Why we need to boost public health spending
Today, health ministers from across the country will gather in Toronto to hash out a new Health Care Accord. The agreement, as its name suggests, focuses on paying for the system of doctors, nurses and hospitals that take care of Canadians after they’ve fallen sick or been injured.
But this accord also presents health ministers with an opportunity to even more greatly affect the health of Canadians by scaling-up public-health solutions that prevent illness and injury from happening in the first place.
Public health refers to those conditions and public goods — clean water, safe food, bike lanes and immunization programs — that make environments healthier for everybody. These goods can’t be bought by individuals. Their benefits aren’t always immediate or even easy to see and measure. They don’t have powerful lobby groups behind them. The result: Public health is chronically underfunded by society, often viewed as the poor cousin of medicine.
According to analyses of health expenditure by the Canadian Institute for Health Information, money for hospitals, drugs and physician services alone accounted for more than 60 per cent of total health spending.
A similar trend shows up in research funding. Last year, the Canadian Institutes of Health Research, the federal government’s health research funding agency that I help lead, invested $973 million in health research. Most went to biomedical, clinical and health services research, all vitally important areas of inquiry. But only 8 per cent of funding — $81,996,703 to be exact — went to public-health research, where some of the greatest opportunities for preventing disease and living healthier and happier lives reside. Clearly, public health must continue to grow in size, prominence and impact.
There are at least four reasons that explain why we, as a society, chronically underinvest in public health. They aren’t the result of politicians not caring about the health of their citizens; my own interaction with health ministers has revealed the opposite to be true. Rather, these barriers are systemic, having to do with how our brains are wired and our societies are organized.
First, humans have evolved to respond to immediate threats and act in ways that will give us tangible personalized benefits, which we can recognize in individual persons. Unlike medical care, the benefits of public health are often not attributable to particular individuals. For example, even though we know reducing air pollution in the environment would cause lung cancer rates to fall, it’s impossible to pinpoint which of us are among those lucky individuals who will avoid getting lung cancer in the first place as a result of today’s clean-air efforts.
Second, democratic political systems encourage shorterterm initiatives that yield immediate benefits. Initiatives that align with four-year electoral cycles make good political sense: Voters want to see payoffs before the next election, and politicians want to deliver those tangible wins for citizens to whom they are accountable. Public-health investments often take decades to show their benefits, well-beyond one election cycle and perhaps after today’s leaders are no longer there to reap the recognition and rewards for their successes.
Third, unfortunately we can’t commercialize or patent public health in the same way as we can medical drugs and devices. This means that we cannot depend solely on companies to spur and scale up public-health solutions in the way that marketable medical technologies have been so successfully spawned and sold.
Fourth, there are powerful industries, such as tobacco and fast food, that fight to keep public-health budgets as small as possible. Their goal is to minimize public health efforts aimed at reducing consumption of their products, no matter the cost to our health.
Unhealthy industries remain mostly unopposed in their lobbying and consequently win too many budget victories at public health’s expense.
This week, our health ministers have a once-in-a-generation opportunity to overcome these cognitive and social traps by using their Health Care Accord to invigorate public health and public-health research in Canada.
Whereas individually they may find it too politically difficult to prioritize public health, together they can unite around a common plan for achieving the world’s healthiest population — a plan that will necessarily involve boosting investment in longer-term, preventative public-health solutions that complement and leverage their existing medical-care expenditures.
Of course, none of this will be easy. Success in reorienting health spending toward public health and prevention has eluded the many individual political leaders who have tried. But our country’s health ministers have a unique opportunity to band together, set an example and collectively lead the way.