Toronto Star: Real health innovation means investing where health begins

From Toronto Star | By Paul Kershaw & Andrea Long

Canadians know the status quo isn’t working when it comes to medical care. Recent polls suggest these concerns may dominate this week’s federal Liberal caucus retreat. Alas, intergovernmental negotiations so far miss the mark on the “innovation” required to disrupt this dysfunctional system.

While reams of evidence confirm that health doesn’t begin with medical care, provincial governments consistently overlook this evidence when designing health policy.

Public dialogue so often asks how much more to invest in medical care to treat those already sick, what share of this funding should be delivered through public or private clinics, and how much of it should be used to pay doctors? These questions are important, but their answers are not enough to make us healthy. We must focus more on the investments needed to prevent illness, and keep people well.

Hospitals and clinics should be the last stops for health, not the first. The first stops are in our neighbourhoods, jobs, child care centres, and schools — something COVID made painfully clear. Good health outcomes require adequate social investments, a fact many doctors try to address when they want to (but can’t) prescribe poverty reduction, child care and housing.

In the 1970s, provincial governments consistently spent more on social services and education than they did on medical care. Now, the opposite is true.

This provides the federal Liberals a big opportunity as they head into this week’s caucus retreat. Rather than invoking the public vs. private zombie under the guise of health innovation, Liberals should confidently observe that their approach to health is more competent than the approach followed by most provincial governments.

According to health science, federal Liberal investments in child care, housing, poverty reduction, and climate action ARE investments in health. Federal leadership has been necessary because provinces have been retreating from investing in the social conditions that shape health and well-being. Any additional federal transfers for health ought to encourage provinces to achieve a better balance in their social and medical spending in order to promote health.

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. That’s why Tommy Douglas, the father of Canadian health care, observed: “Let’s not forget that the ultimate goal of Medicare must be to keep people well rather than just patching them up when they get sick.”

Tommy Douglas’ wisdom signals we all share a clear answer to the question: would you rather flee your burning home or do what’s needed to prevent a fire? Of course we’re grateful for firefighters and their heroism, but preventing fires is much less deadly, damaging and costly. So why do provincial governments choose firefighters over fire prevention when it comes to our health?

The results of this decision are clear. Burned out doctors and nurses. News headlines about people not getting the care they need when they need it.

After decades of neglecting illness prevention and wellness promotion, some additional investments in personnel and clinical services are needed to put out the fire in our medical system. But such investments will never be enough to extinguish the flames on their own.

Medical care and social investments are not an either/or proposition. They are two sides of the same coin. Canada has neglected the social side of the equation for far too long, leaving holes in our health system that have become fire hazards. We must complete our health system by righting this imbalance.