Just before the pandemic set in Canada, there was much talk among federal decision makers about a “wellbeing budget.” Borrowing from New Zealand and elsewhere, Mr. Trudeau’s mandate letters encouraged multiple ministers to “to better incorporate quality of life measurements into government decision-making and budgeting.”
The focus on wellbeing budgets may now seem ironic amid the illness and death caused by Covid-19. But it was also prescient. I believe it helped the federal government respond to the pandemic as comprehensively as it has.
Central to wellbeing budgets is the idea that health doesn’t start with medical care. Health starts with the conditions into which we are born, grow, live, work and age – what my profession calls “the social determinants of health.”
Many of us are keenly aware of these social determinants more than usual. Physical distancing makes it impossible to ignore how our wellbeing is fundamentally shaped by the security of our housing situations; the adequacy of our incomes; our access to education, childcare, parks, and social networks.
Stuck at home, many people are right to feel viscerally that that there is more to health than Covid-19. We can say this without downplaying the risks posed to all demographics by the novel coronavirus, especially our loved-ones who are elderly or have pre-existing conditions.
We should say this as we seek the right balance between slowly phasing out isolation requirements, while preserving progress in flattening the curve.
When the pandemic took root in Canada, I was nervous that governments would respond urgently to the infectious disease, but ignore the social determinants of health, since the two are in tension. Fighting the spread of infection has required us to erode our social determinants through physical distancing that limits access to jobs and incomes needed to pay for shelter, food and other necessities.
Fortunately, the federal government addressed this tension head-on by promoting health in all policies. It married physical distancing requirements with historic investments in income benefits, wage subsidies, and forgivable loans to businesses.
Yes, too many Canadians still fall through cracks. The Canadian Emergency Response Benefit and its sister student benefit are insufficient to pay high housing costs that plagued many of our cities long before the Covid-19 pandemic. Emergency benefits must be increased in regions with more expensive housing to levels adequate to pay local rents. Or policy makers must support landlords to accept payments that are only a percentage of their renters’ pandemic-income: for example, 30%, as suggested by widely used definitions of housing affordability.
As we improve the emergency response in the short-term, let us also lock-in for the longer-term the momentum this response has created for wellbeing budgets. Across governments and their many departments, there is new appreciation that health care providers are the “last line of defense” in a fight against illness that starts with investments in incomes, housing, child care, etc.
Several factors risk governments casting aside this important insight after the pandemic. Public concern about the “readiness” of our medical systems is high. So is our appreciation for the health care professionals who work long hours at personal risks to care for Covid-19 patients, including those who do so for low-wages in extended care facilities. Plus, the much higher death rates south of the border motivate Canadian pride to protect our medical systems.
But if future medical increases overshadow other government investments in social programs, the science shows we won’t make our population healthier.
This will be especially true for younger Canadians whose social determinants are eroded by the high costs of childcare, student debt, precarious work, unaffordable housing and climate change. These policy areas have been neglected in Canadian government budgets over the last four decades by comparison with funds prioritized for medical systems, as shown in a recent study.
By contrast, the Covid-19 emergency response has struck a better balance than governments generally did in the past.
As we aim to renew wellbeing on the other side of the pandemic, may our governments continue to embrace the science of health promotion by investing in the social determinants of health even more aggressively than it invests in medical care to treat illness.
This piece was originally published in the Toronto Star on 4 May 2020.