Everybody’s Business: The Cost of Multi-Department Involvement in Public Health in Alberta

The Institute of Health Economics (IHE) has completed a scan to determine what public health-related costs are borne by government departments, ministries, and agencies. The final report, Everybody’s Business: The Cost of Multi-Department Involvement in Public Health in Alberta, was funded by Alberta Health Services (AHS) as part of the Project 2030 initiative that saw the IHE develop and host three conferences on Becoming the Best: Building Sustainability during the winter and early spring of 2011. While many studies survey risk behaviours and disease prevalence, few undertake to determine what services government are producing and on what scale they are being delivered. That is the purpose of this report.

Public health, the publicly organized efforts to prevent disease and injury and promote health, covers a wide range of diseases and their related risk factors; from smoking to dangerous driving, to environmental causes relating to food, water, and the air. In fact, the causes of disease and their risk factors we must address are so broad they cover almost all groups in society, everywhere people go, and whatever they do. It is not surprising then, that in a broad IHE survey of the public health-related activities of federal, provincial, and municipal governments working in Alberta, we identified 23 federal and 21 provincial departments and agencies, as well as the municipalities, that formally recognized their health roles and were actively involved as “public health suppliers.”

According to the Canadian Institute of Health Information, the Alberta Government spent about $4,592 per capita on health care. Most, over 90%, of this expenditure went to active treatment for diseases, the major ones being cardiovascular, pulmonary, musculoskeletal, and mental health. Many of the risk factors of these conditions have been traced to behavioural or environmental causes, as is seen in the accompanying World Health Organization chart, and are preventable. Figure 1 describes the top ten risk factors as measured in disability adjusted life years for high-income countries, all of which are preventable. Tobacco, alcohol, and an overweight body-mass are the top three areas identified by the World Health Organization.

Figure 1: Top 10 risk factors, DALYs, in high-income countries, 2006. Source: World Health Organization (2008). Global Burden of Disease.

Figure 1: Top 10 risk factors, DALYs, in high-income countries, 2006
Source: World Health Organization (2008). Global Burden of Disease.

We currently know quite a bit about income countries, 2006 the public interventions that can ameliorate risk factors; however, there is virtually no information on how many resources we put into prevention and how we actually allocate these resources. This is, in part, due to the fact that the causes of the disease are so widespread and many different ministries and agencies have responsibilities for different kinds of interventions that can prevent illness and promote health.

This report aimed to develop an accounting of the resources used in “public health” from a broad, multi-agency perspective. For each of the departments or agencies that dealt with health-related risk factors, we captured information relating to 1) the specific risk factors that are addressed, 2) the type of public health services provided and 3) the associated costs (if available). We developed a framework with these components, conducted initial internet searches and then contacted agencies for further information and verification.

We present the costs in four categories. These are the federal government expenditures, which are separated into health ministry or agency (e.g., Health Canada and the Public Health Agency of Canada) and non-health ministry or agency (e.g., Agriculture and Agri-food Canada). We did the same for the provincial ministries and agencies. In addition, costs were divided into two groups: current operating costs and capital costs. We separately included costs for First Nations and Inuit health initiatives, because of the different populations targeted. In fifteen areas of public health as defined by Health Canada, we identified twelve federal ministries, eleven federal agencies, sixteen provincial ministries, five provincial agencies, and municipalities which stated that the public’s health was one of their operational goals. Figure 2 presents the per capita expenditure for each area of public health.

Figure 2: Per Capita Cost of Public Health Functions

Figure 2: Per Capita Cost of Public Health Functions

We were able to trace a total of $327 per capita to specific public health functions. Of this total, 60.5% came from provincial non-health ministries. Capital expenditures were $256 per capita, of which 32.5% were from the federal government. First Nations expenditures, capital and operating, were $2,122 per capita. These results underscore the importance of both health and non-health ministries in addressing our public health needs. They highlight that public health accounting needs to take a broad, multi-agency perspective if we are to understand how we can better prevent illness and injury, and reduce our growing health burden.

Publication Type: Economic Reports

Year of Publication: 2011

Topics: Health Economics / Healthcare Costs, Healthcare Services

Authors: Philip Jacobs, Jessica Moffatt, Egon Jonsson, Arto Ohinmaa, Cathy Gladwin

ISBN (print): 978-1-897443-93-4

ISBN (online): 978-1-897443-94-1