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Nova Scotians have become well-acquainted with the words “public health” over the last year, but what they may not know is that public health has been chronically underfunded for decades and the COVID-19 crisis will make things worse.
A paper published in the Canadian Journal of Public Health last week found that less than 1% of funding from Nova Scotia’s Department of Health and Wellness is budgeted for public health annually.
This is well below the 5 to 6% of health care funding recommended for public health.
In addition, the report’s authors found the last time Nova Scotia’s public health budget met the recommended funding levels was in 1975.
“Everybody’s aware of public health being important because of COVID, and that is really important. But also important are all the other things that public health does that is not infectious disease,” Dalhousie University professor of health promotion and the paper’s co-author Sara Kirk said in an interview.
“The non-communicable diseases, things like diabetes, (sexual health), tobacco control…We were already having a crisis in vaping, and the number of Nova Scotia youth who vape and actually don’t even understand how dangerous it is is quite mind boggling.”
The article titled ‘Fare well to Nova Scotia? Public health investments remain chronically underfunded,’ notes that based on provincial healthcare budgets and current spending, Nova Scotia “is continually in last place” when it comes to public health spending compared to other Canadian provinces.
“There’s so much we could do to keep our population healthy, but we just don’t have the resources. As somebody who researches in this field, it’s frustrating because we know what we should be doing,” Kirk said
“We have evidence. We know what needs to happen. But if the resources aren’t there to translate that into action and build capacity in the system, then we’re not going to get anywhere.”
Public health on life support
In a section called ‘Public health on life support,’ the paper’s authors cite previous research suggesting a 10% increase in public health spending decreases mortality by 1.1% to 6.9%.
“Given the importance of public health efforts for disease prevention and addressing health inequities, and the documented return on investment, governments should be increasing, not decreasing, their investments in public health,” the report states.
The paper’s authors also note that while the province’s response to the COVID-19 pandemic is commendable, it shouldn’t be used to justify “continued inadequate investment” in public health in Nova Scotia.
“Our intention with this (paper) is not to be negative and say, ‘they’re not funding it and that’s bad.’ It’s that we’ve done so well with 1% that I think this is an opportunity to imagine what we could do with a bit more,” Hilary Caldwell, the report’s lead author, said in an interview.
“Hospitals are 40% of our health care budget. Physicians are almost 20%. Imagine 1% more in public health. I’d like to see it at 5% more, but even imagine just 1% more and how much could get done.”
The paper noted the chronic underfunding of public health in the province is particularly problematic given the high rates of non-communicable diseases in Nova Scotia and the health inequities that exist.
“Public health really focuses on health equity too, and targeting groups that might need more care or access to services. We’ve seen greater marginalization as a result of COVID,” Caldwell said.
“Public health is needed to make sure that people are getting the health information and resources they need to stay healthy or get healthy while avoiding going to hospitals or going or accessing health services.”
Caldwell said had they written their paper two years ago, the results would still have been alarming and surprising. But she believes because the pandemic has highlighted the importance of public health, the timing is particularly relevant.
“They’ve (public health in Nova Scotia) done extremely well with what they had before COVID,” Caldwell said.
“Moving forward, it’s a system that’s doing well but could use that increased investment to keep more Nova Scotians healthy or for when another public health crisis happens.”
Pandemic legacy? Honour public health heroes
Kirk, her colleague at the Healthy Populations Institute, agreed. She’s urging people to advocate for increased public health spending by contacting their MLAs to demand proper funding.
“We always hear we have to prioritize the economy or health. No. If you protect one, you’ll grow the other,” she said.
“We are an unhealthy province. We have high rates of chronic disease, and that’s not changed. COVID isn’t killing us, chronic disease is.”
While the province’s COVID-19 response has occurred at the expense of regular public health services and supports, the report notes the pandemic has also “highlighted our province’s public health heroes.”
The paper’s authors are advocating for increased and sustained investment in the province’s public health system, hoping it will be part of the pandemic’s legacy.
“There’s a policy window that COVID has presented, and if we can insert the evidence in at this point in time, then we can hopefully actually change the conversation and build that narrative around why this is important and invest in prevention,” Kirk said.
The report notes post-pandemic investment in public health must go beyond mitigating communicable diseases.
“As it stands, the current investment in public health is too low to meet this goal,” the authors state.
“Public health is everywhere around us. In the way that we build our cities and our towns, in our communities. It really does interface with every aspect of our life,” Kirk said.
“And to only fund it to the tune of 1% is really not enough.”
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