The election is upon us, and unsurprisingly, health care is a main area of focus for all political parties asking for our votes against the backdrop of COVID-19.
The pandemic has shown us how fortunate we are to enjoy publicly funded medical care, strong health infrastructure, and a committed and resilient health work force. We thank them.
Unfortunately, it has also highlighted the gaps and inequities that we knew existed prior to COVID-19 – but which we have been far too slow to address. These challenges are all too visible in the disproportionate impact of the pandemic on women, racialized communities, people with lower incomes, and those who are geographically or socially marginalized.
All major political parties have committed, in some manner, to strengthening the federal role in health care. Conservatives plan to “inject $60 billion into our healthcare system over the next ten years” through increases to the money provinces receive via the Canada Health Transfer (CHT). While their platform is not yet costed, it seems like this promise comes on top of the $37 billion already budgeted for the CHT over the next five years by the Liberal’s last budget. The NDP wants to expand the publicly funded health care system to include mental health services, elder care, dental care and vision care.
So – billions and billions in new medical care spending is a good thing, right? Federal leadership candidates are unified around health as a core priority for Canadians. And Canadians agree with this assessment. Recent public opinion polling commissioned by Canada’s Department of Finance found that we identify physical health and mental health among our top 3 most important determinants of quality of life.
Case closed. We can go to the polls confident that all parties will be investing in the health of Canadians.
Hold on… not so fast. They may be investing in health care – but is this the same thing as investing in health? The answer is No.
Decades of public health and policy research confirm that health doesn’t start with medical care – it starts where we are born, grow, live, work and age. In other words, social, economic, environmental, cultural, and other factors that affect our experiences across the life course all importantly shape our health. The shorthand for these diverse factors is ‘social determinants of health’.
The pandemic has made many of us keenly aware of these social determinants. 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; and our access to education, childcare, parks, and social networks.
If it is important to you that the policy choices made by our elected officials are based on the best available evidence, there are at least two key things that you should know about these determinants of health.
One. Social determinants of health have a stronger influence on our health and wellbeing than does medical care. In other words, we can do more to promote the health of Canadians by supporting child development, housing, education, poverty reduction, literacy, quality employment, environmental protection (and so on) than we can with medical care investments alone.
Two. Money spent on social supports to prevent illness improves the population’s health and prevents avoidable illness more than money spent on medical care to treat people once they are already sick. So for those of you who make decisions based on the bottom line, the tax dollars you want to see invested in health will generate more bang for the buck if they are invested in advancing social wellbeing – and this means directing more funding to sectors other than those responsible for medical care.
Despite the fact that investing in social determinants is necessary to secure the health and wellbeing of Canadians, ever-growing medical care budgets are crowding out opportunities for meaningful action.
Since 1998, annual medical care spending has increased by $98 billion (after adjusting for inflation). Over the same period, the pool of government revenues from which medical costs are paid dropped by $165 billion. Together, these trends mean that there is less and less left over for social investment (See this study for more details). This challenge is amplified by a political culture that prioritizes lower taxes, but also improved medical services. Canadians want to pay less, but not get less – and politicians are complicit in this fantasy by failing to be transparent about the fiscal trade-offs it requires. When our political parties promise more money for medical care without being straight with Canadians about the revenue required to pay for it (not to mention the lack of any clear plan to balance the budget over the next mandate and address historic COVID related debt), it is clear that this pattern is repeating itself in the 2021 federal election.
Younger Canadians are bearing the brunt of seismic shifts in Canada’s fiscal landscape. Because health care needs increase as we age, the majority of medical care spending goes to the growing number of Canadians age 65+. When combined with escalating public pension costs, Gen Squeeze research shows that governments increased per person spending on retirees 4 times faster than spending on younger Canadians since 1976, around when Baby Boomers came of age as young adults. The persistent lack of public investment in social determinants of health for younger generations – like child care, postsecondary education, housing affordability, and climate action – is causing their wellbeing to deteriorate.
In this election, we need our candidates to walk the talk on what it really means to support the health of Canadians. Investments in social determinants are investments in our health and wellbeing. This kind of ‘health in all policies’ approach should be at the heart of the platforms on which political parties are asking for your vote. Politicians and voters alike need to resist the idea that allocating more and more funding to medical care is just and kind… and therefore doesn’t need to be queried. Instead, the evidence would encourage us to cast our votes for parties that promise to grow social spending faster than medical spending – especially for younger Canadians. And we need every party to promise reporting on the balance between social and medical spending every year in government budgets so that the public can monitor whether governments are aligning their policy decisions with existing evidence about what actually promotes health and wellbeing.
Gen Squeeze has the policy solutions needed to advance social determinants of heath, and support health and wellbeing for all generations. We’ll be evaluating the federal platforms against these evidence-based solutions.
This blog was co-authored by Andrea Long and Dr. Paul Kershaw
Dr. Paul Kershaw is Director of the University of BC Masters of Public Health Program in the UBC School of Population & Public Health, and Founder of Generation Squeeze.
Andrea Long is the Senior Director for Research and Knowledge Mobilization at Generation Squeeze