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Insulin needles are prepared at the home of an aboriginal diabetes patient. The Aboriginal Diabetes Initiative may lose out in today’s budget.
Insulin needles are prepared at the home of an aboriginal diabetes patient. The Aboriginal Diabetes Initiative may lose out in today’s budget.

Andre Picard's Second Opinion

The budget's fine print matters to health Add to ...

There will be much said and written about Thursday's federal budget: If words were dollars, there would be no deficit (or debt).

Pundits will pontificate on how Finance Minister Jim Flaherty has balanced stimulus initiatives and restraint measures, declare winners and losers in the doling-out-dollars sweepstakes and howl about taxes imposed and opportunities missed. The Opposition will get in its digs. In short, the air will be ripe with second guessing and election speculation.

However predictable the process and the rhetoric are, though, budgets matter: They matter to our fiscal health and they matter to our physical health.

There is unlikely to be much in the federal budget pertaining to health, aside from some passing self-congratulatory mentions of Ottawa's contribution to Canada's most popular social program (medicare) and some dire words about the need to rein in spending.

Even so, how much Ottawa spends on health is a lot less than it should be. (When medicare began, the federal government footed half the bill; now it's less than 25 per cent.)



The biggest chunk of health spending in fiscal year 2010-11 is the $25.4-billion in cash and $13.1-billion in tax points Ottawa will provide to the provinces and territories. These amounts are set out in the Canada Health Transfer, a deal that expires in 2013-14.

The principal goal of the federal government is to display its bare pockets and plead poverty in a bid to keep provincial-territorial demands for more health dollars to a minimum.

In addition to the transfers, the federal government spends significant sums on health, including about $3.3-billion for Health Canada, $924-million for the Canadian Institutes of Health Research, $648-million for the Public Health Agency of Canada and roughly $27-million or so on sundry other federal agencies such as the Patented Medicine Prices Review Board.

Aside from those big picture and big dollar manoeuvres, much of what matters in the health field can be found in the fine print of the budget.

In particular, a goodly chunk of federal health monies are allocated in grants, big and small, by Health Canada ($1.4-billion annually) and the Public Health Agency of Canada ($255-million each year).

These grants are the lifeblood of countless health organizations and programs across the country. Their continued life or death can hang in the balance of a single seemingly throwaway line in the budget.

For example, the 2007 budget allocated $2-million to the Canadian MedicAlert Foundation for a wonderful program to provide alert bracelets free of charge to children with health conditions or serious allergies.

But these are post-recessionary times, so many groups are on tenterhooks, wondering if they will take it on the neck in the name of belt-tightening.

One of the programs at risk is the Aboriginal Diabetes Initiative.

There are few health issues more pressing than dealing with the epidemic of diabetes in first nations, Inuit and Métis communities. About one in five aboriginal people in Canada have Type 2 diabetes, a chronic condition that is a leading cause of heart disease, kidney disease, blindness and amputation.

Yet, it is highly unlikely that the Finance Minister will utter the word "diabetes" when he rises in Parliament.

Diabetes, a disease of poverty, is a scourge on reserves, in remote communities and among urban native populations. We spend a bundle on treatment (a provincial responsibility) but a pittance on prevention and health promotion (a federal responsibility).

Health Canada invests about $40-million a year in the Aboriginal Diabetes Initiative (ADI - because bureaucrats love to give everything an acronym).

That modest amount of money funds prevention, screening and health promotion in 600 communities and provides a bit of money for national aboriginal organizations to work on diabetes.

There is also a backstory - isn't there always? The vast majority of the ADI money is spent on reserves and in Inuit communities north of 60.

The large and ever-growing aboriginal population in Canada's urban centres also has a severe diabetes problem. It can't be ignored because of the federal government's (under the Conservatives as well as the Liberals) narrow-minded view of its fiduciary responsibility toward Métis and so-called "non-status" Indians.

That underlying issue is too complex to tackle in passing - let's leave it to the Supreme Court of Canada - but suffice to say that $40-million is a pittance to spend on a problem of such breadth and depth.

Yet, perversely, the funding for ADI stops soon - at the end of this month.

It's unclear if there will be any money allocated to aboriginal diabetes in the budget.

But what is clear is that what matters in a budget is not just the big picture and the big numbers. There are programs that, despite their laughably small budgets, speak volumes about our commitment to health and social justice.

So we owe it to ourselves to read the fine print.

Follow on Twitter: @picardonhealth

 

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