A successful strategy will need to tackle the inequitable distribution of power, money, and resources
Deep in the 724-page federal budget of 2021, in Annex 4, is a Gender, Diversity, and Quality of Life statement. With respect to quality of life, the document states:
“The Government of Canada is working to better incorporate quality of life measurements into decision-making and budgeting based on international best practice, expert engagement, evidence on what shapes well-being, and public opinion research on what matters to Canadians.” (p. 410)
Although in its early stages, this initiative could signal important steps towards strengthening social determinants of health in Canada, by supporting a cross-sectoral and whole of government approach to decision-making—including budget allocations—that is guided by community wellbeing.
In other words, the federal government’s Quality of Life strategy resembles, to some extent, a health in all policies approach and a wellbeing budgeting approach.
With that potential in mind, the purpose of this post is to briefly summarize and provide some critical commentary on the strategy, drawing from Annex 4 of the budget and the more detailed discussion paper from the Department of Finance.
First, and significantly, the Quality of Life strategy is grounded in the increasingly obvious drawbacks of the current decision-making framework in governments, which is guided by blunt economic measures like Gross Domestic Product (GDP). While a focus on GDP is effective for generating economic growth, it does not consider how fairly that growth is distributed, nor does it adequately consider negative consequences of economic growth for “non-market” elements of our society, such as the significant environmental consequences of fossil fuel extraction.
In short, the current decision-making framework creates winners and losers with respect to health and wellbeing of people and the planet. A Quality of Life approach potentially represents a significant departure from the current framework.
Second, the strategy builds on important foundations of expertise and infrastructure. These include the Canadian Index of Wellbeing, for which work has been ongoing since the early 1990s, and Statistics Canada’s long history and extensive experience in measuring quality of life in Canada.
Signalling this intention to build on existing expertise and infrastructure, Budget 2021 allocates funds to Statistics Canada, as well as to Indigenous Services Canada and to Environment and Climate Change Canada, to support meaningful, timely, and reliable data and measurement.
Third, the Quality of Life framework is thoughtful and offers a coherent vision for health and wellbeing. It includes five domains, which were selected through broad consultations as being especially important determinants of quality of life.
These are:
Prosperity: Such as affordability of basic goods, like housing, and publicly funded services.
Health: Understood as more than the absence of disease; shaped by conditions in which we grow, live, learn, work, and age; reliable access to timely and appropriate health care.
Environment: Such as the natural environment, which is the foundation of human existence; and the built environment including access to parks and public transit.
Society: Such as having the time and opportunity to foster personal relationships; community vitality and opportunities for cultural expression.
Good Governance: Such as a well-functioning democracy, where all Canadians feel that their fundamental rights and freedoms are respected, can participate in civil society and know that their voices are being heard.
Each domain has 2-4 sub-domains, each of which has several indicators (see Annex 1 of the discussion paper from the Department of Finance).
The domain approach was, appropriately, selected over a single summary measure of overall wellbeing which has been used in frameworks elsewhere. Although single summary measures may be convenient, they also have important drawbacks, perhaps most notably the challenge of constructing such a measure that meaningfully reflects the lived experiences of all Canadians. At the same time, it is recognized that having too many domains can cause other challenges, such as presenting an imprecise guide for policy.
Two lenses cross-cut the five domains : fairness and inclusion, and sustainability and resilience. Cross-cutting means that all domains and indicators would be evaluated for how fair and sustainable they are. These lenses are extremely important, considering that fairness and sustainability (i.e., long-term thinking) are insufficiently considered in the current government decision-making framework.
A key question is whether consideration of fairness and sustainability can be embedded in policy decisions in a substantive and meaningful way.
The federal government’s existing Gender Based Analysis Plus, although not perfect, is one signal that embedding cross-cutting considerations into the policy process is possible.
Overall, there are many positive aspects of this Qualify of Life strategy. It explicitly acknowledges the need for holistic thinking, inclusive thinking, and long-term thinking. These values are no surprise to anyone familiar with the 1986 Ottawa Charter for Health Promotion, which was ahead of its time in articulating a positive and dynamic conceptualization of health and wellbeing, and in identifying a stable eco-system, social justice, and equity (among other things) as prerequisites for health.
The crux, which is a fourth and final point, is whether the extent to which this framework can be operationalized in a way that tackles the inequitable distribution of power, money, and resources, which are the primary determinants of wellbeing and health equity.
Several international organizations (e.g., OECD, UN) and countries have developed quality of life or wellbeing frameworks. Less common, however, is the development of robust mechanisms for integrating these considerations into the policy process (with New Zealand’s 2019 wellbeing budget serving as a notable exception). As scholars of the social determinants of health have long recognized, description of problems far exceeds action to address them.
The framework was reportedly considered in preparing Budget 2021. Although the budget contained some historically significant elements, according to many commentators it was not transformative in the way that many had hoped in terms of, for example, immediate and substantive efforts to redress income inequality through tax reform or public leadership in decarbonizing the economy.
That is not to say that this government is disingenuous in their intention to shift how we define and measure success. However, as described in the excellent work of Cairney and St Denny; intention is not enough for ensuring the realization of ambitious agendas, such as health in all policies and wellbeing budgeting.
The Quality of Life Strategy for Canada could be very significant for wellbeing and health equity for current and future generations. It could, alternatively, turn out to be superficial, or smoke and mirrors. Time will tell.
Lindsay McLaren is a CCPA research associate and a professor at the University of Calgary.