Prevention is an afterthought in Saskatchewan Party health care

Feature by Gregory Beatty

During the Saskatchewan Party’s 15 years in power, healthcare spending in the province has increased by 87 per cent. The government trumpeted that stat in last March’s budget, noting how spending had jumped from $4.4 billion in 2007 to $6.44 billion in 2022.

Well, whoop-diddly doo. Because when you look at the state of healthcare in Saskatchewan today, with province-wide shortages of medical professionals; closed and over-crowded emergency rooms and hospitals; delayed tests and postponed surgeries; prescription drug shortages and more, are kudos really warranted?

To be fair, the system is going through a tough time, anyway. Since the 1970s, demographers have used the colourful analogy “pig through a python” to describe the Baby Boom generation’s impact on society. Fifty years on, Boomers are well into the snake’s large intestine. As their mobility and independence declines, these seniors require greater care.

Covid-19 is another strain on the system, as is Saskatchewan’s growing population. Throw in growing health impacts from climate change (such as wildfire smoke and extreme heat) and ever more costly (but hopefully beneficial) medical technologies and drug therapies, and Saskatchewan faces a daunting challenge.

But it’s all exacerbated by a misguided provincial government that shuns proactive social investments in favour of backend “cures” that are more costly and traumatic for people.

“Cures”, of course, is an allusion to the old “ounce of prevention” proverb. Because that’s precisely what front-end social investments can provide, says Cheryl Camillo, a health policy analyst with Johnson Shoyama Graduate School of Public Policy.

“If you think about the economic cost of healthcare, the most sensible way to reduce costs is by keeping people healthy in the first place,” says Camillo.

“If you were to ask the average person what makes a good life, it would be a roof over your head, with sufficient food, drink and recreational opportunities,” Camillo says.

“What they wouldn’t say is to have a quality of life I want to go have surgery, or see a specialist four times a year,” says Camillo. “Most people would think of quality of life as being able to avoid having to go into a healthcare facility.”

Inequities & Privileges

“Social determinants” is the blanket term that is used to describe different factors or conditions in society that can impact on people’s health.

When you dig into them, most have roots in the inequities (or privileges) of market capitalism.

Food deserts in poorer neighbourhoods that make it hard to access good nutrition is one example, says Camillo.

“If you have poor quality food for a couple of days you can feel how it impacts your energy level — your ability to sleep, and thus your ability to perform, whether it’s at work or school,” she says. “Imagine if someone has poor quality food most days of the week. How that’s going to impact them?”

Other examples of social determinants include frayed social safety nets that put people at risk of poverty and homelessness, vehicle-dependent suburbs that sabotage active living (and even mobility, if you don’t drive), and an underfunded public education system.

“A solid primary and secondary education is a big key to having healthy communities,” says Camillo. “That’s not only where people acquire the tools they need to acquire gainful employment, but also to be good members of the community. And we’ve seen in media reports how many school divisions in Saskatchewan were cutting positions this year.”

Most of the cuts — which were forced on school divisions by years of inadequate government funding — were in support positions such as educational assistants, school psychologists and speech therapists.

Often, these professionals work with children and youth with special needs and other challenges. If they’re not there, the students lose out.

Research shows countries that factor social determinants of health into government planning (the Scandinavian countries being a prime example) consistently rank highest in quality of life.

And yes, Saskatchewan has a good quality of life for many people. But we’ve also got a lot of problems. Two related social determinants in overdrive right now are poverty and homelessness.

The Sask. Party government has been criticized for changes made to its main social assistance program, Saskatchewan Income Support, in 2019.

The government had been warned during consultations that SIS would cause a spike in poverty and homelessness. This didn’t come just from community organizations — the Saskatchewan Landlords Association weighed in, too.

And that’s exactly what’s happened. People are living rough on the street and crowding into shelters at night to keep warm.

Thinking Ahead? Not In Sask.

The Sask. Party government has also drawn criticism for not putting more resources into safe consumption sites and other harm reduction efforts to treat the province’s crystal meth and opioid overdose crises. That would benefit Saskatchewan’s Canada-leading HIV and Hepatitis B rates, too — both are linked to injection drug use.

Lately, the government has taken tentative steps toward more outreach and harm reduction. But at the same time, it’s also created two new provincial police forces in the last year (one for the legislative grounds, and the upcoming Saskatchewan Marshals). It’s pretty clear what the priorities are.

The intent may be to punish people for their moral failings. Modern conservative ideology demands it. But the damage doesn’t stop there.

