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.

A Globe and Mail article published late January revealed the difficulties of obtaining data in fields such as public health and energy economics.

‘Data gaps’ are the “areas at the national level in which data [is] not collected or readily accessible.” This includes inconsistent data collection, which makes it difficult to compare data, and data that is not updated on a regular basis.

For example, the article reports that data gaps have impeded research in a study on whether the American rise in “deaths of despair” — deaths of the white, middle-aged working class — can be observed in Canada as well.

One reason for data deficits lies in the appropriate collection of data. And even if data has been collected appropriately, barriers to accessing the data may remain.

Associate Professor Arjumand Siddiqi from the Dalla Lana School of Public Health explained in an email to The Varsity that, in her experience, data gaps occur in “groups for which we do not make a concerted effort to sample or identify.”

A summary on the evaluation of the Health Statistics Program between 2011 and 2015 highlighted that one of the recommendations made in the evaluation was regarding management.

The summary explained that for health statistics, which includes births, deaths, stillbirths, divorces, and marriages, the information would now be published 10–11 months after the reference period ended.

A recent blog post by Statistics Canada said that more, specific information on the population was needed to resolve the issue of data gaps.

Siddiqi suggested that statistics may be difficult to obtain as the “infrastructure or the mechanisms” regarding availability and accessibility of the information have not been facilitated by statistical agencies like Statistics Canada. For example, Statistics Canada’s Research Data Centres inhibit collaboration between researchers who are not near the centres in which the data they require is stored.

Data in the field of Siddiqi’s research, which is centred on the relationship between social and economic factors and health, are difficult to obtain.

Other areas in which researchers experience difficulty in studying health are racial inequalities.

“Existing surveys don’t have sufficient sample sizes of non-whites, nor are these samples representative of those populations,” said Siddiqi.

While one tool, like the census, would provide information on Canadians, there lacks a relationship between other sources for the collected data to be useful.

It is important for Canadians to know our statistics as “we need to know what’s happening in our society, who is benefitting, and whom we are failing,” said Siddiqi.

We often turn up our noses at employees who come to work sick, wondering why they are not at home recovering, and sparing their coworkers a chance to contract their illness. Yet, many of us  often face barriers to taking days off from work. Fearing financial loss or even dismissal from employment, we soldier through our sneezes and force ourselves to take on work that, in reality, compromises our ability to get well.

As public health students, and members of the Decent Work and Health Network, we know that being forced to work while sick is not healthy. No one should have to choose between getting better and getting paid. Our health should not be a commodity valued at an hourly wage.

No one in the province of Ontario currently has a right to paid sick days; instead, it all depends on the generosity of your employer. Over 1.6 million workers are employed in businesses with fewer than 50 employees, which are exempted from legislation that protects their jobs if they take unpaid sick days. In other words, these workers could be fired for calling in sick.

What we need are paid sick days, so that no worker has to choose between going to work while sick and losing income, or even risking their job. We are part of a campaign demanding that everyone in Ontario gets one hour of paid sick time for every 35 hours worked, meaning seven paid sick days per year for a full-time worker. There are over 145 countries in the world, as well as 23 jurisdictions in the U.S, that give their workers some form of paid sick days. Ontario is rapidly falling behind.

The lack of paid sick days is just a symptom of the broader phenomenon of increasing precarity in the workplace – one that impacts students and young people especially. Whether it is by cycling through unpaid internships and practicum placements for course credit, through casual work in the retail and service industry, or as recent alumni jumping from one contract to the next, students and recent alumni are familiar with the world of precarious work.

Students are more likely to engage in part-time, casual, temporary, or contract work, and often we are not entitled to benefits like paid sick days. Precarious workers are also more likely to be women, newcomers, racialized and Indigenous peoples, and members of the LGBTQ+ community, adding another element of marginalization to the problem.

Ensuring access to paid sick days is one important way the government can improve our workplaces, and work is being done to ensure that these days are secured for employees. In one such action, on April 15, thousands took to the streets in front of the Ontario Ministry of Labour to protest unfair working conditions and labour laws. A diverse group of advocates, from union representatives to students to healthcare professionals, stood together united under the banner of the $15 and Fairness campaign. Along with paid sick days, the campaign is calling for fair scheduling, decent hours for decent incomes, ‘respect at work rules’ that protect everyone, and a 15 dollar minimum wage.

This campaign is especially relevant right now, as Ontario conducts the Changing Workplaces Review, a consultation process aimed at adjusting Ontario’s Employment Standards Act and Labour Relations Act. This historic review is taking place within a new era of changing workplaces, and we need to demand that the recommendations support decent working conditions for all. Paid sick days are a vital demand that must be enacted, but they are just a few of the policies to be implemented in a larger set of comprehensive reforms to our labour and employment laws. 

These reforms can lead to fairer workplaces, which lead to a happier, healthier and more productive workforce. As the next generation of workers and young professionals, we will inherit these outdated and troubling workplace policies unless we start to take active steps to fight for fairness to address these challenges head on.

Anjum Sultana and Antu Hossain are Masters of Public Health students and members of the Decent Work and Health Network. Anjum is the Executive Co-Director of IMAGINE, a student-run clinic affiliated with the University of Toronto. Antu is the health sector organizer with the Worker’s Action Centre.