We often hear that, in Canada, health is a provincial responsibility. This is understood as the provinces having autonomy over, and responsibility for, a large portion of the funding and delivery of health care services. But the influence of provincial policies on health outcomes goes far beyond doctors and hospitals, physiotherapists and pharmacies. Far more than these acute health services, our health is determined by where we work, live and play, by how much money we make, what type of jobs we have, our level of education and our physical environment. These social determinants of health are key to understanding how to improve health outcomes, and how to make wise political decisions.
Elections give us a chance to see ideas on display and consider them in the light of what matters most: will those who wish to lead do so in a way that really improves our lives? All of the political parties in the provincial election have put forward platforms that describe their vision for Ontario's future. How seriously do the parties take the health and well-being of Ontarians? How well do they understand the importance of social and economic factors on health outcomes?
To explore these questions, I examined the platforms of each of the three main parties. Rather than questioning whether or not the policies are realistic and achievable (though that is very important to consider as well), I wanted to see how much the language used and the plans proposed reflect an understanding of the upstream factors that determine health, and a long-term vision to improve them.
So how well do the three parties address these core issues that directly affect Ontarians' health?
Each of the parties work hard to appeal to "pocketbook" issues that would increase the availability of the income earned. For example the NDP offer to remove HST from Hydro payments, the Liberals emphasize the child care cost savings from all-day kindergarten, and the PCs promise to decrease household energy costs. Somewhat surprisingly, the Liberal platform is the only one that talks directly about income, proposing an increase in, and indexation of minimum wage, and it is also the only platform to mention measures to address income inequality through progressive taxation.
All of the parties spill significant ink on job creation, an issue of high importance in Ontario given the economic challenges of recent years. Of course, employment increases income, but studies show that the conditions of employment also have a huge influence on wellbeing. This means more jobs matter, but the type and quality of employment matters more.
Will there be more part time precarious jobs, or jobs with stability and security? What kinds of jobs are being cut at the same time as others are being created? Will access to collective bargaining be strengthened or undermined? Not all jobs are created equal, and using a health lens to evaluate job creation helps us to be more circumspect about these claims.
We see emphasis on education in each of the platforms, attention to the protection of the natural environment by the Liberals and the NDP, and attention to health care access in each platform. But there is no mention of access to or affordability of nutritious food in any of the platforms, and only the Liberals mention housing and homelessness. None of the parties has addressed the critical and growing demand for services for adults with disabilities in the province, or for autism services - issues which the Toronto Star has flagged with their investigative series.
There is little or no mention of the health impacts of policies outside health care by any of the major parties.
It's true, the NDP section on education and active transport references "Healthy Communities", but that is about as far as it goes. The Liberals float a promising idea of developing community hubs to house community-driven health and wellness programs. Otherwise, 'health' policy for each party platform means health care delivery. Acute health trumps the socioeconomic conditions that determine whether those services will be needed in the first place.
Looking for language like this may seem like splitting hairs -- an academic exercise -- but it helps to answer the question of whether or not the parties and their leaders really understand the job ahead.
Andrea Horwath wants things to 'Make Sense,' Tim Hudak 'Wants a Million Jobs,' and Kathleen Wynne has 'A Plan for Ontario.' One can't expect too much from platform titles, but none of the policy books display a focus on improving the health of Ontarians via bettering their social conditions as a primary driver. This leaves it up to the voters to read between the lines.
So what if we asked each party leader the following question: If your platforms were made a reality would we live healthier, happier lives? It's only with this kind of demand from citizens that would-be leaders will start to see that their primary role is to improve the health and wellbeing of the people who elect them.