Where the money isn’t

Every year in Toronto and cities across the country, departments of public health have to fight for their budgets.  In Toronto, the fight was ugly last year.  The mayor wanted no increase.  Toronto Public Health said delivery of student nutrition programs necessitated an increase.  The budget passed, but not without a fight.  Next year is will be the same scramble to make sure no ground is lost.  Forget making a bigger investment in public health.  There is no money for that.  And what you hear right now (or you would if you were in the room)  is the sound of Your Working Girl sighing.

In the case of Toronto Public Health, it has a budget of $241 million — for every $1 the city spends, the province kicks in $3.  That is $89.26 for every man, woman and child in the city.  It handles everything from AIDS prevention, communicable diseases, making children healthy and mental health.  The A-Z list on the website () is remarkable in the number of areas it touches.

By comparison, the annual operating budget of one major teaching hospital is $730 million, with the provincial government footing most of the bill.    That’s an average of $1839 per case, ranging from emergency visits to surgery.

In the past 100 years, we’ve made great strides in health.  The news is good.  We are living longer than ever.  What are the reasons do you think?  Is it the new technology in medical equipment?  The early diagnostic techniques for many diseases?  Pharmaceuticals developed in the last thirty years?  If you answered non, non and non, you’d be right.

The most significant advances in our general health which have added 25 years to our life have been made possible by public health initiatives and not disease-based research.  Here are the 12 greatest public health achievements according to the Public Health Agency of Canada (PHAC):

• Acting on the social determinants of health (such as income, education, early childhood development and social connections)
• Control of infectious diseases
• Decline in deaths from coronary heart disease and stroke (through eating better, exercise)
• Family planning
• Healthier environments (flouride in water for example)
•  Healthier mothers and babies
• Motor-vehicle safety
•  Recognition of tobacco use as a health hazard
•  Safer and healthier foods
• Safer workplaces
•  Universal policies (income maintenance, health care)
•  Vaccination

The funding of health care defies logic.  But check out the Public Health Agency of Canada website to feel proud of your country. And follow them on Twitter.  You never know when that will come in handy!