Abstract
We argue that Canadian provincial governments should contain medical care spending in order to invest more in the social determinants of health (SDH). Others have said this, many times. Doing it has not proven easy. We therefore emphasize the potential contribution of the priority-setting and resource allocation literature. This literature identifies formal tools and approaches that have built cultures of support for resource shifts, while providing pragmatic means for advancing efficiency and equity. Although reallocation towards SDH from other areas of the health care system is financially viable and supported by existing research, it will require new emphasis on the design of population health interventions that make reallocation politically expedient.
Résumé
Nous soutenons que les gouvernements provinciaux du Canada devraient limiter les dépenses de soins médicaux afin d’investir davantage dans les déterminants sociaux de la santé (DSS). D’autres ont dit la même chose, à maintes reprises. Mettre ceci en pratique n’a pas été aisé. Nous insistons donc sur la contribution possible de la documentation sur l’établissement de priorités et l’allocation de ressources. Dans cette documentation, on répertorie les outils et les approches qui renforcent des cultures de soutien à la réorientation des ressources, tout en proposant des façons pragmatiques de favoriser l’efficience et l’équité. Bien que la réaffectation vers les DSS à partir d’autres éléments du système de soins de santé soit financièrement viable et étayée par la recherche existante, elle nécessitera une nouvelle insistance sur la conception d’interventions en santé des populations qui rendent une telle réaffectation politiquement rentable.
Similar content being viewed by others
References
Marchildon G. Canada: Health System Review. Health Systems in Transition 15:1. Geneva: WHO Europe, 2013.
Canadian Institute for Health Information. National Health Expenditure Trends, 1975–2014. Ottawa, ON: CIHI, 2014.
Mossialos E, Wenzel M, Osborne R, Anderson C. International Profiles of Health Care Systems. New York, NY: The Commonwealth Fund, 2015.
Commission on the Social Determinants of Health. 2008. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health. Available at: http://www.who.int/social_determinants/thecommission/finalreport/en/index.html (Accessed January 20, 2016).
Embrett MG, Randall, GE. Social determinants of health and health equity policy research: Exploring the use, misuse and nonuse of policy analysis theory. Soc Sci Med 2014;108:147–55. PMID: 24641879. doi: 10.1016/j.socscimed.2014.03.004.
Exworthy M. Policy to tackle the social determinants of health: Using conceptual models to understand the policy process. Health Policy Plann 2008; 23(5):318–27. PMID: 18701553. doi: 10.1093/heapol/czn022.
Greaves LJ, Bialystok, LR. Health in all policies–All talk and little action? Can J Public Health 2011;102(6):407–9. PMID: 22164546.
Bryant T, Raphael D, Schreker T, Labonte R. Canada: A land of missed opportunity for addressing the social determinants of health. Health Policy 2011;101:44–58. PMID: 20888059. doi: 10.1016/j.healthpol.2010.08.022.
Kershaw P, Anderson L. Is a pan-Canadian early child development system possible? Yes, when we redress what ails Canadian culture. Paediatr Child Health 2009;14(10):685–88. PMID: 21119820.
Kershaw P. Population Aging, Generational Equity and the Middle Class. Vancouver, BC: Generation Squeeze, 2015. Available at: http://bit.ly/GSMiddleClass (Accessed October 9, 2015).
Mitton C, Patten S, Waldner H, Donaldson C. Priority setting in health authorities: A novel approach to a historical activity. Soc Sci Med 2003;57:1653–63. PMID: 12948574. doi: 10.1016/S0277-9536(02)00549-X.
Kendall PRW. Investing in Prevention: Improving Health and Creating Sustainability. The Provincial Health Officer’s Special Report. Victoria, BC: Office of the Provincial Health Officer, 2010.
Masuda JR, Robinson K, Elliott SJ, Eyles J. Chronic disease prevention and the politics of scale: Lessons from Canadian health reform. Soc Work Public Health 2012;27:639–57. PMID: 23145549. doi: 10.1080/19371910903182880.
Brown TM, Fee E. Social movements in health. Annu Rev Public Health 2014;35:385–98. PMID: 24328986. doi: 10.1146/annurev-publhealth-031912-114356.
Raphael D. Beyond policy analysis: The raw politics behind the opposition to healthy public policy. Health Promot Int 2015;30(2):380–96. PMID: 24870808. doi: 10.1093/heapro/dau044.
Author information
Authors and Affiliations
Corresponding author
Additional information
Conflict of Interest: None to declare.
Rights and permissions
About this article
Cite this article
Smith, N., Mitton, C. & Kershaw, P. The reallocation challenge: Containing Canadian medical care spending to invest in the social determinants of health. Can J Public Health 107, e130–e132 (2016). https://doi.org/10.17269/cjph.107.5184
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.17269/cjph.107.5184