This article originally appeared in the National Post.
By Jerome Gessaroli, September 24, 2024
The B.C. government is pursuing a misguided experiment to improve public health by trying to dismantle racism, social and economic inequities, and “other forms of oppression.” However, by turning the quest into an ideological pursuit, with controversial concepts like equity, colonialism, and supremacy, the ministry of health risks diverting attention from proven public health measures.
In the guiding document, British Columbia’s Population and Public Health Framework: Strengthening Public Health, the long-term agenda is to “promote population health and eliminate inequities” by addressing social determinants of health, Indigenous reconciliation and equity-based actions.
In analyzing the document’s language, critical functions — including population-level disease monitoring — are eclipsed by vague, unmeasurable, politically-laden concepts. Social justice terminology appears almost as often as health-care terms. Words like equity appear 44 times, climate 41, and reconciliation 34 times, while key health terms like disease prevention and influenza are mentioned far less. Politically contentious terms like colonialism and supremacy appear 19 times. Overall, there are 380 health-care terms and about 320 social justice-related terms in the report.
Public health policy previously focused on “health disparities,” which refers to measurable differences in health status. Now, the term “health equity” is used, and covers disparities and the fairness and justice behind these differences.
One of the report’s principles is “Health Equity and Anti-Racism.” Here the document says, “Many of the determinants of health, such as income, education, housing … and natural environments, are shaped outside of the health system … [Health equity] … involves challenging and changing the values, beliefs and practices that maintain social and economic inequities, including racism and other forms of oppression.”
In plain terms, this means that achieving health equity requires changing social and economic systems that create wealth inequality, racism, and oppression — quite the set of unargued assumptions, and quite the ask! It’s safe to say these goals are outside both the purview and pay grade of our medical professionals.
Later, the report claims that “anti-colonial, anti-racist, intersectional, and equity-driven approaches to public health governance” are key to addressing the systems that maintain inequities.
Again, in plain language, the ministry believes public health should challenge colonialism, racism, and other forms of discrimination to address purportedly unfair systems that create inequality. The emphasis on unfair systems and policies even hints at a critique of our free-market economy, which is far beyond the ministry’s mandate.
While the report has no single author, the included message from B.C.’s provincial health officer, Dr. Bonnie Henry, is heavily laden with identity-based priorities, particularly around settler colonialism, racism, and reconciliation. She references the UN Declaration on the Rights of Indigenous Peoples as well as Canada’s Truth and Reconciliation Commission.
cWhile the report has no single author, the included message from B.C.’s provincial health officer, Dr. Bonnie Henry, is heavily laden with identity-based priorities, particularly around settler colonialism, racism, and reconciliation. She references the UN Declaration on the Rights of Indigenous Peoples as well as Canada’s Truth and Reconciliation Commission.”
While the report has no single author, the included message from B.C.’s provincial health officer, Dr. Bonnie Henry, is heavily laden with identity-based priorities, particularly around settler colonialism, racism, and reconciliation. She references the UN Declaration on the Rights of Indigenous Peoples as well as Canada’s Truth and Reconciliation Commission.
Addressing the failures over Indigenous health care is laudable and necessary. However, using politically charged terms such as settler colonialism, oppression, and supremacy does little to advance those goals constructively.
Apart from signalling that the ministry has adopted progressive values, these ideas also carry potential adverse consequences. For example, the report says that “evidence-informed decision-making” includes not only scientific data but also First Nations knowledge and lived experience. Instead, evidence-based decisions should rely on scientific data and proven health practices. Including cultural wisdom or personal experience introduces subjectivity, which may undermine evidence-based practices.
One could reasonably question whether the ministry’s support for decriminalizing personal amounts of hard drugs and providing free opioids and harm-reduction paraphernalia to addicts is partly influenced by “people with lived and living experience,” a priority population in the report’s parlance, than by sound, scientific evidence. The negative consequences of opioid diversion and reduced street drug prices are well documented.
Public health plays an essential role in monitoring infectious diseases, promoting vaccination, informing the public on disease prevention, ensuring universal standards, and addressing emergency preparedness and health-care system improvements. All decisions should be guided by scientific evidence and best practices.
Jerome Gessaroli is a senior fellow at the Macdonald-Laurier Institute and leads the Sound Economic Policy Project at the British Columbia Institute of Technology.
