From a population-health perspective, there is much that is welcome in the new B.C. government’s policies and priorities, as revealed in its platform and the ministerial mandate letters. But from a public-health perspective, there is cause for concern.
First, the population-health perspective, which is the primary focus of my columns. As I have repeatedly stressed, much of what makes a community or society healthy is beyond the jurisdiction of the Ministry of Health. The major determinants of health are found upstream in the social, environmental and economic portfolios, and here there are many potentially good policies, assuming they can be put in place.
Poverty is one of the most important contributors to ill health and premature death, and child poverty in particular sets children up for a lifetime of challenges and problems that many can never fully overcome. It generates an excess burden of disease that the health-care system has to manage, at considerable cost. Indeed, the health, social and economic costs of poverty are so high that they are unaffordable.
Under the previous government, B.C. became known for having a high rate of child poverty, low minimum-wage rates, low social-assistance rates and no anti-poverty strategy. So it is encouraging to have a minister of social development and poverty reduction, with a mandate to: “Design and implement a provincewide poverty-reduction strategy with legislated targets and timelines.”
As the B.C. Green Party platform notes: “Alleviating poverty and homelessness will also have a strong, positive impact on people’s health.”
Other strong anti-poverty — and thus pro-health — policies include increasing social-assistance rates, pilot-testing a basic-income program and requiring the minister of labour to implement a $15-per-hour minimum wage by 2021 and “bring forward recommendations to close the gap between the minimum wage and livable wages.”
Unaffordable housing contributes to poverty, homelessness and ill health, so it is good to see that the minister of housing is required to work with a variety of partners to build 114,000 units of a mix of various forms of affordable housing, and to develop a homelessness-action strategy with the minister of social development and poverty reduction.
A second major threat to population health comes from the global ecological changes we are creating, especially climate change. So it is encouraging to see the new government taking this issue more seriously. They seem to recognize the economic opportunities of energy efficiency and conservation and a clean-energy economy, including investing in public transit, and have committed to carbon-reduction targets and a $50-a-tonne carbon tax.
But the NDP platform and mandate letters do not go far enough. The carbon-tax increase does not start until 2020, while the Greens committed to $10-per-tonne increases starting in 2018; nor is there a reference to promoting biking and walking, or zero-emission vehicles, all of which are health-promoting.
Troublingly, the NDP does not name urban sprawl as an issue or propose community and regional urban-containment areas, as do the Greens. In these and other areas touching on the environment and sustainable development, not surprisingly, the Green Party platform is more comprehensive, detailed and health-enhancing.
But it is when we come to public health — that part of the health-care system that is focused on protecting and improving health and preventing disease and injury — that the new government’s platform is most disappointing; they still seem to equate health with health care.
The NDP platform makes no mention of wellness, no reference to obesity, tobacco or alcohol — all major causes of disease and premature death — and only a brief commitment to prevention, mainly in the area of mental health.
Contrast that with the more explicit and detailed commitments in the Green Party platform, which notes that “prevention is better than cure” and promises to “establish a ministry responsible for health promotion, disease prevention and active lifestyles” and to re-balance the allocation of resources between prevention and acute care.
So from a population- and public-health perspective, the best option might have been a coalition government that took the best of both parties’ platforms. Failing that, let’s hope the new government can learn from and adopt the Green Party platform for health and wellness.
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.
