When health ministers meet in Vancouver this week they will discuss what a new national health accord will look like. In this discussion, the federal government has a powerful lever to improve health and health equity in Canada. The health accord is an opportunity to set out conditions that provinces and territories must meet in exchange for funding, including their share of the $36 billion that Ottawa will spend on health in 2016-17.
There is a possibility for the discussion to be about tackling the most important health issues in Canada.
There is a three year difference in life expectancy for both men and women between Newfoundland and British Columbia; the health accord can address the structural factors that lead to this inequity. Do we have the right balance of health promotion, illness prevention, treatment and rehabilitation? How can the health accord help provinces and territories improve the response to issues such as mental illness which get a lower percentage of health spending than is warranted by their impact? The health accord is an opportunity to eliminate the lottery which leads to people in different provinces having different risks of illness and getting different treatments and outcomes.
In the lead up to the health ministers’ meeting British Columbia is calling on Ottawa to change the funding formula used to calculate each province’s entitlement. Currently, funds are simply allocated on a per-capita basis. British Columbia wants the health accord to consider age, arguing that the per-capita formula disadvantages provinces with aging populations while privileging younger provinces, like Alberta.
British Columbia’s proposition is based on how much it costs on average to provide healthcare services to seniors aged 90 and over ($29,206) versus adults aged 35-39 ($2,242) or children aged 1-4 ($1,576). Simply put, it costs as much to serve one 90 year old as it does to care for 18 preschoolers. Most of an individual’s lifetime healthcare costs are incurred in their last years. But if we want a healthier population we must keep young Canadians healthy for as long as possible. Therefore we must look at a broader range of determinants of health.
As a signatory to the Universal Declaration of Human Rights the federal government has affirmed that all Canadians have a right to health. The right to health is about more than healthcare, it includes food and nutrition, housing, access to potable water and adequate sanitation, safe working conditions and a healthy environment. By focusing on the right to health in the health accord we can leverage action on social determinants of health across Canada.
Income, for example, is an important determinant of health. Canadians with low income are more likely to develop diabetes and experience heart attacks than people who are better off. If we all enjoyed the same level of health as the wealthiest Canadians there would be approximately 40,000 fewer premature deaths per year. Poverty and income inequality are bad for our health and we pay through our healthcare systems.
The health accord can reward provinces that are reducing healthcare needs. The fiscal case is clear; Ontario spends around $15.1 billion per year to treat the top one percent of healthcare users, accounting for one-third of the province’s healthcare budget. Ontario prioritizes high cost users through Health Links, a patient-focused case management system that links high cost users with a range of health and social services. These kinds of initiatives improve the health of vulnerable populations.
Another critical avenue is expanding access to essential healthcare services that are not covered under the Canada Health Act, like prescription drugs. Almost 10 percent of Canadians do not use a medication as prescribed because of cost and it is estimated that one in six hospital admissions in Canada could be avoided with the proper use of prescription drugs. The health accord is an opportunity to begin working toward universal prescription drug coverage.
This week’s health ministers’ discussion is the first major opportunity for our new federal government to signal its intentions on not just what they’re prepared to pay for in healthcare but also what they expect in return. There is an opportunity to refocus the discussion on what Canadians need for a lifetime of good health.