Health Minister Leona Aglukkaq was quite right to reiterate this week that the provinces are responsible for the delivery of health services; quite properly, Ottawa provides stable funding while otherwise avoiding meddling in decisions about how those dollars are spent. But that does not mean that the federal government should ignore what appears to be a large socioeconomic gap in health care and outcomes.
A poll commissioned by the Canadian Medical Association suggests that low-income Canadians are in significantly worse health than those with higher incomes and more education. The survey, carried out by Ipsos Reid, found that just 39 per cent of those who earn less than $30,000 believe their health is excellent or good, compared with 68 per cent of those who earn $60,000 or more. Those in the latter group also reported that they smoke less, sleep and exercise more, and eat more vegetables.
While the disparity is not easy to rectify, for governments at any level, there are at least a couple of levers at Ottawa's disposal.
Among the groups to whom the federal government directly delivers health services are on-reserve first nations people and Inuit – demographics that suffer far lower life expectancies and higher infant mortality and suicide rates than other Canadians.
Addressing that reality is not just a matter of upgrading health infrastructure and resources. Through improvements to housing, water quality, education and other social services, Ottawa could help lessen the incidence of costly illnesses such as adult-onset diabetes, heart disease, depression and stroke – ultimately saving the system money.
Less direct, but also important, is the federal government's role in public health, by which it can try to counterbalance some of the underlying factors in the socioeconomic gap.
Those factors are formidable. It is vastly more expensive to eat properly than to buy cheap, highly processed foods, which is why poor neighbourhoods attract fast-food outlets. And many of the better forms of exercise can be expensive.
Public health guidelines and public-awareness campaigns – such as ones about practical, affordable ways to eat more healthily and exercise more – are among the ways that the federal government can help.
Creativity is needed now more than ever. The Ipsos Reid poll found that those making less than $30,000 a year are more likely to cancel gym memberships, delay buying prescription drugs and buy prepackaged foods since the 2008-09 economic downturn.
In other words, the problem is getting worse. Welcome respect for provincial jurisdiction notwithstanding, it presents a national challenge.