Toronto Globe and Mail  [Printer-friendly version]
June 22, 2006


[Rachel's introduction: In Canada, a former minister of health and
welfare says that nation would do far better by spending less on
health care and more on keeping people healthy in the first place,
preventing disease instead of trying to cure it.]

By Andre Picard

Many of us revel in thinking of Canada as a great place to live, a
generous, caring country with a well-woven social safety net that
protects the sick and poor from harm.

But that feel-good image is largely a myth, according to Monique
Begin, the respected former minister of health and welfare.

While we have a generous medical care system, Canada's welfare system
is parsimonious at best, she told delegates to the recent annual
meeting of the Canadian Public Health Association.

More striking still is her proposed solution. "Rebalancing of the
health budget is what is needed," Dr. Begin said.

In other words, let's spend less money on health care and more on
keeping the population healthy.

How do you do that? By tackling what renowned social scientist Sir
Michael Marmot calls the "causes of the causes of poor health" -- the
social determinants of health.

Dr. Begin, unlike so many of today's politicians, is bold enough to
say that, in Canada, we spend too much money on dealing with the
proximate causes of disease -- $142-billion in health spending in 2005
-- and far too little on tackling the root causes of illness in much
of the population -- a lack of adequate income, poor housing,
inequality, hopelessness.

Welfare is in her vocabulary and it's not a dirty word, as it is in
most mainstream political circles.

A recent report from the United Nations Committee on Economic, Social
and Cultural Rights underscored just how frayed Canada's social safety
net has become. It became a central talking point at the CPHA
conference where delegates heard, among other things:

** Minimum wage (which varies by province) is inadequate, to the point
where one-third of full-time workers can't make ends meet.

** Only about one-third of people who are unemployed are actually
eligible for employment insurance.

** Almost 40 per cent of all jobs are part-time or seasonal.

** There are 1.2 million poor children in Canada, and nearly 320,000
of them rely on food banks for their daily bread.

** Welfare rates (which vary by province) provide income that is about
half the poverty rate.

** Our social programs have perverse disincentives, such as those that
require people to quit their jobs and go on welfare to get
catastrophic drug coverage.

** There is shocking poverty among native peoples; not surprisingly,
their health is abysmal.

** Child care is inadequate almost everywhere but Quebec.

** There is an army of unpaid caregivers that has virtually no
official help.

** Social housing is virtually non-existent.

In Canada, only 17.8 per cent of public expenditures are on social
programs other than health; in Sweden, by contrast, that figure is
36.8 per cent. According to the Organization for Economic Co-operation
and Development, 21 European countries spend more on social programs
than Canada, including Poland and the Slovak Republic. Not
coincidentally, all those countries spend less than Canada on health.

The lesson we should be taking from European countries is that one of
the most effective health interventions is income redistribution.

Money is the best drug we have. And, paradoxically, providing people
with a decent income is probably cheaper than treating the illnesses
of poverty, which tend to be expensive conditions such as diabetes,
heart disease and cancer.

Notably absent from the lists of Canada's welfare shortcomings are
seniors. The poverty rate in the over-65 age group is 5 per cent in
Canada, compared with 20 per cent in the United States.

Our elderly are among the best off in the Western World because we
made a determined effort to improve their lot with programs such as
the Guaranteed Income Supplement and progressive tax measures.

This demonstrates that where there is political will, we can tackle
social inequalities.

But look at what we do with children. Ottawa provides poor parents
with the Canada Child Benefit and the National Child Benefit

But most provinces negate that measure by clawing back -- reducing
provincial welfare payments by an offsetting amount, or through

Poverty in children has a life-long reach. Poor children will grow up
to be unhealthy adults.

Dr. Begin, who is currently serving on the World Health Organization
Commission on the Social Determinants of Health, said the message that
social justice is good for our collective health and that the speed at
which we perform hip replacements is not the most pressing health
problem in this country is a tough sell.

Baby boomers are distinguishing themselves as the most selfish
generation to have ever walked the face of the Earth. We love our
health care (which is more accurately described as sickness care) and,
increasingly, we hate welfare.

Yet it is a false dichotomy and a false economy. We can pay now with
decent social programs or pay later with increased health costs.