Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada.

ABSTRACT

This commentary explores public health (PH) investments in Quebec and underlines the challenge of tracking PH resources across Canada. We analyzed governmental data to compare investments across all health and social programs in Quebec from 2004-2005 to 2017-2018. The province's PH budgets suffered from disproportionately low investments and abrupt cuts. These cuts were the largest among all health programs in 2015-2016 (- 7.1%). PH budgets did not keep up with inflation and, in constant dollars, have declined over the last decade. Furthermore, their evolution over the span of 14 years significantly differed from other health programs. On average, programs providing direct services experienced overall budget increases of 81%, whereas PH budgets had the lowest increase of all such programs at only 46%. PH suffers from serious erosion of its capacity. Unfortunately, there is a dire lack of comparable data for provincial, national, and international PH budgets, which further complicates the monitoring of PH erosion. We contend that systematic tracking of PH budgets remains profoundly inadequate across Canada. We recommend (1) regular, comprehensive, and publicly reported analyses of PH budgets; (2) in-depth comparisons of PH investments across Canadian jurisdictions; and (3) a strong PH systems and services research agenda for Canada.