Investing in Wellbeing
UPDATED May 23, 2023 @ 1:00pm
Table of Contents
Introduction
This election, Generation Squeeze is undertaking a rigorous assessment of Alberta provincial party platforms and commitments on five key issues: investing fairly in all generations, investing in wellbeing (not just medical care), housing affordability, family affordability, and climate justice.
Our mission: to help voters better understand how far each party's platform goes towards actually solving big problems facing Albertans, and how these problems help prop up a broken generational system.
Gen Squeeze does not tell you who to vote for, and we don’t aim to portray any party in a favourable or unfavorable light. Our goal is to help voters be as informed as possible about the positions of all of the parties on big issues for generational fairness in Alberta. Learn more about our methodology and commitments to non-partisan and evidence-based analysis
One key symptom of generational unfairness is underinvestment in where science shows us health begins – the conditions into which we are born, grow, live, work and age. Canada's ever-growing medical care budgets are crowding out the social spending that helps make us healthy, especially when it comes to investments in younger generations. But medical care wasn't designed to create health – it was designed to treat people once they're already sick. The best long-term prescription for our health care crisis is to do all we can to prevent people from becoming ill in the first place.
We’ve analyzed the degree to which the UCP and Alberta NDP are acting on 8 actions to ensure that Alberta is investing in wellbeing – and not just in medical care. These 8 actions are identified in our comprehensive policy solutions framework.
↑ Back to Table of Contents ↑
Punchlines
There’s lots of talk about medical care in the Alberta election. The leaders’ debate emphasized that questions about who can be trusted to protect public funding for medical care remain a key issue. Danielle Smith re-affirmed her “public health care guarantee,” while Rachel Notley reminded viewers of Smith’s past statements regarding private payment.
What no one is asking the leaders is who can Albertans trust to promote health and wellbeing. Which party will preserve health care as a sacred trust by investing to make people well, not just treating their illness after they fall sick?
Our new study of party platforms shows that the UCP plans to increase annual spending on medical care by $3.8 billion as of 2025/26. The NDP will add $4.4 billion. These are by far the biggest investments that either party promises in its platform. Unfortunately, this isn’t all good news if you care about helping Albertans get and stay well.
As Albertans struggle with long wait times and not enough access to doctors, it makes sense to inject some new funds into the medical system. But what both parties overlook is that medical care accounts for only one-quarter of our health. Medical care was never supposed to go it alone to foster good health – it’s meant to be part of a wider system supporting people with the things they need to be healthy and well, like decent earnings, homes, child care, and a sustainable planet.
These social conditions may not be the first thing that come to mind when many people think about health, yet reams of evidence confirm that they more strongly influence our health than does medical care. As long as Albertans can’t access safe homes, good incomes, quality child care, and a healthy environment, our medical care system will never be enough to prevent people from dying early.
We’re grateful that we can call on fire departments to put out the flames when we need them, but preventing fires is much less deadly, damaging and costly. So it is with health care. Waiting to invest until people are ill is like showing up with hoses once the fire is already raging. We need to prevent the first sparks from getting out of hand. This means clinics and hospitals should be the last stop, not the first stop, in our health system. The first stops for good health are found in our neighbourhoods, jobs, child cares and schools – something the pandemic made painfully clear.
Alberta used to budget this way. In 1976, the province spent approximately 36 per cent more on social and education programs by comparison with medicine. Now, it’s about 26 per cent less.
These trends suggest it’s no coincidence that while medical costs rise, access and quality aren’t keeping pace. We haven’t been preventing enough people from joining the queue waiting for medical care, especially as our population ages and care needs become more complex. In response, many doctors want to prescribe things like housing, child care, and poverty reduction—but can’t. Instead, many of these medical professionals are burning out, even as the number of doctors per capita goes up. Alberta had 125 physicians for every 100,000 people in 1976, including 68 family doctors. Today, Alberta has 252 doctors for every 100,000 residents, including 124 family physicians.
Unfortunately, both the UCP and Alberta NDP fail to engage adequately with the science of health promotion.
The UCP plans to increase annual provincial spending on medical care, education and social services by $6.5 billion as of 2025/26. More than half (58%) of the new spending will go to medical care, signaling it will grow funding for illness treatment more urgently than social spending on prevention and health promotion.
