CALGARY -- The outgoing president of the Canadian Medical Association warned Tuesday that government has to battle social ills before health care can become sustainable.

"Canada's premiers are fond of saying they want and need to bend the cost curve on health-care spending," Dr. Anna Reid, in her final speech as president, told delegates at the association's annual meeting.

Reid said she doesn't believe politicians totally understand the challenges in health care and suggested their views "are purely about cost cutting."

"An estimated one in every five dollars spent on health is directly attributable to the social determinants of health," she said. "A lot of the people who actually use the health-care system are marginalized populations who live in poverty.

"We know from a study done in Hamilton ... that those who live in low income neighbourhoods actually have to use emergency services and mental-health services much more than other people in the city.

"We will be unable to sustain our health-care system if we do not address these determinants."

Reid said it is critical that doctors continue to be heard. The medical association is involved in the Health Care Innovation Working Group, set up by Canada's premiers along with the Canadian Nurses Association and the Health Action Lobby.

"What is absolutely clear is that Canadians want and expect us, the doctors of Canada, to be advocates for their broader health as well as the health-care system."

Work being done by many physicians creates a "force for good" in society and needs to focus on quality of care, she said.

"I believe that if there is the will among the public, providers and politicians ... that with everyone pulling in the same direction we will be able to achieve the health outcomes that Canadians deserve."

She said an important first step is to convince the federal government to develop a national strategy for seniors care.

A poll released by the association this week indicated most people want a plan which includes an emphasis on keeping seniors in their homes as long as possible.

The poll, done annually as part of the association's national report card on health issues, said that 93 per cent of those surveyed indicated any such plan should address care at homes, hospitals, hospices and long-term facilities.

An equal number suggested the entire system could be improved by keeping seniors at home as long as possible, thereby lightening the load on hospitals and nursing homes.