Remember that social supports contribute more to health than medical care – and expect your share of funding.

Don’t settle for what’s left after medical services eat the biggest slice of the budget pie. This context might help. Since the mid-1970s (after adjusting for inflation):

• Annual spending on social services is up around $4 billion
• Annual spending education is up around $6.5 billion
• Annual spending medical care is up over $18 billion

BC should report the ratio of social services and education spending relative to medical spending (the SE/M ratio).

The SE/M ratio should be a key performance indicator (KPI) in annual government budgets. Since health science recommends that social spending should grow more rapidly than spending on medical care, you can use this KPI as a rationale to call for more urgent public investment in your programs. Adopting the ratio is a low-barrier ask of the BC government in the short-term – but tracking these data is the starting point for bigger budget recalibrations in the years ahead.

Health begins in the social conditions where we live, work and play. It doesn’t begin with medical care.

Many elected leaders equate medical care with health. We need them to be more precise. Medical care receives the most provincial spending, but doesn’t contribute the most to health. We should expect our politicians to be clear about this with taxpayers.

There are many different places we can bring our message.

• Local public health officials can validate the importance of investing in your services for improving community health and wellbeing.
• Local MLAs can bring forward the concerns of their regions, especially when diverse social service sector leads share the same message.
• Ministers responsible for child care, housing, poverty reduction, education and postsecondary can use Get Well Canada evidence to help win more resources for their portfolios at Treasury and Cabinet.
• The Premier has tasked the Finance Minister to “review all existing government programs and initiatives to ensure programs remain relevant, are efficient, grow the economy, and help keep costs low for British Columbians.” Get Well Canada evidence is critical for this task, because it shows that we’ll get the biggest bang for our bucks by investing more urgently in social and education services. They improve affordability and wellbeing more than medicine, which currently absorbs the largest slice of the budget pie.

We need Ministers responsible for wellbeing to join together to grow their power.

We need social sector Minsters to be as powerful as the Minister responsible for medical care. Creating a Cabinet Committee for the Building Blocks of a Healthy Society will help them band together around a shared goal – to grow social spending more urgently than medical spending – in order to re-align the SE/M ratio with health science.

The stage is set for Get Well Canada advocacy in 2025 – read our summary of key advocacy openings to learn more about when to gear up.

This can be a powerful tool to demonstrate sector-wide support for rebalancing provincial investments. More to come!

Following Budget 2025, we’ll draft an open letter to BC politicians that we hope many of you will sign. We anticipate that this letter will call for more urgent investment in the social services you deliver, and ask all elected reps to commit to following Get Well Canada’s evidence-based prescription to reduce medical and affordability pressures.

Spread the word across your platforms to help spark a new way of thinking about what it means to invest in health and wellbeing.

Use toolkit assets to create your own social posts – and amplify and share Get Well Canada posts and those of your FCSSBC allies.

Get your voice out there by penning op eds and letters to the editor for a local or national paper.

This toolkit gives you lots of great messages to use. Your writing will inform Canadians, the media and our political leaders to help change the story on what matters most for health.

Tell us what else Get Well Canada can offer to support your advocacy efforts!

We’re grateful that we can call on the fire department to put out the flames when we need them, but preventing fires in the first place is much less deadly, damaging and costly. Waiting to invest until people are ill is like showing up with hoses once the fire is already raging. To prevent sparks from getting out of hand, we need to invest more in the prevention that helps people stay healthy and well.

Medical care and social investments are not an either/or proposition – they are two sides of the same coin. Governments have neglected the social side for too long, leaving holes in our health system.

Access to medical care doesn’t top the list of the things that matter most for shaping our health. More important is the quality of our housing, the cleanliness of our environment, and our level of education, skills and incomes. That’s why social workers, community housing advocates, teachers, child care workers and many others are at the front lines of our health system. Let’s make sure we invest in their success. It’s a better and less costly way to improve health and wellbeing.

