CPHA Analysis: The 2013 Federal Budget From the Public Health Perspective

The 2013 federal budget is a mixed bag from a public health perspective. While there are several items that warrant a ‘thumbs up,’ the real story is not told in the budget, but rather is found in the government’s main estimates for 2013-2014 that were tabled in February 2013.

The federal government’s support for job creation and rebuilding public infrastructure are important components of the mix of factors that affect the public’s health. This is especially true for communities hit hard by the ongoing global economic situation. Investments in First Nations, Northern and remote communities’ public infrastructure, including improved housing and water supply and sanitation systems, are welcome news. Of particular note is the investment of almost $120 million over five years for the Homelessness Partnering Strategy and the renewed investment in the Affordable Housing initiative.

CPHA is also pleased to see increased investment in protecting our natural environment. This includes investment in clean transportation initiatives to support renewable fuels, a cleaner and more efficient transportation system, and ecoENERGY initiatives targeting renewable energy, energy science and technology, and energy efficiency. Additional investments in a trust fund to help the provinces and territories invest in initiatives that reduce greenhouse gas emissions is also welcomed.

We are pleased to note an allocation of funds over several years to support the economic diversification efforts of the asbestos-mining communities of Thetford Mines and Asbestos, a move that CPHA recommended to the federal government in 2010 as one element of a comprehensive strategy to stop the mining and export of chrysotile asbestos.

The budget also included several other items that could have a positive impact on the health of Canadians. These include the expanded tax relief for home care services, investments to enhance health care services, including mental health services, for First Nations and Inuit communities and the elimination of the preferential excise duty rate for manufactured tobacco, which includes tobacco used in roll your own cigarettes and chewing tobacco.

As is often the case with government budget announcements, however, the challenge is in ascertaining if these investments are “new” money or simply being redirected from existing programs.

In the 2012 budget, the government announced significant cuts to the health portfolio allocations. Health Canada, the Public Health Agency of Canada, and other health-related institutions and agencies funded by the federal government, such as the Canadian Institutes of Health Research and the Canadian Institute for Health Information, all saw their programmatic and operational budgets reduced between 2012 and 2015:

• Health Canada: reductions of $200.6 million
• PHAC: planned ”savings” of $68 million, a reduction of almost 11%
• CIHR: budget decrease of $45 million.

These cuts are not insignificant.

Compounding concern is where the budget cuts are being applied. While some of the budget cuts at Health Canada were absorbed through the sun setting of several initiatives, based on the 2013-2014 estimates the major programmatic cuts appear to be targeted at programs that are meant to prevent addiction to psychoactive substances:

• Health Canada’s Controlled Substances and Tobacco Program: 35% reduction
• Canadian Centre on Substance Abuse: 5% reduction
• Drug Treatment Funding Program: 49% cut
• Drug Strategy Community Initiatives Fund: more than 16% reduction.

These reductions have taken place despite the fact that psychoactive substance use is a major contributor to health care expenditures and costs the Canadian economy over $1.2 billion per year in law and order responses, as well as lost productivity due to mortality, illness and injury. The situation is further compounded by the elimination in the 2013 budget of $15.7 million for the Federal Tobacco Control Strategy, even though over 6 million Canadians still smoke and their health is at risk for cardiovascular disease, respiratory disease and cancers, all significant drivers of health care costs.

While the funds allocated by CIHR in support of research projects have remained fairly steady over the past few years, CPHA is discouraged to note the considerable reduction in funds allocated for CIHR-supported scholarships. The CIHR scholarships budget is being slashed by 30% from the 2010/2011 level. This would seem to fly in the face of the federal government’s stated goal of ensuring that young Canadians are among the most highly educated, adequately trained, and possess the required skills in order for Canada to remain globally competitive and to address our national challenges.

CPHA is also concerned about the significant budget reductions at PHAC. This agency has seen its budget allocation decrease from a $677 million in 2010/11 to $579 million in 2013/14, a reduction of over 14% at a time when the burden of disease in Canada related to chronic disease, injuries, suicides and mental health is increasing. PHAC’s budget for health promotion and disease prevention, public health infrastructure and health security (including surveillance and population health assessment, regulatory enforcement and emergency response) has decreased by over $152 million, or 26%, between 2010/11 and 2013/14. Given these massive cuts, will the federal government be able to fulfil its leadership role to protect and safeguard the health of Canadians when the next public health emergency occurs?

We commend our colleagues working within the federal health portfolio for their dedication to the task at hand. Difficult decisions have been made within the context of reduced budgets and they continue to do their best to make strategic, evidence-informed decisions. CPHA remains committed to working with our colleagues in government, as appropriate.

There are other significant reductions in the budgets of other agencies which will have a direct impact on the health and well-being of Canadians:

• Correctional Services of Canada: 14% reduction
• Hazardous Materials Information Review Commission: 17% reduction
• Patented Medicines Prices Review Board:7.5% reduction
• Statistics Canada, responsible for the collection and analysis of data which informs Canadians about their health and the impact of public policy and programs: an almost 12% reduction.

While the recent austerity budgets are not as drastic as in some European countries, budget cuts can have serious consequences for the public’s health, as noted by Dr. Harvey Fineburg in his editorial, Public Health in a Time of Government Austerity. Kurt Cobb, the US author and columnist, notes that “public health successes are about what doesn’t happen, about people who don’t get sick, and epidemics that don’t get out of control.” Dr. Martin McKee, Professor of European Public Health at the London School of Hygiene and Tropical Medicine, has branded austerity measures implemented by governments in Europe as a health failure, with increasing numbers of suicides, increasing health inequity and increasing numbers of people unable to access health services.

The time is past due for the Government of Canada to apply a “health lens” to determine the impact of its budget decisions on health and health equity.  We do not spend enough on public health in the best of economic times; but are we running the risk of weakening our capacity to protect the public’s health during tough economic times when the risks to individual and community health are multiplied? Only time, and good population health surveillance, will tell.

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For more information contact:

Ian Culbert, Executive Director
Canadian Public Health Association
Telephone: 613.725.3769 ext 137
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About CPHA
Founded in 1910, the Canadian Public Health Association (CPHA) is the independent voice for public health in Canada with links to the international community. As the only Canadian non-governmental organization focused exclusively on public health, CPHA is uniquely positioned to advise decision-makers about public health system reform and to guide initiatives to help safeguard the personal and community health of Canadians and people around the world. With a diverse membership representing more than 25 professions, a track record of success, a collaborative approach and national reach, CPHA is Canada’s Public Health Leader.

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