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IT is not a totally radical idea that poverty, pollution and poor job prospects are at the root of many of society’s health problems. But the notion was given important new currency this week with the release of several reports by the Ontario Premier’s Council on Health Strategy that have been nearly four years in the making.

Ontario Premier Bob Rae inherited these reports from a predecessor but he immediately endorsed them as “profound” and “extremely important.” Which should surprise no one who remembers he spent his politically formative years fighting British poverty in London’s inner city and has heard him speak about it almost every chance he gets.

Unfortunately for Mr. Rae, some of the impact was probably lost because the reports came out on the same day that his Social Services Minister, Zanana Akande, said it will be impossible for the government to live up to its election promise of eliminating food banks in the province over the next five years.

And the NDP government has, for the moment anyway, already cast its lot in the small-is-beautiful debate by agreeing to give great wads of money to the province’s big hospitals to maintain the current system pretty much as is.

Mr. Rae would appear to have the appropriate bedside manners for issues like these. But it is still not clear whether he has the surgical skills to make the tough cuts that are necessary.

In any event, two things stand out from the health-strategy reports, and one of them is how vague most of the recommendations seem to be.

Now, it may be useful from a strategic point of view (and for the nation’s soul) to think of Ontario from time to time as a kind of Third World province, in which poverty and pollution are wreaking a monstrous toll on human health (which they are, up to a point).

But surely we have progressed to a more sophisticated stage in this debate, so we should be looking at the tougher, more immediate issues in the health-care field. What is the appropriate number of doctors, or hospital beds, for a province of nearly 10 million? Do community clinics reduce abuse of the system, or add to it? Should hospitals in the same area be forced to specialize in certain procedures to keep over-all costs down?

And if we are to make the big connection between poverty and health costs, how are we to make the trade-offs? Is the next job-training program for older laid-off workers to come out of the Health Ministry’s budget?

THESE are not just academic questions, especially when you look at the other main ingredient of the Premier’s Council reports – the call for a health-planning agency that is independent and citizen-run.

This is probably the central recommendation and it is important, because it recognizes that spending more money is not the answer to health-care problems. And that to get a handle on burgeoning costs – which have been rising by about 10 per cent a year, well above the rate of inflation or population growth – you have to control the costs and the development of the human resources (doctors, nurses, laboratory technicians) that make up three-quarters of the tab.

This, too, may seem like superfluous advice to the NDP, which recently agreed to give Ontario nurses a hefty average pay hike of about 18 per cent. But that might be just part of a grand plan, if relatively low-cost nurses can be substituted for doctors at more points in the delivery system.

The province might also save health-care money, the reports suggest, if it recognizes its market clout (no Third World jurisdiction here) and buys more trained health specialists from other regions, cutting back on its own, expensive, medical-school system in the process.

But this would work, the council argues, only if the independent health-planning agency were able to earn a significant degree of public confidence and had its own independent and high-level champion at the cabinet table, such as the treasurer or the chairman of Management Board.

Implicit in this central recommendation, which might give Mr. Rae a tough time, is that the Minister of Health (and her ministry) are merely one of several “stakeholder groups” in this debate, and are getting in the way