So long as Canadians can’t access safe homes, good incomes, quality child care and healthy environments, our medical system will never be enough to prevent people from dying early. These social investments not only reduce living cost pressures, they also slow the flow of sickness demoralizing our health professionals and overcrowding our clinics and hospitals.

The most important decision any government makes about health is what share of resources to allocate to the building blocks for a healthy society compared to what share to allocate to medical care.

In 1976, BC spent 20% more on social services and education than on medical care. Today, the opposite is true – BC spends 10-30% on medical care than on social services and education. This reversal means provincial investment decisions no longer follow a key finding of the best health science: that health doesn’t begin with medical care. The choice to allow medical investments to vastly outpace social spending has left two-thirds of British Columbians concerned that our medical system risks crowding out investments in other supports and services that help make us healthy and well.

With BC no longer designing budgets to align with health science, it’s no coincidence that medical costs are rising even while many struggle to access primary care. Or that medical professionals are burning out even as the number of doctors per capita increases. Many doctors may want to prescribe things like housing, child care, or poverty reduction that are essential for good health – but for that we need the provincial government to rebalance how it invests in wellbeing.

When it comes to making wise choices about health, Canadians have a thorny problem. Our beloved medical care system is as much a part of Canadian identity as the maple leaf and hockey. But we’ve left this system unfinished by withholding resources from the social and education sectors that shape health more than medicine. Now we’re paying the price. Medical costs are rising, but access isn’t, leaving patients frustrated and doctors and nurses burned out. It’s time to make room for something more by growing investments in the social conditions where health begins.

We leave our health system unfinished so long as we grow spending on medical services, but neglect investments in the things that keep us healthy – like decent incomes and affordable housing.

Our medical system was designed to treat people after they’ve fallen ill. It wasn’t designed to create health. Clinics and hospitals should be the last stops – not the first – for good health. The first stops in our health system are found in our neighbourhoods, jobs, child cares, and schools.

The most common advice we hear about medical spending is that it should go up, because more dollars are the path to improved health. An effective medical definitely system matters – but only in a supporting role. The star of the show is the social conditions in which we are born, grow, live and age. Health science tells us that governments can help people live longer and healthier by growing spending on social programs and benefits more urgently than spending on medical care.

How many times have you heard that a shortage of doctors is to blame for poor access, long waits and over-use of emergency rooms? Medical staffing challenges are taking a real toll on some communities, especially in rural areas – and that’s an issue we urgently need to solve. But the answer is more complicated than a recruitment campaign, because BC already has more doctors today than in the past. In 1976, BC had 162 physicians and 88 family doctors for every 100,000 people. In 2022, this was up to 270 physicians and 141 family docs. In fact, BC has the most doctors and family physicians of any province in the country. Some may find these data hard to believe, but until we reckon with them we’ll continue to overlook a key part of the story about what’s plaguing our medical system. Get Well Canada has a different prescription.

Anyone who’s waited in line to buy concert tickets knows two things matter for whether you’ll be happy when you reach the front: the number of tickets available (supply), and the number of people in line (demand). Why have we forgotten this simple equation when it comes to our medical system? There are more doctors per capita caring for British Columbians today than in the past, yet too many of us still wait in line for care. Since a larger supply of doctors isn’t the only answer, it’s time to ask why the line of patients is so long – and what we can do to shorten it.

We can help reduce burnout for doctors and nurses by investing more urgently in things that support people to be healthy and well – before they need medical care.

… so it matters that we can count on our governments to make the best investments to improve health and wellbeing. That means following the advice of health scientists when they tell us that our health depends more on the social conditions in which we live than on the medical care we receive.

… and that means putting taxpayer dollars behind the investments recommended by health science. So why isn’t the BC government following this prescription? Decades of provincial budgeting has ignored the best advice by permitting medical spending to rise much faster than spending on the building blocks for a healthy society.

… because we all want to count on getting the care we need, when we need it. That’s why we all have a stake in shortening the line of patients waiting in line at our clinics and hospitals. We can do that by investing more where health begins: in safe homes and communities, where people have enough income to purchase essentials, and services we can fall back on. Doctors can’t prescribe these things – only governments can. That’s why we need our budgets to deliver more timely access to medical care by prescribing social investments that keep pace with medical investments.

