On Thursday afternoon, on the eve of a long weekend, the Ontario government convened public-health officials in the province to let them know that a) the number of public-health units would be reduced to 10 from 35 and b) a new funding formula would result in savings/cuts of $200-million annually.
Toronto, as always, took the brunt of the hit from Doug Ford’s government. Toronto Public Health, which is currently funded 75/25 provincially/municipally, will see its $255-million budget slashed by $86-million immediately, by $107-million next year, and so on, as the formula shifts to 50/50. (Other health units in the province will be funded 70/30 or 60/40, depending on their size.)
Joe Cressy, chair of the Toronto Board of Health, did not mince words in his response to the news: “I say this without an ounce of exaggeration – because of today’s announced cuts, people will die. That’s not rhetoric, it’s a fact. This announcement is callous, it is cruel and it is short-sighted.”
Toronto Public Health, which has operated since 1883, has a sweeping mandate, from preventing the spread of disease to promoting conditions that improve population health.
Local public-health officials do everything from water-quality testing to sexual-health promotion; daycare inspections to school breakfast programs; immunization monitoring to prenatal support; restaurant inspections to monitoring for infectious diseases; ensuring homeless people don’t freeze to death to advocating for harm-reduction measures such as supervised drug-use sites; measures to prevent suicide from bridges through to reducing the impact of pollution from motor-vehicle traffic.
Yet, public health is always an easy target for cost-cutting politicians.
The paradox of public health is that when it works, its benefits are largely invisible. Counting the number of children contracting measles is easy; counting those who didn’t get measles because they were vaccinated is a lot more difficult.
It’s telling that, in the same budget where the government cut public-health funding by $200-million annually, it announced $2.7-billion a year in hospital-infrastructure funding.
“Our budget protects what matters most to Ontarians,” Health Minister Christine Elliott said. “That’s why we’re investing $27-billion over the next 10 years in essential hospital-infrastructure projects so the people of Ontario can receive the quality care they expect and deserve.”
Meanwhile, $2-billion in cuts to public health didn’t merit mention.
Governments, regardless of their political stripes, like spending on what’s visible and lends itself well to ribbon-cutting and credit-taking. Our four-year political cycle encourages and rewards short-sightedness.
When you invest in public health, the benefits lie in the future; they go largely unnoticed, even by those who benefit.
That helps explain why we spend so much on sickness care, and so little on illness prevention.
Medicine, where we spend about 95 per cent of our health dollars, “matters most” because it deals with identifiable people. Voters. Public health deals with abstract statistical lives.
If we invest in preventing climate change, for example, thousands of people may avoid developing conditions such as asthma and COPD, but those who benefit will be unknown and unseen.
When you cut public health, as the Ford government has done, it also reflects a philosophical outlook that individuals matter more than the collectivity.
Public health favours public good over private good, and public-health measures invariably benefit the less fortunate more than the privileged. That’s because the poor and marginalized face infinitely more health risks.
Public-health officials are profoundly pragmatic. You see that reflected in their response to the overdose crisis: Provide safe places for people to inject drugs rather than moralistic abstinence messages.
This approach puts political noses, particularly conservative ones, out of joint.
Improving population health requires societal change and that imposes a cost – a need to change – on the elite and special-interest groups.
It’s no coincidence that the most powerful lobbies in society are those whose actions cause the most harm to health: Tobacco, alcohol, processed food, automobiles, oil, firearms and so on. Public health is David battling countless Goliaths.
That’s why every report examining every public-health crisis – from Walkerton, Ont.’s tainted water to SARS – says the same thing: Public health needs to be well-funded and independent of political influence.
Public-health officials need to have the power to speak uncomfortable truths to power, to protect them (and all of us) from petty, partisan near-sightedness.
And no doubt the next report will say the same, because we have just put out the welcome mat to as-yet-unknown public-health disasters.
André Picard