Health care cuts are counterproductive; Instead of redirecting existing funding, Victoria should be expanding the infrastructure for public health
Vancouver Sun
June 17 2010
By: John Blatherwick, the former chief medical health officer for Vancouver

The B.C. Ministry of Health Services has recently asked health authorities to identify at least a 10-percent portion of their public health budgets to be redirected toward priorities to be identified by Victoria. This is contrary to the recognition following the SARS crisis that Canada's public health infrastructure needs to be expanded. Rather than reduce funding to current core programs, the minister should focus on introducing healthy public policies that promote health and prevent disease, which can markedly contribute to a healthier British Columbia.

Currently, only three per cent of the B.C. health care budget is directed toward public health, prevention efforts -an amount already considered inadequate to produce significant prevention results. Promoting the health of the public and preventing disease lacks the glamour of many health interventions and rarely makes headlines until there are serious threats to population health. The critical work of public health includes a number of broad initiatives that immunize kids, ensure a safe food supply, reduce tobacco use and support families in creating healthy lifestyles. These initiatives have proven to be cost effective in promoting health and preventing disease.

Moving around existing public health prevention resources will not necessarily improve the health of British Columbians in a dramatic way. Instead of redirecting existing funds toward untested programs or media campaigns, the Health Minister Kevin Falcon should introduce, advocate for and support healthy public policies (such as those below) that have the potential to produce significant results in overall improved health of British Columbians.

(1) A comprehensive poverty reduction legislation, as in other jurisdictions in Canada, which includes a detailed and accountable strategy with concrete and legislated targets and timelines to dramatically reduce homelessness and poverty in our province. Poverty is one of the most powerful determinants of health. People on low income suffer more chronic illness, and poor children in particular begin to develop health issues that will challenge them throughout their lives. There is an incredible amount of consensus across the country that there is a way to achieve reductions in poverty and long-term improvements in health. A comprehensive strategy would include:

- Adequate and accessible income support for the non-employed;

- Improved earnings and working conditions of those in the low-wage workforce;

- A plan for affordable housing and supportive housing in B.C.;

- Promoting early childhood development through the provision of universal publicly funded child care.

(2) Policy actions that address chronic disease through the creation of supportive environments in communities. Policies that make healthy choices the easy choices for families and individuals include:

- Provincial leadership in securing federal/provincial policies with respect to food composition (e. g., reduce the salt in processed foods and sugar in beverages);

- Provincial support for unambiguous labelling of healthy choices on chain restaurant menus;

- Provincial initiatives that improve literacy and health literacy, especially for new immigrant and refugee populations;

- Promote, protect and support breastfeeding in B.C. by implementing baby-friendly hospitals, workplaces and communities;

- Support for low-income families to access sport and recreation opportunities.

A health care system that treats illness instead of promoting health is unsustainable and costly. The government's own Standing Committee on Health report on childhood obesity calls for an increase of the budget to six per cent for public health initiatives. If we can continue to find millions for sickness care, we should be able to find the small amount needed to increase prevention to six per cent of the health care budget. Have we forgotten the lesson of SARS, the Walkerton E. coli outbreak, the recent H1N1 response and the overwhelming effectiveness of our immunization program, to cite merely a few examples? We should increase the budget and expenditures in public health -- not erode the already scarce resources.

The government and the minster have policy tools available to them that would significantly improve the health of British Columbians to a degree far greater than any re-directed program funding. Implementing these policies would also reduce health inequities that contribute to the poor health status of many of our citizens, which in turn deprives many, particularly young children living in poverty, the opportunity for success, lifelong achievement and good health. These strategies require leadership and action through legislation, regulation, and healthy public policies without raiding the existing public health budget.