The federal election seems to be focusing largely on issues such as the economy and security. If health is mentioned at all, it is in the context of health care. But as I hope I have made clear in these columns, while health care is a determinant of our health, it is not the main one. While our genetic inheritance also plays an important part, much of our health comes from the environmental, social, economic, cultural and political conditions we create as communities and as a society.
In our system, of course, the federal government does not provide health care or manage a health care system, aside from special situations such as for Aboriginal people and the armed forces. But many other areas of policy for which the federal government does have full or at least partial jurisdiction do influence the health of Canadians.
So as an advocate for health, wellbeing and human development, I want to spell out what federal policy for health would actually look like if the federal government were truly concerned about the wellbeing of Canadians, rather than the wellbeing of the economy (and they are not the same thing)
A real federal health policy would begin by acknowledging that the health and wellbeing of the population is a central concern of government. This would lead to an identification of the main areas of federal responsibility that have the greatest impact on health. Then the question becomes one of determining how to better coordinate policy both within the federal government and between the federal, provincial and municipal governments so as to improve health.
Happily, the Canadian Senate has provided a useful guide. I realise the Senate is not often referred to in positive terms, but not everything the Senate does is bad. A case in point is the 2009 report of the Senate’s Sub-Committee on Population Health. Although completely ignored by the federal and provincial governments, the report contains many worthwhile ideas for improving the health of the Canadian population.
In particular, the report focused much of its attention on ‘governance for health’. If we take seriously the idea that one of the prime functions of government is to improve the health and wellbeing of the population, how would that change the way the government works? Here is what the Senate recommended:
First, they proposed that the federal and all the provincial governments establish a population health policy (none of them have such a policy right now). Second, they recommended that they establish a Population Health Committee of Cabinet, chaired by the PM or the Premier (although I would prefer this to be a Human Development Committee). But no matter what it is called, the point is that it corrects a major oversight in our systems of government. We have economic development and social development and even in some cases (environmentally) sustainable development committees, but not one focused explicitly on human wellbeing and development.
The importance of the PM or the Premier chairing this Cabinet Committee cannot be overstated. It gives the message (sadly lacking in many governments, in practice) that the focus of government is on the wellbeing of the people. Morover, it should also give the message that economic, social and environmental development will be harnessed in the interest of human development, as they should be.
Third, the Senate’s report recommended “that the Prime Minister of Canada convene a meeting with all First Ministers to establish an intergovernmental mechanism for collaboration on the development and implementation of a pan-Canadian population health strategy”. Clearly, this is not something Mr. Harper will do, but someone needs to take leadership, maybe the Premiers on their own?
Another key strand in the Senate report is that governments conduct health impact assessments of major policies and programs that might be expected to have a significant impact on health. What, for example, is the health impact of our existing energy system and what would a ‘healthy’ Canadian energy policy look like? How about a healthy food and agriculture policy, a healthy urban planning and transportation policy, a healthy housing policy?
These ideas are not ‘pie in the sky’; they have been developed and implemented in other parts of the world, notably in the State of South Australia and in some countries in Europe. It is time Canada caught up. It is time for health to matter in this federal election.
© Trevor Hancock, 2015
Originally published in Times Colonist 19 August, 2015