Why do provinces choose firefighters over fire prevention when it comes to our health?

Canadians’ cost of living is skyrocketing and our medical system is on fire. Instead of dousing the flames, health ministers added fuel to the fire when they failed to agree on a plan to stabilize medical care at their most recent meeting.

This failure reflects a lack of awareness that these twin crises are born from the same fundamental problem. For decades governments have bought into a myth that medical care is what most makes us healthy, ignoring science that shows social supports contribute more to our wellbeing.

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 means provinces abandoned the wisdom of Tommy Douglas – the father of health care. “Let’s not forget,” he said, “that the ultimate goal of Medicare must be to keep people well rather than just patching them up when they get sick.”

It’s time to rally around this goal once again.

The solution is as obvious as the answer to this 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. Overwhelmed 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.

Science tells us we need to do more to prevent people from getting sick. It’s old wisdom that an ounce of prevention is worth a pound of cure. A healthy population needs less medical care. But we continue to prioritize cures, pouring more and more money into a medical-care system that has not made us healthier. This strategy has failed. Now is the time to change course.

When provincial governments charge that Ottawa has retreated from investing in health care, they distort the complexity of health funding. They don’t account for intergovernmental transfers through the tax system and they misrepresent the rising value of the Canada Health Transfer that Ottawa pays to the provinces every year. But even more important, this complaint ignores recent federal investments in child care, housing, poverty reduction, mental health – key determinants of health in which provinces could have invested more urgently, but didn’t.

Canada’s health system can’t just be clinics and hospitals. They should be the last stop, not the first, since medical care was designed to treat people only after they’ve fallen sick.

The first stops for wellbeing are in our neighbourhoods, jobs, child care centres, and schools – something that COVID-19 made painfully clear. Good health outcomes won’t materialize without adequate social investments, a fact many doctors try to address when they want to (but can’t) prescribe poverty reduction, child care and housing.

When we act like hospitals are the starting point for good health, it’s no wonder we get stuck putting out medical care fires, and risk being burned in the process. Medical care and social investments are not an either/or proposition. They are two sides of the same coin. Provincial governments have neglected the social side for too long, leaving holes in our health system that have become fire hazards.

Health ministers must tackle this hard truth at their next meeting.


Dr. Paul Kershaw is a policy professor at the UBC School of Population & Public Health

Trish Hennessy leads Think Upstream at the Canadian Centre for Policy Alternatives

Andrea Long is Senior Director, Research & Knowledge Mobilization, at Generation Squeeze

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