Abstract

The Spin Doctor is In: The Role of Public Information in Shaping Health Care

Armine Yalnizyan

This paper examines the role of the public dissemination of information in helping shape and assess public policy reforms in health care.

The last several years have witnessed significant public debate about Canada's Health Care System. The governance questions have centered on whether the public system is sustainable from a cost perspective, and whether the federal government's contribution to public health care is fair or sufficient. The policy questions have centered on whether publicly insured health care services are too broadly or too narrowly defined (raising issues of equity and access) and whether a larger role for for-profit care providers impedes or improves the goals of public health care.

Various actors have been using the media and releasing statistics to persuade Canadians to a particular position on health care. The media releases often include data on spending or, for example, waiting lists. In a field where clinical evidence and scientific method are the norm rather than the exception, the data released on health policy trends are selective and rarely present information in a neutral or unbiased fashion.

The longest-running example of the selective use of information involves the debate between the federal and provincial levels of government with respect to sharing the costs of the public health system. The numbers produced by each camp have varied widely since the late 1990s, largely because of the re-design of the funding vehicle itself.

Introduced in 1996, the Canadian Health and Social Transfer transfers federal funds to the provinces and territories not just for health but also for post-secondary education, social housing, child welfare, and social assistance. Block funds by their nature cannot be deconstructed to unequivocally determine the federal contribution to any component of what is being funded.

Even after two arduous and highly publicized rounds of negotiating, there is still no consensus on what the federal contribution to health care currently is, or will be with a new infusion of funds. The battle continues, permitting other battles based on "insufficiency of public resources" arguments – such as increasing the role of the private sector, scope of service, or waiting times – to rage on.

Bio

Armine Yalnizyan is an economist who has focussed on serving the community, particularly the most vulnerable among us.

Armine worked at the Social Planning Council of Metropolitan Toronto from 1987 to 1997. Aside from her duties as an economist, she also had the privilege of working with local government and community-based groups to develop community audit techniques. These tools help communities assess the strengths and limits of the voluntary sector and the capacity of neighbourhoods to adapt to profound changes in government provisions.

In 1998 she authored a ground-breaking report on income inequality in Canada, entitled The Growing Gap, published by the Centre for Social Justice. In 2000 her follow-up report documented the driving forces behind trends in income inequality, province by province.

In 2002 Armine became the surprised and honoured first recipient of the Atkinson Foundation Award for Economic Justice. She is using that award to focus on the financing of public health care, publishing through the Canadian Centre for Policy Alternatives.

Armine has served on Advisory groups to the federal government on working time and on voluntary sector initiatives, and to the government of Ontario on welfare reforms. She is a founding member of the Progressive Economics Forum; a board member of the Public Interest Advocacy Centre; a co-chair of the Ontario Alternative Budget, and member of the Alternative Federal Budget team; an active and grateful member of the United Church of Canada; and deeply believes in the power of informed public discourse.

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