Lifting COVID-19 restrictions puts extra pressure on already strapped public health resources

Experts say Nova Scotia's chief medical health officer and his staff could be in a tough situation as they seek to fend off any new COVID-19 outbreaks, given that the provincial government spends the least of any province on public health as a percentage of overall health spending.

"I think that public health has been chronically underappreciated," said epidemiologist Susan Kirkland, head of Dalhousie University's department of community health and epidemiology.

A 2019 survey by the Canadian Institute for Health Information, the country's leading authority on health-related statistics, noted Nova Scotia was the province that spent the least on public health, relative to overall health costs.

That leaves Kirkland and others worried that Strang and his 14 staff could be hamstrung as they seek to detect and contain the novel coronavirus, which hasn't been detected in Nova Scotia for about three weeks. Strang noted in an interview earlier this month that his team had been working non-stop and were "extremely tired."

According to the centre for health information, Nova Scotia devoted 1.8 per cent of its 2019 health budget to public health. By comparison, Saskatchewan, with roughly the same population, spent 7.6 per cent, and Strang's counterpart in Saskatchewan has double the staff.

In the Atlantic region, percentages ranged from 4.2 per cent in Newfoundland and Labrador to 6.5 per cent in Prince Edward Island. Ontario is at the top of the provincial list, spending 8.6 per cent of its health budget on public health.

Kirkland says Nova Scotia's spending is "not sufficient now and it's never really been sufficient in the past, I would argue."

During the past three years, outside of special allocations for specific projects, the budget for Strang's office has been roughly $2.5 million. The most recent budget, passed just weeks before the virus was first detected in Nova Scotia, allotted $2.7 million for the office.

There was no extra money in the 2020-21 budget for COVID-19-related expenses.

Kirkland believes part of the reason for the relatively low funding is that people don't appreciate public health because when it works, it's invisible.

"When public health does its job well, nothing happens."

She hopes that a change in perception due to Public Health's central role in the pandemic will spur the McNeil government to do what it and previous governments have been slow to do: put a greater share of the health budget into illness prevention and protection.

"When you think about provincial budgets for health, the vast majority goes into treatment," said Kirkland. "So there's a very small proportion that's left over for prevention.

"I'd like to think it will change but it requires a huge momentum shift."

High-stakes task

There are people who work in a public health capacity within the Nova Scotia Health Authority, but when it comes to emergencies like this pandemic, overall direction comes from Strang and his office.

It's a daunting, high-stakes task considering a new outbreak could force the province to again order shutdowns or impose restrictions.

David Chaundy, president of the Atlantic Provinces Economic Council, did not feel qualified to comment on the allocation of resources within the health budget, but made clear what's at stake.

"We've shut down the economy in ways we would never probably have conceived before," he said. "Although we've had SARS and we've had these other situations in the past, I just don't think anyone was really fully prepared for the type and scale of the shutdown that we've seen due to COVID-19."

Businesses have adapted to the "significant shock" of the first wave according to Chaundy, but many are already worrying about the widely predicted second wave.

Dalhousie University economist Lars Osberg said successive governments have been given to "short-sighted thinking."

"The old phrase is an ounce of prevention is worth a pound of cure," he said. "And the costs are roughly that too. But we've tended to go for the cure and avoid the prevention."

Costs of 'short-term thinking'

Asked if the four-year election cycle might have something to do with that, Osberg was categorical.

"Absolutely!" he said.

"Public-health interventions like early childhood education are investments that pay off for decades and decades and decades," said Osberg. "They don't pay off much in the next four years. They pay off in the long term.

"Those are the sorts of things that short-term thinking — and by governments which have short-term horizons — tend to avoid spending money on."

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