The Alberta NDP intend to spend $8.5 billion more annually on medical, education and social programs as of 2025/26. 52 per cent will go to medical care, confirming the NDP also prioritizes treating illness more than preventing it. That said, the NDP is closer to aligning with the science of health promotion than the UCP, because it offers a somewhat better balance between medical and social spending.
The risk inherent to both party platforms is that Alberta will fail to slow the flow of sickness into our hospitals and clinics – which is precisely the recipe for continuing to overburden the system and burn out doctors and nurses.
Some Albertans may think that higher provincial spending on medical care is a point of pride. Especially now, when so many Canadians are concerned about gaps in our medical system. But the data show this spending isn’t worth bragging about, because it does not buy the province better outcomes.
If more money for medical care was the secret for better health, then Alberta would already be out front of B.C. and Ontario. Alberta spends $5,427 per resident on medical care, compared to $4,997 and $4,864 in B.C. and Ontario, respectively.
Despite higher spending, Canadian Institute for Health Information shows that Alberta ranks below B.C., Ontario and the national average for infant mortality, heart disease mortality, cervical cancer mortality, rectal cancer mortality, avoidable admissions for COPD (lung disease), avoidable admissions for diabetes, and even lower life expectancy.
While Alberta doesn’t often buy better health outcomes, it does buy the best paid doctors in the country.
No matter what your budget priorities are, it makes little sense for Alberta to spend more per capita on medical care yet not achieve routinely better health outcomes – especially when you consider that Alberta also has a younger population. The median age in Alberta is 38. It’s 40 in Ontario and 42 in B.C. A younger population should require less per capita spending on medical care, because we consume most medical services when frailty increases at older ages.
The size of the opportunity to spend more wisely may surprise readers. Alberta would still spend as much on medical care per senior as does B.C. and Ontario if the Alberta medical budget was $2.5 billion less than it is now. That’s a lot of inefficient spending on medical care when you consider that both parties plan to spend less than $1.9 billion for $10/day child care (even when counting the entire federal transfer for the $10/day system).
Since B.C. and Ontario report as good or better health outcomes than Alberta, whatever party is elected to the Alberta legislature in 2023 should grow spending on child care, education, housing and poverty reduction more urgently than spending on medical care (note, we didn’t say anything about cutting medical spending; just growing other investments faster).
Social spending invests where health begins – the conditions in which we are born, grow, live, work and age – capturing the wisdom that an ounce of prevention is worth a pound of cure.
↑ Back to Table of Contents ↑
Summary score table
The table below summarizes scores for the United Conservative and New Democrat parties on each of the 8 criteria for investing in wellbeing. We welcome feedback from parties, including concerns that we may have misinterpreted elements of their platforms when assigning our scores. We commit to revising our scores in light of party evidence that their platforms or other election documents include commitments that align with the evaluation criteria.
Invest in Wellbeing Criteria
Party Scores
Detailed commentary
CLEAR GOALS AND PRINCIPLES
Criterion 1: Do the platforms embrace the goal of creating a health system that promotes wellbeing for all generations?
We are looking for platform language that affirms the goal of investing in wellbeing from the early years onwards.
Neither party engages with this theme directly in their platform materials. No points are awarded.
Both parties have a lot to say about medical care, which is important. But as we discuss more below, health and wellbeing doesn’t begin with medical care.
↑ Back to summary score table ↑
Criterion 2: Do the platforms commit to the principle that health doesn’t start with medical care?
Health begins where we are born, grow, live, work, and age. These social conditions may not be the first thing that come to mind when many people think about health, yet reams of evidence confirm that they more strongly influence our health than does medical care. As long as Canadians can’t access safe homes, good incomes, quality child care, and a healthy environment, our medical care system will never be enough to prevent people from dying early.
Amid all of the discussion of Alberta’s medical system in this election, neither the UCP nor the Alberta NDP acknowledge that health doesn’t start with medical care. There is no mention of the health science that confirms that health and wellbeing are shaped more by social spending than by medical spending.
No points are awarded to either party.
As Albertans struggle with long wait times and not enough access to doctors, it makes sense to inject some new funds into the medical system. But what both parties overlook is that medical care accounts for only one-quarter of our health. Medical care was never supposed to go it alone to foster good health — it’s meant to be part of a wider system supporting people with the things they need to be healthy and well, like decent earnings, homes, child care, and a sustainable planet.
