Many will remember the New Year of 2022, when the Prime Minister of Quebec, François Legault, announced at the last moment the imposition (for the second time) of a curfew. With exceptions, no one could go out between 10 PM and 5 AM under penalty of a fine of $1,000 to $6,000. The curfew ended on January 17.
It was later revealed in the media that public health in Quebec was unable to scientifically justify the use of this measure. In an advisory, Montreal’s public health department even opposed this decision.
“The politicization of public health” during the pandemic and the way it was used can lead to distrust in our healthcare system, asserts Erin Strumpf, co-author of the CIRANO study titled “Addressing Epidemiological Crises: Yes, but at What Cost?”.
“If the government ‘uses’ public health as a reason to implement certain policies — we remember the curfew of January 2022 — it was justified at that time by public health which recommended we do this, but the truth we discovered several months later is that public health did not recommend this measure,” Ms. Strumpf recounts.
“As soon as our trust in public health decreases, it will be more difficult to [bring] people to get tested and engage in chronic disease prevention measures,” explains the researcher. She believes that the reputation of public health has been greatly weakened.
According to Ms. Strumpf, to “catch up” with distrustful people, it would be relevant to understand who they are and what their perspective on public health is.
Generally, public health management of the pandemic has been a success, asserts Ms. Strumpf, who does not deny the very significant challenges that arose. “If we face a new crisis, another pandemic, we need to be able to demonstrate successes of the constructive role that public health can play,” Ms. Strumpf argues.
Prevention and Promotion Undermined
In the pre-pandemic years, spending on prevention was the second most important expenditure, behind health promotion spending, indicates the CIRANO study. In 2020-2021, it was surpassed by expenditures on emergency monitoring and health risks as well as credits given to community organizations.
“Reducing spending on prevention and health promotion may have had deleterious effects on the health of populations,” mentions the study. There are concerns about an increase in chronic diseases that may not have been detected early, which could also create additional pressure on the curative system.
If it were to be done again, could the government have gained benefits from an investment in prevention and health promotion? Not from a monetary perspective, according to Ms. Strumpf. “Prevention rarely saves us money in the future. But prevention, effective management of chronic diseases, and health promotion can produce health for the population in a more effective way than care.” In other words, it can save lives, but not save public funds.
Spending on emergency monitoring and health risks for 2020-2021 represents an increase of nearly $7.80 per capita compared to the predicted average value without the pandemic, a relative difference of over 3000%.
This type of additional spending came at the expense of investments in ongoing population health monitoring, health promotion, and disease prevention.
Health promotion expenditures were $2 per capita lower, representing a 16% difference compared to a scenario without the pandemic. Disease prevention expenditures were approximately $2.30 per capita lower, which represents a 30% difference.
The study also notes variations in the amounts invested according to socio-health regions.
“We must remember that we were in a health crisis, so it is not so unexpected that there would be a shift or substitution of funding,” stated Ms. Strumpf, who is also a full professor in the Department of Economics and the Department of Epidemiology, Biostatistics, and Occupational Health at McGill University.
The harmful effects on the population’s health will primarily depend on the duration of the decrease in allocated funds. “We cannot currently see if the decrease in funding for health promotion and prevention has continued to decline in the years well after the pandemic. We only have the two [first years] of the pandemic,” Ms. Strumpf specified.
She indicated that there have been challenges in accessing data and hopes that with this foundation it will be easier to obtain data for the coming years. The CIRANO study used several sources of population health and socioeconomic data, including the Canadian Community Health Survey and other demographic data from Canada and Quebec.
Ms. Strumpf also provides an important nuance. “When we talk about screening for cancer or other preventive measures, they have decreased for several reasons, it’s not just the reduction in funding. Clinics were closed, people were unable or unwilling to leave their homes. Everything was disrupted,” she says.
She seeks to know if this funding will be increased to avoid the anticipated consequences. For now, this question remains unanswered.
The health content from La Presse Canadienne is funded through a partnership with the Canadian Medical Association. La Presse Canadienne is solely responsible for editorial choices.
Future Trends in Public Health and Pandemic Management
The 2022 New Year’s Eve in Quebec marked a poignant moment as Prime Minister François Legault imposed a curfew, raising significant questions about government decision-making and public health policy. This curfew, which was later found to lack scientific justification by Montreal’s public health department, highlights a critical future trend: the increasing demand for transparency and evidence-based policies in health governance. As public trust wanes, stakeholders will likely advocate for more rigorous accountability mechanisms within the health system.
Restoring Public Trust in Health Systems
With the politicization of public health becoming more evident, researchers like Erin Strumpf suggest addressing distrust directly. Future strategies may involve engaging communities to understand their perspectives on health policies, potentially leading to tailored communication strategies that foster trust. This could also include enhancing public health education initiatives that provide clarity and encourage participation in health measures, especially during future crises.
Shifts in Health Spending Priorities
The CIRANO study emphasizes a concerning trend: the reduction in preventive and health promotion expenditures during the pandemic. As emergency monitoring expenses surged, funds for ongoing health promotion dwindled, which could lead to a rising incidence of chronic diseases. Looking ahead, governments may face pressure to rebalance budgets, recognizing that prevention not only saves lives but can also reduce the long-term burden on healthcare systems. Future budgets are likely to reflect a renewed commitment to preventive health initiatives.
Challenges of Access and Behavioral Change
Strumpf’s remarks on the decline in cancer screenings due to clinic closures and public apprehension signal another trend: health access will increasingly demand innovative solutions. The rise of telemedicine and remote health services is likely to continue, aimed at bridging the access gap exacerbated by the pandemic. Future health strategies may focus on seamless integration of technology into traditional healthcare practices, ensuring that essential services remain accessible to all populations.
Monitoring and Data Utilization
Future public health management will also increasingly rely on data to inform decisions. Efforts to strengthen surveillance systems for early detection of emerging health issues will be crucial. Initiatives to improve data collection and sharing can facilitate timely responses to potential health crises, ensuring that resource allocation aligns with real-time assessments of public health needs.
Regional Health Disparities
The disparities in health investments discussed in the CIRANO study may prompt future emphasis on equitable health resource distribution. Advocating for targeted funding and initiatives that address the unique needs of diverse socio-health regions will become a core focus for policymakers, as they strive to establish a more resilient public health framework capable of responding to varied local challenges.