Many ministries could be Ministry of Health
Dr. Trevor Hancock
27 November 2017
Despite its name, the Ministry of Health is anything but focused on health. Like the ‘health care system’ it directs, it is largely focused on managing people with all manner of diseases, injuries or disabilities. Only a small part of the system is devoted to keeping people healthy and preventing them from becoming ill or injured. It would be more correct to call it the illness care system, and the Ministry of Illness Care Management.
This is not to denigrate the system, or the many good people who work there, but simply to describe its function accurately. Like everyone else, when I am ill or injured I want a good quality illness care system to care for me. But most of the time I am not ill, and I would much prefer to avoid being sick or injured. And most of what keeps us healthy or makes us ill comes from outside the health sector.
If the current system and Ministry are not focused on keeping us healthy, who is? What Ministry, or Ministries, are or should be keeping us healthy? The answer is – most of them. But if we are going to re-name the Ministry of Health, should we not do so for these other ministries, naming them for their function rather than for the issue they manage. What would they look like if their mandate was more explicitly to improve the health of the population. So let’s look at some of these other ‘health’ Ministries, and what they could be doing.
A good place to begin is a set of ‘prerequisites for health’ identified in a key 1986 World Health Organisation document, the Ottawa Charter for Health Promotion. The Charter identified peace, shelter, education, food, income, sustainable resources and a stable ecosystem, social justice and equity. And I would add good early child development experiences, clean water, clean air, clean and reliable energy and – since we are 80% urbanized and spend 90% of our time indoors – healthy built environments, including good transportation systems.
Let’s start with peace. From a public health perspective, the best sort of crime is the one that doesn’t happen; ditto for violence, abuse and neglect. So we need a Ministry of Crime and Violence Prevention and Community Safety. Its first task would be to identify and address the factors that lead to crime and violence – including domestic violence and violence against women, school and workplace violence, bullying and harassment, elder abuse, racism and so on. All the policing functions would remain, of course, but as with illness care, good prevention should reduce the problem and ultimately the cost.
Next comes shelter. In a country this rich, no one should be homeless and housing should be affordable for those on limited incomes. Again, preventing people becoming homeless is not only more humane, it is less expensive than continued homelessness. The federal government’s recent announcement that it will enshrine the right to housing in legislation is a good start, as is the commitment to re-entering the social housing arena.
A provincial Ministry of Shelter and Housing Quality would be responsible for ensuring that right is recognised and implemented and that there is an adequate supply of decent affordable housing. But since there is more to housing than availability and affordability, this ministry would also need to address such aspects as quality, suitability (e.g for people with disabilities), energy and resource efficiency. And it would need to collaborate closely with other ministries that deal with the built environment, such as community planning and transportation; more about them next week.
The third prerequisite is education, although that may be too narrow a term. What we really want is a society full of educated, innovative and creative people who continue learning throughout their lives. So we need a Ministry of Learning that takes on responsibility for all learning, both in the formal systems of pre-school, kindergarten, school, college and university and in the wider realms of workplace and community learning, including ESL and other education for new immigrants and refugees.
Next week I will explore more ‘other ministries of health’, and the following week I will propose a new way of organising government more consistent with 21st century needs.
© Trevor Hancock, 2017