To the extent health is an issue in the federal election, it will be about health care, as usual. Now I am not saying health care is an unimportant issue, but this focus on ‘health care as health’ is wrong for two reasons. First, health care is a provincial responsibility under the Constitution, so the federal government plays no real role in managing Canada’s various provincial and territorial health care systems.
Second, and more important, health is not health care, it is a much bigger issue – and one where the federal government can indeed play a major role. If we really want to improve health care, we must improve health, thus reducing the growing burden of disease and injury the health care system has to handle.
So as we think about the federal election, look at party platforms and promises, and engage with candidates, the question we should be asking is “What will you do to protect and improve the health of Canadians?” Here and in the next few columns I will discuss the policies I believe we should be looking for to determine whether our political leaders really understand and care about the health of Canadians.
In this I am not alone. The Canadian Public Health Association (CPHA) has identified eight top election issues and has produced an excellent set of resources for citizens and public health professionals, giving easy access to the parties’ platforms and tools to help people engage candidates in their riding (see www.cpha.ca/election-2019)
CPHA’s priorities include such basic determinants of health as income, housing, early child education and climate change. They also focus on the opioid crisis, decriminalization of personal use of psychoactive substances, racism, and not surprisingly, on the funding of public health. To this list, I would add food, transportation and urban development, although the latter, like health care, is within provincial but not federal jurisdiction.
But over and above all of this is the need for a comprehensive and strategic approach to improving the health of Canadians. There was a time, in the 1980s and 1990s, when Canada was a world leader on these issues, but sadly that is no longer the case. As with so much else that is wrong with public policy, it is not lack of knowledge that leads to poor policy choices, but lack of wisdom, lack of a long term perspective and the inability to act in the public interest rather than in the interest of powerful corporate and institutional players.
The first step in making the health of Canadians a priority is to recognize that the Minister of Health is actually largely the Minister of Illness Care, and that it is the Cabinet as a whole, and the Prime Minister or Premier in particular, that is really the ‘Minister of Wellbeing’. Improving the health of Canadians depends more upon the Ministers of food, housing, education, finance, social development, environment and climate change and others than the Minister of health.
The Canadian Senate recognized this in a 2009 report that recommended “A new style of governance: leadership from the top to develop and implement a population health policy at the federal, provincial, territorial and local levels with clear goals and targets and a health perspective to all new policies and programs”.
Specifically, the Senate recommended creating a Cabinet Committee on Population Health (which should be chaired by the Prime Minister/Premier) that would develop and implement a population health policy. This policy would require an assessment of the health impact of policies in all sectors, and a spending review to determine where we would get the biggest health/human development return on our investment.
To this, I would add the creation of an independent Canadian Population Health Officer, reporting to Parliament (not to the government) on the effectiveness of public policy and programs in improving the health of the population.
The report sank like a stone! So if you are concerned with the health of the population and the sustainability of the health care system, you should ask candidates if they will commit to creating a Cabinet Committee on Population Health, displacing economic development as the central focus and instead putting development of human wellbeing at the heart of government.
© Trevor Hancock, 2019
Originally published 17 September 2019