Cuts to public health: What’s the worst that can happen?

BENJAMIN REMPEL

The same question is asked at nearly every public health conference: Why is public health so poorly funded? Normally a government representative stammers through a prepared answer: “We are investing where the money is needed.” I’ve learned this actually means “public health is not a priority. No one knows what it does. And besides, what’s the worst that can happen?”

Ontario’s public health budget in 2019 did not even top $1.3 billion — a sliver of the overall $63 billion health-care budget. Each year, public health units make a strong case for increased funding to improve infectious disease surveillance, compliment communitybased health promotion programming, and alter health systems to better produce impactful outcomes.

But the requests are waved away. Besides, what’s the worst that can happen?

In spring 2019, Premier Doug Ford initiated foundational changes to the structure and operation of public health. The plan was to reduce the number of public health units from 35 to 10 and slash funding by $200 million per year. Public health-related agencies would either be forced to merge or work within reduced budgets.

Public health leaders were livid. Several associations appealed the decision. And many warned bad things would happen. Nothing worked. Well, in the end, something worked.

It should be said that in recent weeks, Ford has been admirable.

His daily press briefings are transparent and empathetic. And to be fair, COVID-19 was a slow burn coming out of Wuhan. Even our top experts didn’t recognize it for what it was until the screams from Italy became deafening. And when they did, our provincial government acted decisively to enact unprecedented health and safety measures. Ford, for his part, has recently reinvested funds back into public health to help mitigate and minimize this crisis.

But there is a niggling feeling that a portion of the panic and chaos could have been avoided if adequate, sustained, public health funding had been invested decades ago and with a long-term view. Months from now, when the worst of COVID-19 is behind us, will this infusion of funding dry up?

Public health typically manoeuvres behind-the-scenes. It advocates for healthy policies, promotes the social determinants of health, and works with partners to reduce social and health inequities. But just because it operates outside the spotlight, doesn’t mean public health ought to be first in line for budget cuts.

COVID-19 is horrible. The mortality and morbidity this virus causes is heartbreaking. The stress, upheaval and foundational shifts to our social fabric will reverberate for years, if not decades. But if any good is to come from COVID-19 it is this: no one again will dismiss the value of public health or question what’s the worst that can happen?

Sadly, we now know the answer. Benjamin Rempel