Getting a Better Health Bang for the Buck

By Dr. Trevor Hancock 
Professor and Senior Scholar, School of Public Health and Social Policy, University of Victoria

In hard times, it is even more important to ensure that every tax dollar is wisely invested. And when you are spending more than 40% of all the tax dollars, its specially important to do so. So if one was a frugal politician with a sensitivity to the public purse, how would one best spend the government’s revenue?  When it comes to health, there are two forms of ‘bang for the buck’ to consider.

First, how do we get the biggest health bang for the public’s buck? For the most part, not by investing yet more in health care. This point was made as well as anyone has made it, surprisingly, by a very distinguished Canadian heart surgeon, Dr. Wilbert Keon. As a Senator and co-chair of the Senate’s Population Health Sub-Committee, he noted in an interview with The Hill Times in January 2008 that

“Increased expenditures on healthcare are likely impacting negatively on the general health of our population by virtue of diminished investments in other areas like education (especially early childhood education), public housing, income security, and other public services.”

So the first thing to do is to recognise that the major determinants of health lie beyond health care, and invest accordingly, in Ministries that deal with these fundamental determinants of health. This is going to require following the recommendations of the Senate Sub-Committee on Population Health, whose 2009 report was conspicuously ignored by Canada’s federal and provincial governments.

Specifically, the next Premier, whomever it may be, needs to establish and chair a Population Health Committee of Cabinet and adopt a ‘whole of government’ approach to improving health in BC. This  will require undertaking health impact assessments of policies that are having or might have an impact on the health of the population, and ensuring health is a key consideration in all policies, as is the case in South Australia.

In fact they might do well to go further and support a ‘whole of society’ approach by establishing a Premier’s Council on Health, as was done in 1987 in Ontario. That Council, regrettably killed by the Mike Harris government as soon as they took power, brought together the Premier, several key Cabinet Ministers, health care leaders and wider civil society leaders, all working together to improve health. Together, they can examine the wider societal benefits of a healthier population and address population health issues across society as a whole.

The second strategy concerns getting the biggest bang for the health buck, by wisely investing the $16 billion that is in BC’s health budget. Here the wise politician will take advice from the 2010 report on “Investing in Prevention” from BC’s Provincial Health Officer.  Put simply, prevention is sometimes a cost saving and usually a more cost-effective intervention than treatment. It is also kinder: most people would prefer not to have a disease or injury in the first place, they would prefer to avoid the pain and suffering, inconvenience and loss of income that usually results.

Investing in prevention within the health care system involves three main strategies:

  • Further strengthening and renewing public health services, expanding them where necessary.
  • Ensuring that everyone in BC has barrier-free access to the suite of effective preventive services recommended by BC’s Clinical Prevention Policy Review.
  • Improving health literacy and creating supportive social, physical and policy environments that enable people to make health choices.

These strategies, while not free, are relatively inexpensive, and will yield a better return on investment than further investments in high-tech health care. They can be funded in part through another prevention strategy – preventing the wasteful and expensive harm that health care can do – and in part by the higher tax revenues and reduced costs that will result from enabling people to be healthy, reduce their need for health care and, in many cases, earn a living and pay taxes.

So if I was an incoming Premier faced with almost half my revenues going into health care, that is where I would invest to get a bigger and better health bang for my buck.

Additional reading: 

Investing in Prevention: Improving Health and Creating Sustainability | The Provincial Health Officer’s Special Report – British Columbia | Author: PRW Kendall | September 2010

A Healthy, Productive Canada: A Determinant of Health Approach | The Standing Senate Committee on Social Affairs, Science and Technology Final Report of Senate Subcommittee on Population Health | June 2009

Health for all: questions from the past, lessons for the future | Senator Wilbert Keon | The Hill Times, Monday January 21, 2008

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