… and it would be nice if hiring more doctors were the silver bullet to fix our medical system. Beefing up staffing is one ingredient, but it’s not the whole recipe. That’s because BC already has more doctors per capita than in the past – and more than any other province. Deeper solutions must grapple not only with the supply of doctors, but also with why the line of patients in need to care is so long. We can start by considering root causes of ill health, like poverty and unaffordable housing. Investing in these (and other) social supports can improve health outcomes and decrease cost pressures.

… which means making sure governments have the information they need to make good decisions. When it comes to health, decisions should be guided by data on medical care AND data on the social conditions where health begins. To fill this gap, we’re calling on the province to report and monitor data on the scale of social spending relative to the scale of medical spending. When this investment ratio isn’t optimal, we’re not getting the best bang for our health dollars.

… but it’s hard to manage what we don’t measure. To improve the health of British Columbians, the province should add a critical indicator to annual budgets: the ratio of social and education spending relative to medical spending (SE/M ratio). This indicator is the north star our province should follow to design healthy budgets.

BC’s current deficit IS alarming – but this makes it all the more urgent to switch tactics. Rising medical spending is the biggest contributor to growing deficits, so containing spending growth is a key strategy to restore balanced budgets. Health science encourages BC to recognize that medical care is a costly way to improve health outcomes. Governments can help people live longer and healthier by growing spending on social programs and benefits more urgently than spending on medical care.

We get more bang for our bucks when we ensure that increases in medical spending don’t crowd out investments in the building blocks for a healthy society. Plus, a heathier population will save us money in the long-term. The 2024 BC budget strayed from this evidence, increasing spending on medical care by more than any other year – $4.5 billion in 2024, growing to $6 billion more by 2026.

British Columbians know the importance of investing in health, not just medical care. More than half are willing to pay a bit more in taxes so government can invest more in things that help make people healthy and well – like lifting people out of poverty, making housing more affordable, and ensuring kids gets off to the best start in life – while also slowing the flow of sickness into emergency rooms and doctors’ offices.

Investing more urgently in the social supports that create health does NOT require cutting medical funding, and cuts are not what Get Well Canada recommends. BC can rebalance its budget by focusing on where to put new spending – making sure these new investments grow social spending more urgently than medical spending. That’s how our government promotes health in all policies.

7 in 10 British Columbians agree that for every $1 added to medical care to treat illness, governments should spend at least $1 to protect the building blocks for a healthy society, like housing, child care and poverty reduction

It’s true that too many British Columbians don’t have adequate access to primary care, and that some communities are struggling to keep emergency rooms staffed and open. These are urgent problems we need to fix. A real commitment to solutions means looking at more than recruiting health professionals. BC has more doctors relative to the number of residents today than at any time in the province’s history, so ramping up hiring isn’t enough on its own. We need to think about how we can shorten the line of patients needing care – and that means investing in the social conditions where health begins.

Having enough doctors matters, especially as BC’s population ages. The complex care needs of our aging loved ones are a key driver of demand for medical services. Yet research shows that doctors do have a vested interest in expanding services for our elders. With the number of physicians per capita increasing, offering more services sustains demand – and in turn, physician incomes. The punchline is that medical service expansion is driving up medical costs more than population aging itself. It’s essential to keep this broader context in mind as we search for the right mix of ingredients to fix medical care challenges.

Making sure all British Columbians have access to a doctor when we need one is a top priority. Since most of us use more medical care in retirement, it’s especially important for our elders. Recognizing the role that population aging plays in driving increased medical spending is a critical starting point for the systemic fixes we need to improve access. That’s why it’s disappointing that successive provincial governments haven’t planned adequately for the aging of our population – or the fiscal pressures it creates. Now, rising medical spending is both driving up provincial deficits, and squeezing investments in the social conditions where health begins, especially for younger people.