In the B.C. election last year, Premier John Horgan’s party campaigned on a platform that promised to increase spending on medical care more than any other social policy.
But new research published in the Canadian Medical Association Journal cautions the Premier against this strategy. Don’t grow medical care spending more than other social spending, the research warns, because health doesn’t start with health care.
That’s the finding from decades of science. It shows that health starts where we are born, grow, play, work and age. Think social expenditures like childcare, housing, early childhood and post secondary education – because having a decent income, an education, secure housing, and a safe and clean physical environment are the real determinants of health.
These conditions are shaped by the distribution of wealth, income, education, employment, housing, food, human impact on the environment, and the many government policies that influence these factors.
While it may seem surprising, this means health promotion is actually the domain of social, economic and environmental ministries of government, whereas medical ministries treat illness more than they prevent it. Accordingly, the World Health Organization routinely urges governments to adopt a “health in all policies” perspective.
As a result, it is worrisome that per capita medical spending in Canada has increased ten times faster since 1981 than did social spending.
In fact, the typical young British Columbian today pays around 50-60 per cent more in taxes for the medical care of people over age 65, in comparison with taxes paid for medical care by today's aging population when they were young. This happens even though total taxes overall are down 12-20 per cent.
Such a spending pattern associates with lost opportunities to improve life expectancy and prevent avoidable mortality by comparison with a more even distribution between medical and social investments. This is the provocative finding reported by Dr. Daniel Dutton and colleagues in a new study about the health impact of government spending.
So when it comes to evaluating the 2018 B.C. budget, the latest research reveals we should judge it to be healthy only if new spending on programs like child care, housing and poverty reduction outpace new investments in medical care.
Homes for health
A healthy budget isn’t just about spending, however. A commitment to health in all policies also invites review of government decisions that shape major costs of living – like housing.
Average home prices used to cost four times median earnings for typical young British Columbians in 1976, but now cost 14 times that amount. Stabilizing home prices does not require additional public spending so much as adaptations to outdated policies that limit supply by restricting density in urban centres, and increase demand by sheltering real estate wealth from taxation.
In response, a healthy B.C. budget needs bold measures to rein in home prices, because high home costs make the conditions into which we are born, grow, play, work and age so much more challenging. The government can achieve this goal this by:
- restricting harmful demand that results in empty homes and short-term rentals for vacationers at the expense of homes for locals
- stimulating a surge in suitable supply, including purpose-built rental, by encouraging cities to open up their zoning for more homes
- taxing housing wealth fairly when measuring people’s ability to pay for medical care.
Health scholars like me are interested in taxation because research suggests governments would be wise to generate revenue more often by taxing what harms health (like home prices outpacing earnings) and less by taxing what promotes it (like higher median earnings).
Such logic encourages the provincial government to consider reducing income taxes for everybody, or eliminate the medical services premiums for everybody, by implementing a modest 1 per cent annual tax on home wealth valued above $1 million (for which payment could be deferred until the sale of the home).
Not only would this re-balancing of how the province collects government revenue discourage the high home prices that harm population health, the vast majority of British Columbians, including over 80 per cent of home owners, would save money. It’s a policy option worth further consideration.
The same goes for pricing carbon. Since many medical scientists judge that climate change is the greatest risk to human health, it is time to revisit why carbon pricing only generates 2.4 per cent of B.C. government revenue.
Tax more what we don’t want (housing speculation, pollution), so we can tax less what we do want (income). Find a better balance between investing in programs like child care and medical care. And modernize housing policies that currently limit suitable supply and increase harmful demand to drive up our major cost of living.
That’s what research about population health recommends for government budgets. Hopefully, the new B.C. government will follow through.
When the budget is released, we’ll help you understand whether the BC NDP are coming through on their big ticket affordability promises, or whether they seem to be kicking the can further down the road. Join us at our live event in Victoria B.C., or livestream from anywhere in the province!
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