Election 2015: Health issues primer

Early release, published at www.cmaj.ca on September 14, 2015. Subject to revision.

For the past 30 years, in poll after poll with only one exception, Canadians have declared that health care is the most important issue they face. Yet more than a month into the federal election campaign, health care is languishing on the list of political priorities. Why?

Health care is rarely a federal ballot question because it doesn’t move voters emotionally, says Tasha Kheiriddin, a political commentator for the National Post, CBC and CTV. “The best shot to get on the agenda is to figure out which buttons to push,” Kheiriddin said during an election readiness session at the Canadian Medical Association’s General Council Aug. 25.

End-of-life rules, access to pharmaceutical medicine, high suicide rates: these and other highly charged issues are being put forward by advocacy groups but with little apparent effect so far.

A contributing factor may be the federal government’s ongoing mantra that health care is a provincial responsibility – a skeptic might argue that this is a disingenuous response given that the feds are the fifth largest provider of health care in Canada. More pointedly, under the Canada Health Act the federal government is responsible for ensuring a system with public administration, comprehensive coverage, universality, portability and accessibility.

These were assured by the 2004 Health Accord, which stemmed from the 2002 Romanow Commission Report in response to years of declining federal funding and leadership. The Conservative government let the Health Accord expire in 2014, and with it federal financing began to decline: the provinces and territories will likely receive $36 billion less for health over the ensuing decade. Roy Romanow, head of the 2002 commission, says the system is in distress and near its tipping point.

Underlying some advocates’ calls for action are pleas for federal leadership to improve health care and, in some instances, to save it. Among the federal parties, only the Liberals have declared that health care ought to be a federal issue. In a letter to the premiers, Liberal leader Justin Trudeau wrote: “When it comes to our health and well-being, we want and expect our political leaders to make real progress on the issues that intimately affect us and our families.’’

What follows is a primer on some of the ongoing health care issues that the new government will have to address regardless of their stance, or lack of it, during the election.

Aboriginal health

The grim statistics concerning the health of First Nations, Inuit and Métis people in Canada tell an unforgiving tale. These Canadians have a higher incidence of chronic illnesses (such as diabetes), illnesses that are rare in the general population (such as tuberculosis and rickets), dramatically higher levels of homicide and youth suicide, and a life expectancy five to seven years lower than non-Aboriginal Canadians.

First Nations’ adults are more than twice as likely as other Canadians to die from avoidable causes (including diabetes, lung cancer, accidental injuries, drug- and alcohol-related causes and suicide), according to a benchmark Statistics Canada study published in August.

Those statistics prompted the Assembly of First Nations to launch a campaign to “close the gap.” In a Sept. 2 document, the assembly called on the federal government to work with the chiefs, within two years, on a First Nations health plan that includes investments in prevention, promotion and health services, plus better access to culturally appropriate health human resources. The assembly is also asking the federal government to implement a First Nations Mental Wellness Continuum Framework, and to ensure that no First Nations’ child faces delays or disruption in health services because of federal/provincial infighting over who bears the cost.

Despite the dire statistics, Aboriginal health has not taken on a prominent role in the election campaign, with the exception of promises by both the NDP and the Liberal Party to hold an inquiry into missing and murdered indigenous women, if either is elected. The Conservative Party has refused to hold such an inquiry, which is among the 94 recommendations from the Truth and Reconciliation Commission.

That commission also called on the federal government to close the gaps in health outcomes, establish healing centres, increase the number of Aboriginal health care providers and recognize the value of Aboriginal healing practices, among other health-related recommendations. The Conservative Party has promised to study the recommendations, the Liberal Party has promised to implement all of them and the NDP has pledged to work with First Nations’ representatives to identify the most pressing actions required.

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