Healthcare workers and other emergency services such as police, fire and EMTs also suffer, says Camillo.

“If someone visits the emergency room a few times a month because of exposure or injuries from living outdoors, there’s very little the healthcare professionals can do to solve the underlying problem,” she says.

“There may be a transition worker at the hospital who can try to connect the person to social services, but there’s probably little opportunity to follow up. It’s frustrating when the person keeps showing up for the same reason, and it impacts on the staff’s ability to be effective.”

That frustration, and the extra stress it’s placing on workers in an already strained healthcare system, is causing burnout. People are leaving their jobs in droves, forcing the government into costly recruiting campaigns [see sidebar].

Edmonton’s inner city recently saw an outbreak of shigella — a highly infectious bacteria that causes diarrhea (sometimes bloody), fever and stomach cramps. Imagine trying to survive that while living on the street. Imagine the streets you’re living on, too. Because ultimately, whole communities are affected — residents, businesses, employees and visitors alike.

City taxpayers take a hit from the soaring demand for emergency services. More money has to be budgeted to fund them. During the Sask. Party’s reign, for instance, Regina’s police budget has risen from $49.5 million in 2007 to $92.8 million in 2022 — or 87 per cent! Saskatoon’s police budget, meanwhile, has risen from around $60 million in 2007 to $119.7 million today — 100 per cent!

Camillo contrasts the Sask. Party’s lax policy on health and quality of life issues with its laser-like focus on “growth”. The government’s latest plan, she says, starts with a letter from the premier that says the purpose of growth is to build a better quality of life for Saskatchewan people.

“Then there are 30 goals for 2030. When you look at them, they are very detailed, such as grow Saskatchewan’s agrifood exports to $20 billion, increase value-added agricultural production to $10 billion, crush 75 per cent of Saskatchewan canola,” says Camillo.

“Well, remember that quality of life objective in the letter? There’s not one goal related to that. Unless you look at the very last one, which says reduce surgical wait times to a three-month target.

“I would argue [shorter surgical wait times are] not really a quality-of-life goal,” says Camillo. “There’s nothing about housing, food or clean water.

“So in this detailed growth plan there’s nothing that specifies how the government is going to achieve that quality of life,” Camillo concludes. “That tells me it’s really not a priority.” ■

Sidebar

Backwards Priorities

Saskatchewan’s healthcare system was already struggling before Covid, says Bashir Jalloh.

“We had challenges with staff shortages, increased workloads and stress in the workplace,” says Jalloh, who, as the president of CUPE 5430, represents over 13,600 Saskatchewan healthcare workers. “Then the pandemic hit, and it made things worse.

“The challenges we have now are mainly around recruitment and retention. We do not have enough staff to do the day-to-day work,” he adds.

“Rural communities have been hardest hit,” adds Jalloh. “Because of staffing, we’ve seen a lot of hospital closures and reductions in long-term care beds. That’s true all over: the Kamsack area, Canora, Prince Albert, North Battleford, Estevan, Carlyle, Melville, Yorkton. It’s the same problem.”

On the recruitment front, the government recently completed a mission to the Philippines. But that’s a short-term fix, says Jalloh. What the government should do, according to CUPE, is develop more locally trained healthcare workers (creating opportunities for Indigenous people to work in their home communities!), and work harder to retain the healthcare professionals who are already here.

“One major problem we have with Saskatchewan Health Authority is precarious work,” says Jalloh. “Most of the jobs that are posted are part-time casual. We flagged that with SHA, and even went to the ministry last fall to make that case.”

“If people graduate with $50,000 in student debt and they don’t have a full-time job, just part-time or casual, then they are going to look for opportunities where they can get a full-time job. And I don’t blame them.”

Another short-term fix the government is relying on is contract nurses and technicians, says Jalloh.

“When you do that, you pay two to three times as much as for regular workers,” he says. “You have lab technologists working side-by-side with contract workers who are making two or three times their wage.”

As you might imagine, that does wonders for workplace morale. And with healthcare workers in short supply everywhere, workers who aren’t happy have no shortage of options to move on.

The bottom line: while the Sask. Party government pulls out all the stops to attract healthcare workers to the province, it’s not extending the same consideration to veteran healthcare workers who worked through the pandemic, says Jalloh.

“There is nothing in that package for them,” he says. “People are recruited and come here, they work two or three years, then leave.

“Do something for those folks who are currently in the system,” he says.