It is not yesterday that we did not invest enough in public health in Quebec, but it is only since the start of the pandemic that it is obvious to us.
Posted at 5:00 a.m.
Unfortunately, we had not yet felt any large-scale mobilization to remedy this problem in Quebec. That could change (and, please: it should change!) now that the Commissioner of Health and Welfare, Joanne Castonguay, has just published her investigation report on the performance of care and services for the elderly during the first wave.
One of the two parts of the report is entirely devoted to strengthening the strategic role of public health (the second deals, more generally, with governance). And the conclusions are relentless.
Starting with those on underfunding, which testify to an embarrassing backwardness of Quebec in Canada as a whole, but also in the world.
In 2019, while overall health spending in Quebec amounted to $58.6 billion, the share reserved for public health was only 2.2% (i.e. $1.3 billion). This share is “the lowest of the Canadian provinces”.
But wait, that’s not all! Quebec is also the only province where this share fell between 2010 and 2019 (on average by 3.5% per year).
Quebec’s investments in public health per capita are not only lower than in the other provinces, but also than the average, in terms of preventive care, for OECD countries.
Let’s face it: public health is traditionally the poor relation of health systems. But in Quebec, this poverty is even more flagrant than elsewhere.
It’s downright embarrassing. It is also a very serious handicap, especially in the event of a health crisis.
The report tells us that “the various studies analyzing the success or failure of countries in managing the pandemic establish a clear link between continuous and significant investments in public health and the impact of COVID-19”.
The data collected in the field point in the same direction.
Some 150 people were interviewed as part of the commissioner’s investigation. Several made the link with the underfunding and the fact that they had difficulty in exercising “quickly all of their responsibilities in connection with the management of the pandemic”.
The reform of Gaétan Barrette, in 2015, was cited. The minister had pulled out the ax, and the power of authority of public health actors had been reduced, we can see in retrospect.
“We had cut 30% of the public health budget. Imagine in a context where a pandemic arrives and it was difficult to function in a normal context. And we had difficulties. We had lost a lot of stakeholders, ”said one of the actors of the network, quoted in the report on condition of anonymity.
Underfunded, public health is also marginalized and its leaders work too much in silos. That, too, needs to change urgently.
Of course, we will never know exactly what would have been done differently if more money had been invested in the public health system and if it had been valued more. But it is obvious that his performance would have been superior and that he would have been better able to react at the quarter turn.
Some said they believed, for example, that there would have been better collaboration between network players and that screening would have been easier.
We can also think that we would have seen an improvement in Quebec’s risk analysis and surveillance capacities. Maybe even our pandemic crisis management plan would have been updated and tested.
Certainly, the status quo is inconceivable.
Public health must now be valued.
It must be at the top of the priorities of the Ministry of Health.
And when we think about ways to change the situation, it would also be useful to rethink the role of the national director of public health, as we wrote recently.
Should he keep his two hats and remain assistant deputy minister? Joanne Castonguay has not decided, but she pleads for more transparency. In particular, it considers that it should be able to make its opinions public independently.
Let’s end with a word of caution: the government has a golden opportunity to take action, and it shouldn’t let it slip away.
If we don’t restore public health in Quebec to its former glory, when we have just demonstrated that its deficiencies had an impact on the fiasco of the first wave, when will we do it?