Health: investments in prevention, these unloved

Neglected during the years of austerity, public health currently accounts for 2 to 3% of the Canadian health budget. This label includes disease prevention and the promotion of good health practices: public health programs therefore help reduce deaths and reduce hospitalization costs, and not just during health crises.

Whatever the government and the country, however, investments in public health prove undervalued and are often the first to be cut. The “cure” prevails over the “prevention”.

“Public health often goes under the radar of governments, because prevention does not bring results in the short term. It is not a noisy policy and the results are often a bit confusing and difficult to correlate with the measures, ”says Professor of Health Management, Evaluation and Policy, at the University of Montreal School of Public Health, Olivier Jacques.

His recent study, conducted with colleague Alain Noël, confirms that public health is more vulnerable to fiscal austerity and attracts fewer votes due to its invisibility. Even more “left” governments, it says, invest little in public health.

To reach this conclusion, the researchers analyzed the policies of 25 OECD countries between 1970 and 2018. Olivier Jacques and Alain Noël realized that governments with national health services invest larger amounts than they do. reliance on social health insurance systems.

Although very different in this respect, the United States and Canada still perform well in this comparison between investments in treatment – “treatment” – and prevention; they are doing better than many European countries often admired for their social policies and better than Australia and Japan. Although the United States and Canada also remain oriented much more towards treatment than prevention.

Healing prevails, left and right

The pandemic has shown that an investment that is too focused on care and not enough on prevention highlights its shortcomings when a health crisis occurs. In particular with the most vulnerable populations.

However, both governments linked to the “right” (read, more liberal and against state interventionism) and those more “left” (more favorable to social policies) invest more often in health to support treatment than prevention.

“The money will go more to hospitals and frontline care, but little to public health prevention programs. Above all, we will preserve what is visible ”, confirms Olivier Jacques.

However, he points out that even though Quebec’s public health spending appears to be lower than that of other provinces – up to 6% in British Columbia. – there has been an increase since the 1990s.

OECD countries spend an average of 2.3% of their health budgets on public health, while the Canadian government dedicates nearly 7% to it.

A comparison between Canadian provinces, in another unpublished study by this researcher (“The Political Economy of Public Health Expenditures: Evidence from the Canadian Provinces”), shows the same trend of investments made between 1975 and 2018: regardless of government, the curative takes precedence, and by far.

An increase in health transfers to the provinces would not guarantee an increase on the prevention side, the researchers argue.

A reality on the ground to be clarified

Revision Social Sciences and Medicine is one of the most prestigious journals in the industry with a truly robust peer-review process, comments University of Victoria School of Nursing professor Damien Contandriopoulos.

However, some doubts remain about the validity of the data used. “I know the database in question and my experience is that it often poses problems in international comparisons, [comme] the labeling of “curative” versus “preventive” expenses. For example, for Canada, the sharp increase in prevention spending is, in my opinion, attributable to the wave of regionalization of the 1990s, when public health units left hospitals, ”says this expert.

Professor Contandriopoulos also has doubts about the typology used by two references in the study (National Health Services vs. Social Health Insurance). “This typology is classic, but the reality on the ground changes enormously from one country to another. These two problems (data and somewhat random typology) increase the probability that the results are less correlated with the reality on the ground ”.

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