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Thursday, 28 February 2013

Public health funding debate - diving deeper

One of Canada’s premier interactive health sites is supported and written through St. Mike’s in Toronto.  Healthy Debate  provides a forum for discussion of the whole range of health issues, and is to be commended for recognizing public health’s contribution to the health system.   Dr. Monika Dutt has initiated a discussion on How public health funding in Canada needs to change .  Join the conversation and support the discussion.

Those that have been through the ringer will recognize that the funding debate is complex.   What constitutes “public health” in the general sense about the organized efforts of society to prevent illness, improve health and protect wellbeing – can range broadly.  Not surprising, in the 1910’s the Canadian Public Health Association was a strong advocate for the establishment of a system of hospitals in Canada, which led to the Canadian Hospital Association and subsequently the Canadian Healthcare Association.

In the post war years and green paper documents, public health was again active in support of health service which led to Tommy Douglas’ medicare efforts based on the Swift Current health cooperative.  As we run through the decades, “public health” has fostered the birth of home care, been a strong partner and advocate for community mental health, driven efforts to improve care for seniors in residential settings.  Currently we may be seeing a divergence of maternal-child programming as it strives for independence from other public health services. 

Thus the major role of “public health” remains in initiating and stimulating change that aligns with its core definition.  

How then can the value and efforts of public health be weighed in gold?  Many efforts for preventing illness and reducing the consequences of disease on other health services are now embedded and entrenched in other pillars of the health care system.  Some administrators may legitimately argue that they are already investing more than a targeted amount in prevention efforts, while the formal “public health” sector scrounges to survive on meagre crumbs.  

Dr. Dutt admirably flags the tension that constraining resources are causing.  While health systems struggle to maintain minimum operational levels in the face of growing populations, ageing populations, inflation, utilization creep and technological developments – arguments that public health can make a difference if you invest more are falling on deaf ears. 

But, were in not for the successes of public health to date, the system would have collapsed long ago.  Hospitalization rates have been reduced to between one-quarter and one-half peak rates.   There is evidence supporting compression of morbidity and overall reductions in health care utilization due to healthier populations.  Perhaps the one failure has been an increasing cohort dependence and expectation on accessing and utilizing health care that contributes to the utilization creep – fuelled by a health care industry that needs to self-propagate.

We in public health need to remain grounded in the very efforts that Dr. Dutt has identified.  We must also be willing and able to adapt to a rapidly changing environment and not sit on our past laurels.   Conversely, for  health care readers, a new recognition and respect for public health as integral part to the solution could foster constructive efforts rather than competitive ones. Health care administrators should receive mandatory public health training and experience before feigning expertise in the topic.  

As Dr. Dutt suggests, there is a strong rationale for protecting up to 5% of the budget for public health – and labelling it as a future benefit. Many companies use fiscal targets for research and development activities which this parallels.  However, such funds must be linked with public health professionals actively responding to the challenges of today – and those are difficult and uncomfortable, unlike some past public health activities.  

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