The SEP-BMI association in Canada is complex, showing variation by gender, by aspect of SEP, across the BMI distribution, and at different time points. The association departs from the more consistent social gradient in health, thereby challenging our view of BMI as a typical health issue.
Funding for Canadian public health care has long relied on a "pay-as-you-go" funding model: for the most part, government pays for health costs each year from taxes collected in that fiscal year with effectively nothing put aside for projected rising health-care costs in the future. But the future of Canadian public health care is going to get more expensive as the relatively large cohort of baby boomers reaches retirement age. As they exit the work force, and enter the ages at which Canadians use the health-care system more, a smaller population of younger workers is going to be left paying the growing health-care costs of older Canadians. If Canadians intend to preserve a publicly funded medicare system that offers a similar level of service in the future as it does today, under the pay-as-you-go model, eventually peak taxes for Canadians born after 1988 will end up twice as high as the peak taxes that the oldest baby boomers paid. The "payas-you-go" model has become like a Ponzi scheme, where those who got in early enough make out nicely, while those who arrive late stand to suffer a serious financial blow. This should concern both Canadians who value a comprehensive public health system as well as Canadians who value competitive tax rates: There is no reason to be certain that future taxpayers will blithely accept having their taxes substantially increased to finance health care for another, older generation that did not pay for a significant portion of its own health care. If the burden proves too high for the taxpaying public to accept, that could well jeopardize Canada's health-care system as we know it. If Canadians intend to preserve their iconic public health system, and are unprepared to unjustly overburden future generations with the tax bill left by their parents and grandparents, provincial governments must make strong and rapid efforts to reform the health system. They must find more cost-efficient ways of managing medicine, including new approaches to eldercare, chronic disease prevention and better health promotion. If policymakers respond in time with a workable strategy and adequate effort, the substantial financial health-care liability currently faced by future generations may not be eliminated entirely, but it can still be reduced dramatically. † The authors wish to acknowledge the helpful comments of the anonymous referees.
This paper describes a collaborative process of identifying and prioritising current and future water research questions from a wide range of water specialists within South Africa. Over 1 600 questions were collected, reduced in number and prioritised by specialists working in water research and practice. A total of 59 questions were finally proposed as an outcome of the study and are categorised under the themes of change, data, ecosystems, governance, innovation and resources. The questions range in scale, challenge and urgency, and are also aligned with prevailing paradigms in water research. The majority of the questions dealt with relatively short-to medium-term research requirements and most focused on immediate issues such as water supply, service delivery and technical solutions. Formulations of long-term research questions were sparse, partly because some of the principles and methods used in this study were difficult to apply in the South African context, and also because researchers are influenced by addressing what are believed to be the more immediate, short-term water-related challenges in South Africa. This is the first initiative of its kind to produce a comprehensive and inclusive list of research priorities for water in South Africa.
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