Originally published in The Hill Times.
Jurisdictional debates have become the roadblock in the Canadian conversation about poverty, well-being, and health care. This obstacle is inevitable considering the way Canada is governed. But are jurisdictional arguments truly an insurmountable barrier or are they instead an easy way of letting the federal government off the hook? We fear it might be the latter.
It is no secret that there are great disparities in health and wellbeing within Canada, and it will come as no surprise that these outcomes are the result of factors that reach beyond healthcare and personal lifestyle choice. They are, in fact, rooted in employment, education, housing, and the environment. You could call these the determinants of health or the causes of poverty. Either way, this is a wicked problem that Canada needs to address now. First Nations, Inuit, and Métis peoples are by far the most affected, their well-being compounded by a history of colonial policy. We also know that those in the lowest income quintile in Canada are disproportionally affected, demonstrated by their life expectancy being three to five years less than those in the highest quintile.
To truly address the issue of inequitable well-being, we must address these determinants of health, or more simply the roots of poverty in Canada. A Health in All Policies (HiAP) approach would be a good step forward. This approach suggests that policies work horizontally across sectors, vertically through various levels of government, and interdisciplinary to include community organizations, NGOs, and First Nations, Inuit, and Métis leadership.
Versions of this approach are already at work in some government policy in Canada. Every province and territory, except for British Columbia, has developed or announced that they are working towards a poverty reduction strategy. Some cities, like Toronto and Edmonton, are working on tackling poverty on the municipal level as well. Strategies like these demonstrate that cross-sectoral action can be taken to prevent and reduce poverty and by extension, improve health and wellbeing. We just need a federal plan.
There are federal policy intersections in all areas of health, well-being, and poverty through provision of transfers to the provinces and territories, income security programs, employment, childcare, and programs and services to First Nations, Inuit, and Métis peoples. Yet, despite the government of Canada’s resolutions to end poverty (such as the recently-passed Motion 534 on child poverty) it does not have a national plan to address it, and thus, by extension, has no plan to address the health and well-being of people living here.
Through a national plan, the federal government can provide the leadership infrastructure, and resources, while coordinating between different regions and sectors of government including the provinces, territories, municipalities, and First Nations, Inuit, and Métis leadership. A national framework will ensure that we don’t have an oasis of good health and well-being in one part of the country while other parts suffer. It would foster innovative policies to address traditional barriers to multi-sectoral work and ensure measurable goals and timelines are in place to track progress and increase accountability. By addressing poverty with a national approach, the federal government fulfills human rights obligations and ensures that human dignity is maintained and respected.
Governments should work together on issues of health and well-being, instead of abdicating responsibility or trying to claim lack of jurisdictional duty. Finland has adopted a ‘Health in All Policies’ approach, where various levels of government and the private sector collaborate to address the intersections in education, finance, housing, transportation and social assistance. They are coming together to address the determinants of health and the causes of poverty in an effort to increase the well-being of the Finnish population.
While addressing poverty, health, and well-being will no doubt cost money, a HiAP approach can work to create a system where both the costs and the positive returns are shared between different levels of governments. Better health and nutrition will mean increased adult worker productivity and childhood educational attainment, both of which are powerful mechanisms of income growth. And, by addressing poverty more upstream, we would see savings in criminal justice, social service, and health care spending.
Nothing worth doing is ever easy. Improving health and well-being by addressing poverty using a HiAP approach will take hard work. It will take cooperation and negotiation. It will mean that those with decision-making powers in Canada will have to make the right choices.
A society is measured not by how they treat their most well off, but by how they treat their most vulnerable. The development of a national anti-poverty plan is a great place for Canada to start.
Photo Credit: (Flickr CC – Doug)