Get Well Canada is asking Canadians and their governments to think more broadly about the ingredients for good health. Health is about more than the medical care we receive in clinics and hospitals. Instead, the evidence tells us that the factors most critical for shaping health are the economic, social and environmental conditions in which we live.
Making sure that public investments reflect this broad understanding of health requires new approaches to designing and implementing health-related policies on behalf of Canadians. Happily, there are places to look for inspiration and guidance as we take up this important task.
Two global policy movements are converging to make clear why the goals of Get Well Canada are so critical for securing the long-term health of Canadians. One is well-being budgeting. The second is health-in-all-policies.
Wellbeing budgeting
In countries around the world, momentum is growing for governments to look beyond traditional indicators of economic performance (like gross domestic product) when measuring their success. Many jurisdictions are adopting broader well-being or quality of life frameworks to inform their budget and policy agendas. Canada has contributed leadership to this area with the federal government’s new Quality of Life Framework, a tool designed “to help drive evidence-based budgeting and decision-making.”
Budgeting tools organized around the goal of well-being or quality of life typically include a wide range of indicators across different domains, like health, environment, governance, social supports, prosperity, security, etc. Many frameworks also emphasize cross-cutting values that apply to all domains—for example, fairness, inclusion, equity, and sustainability.
By holding governments to account on a wide range of interconnected indicators, well-being budgeting frameworks can help identify intersections between policy issues, resisting the siloed approach that can result when each individual department is accountable only to its own priorities and agenda. Creating space for more integrated assessment of policy priorities, gaps, and impacts also has potential to prime governments to think about the balance of investments, and their relative contribution to a common agenda to advance well-being.
These opportunities reinforce the goals of Get Well Canada. Recognizing that the conditions in which we are born, grow, live, work, and age matter more for our health than the medical care we receive means that we must consider a range of economic, social and environmental policies as well-being policies. The interconnected measurement approach at the heart of well-being budgeting can help facilitate this. Integrating metrics like the ratio of social to medical spending into well-being budgeting frameworks would further assist governments by creating space to explicitly consider the balance of investments across key domains.
Health-in-all-policies
When we recognize that diverse social, economic and environmental conditions all matter more for our health than medical care, one implication is that the policies that shape these conditions should be considered health policies.
That’s the idea at the core of the health-in-all-policies (HiAP) movement. HiAP tells us that governments should consider impacts on health from investments they make in things like housing, child care, and reducing poverty—not just access to doctors, clinics and hospitals. Accomplishing this requires governance tools and approaches that support greater collaboration and coordination across sectors and government departments.
HiAP approaches are being implemented in jurisdictions around the world and are championed by the World Health Organization, the Global HiAP Network, and the recently launched Canadian HiAP Network.
Within Canada, Quebec is a longstanding leader in HiAP implementation, most recently through its cross-sector approach to preventing ill health. Other provincial, regional and local governments also have experimented with HiAP.
One common way in which HiAP is implemented is through the use of Health Impact Assessments—tools that facilitate systematic analysis of the health impacts of policies and programs led by sectors outside of health, as well as ways to mitigate any negative or uneven effects.
Realizing the goals of Get Well Canada would build on this approach by embedding similar considerations at the highest level of government decision-making—the budgeting process. A HiAP-informed approach to budgeting would ask whether the investment decisions in governments’ budgets align with the evidence about what matters most for health. Not only the medical care that we likely all think of first, but the social conditions we experience across the life course.
Applying HiAP principles to decisions about the amount of funding allocated to each department—not just to assessing the health impacts of individual policies or programs developed with this funding once it is assigned—would lay the groundwork for monitoring the balance of social and medical investments. As Get Well Canada champions, this is a critical first step for ensuring that we don’t neglect investments in promoting health and well-being as we strive to cover the cost of the more complex medical needs of an aging population.
How does this convergence point to solutions?
As Canadians wrestle with the latest round of anxiety about our medical care system, and too many people struggle to access timely care, it’s surprising that government responses are largely stuck in the same narratives we’ve long heard: more money, more doctors, more ‘experimentation’ in delivery models (i.e. privatization). Few bold ideas have been forthcoming.
Get Well Canada argues that the solution to the current ‘crisis’ is to slow the flow of illness into our overburdened clinics and hospitals, to reduce pressure on medical care personnel and services. We can do this by investing with greater urgency in the things that help keep us healthy and well—the social conditions in which we are born, grow, live, work and age.
Conveniently, these investments will also help address the affordability crisis squeezing too many Canadians.
It’s notable that the global health policy movements discussed here converge to support Get Well Canada’s advice. Well-being budgeting makes governments accountable for progress across diverse indicators of wellness, creating space to consider the intersections of medical and social outcomes. A HiAP approach to government budgeting would institutionalize recognition that health is more than medical care—and that the balance of investments in medical and social supports is a relevant metric to inform allocations between departments.
What we need now is for provincial and federal governments across Canada to recognize that these health policy movements all identify the same ingredients for a solution—to grow social spending more urgently than medical spending—and to be bold about how we must design government budgets to help Canadians, and our health system, get well.
