BCCA 245

  1. Does the BC Medicare Protection Act violate the Canadian Charter of Rights and Freedoms, by restricting the ability of residents in British Columbia to pay privately for medically necessary health care services in order to receive more timely service?

  2. S. 7 of the Charter: Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice

  3. Decision: While long waits for treatment have denied some patients their charter rights to life and security of the person, those violations are permitted under the principles of fundamental justice

  4. The Act is meant to ensure equitable provision of health care, and prevent the creation of a two-tier system where access to potentially life-saving treatment depends on wealth
• Almost 1 in 10 needing health care services were not able to schedule one or more appointments needed during the first year of the pandemic
• Most needing health care services in 12 months preceding the survey reported that they received all the services needed, while one in seven reported an unmet need
• Four out of five people who experienced difficulty accessing health care services reported a negative impact on their life
• Over one-quarter of Canadians delayed contacting a medical professional during the first year of the pandemic
• Over half of First Nations, Inuit, and Métis adults needing health care services experienced difficulty during the first year of the pandemic
• Source: https://www150.statcan.gc.ca/n1/daily-quotidien/211123/dq211123b-eng.htm
• Challenges in this field

  • A broad range of health indicators
  • An aging and changing population
  • The seemingly limitless medicalization of different physical, psychological, and even social states of being
• Differential access to health care across society
• Lack of integrated, universally accessible, and culturally informed health care accompanied by lack of political will to change