Robert Cushman has been called a social engineer instead of a mere doctor, praised and pilloried for delving into smoking and pesticide bans, needle exchange programs, and bicycle helmet laws during his career in public service.
Now one of Eastern Ontario’s top health care officials, he has another target: Canadians with unhealthy living habits who threaten to overwhelm the system as it prepares for an onslaught of baby boomers living longer and demanding costlier medical treatment.
The chief executive officer of the Champlain Local Health Integration Network wants doctors to get tougher with patients and wants employers to take more responsibility for the health of their workers.
Dr. Cushman said medical professionals need to place a higher premium on promoting individual responsibility and risk factors to their patients — especially physical activity, weight, tobacco and alcohol.
“We need to get tougher on this,” he said. “As a public health physician, you get accused of social engineering when you look at a few regulations, but education only goes so far. A lot of these things go backwards if you don’t maintain pressure.
“Health professionals have been more timid on this than we have needed to be, because we don’t like to play hardball. We’re nurturing and caring.”
Dr. Cushman, who co-ordinates funding and delivery for more than 200 health care providers from Cornwall to Deep River, was the Ottawa-Carleton region and City of Ottawa medical officer of health from 1996 to 2005. From the outset, his definition of “prevention” included poverty and other social factors contributing to illness, making him one of the area’s best-known public officials.
Dr. Cushman helped the controversial indoor smoking ban take shape, supported a citywide ban on cosmetic pesticides and battled former Ottawa police chief Vince Bevan to preserve the city’s crackpipe program in 2005.
A 2002 Citizen editorial chided him for issuing policy comments on everything from light rail to sport utility vehicles. But Dr. Cushman was unapologetic in his role as a health advocate, warning Ottawa residents that same year that physical inactivity was a major health risk facing the city.
A Champlain network report last December reported that diabetes, asthma, smoking and heavy alcohol use were all on the rise across the region, especially in poorer rural areas.
Dr. Cushman had no shortage of personal examples during his Citizen meeting, starting with the “illness behaviour” he often notices among the family and friends of hospital patients.
This past weekend, he saw 10 teenagers in a row cycle past his house — none wearing helmets. This angered the man whose research and activism helped create a mandatory under-18 helmet law in the early-1990s.
And he mentioned talking to the manager of his local hardware store about stocking chocolate bars and candy on shelves a couple feet off the ground, hidden from adults, but at the perfect eye level for a small child.
“This system belongs to us, we pay for it,” Dr. Cushman said.
“And if we’re demanding a better performance from our doctors, our bureaucrats, our nurses and our hospitals, it’s about time we demanded a better performance from our citizens.”
Dr. Cushman hopes the Champlain network and municipal public health departments can help connect people to services ranging from gyms and personal trainers to social workers.
He also wants the private sector to promote better wellness in the workplace, from fitness equipment and employee assistance programs, to enforcing the boundaries of outdoor smoking areas, to corporate taxes earmarked for health care.
“I think that corporations and businesses have a selfish vested interest in having a healthy, happy workplace,” said Dr. Cushman, adding that companies benefit from publicly-financed health care when luring workers or maintaining jobs.
Originally written By: Andrew Thomson