We’re grateful that we can call on fire departments to put out the flames when we need them, but preventing fires is much less deadly, damaging and costly. So it is with health care. Waiting to invest until people are ill is like showing up with hoses once the fire is already raging. We need to prevent the first sparks from getting out of hand. This means clinics and hospitals should be the last stop, not the first stop, in our health system. The first stops for good health are found in our neighbourhoods, jobs, child cares and schools — something the pandemic made painfully clear.
So long as we fail to slow the flow of sickness into our hospitals and clinics, we’ll continue to burn out doctors and nurses. That’s why neither party is planning adequately to help Albertans Get Well.
↑ Back to summary score table ↑
Criterion 3: Do the platforms commit to the principle that we should plan for all ages?
It’s important to plan wisely to ensure that our shared resources meet the needs of Canadians of all ages. Yet for decades, we’ve planned primarily around older generations, while squeezing the wellbeing of younger people. Year after year, federal and provincial government budgets increase spending on retirees far faster than spending on younger people — a trend likely to accelerate post-pandemic as demands for medical care and long-term care increase. We’ve asked younger people to use more of their tax dollars to support this growing spending, while dodging questions about whether today’s retirees (who enjoy more wealth that previous generations) should pay a fair share for the services they need and use.
We all want to ensure the wellbeing of our aging parents and grandparents, and that means investing more later in the life course when health and support needs are higher. But this biological reality isn’t the only consideration in planning for all ages — social, economic and environmental trends also matter. And for many younger people today, these trends mean that they are being squeezed between higher costs for things like housing and child care, a deteriorating climate, and growing public debts — compromising their wellbeing, and the wellbeing of their kids.
Both parties include commitments in the platform materials for “children” and “seniors.” For example, the UCP offer the “Seniors Discount”, and commit to $10/day child care. The NDP commit to help “seniors stay healthy at home”and propose a Kids Activity Tax Credit,” and more money for $10/day child care than the UCP will invest.
We award a half point to each party on this criterion. A full point would be awarded if we saw language in their platforms confirming the parties embrace an age or generational lens to evaluate the efficacy of their investments in health and wellbeing across the life course.
↑ Back to summary score table ↑
POLICY PILLARS
Criterion 4: Do the platforms propose actions to increase social spending faster than medical care spending?
In a nutshell, this criterion is about asking our governments to embrace the wisdom that “an ounce of prevention really is worth a pound of cure.”
Research shows that government spending on social programs — things like poverty reduction, housing, child care, and so on — often has a stronger association with our health than spending on medical care. In concrete terms, a higher ratio of social spending relative to illness treatment is linked with greater life expectancy, lower infant mortality and fewer potential years of lost life.
This means that Albertans will “Get Well” when we invest in safe and affordable homes, living wages, quality child care and schools, and a healthy environment—even more urgently than we invest in medical care. Growing spending on social supports can help to reduce pressure on our health system by slowing the flow of sickness into clinics and hospitals, and tackle the affordability crisis many Albertans are facing. Growing social investments will also generational tensions created by medical spending.
For this criterion, we assess party platforms by examining the ratio of aggregate spending on medical care relative to aggregate spending on childcare, parental leave, grade school, postsecondary education, housing, and other social services.
The UCP has not published on its website a costed platform for the 2023 election campaign. We therefore rely on the UCP’s 2023 budget to assess spending commitments to medical and social issues. The following Table shows that the party plans to increase provincial spending on medical care, education and social services by $6.5 billion as of 2025/26.
More than half (58%) of the new spending will go to medical care. This signals that the party proposes to grow medical care spending more urgently than social spending. By contrast, health science research shows that governments are more likely to improve life expectancy and reduce outcomes like avoidable deaths by growing social spending more urgently than medical spending.
We subtract half a point from the UCP for this criterion.
The following Table shows that the Alberta NDP plan to spend $8.5 billion more on medical, education and social programs by 2025/26. That is $2 billion more than the UCP plan to grow spending.
Medical care will receive 52% of this new investment. Since this signals that the NDP also proposes to grow medical care spending more urgently than social spending, we also subtract half a point on this criterion.
It’s worth noting that the NDP is closer to aligning with the science of health promotion than the UCP, because the UCP is allocating even less of its new investment to social and education issues by comparison with medicine.
Still, by growing medical spending more urgently than social spending, both parties build on the Alberta tradition of spending more per capita on medical care than BC and Ontario – Canada’s other two large, populous English-speaking provinces.
