The Globe & Mail: Fixing the affordability crisis is key to fixing medical care

Originally published in The Globe & Mail on October 28, 2023

Financial security matters more for our health than access to doctors. Whether you are concerned about declining affordability or growing medical care pressures, governments need to better balance spending on medical care with other priorities that are critical to our well-being, such as reducing poverty, the costs of housing and child care, and climate risks.

A poll sponsored by the Canadian Medical Association this summer found that one in five Canadians don’t have a family doctor. Provinces such as B.C. have responded with recruitment and retention plans for family physicians, including a $135,000 annual pay increase.

If having more doctors were the primary solution to our health challenges, we should have made lots of progress over the past several decades. There were 143 physicians for every 100,000 residents in 1976, compared with more than 240 today, according to the Canadian Institute for Health Information.

Risk of burnout among medical professionals is a growing concern. But a narrow focus on the number and earnings of doctors ignores a root cause of the problem: the number of patients. To decrease patient-loads, we must reduce some of the causes of medical problems, including financial insecurity and the costs of an increasingly unpredictable climate.

Canada’s four most populous provinces spent 16 to 36 per cent more on social and education programs than on medicine in 1976. Now they routinely spend five to 28 per cent less. This is fiscally inefficient and signals governments invest more to treat illness than they do to prevent it.

Budgeting more for medical care may be viewed as a vote-getter, but recent online polling by Research Co. for Get Well Canada shows that it’s time for a course-correction. Across Canada, 78 per cent agree that “So 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.” (The poll surveyed 1,002 adults in August.)

Medical care and social investments are not an either/or proposition – they are two sides of the same coin. Yet eight in 10 Canadians worry that “we’ve neglected the social side for too long, leaving holes in our health system.”

The same proportion believes “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.” Adequate income, affordable housing, and healthy climate top the list of what respondents prescribe to promote health.

Many Canadians worry that provincial governments don’t strike the right balance between promoting health and treating illness. Seven in 10 agree that “Spending on medical care is growing so fast that it risks crowding out spending on other supports and services that help make Canadians healthy and well.”

For every $1 added to medical care to treat illness, 77 per cent think governments should be spending at least $1 to protect the building blocks for a healthy society, like housing, child care and poverty reduction.

Most are even willing to put their money where their mouth is. Fifty-five per cent said they “would be willing to pay a bit more in taxes” to keep people from needing to visit emergency rooms and doctors’ offices.

These polling data reveal that Canadians embrace the adage that an ounce of prevention is worth a pound of cure. There’s good reason for governments to follow their lead as they struggle to balance their books.

Governments can address the affordability and medical care crises – while also relieving pressure on their budgets – if they better balance their investments.

The most important decision any government will make about our health is what share of the budget pie to invest in the building blocks for a healthy society. When this slice is consistently smaller than the piece for medical care, we are more likely to get sick or injured, because good health begins where we are born, grow, live, work and age – not in doctors’ offices.

This isn’t about cutting medical care. It’s about ensuring a bigger share of the next available tax dollar goes to social supports.

When we can rely on adequate incomes along with affordable housing and child care to help keep us well, we ease the load on doctors, nurses and hospitals. Canadians will be wealthier and healthier when we do.

Dr. Paul Kershaw is Founder, Lead Researcher & Executive Chair of Generation Squeeze. He is a policy professor in the UBC School of Population and Public Health, and Director of the UBC Masters of Public Health program.