Ryan Meili is a Family Physician in Saskatoon, vice-chair of Canadian Doctors for Medicare, a Broadbent Institute research fellow and author of A Healthy Society, how a focus on health can revive Canadian democracy.
Canadians today have, in many ways, greater access to information than at any time in history. This should be enormously empowering, as citizens become able to better understand the facts that impact their lives, and to share that understanding through ever-broadening social networks. This citizen empowerment offers great potential for informing and organizing people to demand policies that improve the quality of their lives. It also inspires great hope among those who seek a more egalitarian society. However, access to information is a threat to those who have a vested interest in allowing income inequality to grow and an intent to decrease social investment on the part of government.
Decades of focus on a narrow economistic set of goals for Canada have resulted in minimal increases in quality of life and worsening circumstances for many Canadians. Our rankings in comparison to other OECD countries are among the lowest in many social factors, and our health outcomes are declining accordingly over time. The latest OECD report states that we have fallen from 8th place in life expectancy in 1980 to 17th. In infant mortality we’ve fallen from 10th to 26th.
The ideal response to this would be to identify that we are slipping further and further away from what should be our goal as a society, that of optimal health and wellbeing for Canadians, and use the information available to us to mobilize the best policies. A less rational response is the one we’ve seen from the Harper Government, which could be characterized as: “What we don’t know will hurt us, but oh well.”
When discussing what makes a difference in the health of Canadians, we tend to think first of the health care system. Doctors and hospitals, physiotherapists and pharmacies; these things are important. But they are far less important than other elements of people’s lives. Income, education, employment, housing, nutrition, and the wider environment have a far greater impact on whether we’ll be ill or well, whether our lives will be long or short. These upstream determinants of health are outside the purview of the health care system, but they are very much in the realm of politics and public policy.
This means that in order to guide policy in ways that will improve our lives the most –that improvement being best measured by improvements in our health and wellbeing – we need to understand what is happening in a wide variety of fields. We need to be gathering new data, interpreting that information, and communicating its implications to decision-makers and the public.
In the last ten years decisions have instead been made to keep Canadians ignorant of the reality of our circumstances. The most obvious and egregious of these has been the cancellation of the long-form census, which has left a glaring gap in our ability to collect the data needed to make smart decisions. Even if a future government should reinstate a proper census, there has already been an irreplaceable loss of essential knowledge.
Dozens of agencies that interpret data and perform original research have been eliminated or deeply cut. These have been in varied fields, including women’s health, Aboriginal health, environmental surveillance and many more, prompting protests from the typically politically reticent scientific community, including the grim Death of Evidence funeral march on parliament, and the birth of organizations like Evidence for Democracy dedicated to highlighting how important scientific information is if citizens are to make well-informed decisions.
In the field of health care, much has been made of the end of the health accord between the federal and provincial governments. This set of agreements between the federal government and the provinces was meant to restore some of the federal share of health care funding and to use those added dollars to improve quality and accessibility of care. This accord ended in 2014, and Prime Minister Harper has refused to meet with the premiers to negotiate a new accord and has instead unilaterally imposed a new formula that will over time significantly decrease the federal portion of health care funding.
The abstention of the federal role in addressing the health of Canadians goes beyond a decrease in dollars, and also includes the cancellation of the Health Council of Canada. This body was tasked with making recommendations to improve the quality and accessibility of health services across the country and effectively baseline national health standards. Its elimination is a further departure from our ability to understand and adapt to challenges in health. The Health Council of Canada analyzed the data on key elements of our health system such as wait times or physician supply, and highlighted the most promising innovations from different provinces. Its demise severely hampers our ability to improve upon our public healthcare system, meaning we are less able to leverage local improvements to provide Canadians with the best quality of care.
Along with the decrease in information being gathered or analyzed have come deliberate barriers to communicating what we do know. From muzzling of government scientists to deep cuts to the CBC, the story of science and knowledge is being increasingly silenced. The strategy is simple, and sinister: if there is no data, there is no way to be held accountable. If people don’t see the way in which decisions being made are worsening the quality of their lives, they can be convinced to continue to vote in favour of policies that hurt them.
The war on knowledge is a war on the health of Canadians. We need a government that will embrace the information age and use evidence to improve our lives. We need a government that has the health of Canadians as its greatest priority. Ten years in, it’s clear that that government is not Stephen Harper’s.