The road to reviving Canada's sluggish productivity may lead straight to an emergency department -- or an operating room -- or an immunization clinic.
Sound implausible? Only if you consider public health care from the tired and usual point of view -- which is that it is a consumption good, sucking ever-larger amounts of money out of a shrinking taxpayer pocket. Strike another commission, Canada.
But if you can accept the notion that public health care, if optimized, could be an investment good yielding future wealth as opposed to a consumption good using up current wealth and resources, the road to reversing our productivity slide seems suddenly to be freshly-paved.
Take a pass on the commission, Canada. Take a progressive look at public health care.
Health care is a form of human capital. Considered in the broadest sense, health care encompasses public education and prevention services as well as the delivery of care when illness strikes. As such, it is actually one of society's critical means of keeping our population productive.
The correlation between health and productivity has been illustrated in different ways. The Canadian Institutes of Health Research estimated the outbreak of severe acute respiratory syndrome (SARS) in 2003 took US$3.6 billion out of Canada's GDP and 1 per cent off its economic growth. Imagine the consequences -- both economic and human -- had SARS gone unchecked.
More recently, the Fraser Institute estimated that work-time productivity losses due to long waits at hospitals and to see specialists cost the Canadian economy C$1.08 billion in 2011. The cost tripled to $3.29 billion when time outside of the working period was included.
These examples are at the system level. Think of the value impacts, as well, at the individual level: having a worn-out joint replaced or having a heart attack treated can allow people to remain productive for years beyond what would have been their original "shelf life."
Canadians can't afford productivity losses. We've had two decades of sluggish productivity growth. The Conference Board of Canada reported last year that our productivity level has fallen to 80 per cent of the U.S. level from a high of 90 per cent in the mid-1980s.
If we can agree that efficient health care is an enabler of productivity and that productivity is key to wealth, the next steps should be easy: first, view public health care as a significant driver of our economy; next, consider our expenditures in health care as a potential investment yielding future wealth; and finally, manage those investments strategically to ensure we get maximal value for our money.
The latter will take much effort given the inefficiencies in public health care in Canada.
This would be a cathartic and defining shift for Canadians, who have been locked in a philosophical debate over public vs. private health care. In fact, the core issue should be how to get maximal value for all of our health dollars. This is not about spending more or spending less; it's about investing for value.
"Show me the value" should be the new mantra in public health care. Indeed, it seems to be gaining traction.
The premiers last year created a Working Group on Health Care Innovation to "enhance patient care and improve value for taxpayers." Ontario's government this year announced an action plan that will shift funding to "where we get the best value."
This summer, Alberta's health care agency, Alberta Health Services, launched its first group of Strategic Clinical Networks, a new concept in public health care in Canada. They will bring together medical practitioners, patients, business people, researchers and others in teams that conceive and carry out projects aimed at improving health care services to achieve outcomes for all Albertans and generating measurable value for the public money invested.
We appear to be finally moving away from viewing public health care as an economic burden.
The new view emerging is that of an extremely valuable asset -- an asset that is a big part of the economy and can be managed better and exploited more fully by drawing on the bright minds, unique perspectives and special skills that exist in the medical, business, social and academic communities.
As this asset strengthens, productivity will continue to grow and the important correlation between strategic health care investments and our economy will become abundantly clear.
Smoking rates for both men and women have fallen over the last decade. Rates for men fell from 28.1 per cent in 2001 to 22.3 per cent in 2011 and for women, from 23.8 per cent to 17.5 per cent.
Since 2001, the largest smoking decline for both sexes occurred among teens. Young people aged 15 to 17 saw rates falling from 20.8 per cent to 9.4 per cent in 2011. And teens aged 18 to 19 saw rates drop from 33.7 per cent to 19.1 per cent.
The proportion of non-smokers aged 12 and older who were regularly exposed to second-hand smoke at home declined from 10.6 per cent in to almost half at 5.5 per cent in 2011.
In 2011, 40.4 per cent of Canadians aged 12 and older reported that they consumed fruit and vegetables five or more times per day. This was down for the second year in a row from the peak of 45.6 per cent in 2009.
In 2011, 53.8 per cent of Canadians were at least 'moderately active' during their leisure time, up from 52.1 per cent the year before. 'Moderately active' would be equivalent to walking at least 30 minutes a day or taking an hour-long exercise class at least three times a week.
At least 60.1 per cent of Canadian men, about 7.6 million, and 44.2 per cent of women, roughly 5.6 million, had an increased health risk because of excess weight. These rates have remained stable since 2009.
In 2011, 18.3 per cent of Canadians aged 18 and older, roughly 4.6 million adults, reported height and weight that classified them as obese. This rate was unchanged from 2009. Between 2003 and 2011, obesity rates among men rose from 16 per cent to 19.8 per cent, and among women, from 14.5 per cent to 16.8 per cent.
In 2011, 19 per cent of individuals aged 12 and over reported heavy drinking, up from 17.3 per cent in 2010. Heavy drinking increased for both sexes. The proportion among males rose from 24.8 per cent to 26.8 per cent and among females, it rose from 10.1 per cent to 11.4 per cent. Heavy drinking refers to consuming five or more drinks per occasion and at least once a month during the year prior to the survey.