What if we measured government success by health outcomes?

In Canada, a small proportion of adults disproportionately interact with our health care, criminal justice, and social welfare systems. The symptom? Poverty. Children in poverty live in more crowded, noisier, and lower-quality housing. They have fewer social supports and poorer family dynamics. Their neighbourhoods have more polluted air and water quality, more crime, and are more physically deteriorated, with inferior schools, and less access to municipal services. Research shows that the impact of growing up in poverty can trail people for the rest of their lives, resulting in lower social attainment and even an earlier death. Breaking the link between poverty and health is a “wicked problem” because of the many drivers at work, and it’s one reason why a growing number of governments in Canada and globally are implementing a health-in-all-policies approach to decision making. It’s an approach that places health outcomes at the centre of governments’ goals for success and it can help us address a range of market failures, such as poverty reduction, but also including increased sustainability, better adaptation to climate change, and smarter employment policies for a more precarious labour market. But it does require a change in mindset. Right now, many Canadian governments have it backwards: their key measures of success are keeping taxes at historic lows, cutting public services in the name of reducing deficits, and GDP growth. None of those metrics matter if Canadians have worsening health and mental health outcomes, if we don’t have proper supports when we hit hard times, or if climate change is making our communities less liveable. What if we measured government success by health outcomes? It would shift the priority from politicians purposely keeping taxes low for political advantage to a focus on what residents need to be healthy, happy, and resilient. It would shift the “cost” frame that has politicians focused on tax cuts to a “values” frame, where we measure the long-term value of early learning investments in our children or the value of affordable public transit from a public health and community well-being standpoint. Take public policy decisions on alcohol, for example. In Ontario, the previous provincial government started the expansion of alcohol sales to grocery stores and corner stores in 2015. The new government is intensifying this trend. They’re promoting buck-a-beer. They plan to let municipalities designate public areas for alcohol consumption (like parks), and to allow alcohol to be served as early as 9 a.m. in licensed establishments. And more. Newly published research by the University of Ottawa shows how expanded alcohol sales led to a nearly 20 per cent increase in alcohol-attributed emergency department visits in Ontario over 2016-17. This, and other evidence, suggests that while the current proposals might stimulate the economy and government revenue through increased alcohol sales and taxation, they will also will lead to even more alcohol-related health issues. Older people with alcohol dependence and people of lower socioeconomic status are most at risk. That will increase the burden on the health care system at the same government is trying to end “hallway medicine.” A health-in-all-policies approach helps us connect the dots. It helps us think beyond the next fiscal quarter or the next election cycle. It helps us plant the seeds for long-term success, saving governments money down the road and helping Canadians live up to their full potential. A health-in-all-policies approach works best when federal, provincial/territorial, and local governments work together to develop healthy policies. In Canada, there are examples of this starting to happen across the map. On the north shore of Lake Erie, in neighbouring Chatham-Kent and Elgin-St. Thomas, community leaders’ cabinets are facilitating collaboration on a range of local issues with local government, First Nations peoples, public health organizations, the chamber of commerce, the school board, police, and social service providers. In Quebec, the provincial government has made changes to the Public Health Act that give the medical officer of health the power to delay the adoption of new policy proposal where health outcomes are threatened, resulting in a system that is slowly growing healthier public policies. Yes, the economy still matters to these governments. But they’re adopting new practices that take into account health and well-being. And that’s good for everyone. Ketan Shankardass is a social epidemiologist at St. Michael’s Hospital and Wilfrid Laurier University. Trish Hennessy is executive director of Upstream Institute. The Hill Times