Cuts to public health funding by the Ontario government announced in April have taken the media by storm, leading a tripartisan group of previous Ontario Health Ministers to urge the government to reverse its decision.
But is this political treatment of public health a new phenomenon, or is this appended to a long history of budgetary cuts and perceived underfunding of its practice and research?
Another event in a long-lasting pattern
Dr. Steven J. Hoffman — the Scientific Director of the Canadian Institutes of Health Research’s Institute of Population & Public Health — and his colleagues would agree with the latter. In a timely paper published in May, the authors argue that public health in Canada is underfunded.
They assert that the 5.5 per cent of total Canadian health spending allocated to public health practice fails to sufficiently fund the range of work that public health practitioners are expected to undertake — from food and drug safety, to occupational health, to health inspection, and more.
More importantly, Hoffman and his colleagues point out that the current rise in the frequency of chronic disease, mood disorders, and anxiety disorders in Canada has failed to garner a “significant” increase in budget allocation to the appropriate venues of public health.
They say that this results from the public health community lacking an appreciation for the process of policymaking, which causes them to fail to account for the reasons why public health isn’t a clear win from a political perspective.
As a solution, the authors propose developing knowledge of political tools and processes among public health officials.
Public health saves lives
Public health efforts are focused on long-term goals, such as preventing, rather than curing, illnesses, or on analyses of statistical trends within the field. Often, its work seems intangible to the public, and is not exploitable by politicians.
Attempts to pull down the 28.1 per cent Canadian adult obesity rate, for example, would require public health officials to target multiple industries. They may need to advocate for businesses to change food labelling, health care providers to provide more expansive training programs, or ask municipalities to adjust local regulations, according to the 2011 Obesity in Canada federal report.
Such efforts aim to change individual behaviour on a large scale through multiple forms of societal intervention. However, it is difficult for non-experts to trace their effects back to conscious public health efforts.
The more these efforts are hidden from voters, the less clout they gather on the political agenda of politicians, who are already wary of being unable to reap rewards from these efforts within the timeframe of the election cycle.
Solutions to the lack of political will for public health funding
To solve this problem, the authors ask for members of the public health community to better appreciate the policy-making process and the actors involved in it, so that public health agencies can adapt strategies to the kind of policy-making network relevant to specific healthcare issues.
They similarly argued for improved understanding of policy instruments — regulation, communication, taxing, and spending — so that the regulatory tools used for public health can be better used. Increased efforts to spread awareness of public health efforts may counter its lack of priority in the voter base.
In the wake of the opioid overdose crisis, mental health crisis, and spread of preventable chronic diseases forming the leading causes of death in the province, public health cannot be more vital in addressing our most urgent needs. Whether the output of a work is deemed tangible or not by some individuals should not make the verdict over the survival of that field of work.
Nonetheless, concerted effort to engage with the political system in the push for improved funding and policy can ultimately win over politicians and policymakers.