Open letter: Time for robust social infrastructure investments that supports public health

December 24, 2021 

The Honourable Tim Houston
Premier of Nova Scotia 
One Government Place
1713 Barrington St.
Halifax, NS 
B3J 2A4 

Sent Via Email:

Dear Premier Houston,

As our province enters yet another wave of this pandemic, Nova Scotians tuned in to listen to a briefing from both you and Chief Medical Officer Dr. Robert Strang. You both spoke extensively about the mental anguish and distress brought on by this virus and by emergency restrictions, which you described as “torture,” and you and Dr. Strang warned that the anxiety and mental health consequences are only going to get worse. However, while the message delivered by yourself and other leaders is that “we are all in this together,” the public policy being utilized tells a much different story. 

The message being heard is: “you are on your own.” 

The resulting stress upon the province’s workforce is felt, and both Dr. Strang and yourself warned that it will likely be exacerbated by the growing numbers of individuals who have been exposed over the last few weeks. The potential risks to the province’s fragile infrastructure, including the health care system, are significant.

Such sobering news can certainly intensify the anxiety felt by Nova Scotians considering a new set of restrictions during a time of year that holds profound emotional power for many. Furthermore, we must now prepare again to face the financial burden of restrictions, as many will lose hours of work and wages, this time with only limited financial supports of federal COVID-19 wage programs. This will certainly deepen the effects of the shadow pandemics afflicting far too many of us: domestic violence, loneliness, homelessness, mental health. 

In 2020, as the pandemic ramped up and restrictions tightened, municipal police departments across Nova Scotia responded to about 20 per cent more crisis calls overall. This has been coupled with increased rates of substance use, particularly among women with kids under the age of 13. Then of course the burden of COVID-19 itself, which has demonstrated that the vulnerabilities of our health care system affect us all. When the system is “at capacity” as indeed we were told that we are, this means that everyone suffers, not only those struggling with COVID-related illness, but also those dealing with all sorts of health challenges, leading to avoidable death and illness for far too many whose screenings and treatments are deemed to be less urgent.

We call on your government to shift your approach to public policy to ensure that policy reflects the sentiment that “we are all in this together.”

It is time for your government to finally address the long-standing gaps in the social safety net. And sadly, these gaps are great, given the many reports of inequities of accessing health care for many Canadians, aggravated by systemic racism, structural colonialism, bias against the 2SLGBTQIA+ community as well as the dangerous stigmas that confront too many of those who experience mental health and substance use challenges. At this time of crisis, we ought to be doubling down on efforts to address the causes and consequences of discrimination, including anti-Black and anti-Indigenous racism, to ensure that negative health outcomes created by inequality and inequity do not burden a health care system that is already at capacity. 

On December 8, 1966, the House of Commons passed the Medical Care Act. For 55 years, generations of Canadians have had access to health care based on need, rather than ability to pay. This national policy sets us apart from our southern neighbours, who often risk becoming homeless and bankrupt, and removes a profound obstacle that can impair an individual’s ability to access life-saving care. 

We are overdue for similar investments in our social infrastructure, to expand resources, support providers, and apply evidence-based strategies to improve health outcomes and reduce costs and burden on direct provision of health care. Contemporary research highlights the importance of recognizing the social determinants of health. The World Health Organization further notes that no public health strategy is complete without dedicated focus upon these, with special attention to the promotion of mental health

Multiple recommendations have been made to ensure adequate funding and resources for a public health approach to population mental wellness. This is more important than ever, with over 40 per cent of Canadians reporting a decline in their mental health since the pandemic began, statistics that will only get worse as Omicron-related restrictions set in. 

With a projected $100 million surplus and lots of fiscal capacity, now is the time for deep investments into our social safety net. By taking this approach to public policy you can not only reduce the burden on the healthcare systems (including mental health and substance use systems) but ensure a just transition towards a green economy. Investments must be made in:

We are living in unprecedented times, and this requires a different approach to public policy. An approach that recognizes the role for truly collective response to care to address the full range of health concerns that are threatening to put our health care system at risk. 

Now is the time to recognize the gaps in our current system. Rather than taping over cracks by preserving the status quo processes – such as the false split between physical health and mental health and our social infrastructure – this is the time to recognize that true public health requires addressing the substantial holes in our social safety net.

Kind regards, 

Alec Stratford MSW, RSW
Executive Director/Registrar
Nova Scotia College of Social Workers 

CC: Iain Rankin, Leader of the Liberal Party of Nova Scotia; Gary Burrill, Leader of the New Democratic Party of Nova Scotia