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Health accord full of gaping holes

Dear Mr. Chrétien and Mr. Manley:
The National Council of Welfare observed your negotiations with the provincial premiers and territorial leaders on the health accord with ambivalence.
The members of the Council applaud your commitment to ensuring the continuation of a national Medicare system. We are pleased at your decision to finance home care and catastrophic drug costs, two programs that may help reduce the risk of financial ruin because of medical needs.
We are concerned, however, that the accord left gaping holes in health care. We are particularly concerned that the most disadvantaged Canadians are most likely to be hurt by the omissions in the new agreement. The Council calls on you in tomorrow’s federal Budget to address three programs that will close those gaps: a national child care system, increased support for the National Child Benefit, and a concerted focus on the health and well-being of Aboriginal people.
Medicare is one of the foundations of Canadian social policy, and it is the program most Canadians know best and love. But health policy experts and most Canadians acknowledge the fact that more medical service is not the solution to improving the health of our population. The federal health department and most of the health departments in the provinces and territories have long since officially recognized that medical care is just one of many factors that affect the health of the population.
Poverty, social supports, education, employment and working conditions, social and physical environments, genetic endowment, child development, personal practices, gender and culture all influence health outcomes. All these factors are important, but research has proven again and again that income and social status make a far greater difference to the health of the population than any other influence. Again and again studies show that poor people are more likely to be sick, to be injured and to die early. Babies born to poor families are smaller and sicker, and they grow into children who are more likely to be injured, to get sick, and to have behaviour problems, to need special education, repeat grades and drop out of school. Aboriginal people - a group struggling with poverty and political disenfranchisement - face appalling health conditions as a result. Health and social policy are inseparable. Unless governments address the root causes of health problems - and especially poverty - we can never control the costs to the health care system.
Government investment in the determinants of health - the root causes of health problems - will have a far greater effect on the health of Canadians than a simple investment in medical services. When social inequalities increase, the health of the whole population decreases. The cost of medical care, of course, goes up. A commitment to reducing poverty, and especially poverty that affects early child development, is the most sensible and cost- effective investment in the health of Canadians. Only an investment in preventing health problems can make our medical system sustainable.
So, while the members of the Council commend you on investing in medical care, we recommend in the strongest possible terms that the upcoming Budget invest in three major social programs that will protect more Canadians from living in poverty, getting sick and getting hurt and needing medical treatment. Only by doing this can we create an environment that will support good health for all Canadians in an affordable, sustainable and humane manner.
1. The National Council of Welfare strongly recommends that the federal government establish a national child care system. The program must ensure adequate funding for provincial and territorial governments to create regulated child care spaces that provide high-quality early education. The Council recommends at a minimum an investment of $200 million in the first year, $400 million in the second year, and $800 million in the next year.
Child care is a fact of life in the 21st century. Most mothers of young children have paid jobs, and their families rely on the income of mothers to make ends meet. Child care is essential to any efforts to help parents to finish their educations, find and keep jobs. But regulated child care exists for only 12.1 percent of our children. The absence of a system of high-quality care is a missed opportunity to provide Canadian children with the best early education possible.
2. The Council has heard rumours that the federal budget will include funding to increase the National Child Benefit, putting more money in the pockets of low- and modest-income parents. While we support increased funding to this program, we urge the federal government to stop allowing provincial and territorial governments to claw back part of the money from those parents who are forced to rely on welfare to support their families. All families on welfare live far below the poverty line. Taking money away from the poorest of poor families jeopardizes the health and development of too many young children.
3. The Council recommends the creation of Aboriginal health partnerships that pull together existing funding and programming for Aboriginal people into a coherent system of health care and promotion. Aboriginal people themselves must be involved in directing these services, and in developing the programs and policies that will ensure that the root causes of health problems are addressed.
John Murphy