Harvey Skinner is a distinguished public health activist and academic, yet for him Public Health is simply about the health of the people.
“What needs to happen is 2 things: we need to go back to the 19th century, when health really was the responsibility of the individual and families. That got co-opted in the twentieth century by doctors, hospitals and pharmacies. In one way we need to go back and rebalance, so people have more responsibility again.
“At the same time, we need to go forward into the 21st century, and use all our new technology to be an enabler of e-health solutions. We need to provide patients with portals to their health. If we’re lucky, most of the time we’ll be healthy; occasionally when we do have a situation due to injury or illness, we’ll have timely access to safe and effective care. And in the smartphone era you can have access not just to medical care but to a psychologist, your personal trainer – you can have individualized intervention, all using your smartphone!”
None of this is merely theoretical. Harvey’s experience is rooted in personal reality.
“I have an 89-year-old mother and a 91-year-old aunt. I’m pretty much their primary advocate at this stage. I wish I had access to my aunt’s electronic health records and support records, as well as my Mom’s, because I could be much more effective in helping them. There are many people like me, so to really be People-Centred we need access to records, to decision supports; access to what networks of services are available in the community. These are the things we need to supply, so people can make good – or better! – decisions. Only about twenty per cent of our healthcare takes place in hospitals or clinics. Most takes place at home and involves yourself and homecare… or family members who’re helping.
“I’m also thinking of my brother. He lives an hour and a half south of Calgary. Last June he started noticing he was having problems in swallowing. It got progressively worse, and turned out it was a very large tumour on his brainstem. So he got scheduled at the Foothills Hospital in Calgary for an operation.
“I went out to Calgary for the operation day. I was impressed with Foothills. The surgeon was very down to earth and very well versed. It was an eight-hour operation, very tricky – you cut the brain stem, you’re out - so it’s not an easy thing.
“But the good news is this type of cancer is very very slow-growing. He would’ve had it for years and years. So they’ll monitor it, but the location makes it impossible to do chemo and radiation on it. At present in 2011 he’s still in hospital in the Rehab area of their Cancer Care. I stayed there over Boxing Day and spent New Year’s Eve with my brother, and that was the first time we’d spent a week together since we were teenagers! We had good conversations.
“He gets incredible care from the nurses. But he jokes with them, so he’s become their pet. I’m impressed with how positive Charlie’s been.
“The team in Calgary was very open with providing information, and I think appreciated our involvement in the teamwork. They had a major conference and they were preparing us that he’d continue to have a trache [tracheostomy tube] and to be fed through a stomach tube, so they set up a sort of ‘prove us wrong’ situation. He called me up one day recently and said, ‘Harvey, I have a big smile on my face! I just had four teaspoons of chocolate pudding!’ And later he had some apple sauce, and now they’re looking at taking out the trache.
“Helen his wife has really stepped up and he really appreciates my visiting and being out there twice. I’ve also called; our cousin Marlene, who’s a nurse, has called; we’ve all been in touch. He said that’s what’s really helped him to keep positive. I call about every other day now.
“I think it shows that if he hadn’t had family… You spend long days in the hospital. This is a very long recovery. And it’s unlikely he’ll be able to work again, so there’ll be financial challenges ahead. But, ‘I am my brother’s keeper.’
- There you have an example of the larger need for People-Centred care.”
Meanwhile, Harvey’s caring mind is busy.
“We need to have a dialogue on the End of Life. It presents very difficult ethical dilemmas. A lot of money is spent on Last Years hospitalizations. More and more technology has come along to keep us alive, but with what quality of life? Our current approach to health is not sustainable. We have an aging population. The health budget 10 years ago was 32%, now it’s 46%; it’s estimated to be 70% of our total budget by 2020. We’re sinking our system!
“It may be scary to look at health throughout our whole life course, but we need to try to have as good a health system as possible.”