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This Is How Bureaucracy Affects Health Care

Part of the problem is that when there are so many bureaucrats, we get a phenomenon referred to as "circling back."
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"Bureaucracy defends the status quo long past the time the quo has lost it's status. " – Laurence J. Peter

Trans Fats. Undoubtedly the most deadly form of fat that humans consume. In 1903 Wilhelm Normann, developed a process whereby a single hydrogen atom moved from one side of a fat molecule to another. Theoretically, it should have made minimal, if any difference, because hydrogen atoms are really really tiny. (A somewhat mind blowing link explaining just how tiny they are is here).

Yet such a simple change was noted to have significant benefits for the food processing industry. By the 1960s, as people needed longer and longer shelf lives on food, trans fats were able to provide that, at lower costs. Additionally, you could use LESS trans fats than animal fats in any given product, and so food manufacturers could claim that their products were low in cholesterol.

However, by the late 1970s, concerns began arising about just how healthy these artificial trans fats were. The WHO had an expert consultation on Fats and Oils in 1977 that listed concerns but didn't make any recommendations. A second WHO meeting in 1993 recommended that one should reduce the intake of trans fats. This recommendation was partially based on studies in the New England Journal of Medicine (1990) and a study in the medical journal "The Lancet" (1993) that showed trans fats increased the risk of heart attacks.

Of particular concern to those of us in Canada is that Canadians had one of the highest intakes of trans fats in the world in 1995. Despite education, intake of trans fats persisted at a higher than safe level well into 2012 (the last date for this information I could find).

The really eye opening part for me however was the effect of a ban by Denmark on trans fats (to no more than two per cent of total fat) in any food products in 2004. Within two years, the deaths from heart attacks and strokes dropped by four per cent. That's just the DEATHS, the number of heart attacks and strokes that did not result in death dropped dramatically.

In Canada, experts have estimated that regulating trans fats could avert 12,000 heart attacks over 20 years. Put simply, there is simply no good that can come out of eating trans fats.

Part of the problem is that when there are so many bureaucrats, we get a phenomenon that bureaucrats refer to as "circling back."

And while Health Canada initially was ahead of the States by implementing a voluntary guideline on trans fats in 2009. However, since then, not much has happened. It was only in April of this year that Health Canada proposed to ban trans fats. Even then, it was just a "Notice of Proposal" along with an admission that they have to actually "form the regulation." Once formed, it will be a year after that that the ban comes into effect.

This to my mind is a complete failure of bureaucracy, and the type of thing that drives physicians like myself crazy. As I've mentioned before, in Canada we have two times as many health care bureaucrats per capita as Japan, four times as many as Australia, and ten times as many as Germany. Yet we are unable to pass a simple piece of legislation (just copy the Danish one for crying out loud) that will clearly save lives, and costs to the health-care system.

Part of the problem is that when there are so many bureaucrats, we get a phenomenon that bureaucrats refer to as "circling back." I first learned of this when I was the Health Links lead physician for South Georgian Bay. As I wrote about in my Toronto Sun piece, despite the fact that we had a great idea that reduced admissions from nursing homes to hospital by over 50 per cent, and cost a relative pittance ($70,000), we couldn't get the bureaucrats in charge to fund the project because one department wouldn't approve something without 'circling back' to another, which would 'circle back' to yet another and so on.

We finally only got the project going to due to a generous grant from the Collingwood Hospital Foundation, and have been saving lives ever since (but of course been stymied from scaling up the project to the whole province).

In much the same way, the trans fat ban seems to be caught in between multiple levels of government and their various bureaucrats.

In 2007 for example, in Ontario, then Education Minister Kathleen Wynne quickly realized how dangerous trans fats were, and banned them from school cafeterias in a smart, proactive move (yes Omar Khan, I complimented Kathleen Wynne, sit down already). However, this was just the education ministry. The Health Ministry in Ontario didn't act on this, likely feeling this was a federal problem. Even a request by the Ontario Medical Association in 2009 that restaurants provide nutritional labelling on their menus didn't get enacted until this year.

This didn't stop another level of government, the City of Toronto, from proposing the same ban in restaurants in 2007. But as of 2016, this still hadn't been accomplished because of back and forths between municipal, provincial and federal agencies.

And so now, 10 years AFTER first being considered, and 13 years after successfully being implemented in Denmark, we are now finally getting around to maybe, perhaps, banning the most dangerous fat on the market.

When you have so many bureaucrats per capita in health care, is it too much to ask that on those occasions when a no-brainer of an idea happens, that they act quickly and decisively to pass the right regulation? And if they can't do that to protect the population, is it not reasonable for the people of Canada to ask why so much of their tax money is diverted to bureaucracy?

The people of Canada deserve better.

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