Health care is — by a long shot — the most expensive sector for the B.C. government. The budget forecasts that in 2018-19 it will total $21.65 billion, which represents a whopping 40 per cent of the overall provincial budget.
Given that 64 cents are going to health-care services for each dollar spent by the province, it is surprising that this sector received so little attention in recent budget debates.
Yes, new money is going to be invested to improve services for seniors, as well as to strengthen primary care. But to put those multimillion-dollar announcements in perspective, they account for just under two per cent of health expenditures. The biggest health-care news from the budget is that the NDP government has decided to stay the course on health-care services (a situation that will probably attract jealousy from health-care providers in provinces such as Quebec or Ontario, embattled in vicious political struggles).
But, paradoxically, despite the government’s choice to leave the health-care sector on its current track, this budget is full of healthy choices.
A huge body of evidence shows that health-care services provision isn’t the main contributing factor to population health. What matters most is wealth redistribution, a safe place to live, social connections and access to education. With its focus on housing, child care and social justice, the budget is packed with healthy investments.
Providing accessible, high-quality daycare has been shown to contribute to social justice both through improved academic success for disadvantaged children and through improved job-market access to women. Investing in affordable housing can contribute to wealth redistribution and reduce homelessness. Eliminating the Medical Services Plan premiums is a move toward more equitable taxation.
This is not to say that everything in this budget is perfect. The investments made in primary care are a good first step, but converging evidence shows that the solution isn’t funding more of the same. Effective primary-care models rest on a redefinition of professional boundaries (more nurses and other professionals working in team-based care) and of the nature of the care itself (more community care, prevention and public health). Technological and demographic changes make this the only proven way forward to simultaneously control costs while improving quality and access. But such teams won’t take off without a clear political commitment, something we haven’t witnessed yet.
In the same way, environmental threats and climate change are now the biggest determinants of human health. Latest forecasts from credible sources — ranging from the World Health Organization to the International Monetary Fund and from The Lancet to The Economist — all show that policy changes to address those threats will have to be bold and rapid. To make sure that environmental degradation doesn’t undermine public-health gains from past decades, B.C. will need an integrated strategy encompassing resource extraction and exploitation all the way to transportation and urban planning.
This first NDP budget suggests there is an emerging broader perspective on health at play, with a focus on the social determinants of health. If indeed this is what we are witnessing, this is a great first step to improve the health of British Columbians. The next steps will tell for sure how evidence-based B.C.’s future health strategy is.
Susan Duncan is the director of the School of Nursing at the University of Victoria; Astrid Brousselle is the director of the School of Public Administration; Damien Contandriopoulos, Bernie Pauly and Kelli I. Stajduhar are professors in the School of Nursing.
