Contrary to what the pandemic would have us believe, public health is about much more than COVID-19.
Public health is about keeping people healthy in the first place, so that they are less likely to need health care — “sick care.”
Public health is about the social determinants of health, which are the social, economic, ecological, and political factors that shape peoples’ lives and, therefore, their health and well-being.
These considerations are crucial for well-being budgeting, which this government has previously expressed as a priority.
To consider what throne speech 2020 means for public health, it requires examining the speech in its entirety, not just the sections about COVID-19.
The throne speech’s first pillar is to fight the pandemic and save lives. This is largely the domain of the health care system. Preventing and containing the spread of COVID-19 falls to the public health arm of that system, which, according to the Canadian Institute for Health Information, receives around 5% of all health care spending (and even less in some provinces).
As the pandemic demonstrates, that allocation is disproportionate to the importance of public health.
While the speech acknowledged that local public health authorities are the backbone of the nation’s efforts to stop communicable disease outbreaks before they start, there was no indication of an increase in funding support and resources (e.g., via health transfers to provinces) to those local authorities.
The throne speech promised federal government support to help provinces increase their testing capacity, which is welcome. In addition to reducing line-ups, robust testing infrastructure is essential for accurate estimates of morbidity and mortality from COVID-19, which are, in turn, essential foundations for an evidence-based public health policy response.
But preventing ill health—including, but not limited to, COVID-19—and promoting health and well-being in an equitable manner demands attention to government priorities beyond health care. Although this is not well recognized in the Canadian population, no amount of spending on health care will address the social determinants of health.
There is an enormous amount of research showing that the primary determinants of health and well-being have to do with the resources (e.g., income), opportunities (e.g., education), and power (e.g., inclusion and voice) that are available to individuals and communities—as well as the public policies that shape those conditions.
From this perspective, now is not the time for austerity, which the government acknowledged in the throne speech. Quite the opposite: investments in three key areas that affect public health are needed now more than ever.
- Income inequality and health
Research shows that income inequality—a large gap between the rich and poor—is toxic for health, for everyone. It also shows that health follows a social gradient: the higher the income of individuals, households, and communities, the better the health outcomes.
Healthy public policy must, therefore, consider the income spectrum.
With the Canadian Emergency Response Benefit (CERB), the federal government demonstrated that it could be nimble and generous in supporting millions of Canadians affected by lost work.
Tackling income inequality, and its implications for health, demand attention to the top of the income scale as well. A recent CCPA analysis showed that, far from losing money during the pandemic, Canada’s billionaires have continued to accrue wealth.
The throne speech promise to identify ways to tax extreme wealth inequality—that’s a step in the right direction.
- Health across the life course
Research strongly supports the benefits of investing in high quality early childhood education for health and well-being—not only for children, but for society as a whole.
From that point of view, there are few more important sentences in the speech than where the government promises to make a significant, long-term, sustained investment to create a Canada-wide early learning and child care system.
As Pat Armstrong writes, the COVID-19 pandemic put on display Canada’s history of devaluing seniors’ care, including caregivers. Attention to these issues, in the form of working with provinces to set national standards, is promising but may not go far enough, fast enough. Immediate action is required.
The government re-stated its commitment to increase Old Age Security (OAS) for seniors once they turn 75. As one of the only universal social transfers in Canada, with demonstrable effects on health, this initiative is an important healthy public policy initiative.
- Ecological determinants of health
As noted by the Canadian Public Health Association: “The relationship between human beings and the ecosystems of which they are a part is profound. The links between health and the environment are as old as human culture.”
We are living in a climate emergency, and as Trish Hennessy has noted, the magnitude of the climate emergency is equal to, if not greater than, the COVID-19 pandemic. For health and well-being for all, aggressive, sustained climate action is needed now. It remains to be seen whether this government will deliver.
Public health is defined as the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society.¹
This is public health—and these are the investments required to improve public health.
Lindsay McLaren is a CCPA research associate, and a Professor in the Department of Community Health Sciences and the O’Brien Institute for Public Health at the University of Calgary.
¹Last, J. (ed) (2001). A dictionary of epidemiology, 4th edn. New York: Oxford University Press.