Some Albertans may think that higher provincial spending on medical care is a point of pride, especially now, when so many are concerned about gaps in our medical system. But the data show this spending isn’t worth bragging about, because it does not buy the province better outcomes. According to the Canadian Institute for Health Information, Alberta ranks below BC, Ontario and the national average for infant mortality, heart disease mortality, cervical cancer mortality, rectal cancer mortality, avoidable admissions for COPD (lung disease), avoidable admissions for diabetes, and even lower life expectancy.
No matter what your budget priorities are, it makes little sense for Alberta to spend more per capita on medical care yet not achieve routinely better health outcomes — especially when you consider that Alberta also has a younger population. The median age in Alberta is 38. It’s 40 in Ontario and 42 in BC. A younger population should require less per capita spending on medical care, because we consume most medical services when frailty increases at older ages. Despite this, Alberta spends $5,427 per resident on medical care, compared to $4,997 and $4,864 in BC and Ontario, respectively.
The size of the opportunity to spend more wisely may surprise readers. Alberta would still spend as much on medical care per senior as does BC and Ontario if the Alberta medical budget was $2.5 billion less than it is now. That’s a lot of inefficient spending on medical care when you consider that the province spends only $1.6 billion for $10 per day child care (even when counting the entire federal transfer for child care). Since these provinces report as good or better health outcomes than Alberta, whatever party is elected in 2023, it ought to grow spending on child care, education, housing and poverty reduction more urgently than spending on medical care. These are investments where health begins — the conditions in which we are born, grow, live, work and age — rather than waiting to treat illness after Albertans have fallen sick.
↑ Back to summary score table ↑
Criterion 5: Do the platforms acknowledge that the aging population didn’t entirely prepay for the medical care it now uses?
Today’s retirees worked hard to support their families, and contributed the tax dollars asked of them by governments. Despite playing by the rules, haven’t paid enough to cover the full cost of the services they use in retirement. With pressure growing to add things like pharmacare and long-term care to the medical care purse, the unpaid bills retirees are already leaving likely will rise.
There are good reasons to invest more in medical care for the aging family members we love. The evidence is clear on that — just as it’s clear on the benefits of investing more in programs that would disproportionately benefit younger people, like affordable housing, post-secondary education or parental leave. But even good programs have to be paid for. The timing of new medical care investments is particularly likely to grow generational unfairness if we don’t also talk about how to invite today’s retirees to pay a fair share of these new costs.
Neither party makes any mention of the intergenerational revenue challenges that face Alberta when it comes to increasing spending for the medical care of the aging population. No points are awarded.
↑ Back to summary score table ↑
Criterion 6: Do the platforms ask retirees to pay a fair share for expanding medical care for the aging population?
Generational reciprocity means, in part, that each generation pays for what it wants and uses, contributing in proportion to the needs, opportunities, and wealth it inherits. This doesn’t mean each generation should contribute equally — but it does mean each generation should contribute fairly. Precisely how much is fair may be difficult to define, but it’s likely we can all agree that it’s unfair to contribute so little that you leave your bills unpaid, creating debts for those who follow, especially when your own wealth is increasing.
Neither party makes any mention of the intergenerational revenue challenges that face Alberta when it comes to increasing spending for the medical care of the aging population. No points are awarded.
↑ Back to summary score table ↑
MONITORING & ACCOUNTABILITY
Criterion 7: Do the platforms propose to initiate annual reporting on the ratio between social spending and medical care spending?
Monitoring spending over time supports political leaders to make informed and efficient spending decisions. That’s why we’re asking governments to implement annual reporting on the ratio between social spending and medical care spending. The ratio would allow them to track relative investments in treating illness vs improving the social conditions in which health begins — and whether these investments find the right balance.
Neither party commits to reporting on the ratio of social spending to medical care spending in the annual Alberta budget. No points are awarded to either party.
↑ Back to summary score table ↑
Criterion 8: Do the platforms propose to appoint government point people responsible for social determinants of health?
It’s much more likely that Canadians and their governments will cultivate a broader understanding of health — and put in place the investments to back it up — if governments have a Deputy Minister, Parliamentary Secretary, or similar specifically tasked with advancing the social determinants of health.
Neither the UCP nor the Alberta NDP commits to having a high-level official responsible for advancing investments where health and wellbeing begin — in our neighbourhoods, child cares, schools, homes, etc. No points are awarded.
↑ Back to summary score table ↑
