Show you can lead in public health policy, Ottawa

Within Canada’s federal and provincial governments there may be feelings of relief that the latest round of wrangling over health-care funding has wrapped up. On top of previously-announced increases in federal transfers over the next decade, the provinces and territories have agreed to receive an additional $46.2-billion via the Canada Health Transfer and another $25-billion through bilateral agreements in four priority areas: family health services, health workers and backlogs, mental health, and substance abuse. The federal government can now check ‘health-care funding’ off its to-do list. On the provinces’ and territories’ end, funding has been gained with remarkably few constraints on how it will be spent. According to analysis by the Canadian Centre for Policy Alternatives, provinces and territories are required to spend on average only 58 per cent of the total $196.1-billion in federal health transfers on actual healthcare spending, with 42 per cent going toward whatever premiers choose. As for the priority areas targeted through bilateral deals, these are so broad that, as journalist Paul Wells has noted, “t would be fiendishly difficult for any province to avoid spending money on these federal priorities.” Substantively, however, this deal is underwhelming for observers who expected to see more robust federal intervention to address the much-discussed systemic failings of Canadian healthcare. In contrast to the federal government’s prior insistence that conditions were needed to fix broken systems, this deal's ambition falls short. In the words of health columnist André Picard, “hat’s dispiriting about the whole process is how much it has focused almost exclusively on money.” Large parts of Canada seem to believe, to quote health policy expert Steven Lewis, that “Ottawa has neither the power nor legitimacy to demand real accountability for health system performance.” The current federal government certainly seems to believe so. If we’re not going to see Ottawa use tied funding to produce real impact on health systems, is there anything left to hope for? Actually, yes: there is another avenue at its disposal, one that’s both farther-reaching and cheaper. Instead of fixating just on the incredibly costly medical systems that treat us when we’re sick, the federal government can decide right now to invest policy leadership in strengthening the public health systems that keep us healthy. Public health systems aren’t only important in pandemics, they also help prevent injury and avoidable disease, help support healthy families and communities, prepare for emergencies, and reduce health inequities across Canadian populations. Ian Culbert is executive director of the Canadian Public Health Association. Handout photograph Currently, as a result of provincial/territorial disinvestment and malign neglect, Canada’s public health systems are neither cohesive or comprehensive, nor are they accountable for the outcomes they achieve. This patchwork of disjointed federal and provincial/territorial systems weakens the capacity of public health professionals to deliver high-quality services that keep Canadians healthy. These failings undermine Canadians’ ability to access acute care when they need it. As noted by Canada's Chief Public Health Officer Dr. Theresa Tam, reducing the demand on doctors, nurses and emergency rooms is imperative: “part of the solution” to the crisis in acute healthcare, she noted “is actually shoring up public health.” That’s why the Canadian Public Health Association (CPHA) is urging Canadian governments to commit to strengthening public health systems nation-wide. The first step is for Ottawa to convene provincial and territorial governments and other key stakeholders in a working group on policy foundations for public health services. Initially, the working group should address the core public health functions and the population-level health goals that public health services should aim to achieve for Canadians. That foundation will ground the analysis of the workforce competencies and training needed to deliver those services, as well as governance approaches required to make systems deliver on their mandates. In discussing CPHA’s proposals this winter with government officials and Parliamentarians, we’ve heard much support and agreement that a window of opportunity is open for the federal government to exercise policy leadership in an arena with huge potential for public benefit. Addressing the foundational structure of public health isn’t a project that the provinces and territories will ever take up on their own. Only the federal government can initiate the collaborative effort that, in the end, may do far more for Canadians’ health than a dozen future rounds of healthcare funding battles. Ottawa, it’s time to show your health policy chops. Ian Culbert is executive director of the Canadian Public Health Association. The Hill Times