If we want a healthier Canada, we should spend less on health care.
That's the counterintuitive conclusion of a new study.
But, of course, there's a catch: To reap the benefits, we need to spend the savings on social programs such as income assistance, subsidized housing, early childhood education and affordable child care.
In other words, we don't need to spend less on health, we need to do a better job of allocating our health dollars.
To start, we must redefine "health spending."
The vast majority of our health dollars go to providing care after people fall ill – principally for hospitals, physician services and drugs. Only about 5 per cent of health dollars go to prevention and health promotion.
But that's only part of the story. We spend about three times as much on sickness care as we do on social programs. This is a rough estimate, of course: While we track our sickness care obsessively – a large institution, the Canadian Institute for Health Information, was created solely for this purpose – no one is really tracking how much Ottawa, the provinces and territories invest collectively in social welfare.
That's where the new study, published in Monday's edition of the Canadian Medical Association Journal, comes in.
A team led by Dr. Daniel Dutton of the School of Public Policy at the University of Calgary compared funding for health care (read: sickness care) and social services from 1981 to 2011.
They found that average per capita spending for health was $2,900, almost three times the $930 per capita spending for social services.
More striking still is that health spending increased much more quickly than social-welfare spending over those three decades.
"Real" health spending (minus the impact of inflation) per capita doubled to $4,000 from $2,000 in that period. Meanwhile, real social spending rose to just $970 per capita from $770.
If you prefer the more traditional budgetary numbers, we spent $136-billion on health care in 2011, compared with $49-billion in 1981. By comparison, $33-billion went to social programs in 2011, up from $19.7-billion. (Again, these are constant dollars.)
Dr. Dutton's research team also looked at the impact of spending choices on health outcomes – specifically avoidable mortality, infant mortality and life expectancy. With some fancy math, they showed that if governments had spent one more cent on social services for every dollar spent on health, life expectancy in this country could have increased by another 5 per cent and avoidable mortality could have dropped an additional 3 per cent. (In their calculations there was no appreciable effect on child mortality.)
In a related commentary, Dr. Paul Kershaw of the School of Population and Public Health at the University of British Columbia said "these results add to evidence that should impel governments to seek better balance between medical and social expenditures."
That spending on social programs provides far more bang for the health buck than spending on sickness care is not news. We've long known that the conditions in which people grow, work, live and age (what academics call the social determinants of health) matter a lot more to the health of individuals and society than medicine does. Having a decent income, an education, housing, food security, a sound physical environment and a sense of belonging is what allows you to be healthy. People's health can also be adversely affected by racism, sexism, homophobia and other circumstances that interfere with those basic needs.
In democratic, just societies, we tackle these inequities with laws, political actions and social programs designed to redistribute wealth.
The new research reminds us that when we fail to do so, we pay the price in lost lives and life expectancy.
Yet, at the end of the day, we always pour money into sickness care and wind up shortchanging social programs that would result in people being healthier 10, 20 and 30 years down the road.
It is an approach best illustrated by a parable: One day, a group sitting by a river sees a baby in the water. One of them dives in to save her. Soon, more babies appear, and the bystanders all jump in to save the children. But one person has the presence of mind to go upstream and figure out how to stop babies from falling into the river in the first place.
In our public policies we need more of that upstream thinking, beginning with a sounder redistribution of health and sickness care spending.