Humanities CMAJ

E654 CMAJ, September 17, 2013, 185(13) © 2013 Canadian Medical Association or its licensors

A Healthy Society: How a Focus on Healthcan Revive Canadian DemocracyRyan Meili, with a foreword by RoyRomanowPurich Publishing Limited; 2012

This quick and enthusiastic intro-duction to the literature on thedeterminants of health, written

by a young family doctor, is timely,aligning well with the current policydirections of the Canadian MedicalAssociation.1 Dr. Ryan Meili’s passionand his ability to give a real sense of thepeople and places he has encountered isevident, particularly in the striking anec-dotes that bring theoretical concepts tolife. At one point, we are transported to agathering under a mango tree in Tevele,Mozambique. We also travel to Brazil,and to various locales in Canada,although mostly in his Saskatoon com-munity clinic.

The author also has a gift for memo-rable metaphors. Among many, he com-pares unchecked economic growth tocancer; to basing an economy on sellingraw materials to a garage-sale economy;and he suggests that rather than run gov-ernment as a business, it should be run asa family.

Meili heads the division of socialaccountability at the College of Medicineat the University of Saskatchewan, and isvice-chair of Canadian Doctors forMedicare. He also has a history of politi-cal activism (including a run for provin-cial NDP leadership) and is a physicianmentor with SWITCH (Student WellnessInitiative Toward Community Health),which brings students in various healthprofessional programs together with resi-dents to work in “core communities” inSaskatoon. Half of the royalties from thisbook are being donated to SWITCH.

The volume is well written and a goodread, albeit less successful as nuancedpolicy analysis. The author tends toassume that any reasonable person willshare his passion for improving the livesof vulnerable individuals. Early in the

manuscript, he argues that “we need aclear objective that will inspire peoplefrom diverse circumstances to worktogether for a greater good” and proposesthat everyone will agree that this commonobjective is health. He uses this to arguefor a series of progressive reforms,including potential changes to policiesaffecting taxes, food security, housing,criminal justice, environmental protectionand climate change, education, and childcare, which he justifies as evidence-based, cost-effective investments inimproving the health of the population,especially the most vulnerable.

The book ends with a ringing pleafor a more participatory democracy.Meili believes that people are ready forthe “high road” and that they largelybelieve that we are all in it together.One chapter concludes with a series ofsentences, in the best John Lennon tra-dition, imagining something better; notonly imagining “a government thatinvolves the people meaningfully indecision-making, judging every deci-sion it makes not on short-term politicalgains but on the real impact on people’shealth” but also imagining “electionsthat are truly based on whether thecountry has become a healthier place.”

Cynically, one might suggest that this

argument constitutes health imperialism,and that people, although they emphati-cally want good health, might also deemother things to be important. Practically,one might suggest that there are deep,and growing, ideological differences insociety, and that not everyone will nec-essarily agree that we have an obligationto help our neighbours. Meili appears toharbour an optimistic view of humannature and its ability to avoid selfishnessand seek the common good. He stressestrying to avoid polarization and findcommon ground, giving as an examplehis own father, whose “political affilia-tion has always been to the right” butwho is “a very good man.”

One might pick a few nits with someof the analysis, or the rather minimalreferencing (although the book doesnote many key references), but this fas-cinating book is not intended to providean academic perspective. It is intendedas a stirring call to action. Given howmany of his stories feature grand plansthat were never implemented andunsuccessful political campaigns,Meili’s continued enthusiasm is com-mendable; he continues to see the glassas half full rather than half empty. Hispatients and students are obviouslylucky to have him.

Raisa B. Deber PhDInstitute of Health PolicyManagement and EvaluationUniversity of TorontoToronto, Ont.

Raisa Deber has published extensively onCanadian health policy; her recentpublications include Case Studies inCanadian Health Policy and Management,2nd edition, University of Toronto Press(in press), whose real-life examples werecoauthored with over 120 graduates of hercase studies course.

Reference1. 12th annual national report card on health care.

Ottawa (ON): Canadian Medical Association;2012.

CMAJ 2013. DOI:10.1503/cmaj.121556

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