Economic strategy must include the health of the workforce
Canada’s premiers spent this week in Charlottetown talking about the economy, internal trade, nation-building projects. The International Monetary Fund says tearing down our internal trade barriers alone is worth $210B, close to seven per cent of GDP, and the premiers are right to chase it.
Remember that number. Seven per cent.
Health made the agenda too, the way it always does. As a demand for more money, the way it always does.
The premiers warned of a fiscal cliff as health agreements begin to expire next year. Some called for the federal share, now around 21 per cent, to climb back toward half. And their closing communiqué asked for one thing above all: increased unconditional and flexible federal funding.
Unconditional – their word. A bigger cheque, with nothing said about what the cheque is meant to buy.
I’ve been a family physician for more than three decades. I’ve taken on patients who went years without care, arriving with conditions that could have been caught in time and weren’t. And I’ve watched patients I’ve known for years leave work because illness left them no choice.
Lack of healthcare access costs us workers. So does illness itself. The toll lands on whole families, who are often my patients too. The strain on a household is easy to see from the inside. The strain on the economy is the same strain, spread across millions of households, and we’ve never added it up.
The Canadian Institute for Health Information (CIHI) reports that 5.7 million Canadian adults had no regular healthcare provider in 2024. Over the past five years, the supply of family physicians per person went down, not up. And CIHI’s own conclusion deserves a second read: closing this gap will take a system-wide approach that goes beyond adding more healthcare professionals.
Britain has already put a price on ignoring this. A review commissioned by the UK government reported last fall that ill health is now the biggest reason working-age Britons leave the workforce, costing the state £212B a year. Seven per cent of GDP.
The same seven per cent our premiers are chasing through internal trade, we are already losing through poor health.
Look at where our money goes. Last fall’s federal budget put five billion dollars into bricks and mortar: hospitals, emergency rooms, medical schools.
Yet the real return sits with the family physician who holds the whole picture of a patient over years, working with the nurse, the pharmacist, the social worker and the specialists, pulling what each contributes into one integrated care plan. That’s the kind of work that manages a health problem early, before a permanent exit from the workforce becomes inevitable.
Since 2023, provinces have filed action plans and reported against a set of indicators. But an indicator only tells you where you stand. It can’t tell you if you are moving in the right direction. Thirteen jurisdictions each spend health dollars using their own ideas of what good primary care looks like, without a common reference point. That’s about to change.
A revised national standard for primary healthcare went through public review this spring, shaped by provinces, patients, leaders, researchers and clinicians across the country. It describes what good primary care looks like anywhere in Canada: comprehensive, coordinated and continuous, delivered by a team built around the patient.
It’s a reference point every jurisdiction can use – a North Star. And it arrives just as the next health agreements are being negotiated.
So, here’s my ask of the premiers, and of the Prime Minister who sat down with them. When you negotiate the next health agreements, give the money an aim. Point it at the standard, the way jurisdictions across the country already build to the National Building Code: no federal mandate, each province designing for its own context at its own pace. Then report progress publicly, so Canadians can see whether the money is buying health.
Our political leaders came to the birthplace of Confederation to build a more competitive country. The health of the people who will build it belongs inside that plan, not beside it. The North Star is ready. The question is whether the premiers will look up.
Photo courtesy of Joey Coleman, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons
