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A “health in all policies” review of Canadian public finance



Consistent with evidence that health is shaped primarily by its social determinants, health systems research shows that government spending on social programs often has a stronger association with population health than medical care investments. This study aims to support Canadian provincial and federal cabinets to act on this evidence by engaging with the concept of “health in all policies” (HiAP) during budget deliberations.


The study is descriptive, analyzing secondary, publicly available data about federal and provincial budgets to explore how public finance for social determinants of health (SDoH) investments in earlier (< age 45) and later (age 65+) life course stages has evolved since 1976 relative to investments in medical care.


Medical care spending increased $3983 per person age 65+ since 1976. This increase is 45% larger than the combined increase for childcare, parental leave, family income support, education, and medical spending per person under age 45. Of the new spending on younger Canadians, medical care received the largest investment. Whereas medical spending for retirees increased just over half the pace of retirement income spending, medical spending for younger Canadians increased nearly as much as their total package of SDoH policies.


There has been greater alignment between the HiAP concept and Canadian public finance for seniors than for younger Canadians since 1976. Results provide decision-makers with important retrospective information by which to evaluate future public investments in and beyond medical care, across the life course, along with plans to finance those investments.



Il est démontré que la santé est principalement le fruit de ses déterminants sociaux, et comme de fait, la recherche sur les systèmes de santé montre que les dépenses publiques relatives aux programmes sociaux sont souvent plus fortement corrélées à la santé des populations que les investissements dans les soins médicaux. Notre étude vise à aider les Cabinets provinciaux et fédéraux du Canada à en prendre acte en introduisant le concept de « la santé dans toutes les politiques » (Health in All Policies, ou HiAP) dans les débats budgétaires.


L’étude est descriptive; elle analyse des données secondaires accessibles au public sur les budgets fédéraux et provinciaux pour déterminer comment le financement public des investissements dans les déterminants sociaux de la santé (DSS) aux stades précoces (< 45 ans) et ultérieurs (65 ans et plus) du parcours de vie a évolué depuis 1976 par rapport aux investissements dans les soins médicaux.


Les dépenses en soins médicaux ont augmenté de 3 983 $ par personne de 65 ans et plus depuis 1976. Cette augmentation dépasse de 45 % l’augmentation combinée des dépenses en services de garde, en congés parentaux, en aide au revenu familial, en éducation et en soins médicaux par personne pour les moins de 45 ans. De toutes les nouvelles dépenses pour les Canadiens plus jeunes, les soins médicaux ont reçu les investissements les plus importants. Alors que les dépenses médicales pour les retraités ont dépassé d’un peu plus de la moitié le rythme des dépenses en revenus de retraite, les dépenses médicales pour les Canadiens plus jeunes ont augmenté presque autant que les dépenses pour l’ensemble des politiques de DSS à leur endroit.


Depuis 1976, il y a une plus grande concordance entre l’approche HiAP et le financement public du Canada pour les aînés que pour les Canadiens plus jeunes. Ces résultats offrent aux décideurs d’importantes informations rétrospectives pour évaluer les futurs investissements publics dans les soins médicaux et les déterminants sociaux de la santé pour tout le parcours de vie, ainsi que les plans de financement de ces investissements.

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  1. 1.

    Due to data limitations, the 1976 calculations assume (i) all people in postsecondary in that year have a certificate/degree and (ii) all people over the age of 35 in postsecondary fall in the under-age-45 cohort. These assumptions overestimate the percentage of people under 45 who had postsecondary credentials in 1976, and thus underestimate the increase in the proportion of people under 45 with postsecondary credentials as of 2016. The latter underestimation means the per capita decrease in spending on postsecondary as of 2016 is likely larger than reported in Tables 5 and 6.

  2. 2.

    CIHI data signal minimum demand increases, because use of publicly paid medical care also reflects supply constraints.

  3. 3.

    The sensitivity analysis (which attributes 1998 per capita age data reported by CIHI to 1976) suggests that figures reported in the primary results underestimate the annual per capita increase in medical care spending for Canadian seniors by $905 between 1976 and 2016.

  4. 4.

    The sensitivity analysis (which attributes 1998 per capita age data reported by CIHI to 1976) suggests that figures reported in the primary results overestimate the annual per capita increase in medical care spending for Canadians under age 45 by $77 between 1976 and 2016.


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Correspondence to Paul Kershaw.

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Kershaw, P. A “health in all policies” review of Canadian public finance. Can J Public Health 111, 8–20 (2020).

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  • Health in all policies
  • Social/medical spending ratio
  • Social determinants of health
  • Health systems
  • Resource allocation


  • La santé dans toutes les politiques
  • Ratio des dépenses sociales aux dépenses médicales
  • Déterminants sociaux de la santé
  • Systèmes de santé
  • Allocation des ressources