NDP and UCP battle to be strong on medical care — not health

Medical care is a hot topic in the run-up to the Alberta election. The key question, as the televised leaders’ debate emphasized, is who can be trusted to protect public funding for medical care. UCP Leader Danielle Smith reaffirmed her “public health care guarantee,” while NDP Leader Rachel Notley reminded viewers of Smith’s past statements regarding private payment.

What no one is asking the leaders is: Who can Albertans trust to promote health and well-being? Which party will preserve health care as a sacred trust by investing to make people well, not just treating illness after they fall sick?

Our new study of the parties' platforms shows the UCP plans to increase annual spending on medical care by $3.8 billion as of 2025-26. The NDP will add $4.4 billion. These are by far the biggest investments promised by either party. Unfortunately, this isn’t all good news if you care about helping Albertans get and stay well.

As Albertans struggle with long wait times and not enough access to family doctors, it makes sense to inject new money into the medical system. But both parties overlook the fact that medical care accounts for only one-quarter of our health. Medical care was never supposed to go it alone — it’s meant to be part of a wider system supporting people with the things they need to be healthy and well, like decent earnings, homes, child care, and a sustainable planet.

These social conditions may not be the first things that come to mind when many people think about health, yet reams of evidence confirm they more strongly influence our health than medical care. As long as Albertans can’t access safe homes, good incomes, quality child care and a healthy environment, our medical system will never be enough to prevent people from dying early.

We’re grateful we can call on fire departments to put out the flames when we need them, but preventing fires is much less deadly, damaging and costly. So it is with health care. Waiting to invest until people are ill is like showing up with hoses once the fire is already raging. We need to prevent the first sparks from getting out of hand. This means clinics and hospitals should be the last stop, not the first stop, in our health system. The first stops for good health are found in our neighbourhoods, jobs, childcare centres and schools — something the pandemic made painfully clear.

Alberta used to budget this way. In 1976, the province spent approximately 36 per cent more on social and education programs than on medical care. Now, it’s about 26 per cent less.

These trends suggest it’s no coincidence that while medical costs rise, access and quality aren’t keeping pace. We haven’t prevented enough people from joining the queue waiting for medical care, especially as our population ages and patient needs become more complex. In response, many doctors want to prescribe things like housing, child care and poverty reduction, but can’t. Instead, many of these medical professionals are burning out, even as the number of doctors per capita goes up. Alberta had 125 physicians for every 100,000 people in 1976, including 68 family doctors. Today, Alberta has 252 doctors for every 100,000 residents, including 124 family physicians.

Unfortunately, both the UCP and Alberta NDP fail to embrace the science of health promotion.

The UCP plans to increase annual provincial spending on medical care, education and social services by $6.5 billion as of 2025-26. More than half (58 per cent) of the new spending will go to medical care, signalling illness treatment is considered more urgent than social spending on prevention and health promotion.

The Alberta NDP intends to spend $8.5 billion more annually on medical, education and social programs as of 2025-26. Of that,52 per cent will go to medical care, confirming the NDP also prioritizes treating illness over prevention. That said, the NDP is closer to aligning with the science of health promotion than the UCP because it offers a somewhat better balance between medical and social spending.

The inherent risk of both parties’ promises is that they will fail to slow the flow of sickness into our hospitals and clinics because they don’t invest urgently enough to promote well-being and prevent illness. An overburdened system is a recipe for burnout for doctors and nurses.

Some Albertans may consider higher provincial spending on medical care as a point of pride. Especially now when so many Canadians are concerned about gaps in our medical system. But the data show this spending isn’t worth bragging about because it does not buy better outcomes.

If more money for medical care was the secret for better health, then Alberta would already be ahead of B.C. and Ontario. Alberta spends $5,427 per resident on medical care, compared to $4,997 and $4,864 in B.C. and Ontario, respectively.

Despite higher spending, the Canadian Institute for Health Information shows Alberta ranks below B.C., Ontario and the national average on health outcomes for infant mortality, heart disease, cervical cancer and rectal cancer mortality, and avoidable admissions for COPD (lung disease) and diabetes. Albertans also have a lower life expectancy.

Even though high spending on medical care doesn’t consistently purchase the best health outcomes for Albertans, it does result in Alberta doctors being the best paid of any in Canada.

No matter what your budget priorities are, it makes little sense for Alberta to spend more per capita on medical care yet not achieve routinely better health outcomes, especially given the province’s younger population. The median age in Alberta is 38, compared to 40 in Ontario and 42 in B.C. A younger population should require lower per-capita spending on medical care because we consume most medical services when frailty increases at older ages.

The size of the opportunity to spend more wisely may surprise readers. Per-capita medical spending in Alberta would remain on par with B.C. and Ontario even if the total budget for medical care in Alberta was $2.5 billion less than it is now. To put that large sum of inefficient spending in context, Alberta only plans to spend $1.9 billion per year for $10-a-day child care.

Since B.C. and Ontario report as good or better health outcomes than Alberta, whatever party is elected to the Alberta legislature on May 29 should grow spending on child care, education, housing and poverty reduction more urgently than spending on medical care. To be clear, we aren’t suggesting medical spending be cut, just that other investments should grow faster.

Social spending invests where health begins — the conditions in which we are born, grow, live, work and age — capturing the wisdom that an ounce of prevention is worth a pound of cure.

Dr. Paul Kershaw is a University of British Columbia policy professor and founder of Generation Squeeze. Andrea Long is Gen Squeeze’s senior director of research and knowledge mobilization.

They are the authors of a new study of housing commitments made by the UCP and Alberta NDP in the 2023 election. This analysis is part of Generation Squeeze’s non-partisan, evidence-based Alberta Voters Guide. The guide helps to inform Albertans about actions parties are proposing to address key issues in the 2023 election, like affordability, health and protecting natural resources. Follow us at www.gensqueeze.ca, Twitter, Facebook and listen to our Hard Truths podcast.