The case for Health in All Policies
No other province in Canada is on a public spending teardown quite like Ontario, where the daily newsfeed is filled with spending cuts (Alberta may be soon to follow).
The only heartening development is the release of a secret document that shows public servants have been living up to their responsibility: advising governments to, first, do no harm. They’ve been warning the government about the health risks of slash-and-burn politics.
A Toronto Star story shows public servants have warned: “among the ‘key risks’ facing the Tories could be ‘adverse impacts on an individual’s health and well-being.’ Cuts would create longer waits for children seeking diagnosis and early intervention, ‘leading to poorer health outcomes.’”
Loyal followers of social determinants of health research will recognize the evidence behind such warnings: earlier interventions and more robust early supports for children are linked with better physical health, mental health, and educational outcomes.
Tearing down these supports yield worse outcomes, especially for children living in poor households.
Provincial public servants aren’t the only ones warning the government.
When officials first learned of the government’s plan to cut funding to Toronto Public Health, Toronto City Councillor Joe Cressy warned:
“People will die.”
The Ontario government claims that it’s cutting to tackle the provincial deficit, but that deficit is highly manageable. Cuts will do more harm than good.
As public health units across Ontario learn about funding cuts and forced mergers with other public health units, even more warning bells are ringing.
Thilina Bandara, PhD in Community and Population Health Sciences, University of Saskatchewan—and Upstream board member—wrote in this National Post oped: “A systematic review of the cost effectiveness of public health interventions suggests that cuts to public health activities for the sake of cost-saving represent a false economy. This is because public health interventions pay for themselves in future health-care costs at a staggering 14.3:1 ratio.”
What if the key measure of public policy success was public health and community wellbeing?
It would be easier to depoliticize many public policy decisions, because decision-making would be based on evidence, not ideology or cut-throat politics;
It would lead to a Health in All Policies approach, where the question of people’s health and wellbeing wouldn’t be relegated to one ministry (health) but to all, including economic development, finance, education, housing, and more;
Investments in programs and public supports focused on making us all healthier and our communities more sustainable and resilient would position us to do better on that other metric—local economic growth. Because what’s the best thing for local economic growth? A healthy and stable community.
Shift the frame.
“Don't tell me what you value, show me your budget, and I'll tell you what you value.” ― Joe Biden
Feed Your Head
What if we measured government success by health outcomes? Ketan Shankardass and I teamed up to co-author this Hill Times oped.
WHO on Health in All Policies (HiAP): The World Health Organization (WHO) has a guideline for countries intent on creating a coherent HiAP approach.
HiAP primer: Ketan Shankardass et al wrote this primer on Health in All Policies which is a must-read on this subject.
We need HiAP in Canada: Paul Kershaw on the need for Health in All Policies in Canada in this CMAJ article.
Health care doesn’t start at the doctor’s office. This California doctor takes an upstream approach to diagnosing one woman’s health problems and things change for the better.
World’s first wellbeing budget: Thank you New Zealand.