The Social Determinants of Health: How do we reward long-term thinking in a 4-year election cycle?

Finance Minister Doug Horner was quoted as saying the following in last Friday’s Calgary Metro, with regard to the Alberta Budget:

“We are having a tough time here.  We’re going to have five million people in this province within 17 years.  Where are their kids going to go to school?  Where are they going to have hospitals to go to?  How are they going to get to work if the road isn’t there?”

Last week, Sustainable Calgary responded to dialogue around the budget with the following tweet: “Would love more room 4 long-term spending strategies in #ABBudget & gov budgets in general: investing in human capital can save $$ down road”.

As witnessed by Horner’s comments, the Alberta government is, of course, making long-term spending decisions.  However, they also likely feel like they have to pick and choose where they spend their limited funds, in ways they feel best reflect the views and the interests of the public. This is the conundrum governments have to face.

Picking-and-choosing where we spend gets particularly difficult, however, in light of research emerging from the health and social sectors.  The research shows that investing in the “social determinants of health” – things like income, education, early childhood development, and housing – is key to preventing and reducing the costs associated with poor health and poverty.  Investing in these areas removes pressure for the health care system and the justice system, among others, and positions people to contribute more fully in our economy: they end up having more time, more capacity, and fewer sick days.  The research suggests that investing in the social determinants of health is actually less expensive than the negative repercussions of not investing.  Lastly, it suggests that the most benefit is reaped by addressing all of the social determinants at once.

In summary, we shouldn’t be stingy when it comes to investing in people, because we’ll reap the rewards later – in a big way.

So far, there hasn’t been significant room for this line of thinking.  In my experience, it’s not because people don’t believe the economic arguments; rather, you can narrow it down to two broad reasons:

  1. There  are many potential expenditures competing for a limited budget;
  2. Spending in new ways is intimidating, particularly when the expected benefits are years down the line –what if it doesn’t work out way we expect it to?  How does this affect re-election?

Limited budgets can be addressed in several ways.  We can impose austerity measures.  We can go into debt.  And/or we can increase our revenue streams through tax reform.  This blog, however, focuses on the second point.

Citizens – voters – have a hard time with long-term strategies, and for good reasons.  We can’t always see progress within 4 years.  How can we trust that our governments are “on track”?  How can we trust that more investment now will reap savings 16 years from now?

To make things more complicated, innovation often involves a certain amount of trial-and-error.  With government spending, however, we voters can quickly lose faith when things do not work out as planned.  Meanwhile, getting a strategy or tactic wrong the first time might mean doing it that much better the second time.  How can we account for this as voters?

This brings me to evaluation and accountability.  What if we developed frameworks to help voters evaluate governments in a consistent way every 4 years?  What if these frameworks included strategies to evaluate long-term spending?  What if they included strategies to evaluate innovation within government policy?  What if we got major media outlets to report on these frameworks every 4 years, to help keep us up-to-date?  Could better measurement  – ie better communication between citizens and government – actually enable more innovation and progress in government policy?

Developing indicators and reporting on them is something Sustainable Calgary has been doing for YYC for over 10 years.  This year, we’re adding a new category to our indicators: a category around governance.  We haven’t settled on indicators yet, but we’re hosting a day to hash through some of these things on March 16, 8:30–3 at Hillhurst United Church.  If you’re interested in good governance and how we measure it, please RSVP here!


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