Feds should demand data from provinces

Hey there, time traveller!
This article was published 09/04/2021 (1998 days ago), so information in it may no longer be current.

YET again the provinces are wailing about the need for more federal money for health care, with no strings attached. These are the same provinces that have for decades grossly underfunded long-term care. And as we are seeing in real time, many of the provinces are scrambling at the last minute to have the data to understand and manage the pandemic, most recently in rolling out vaccinations.

Of course, the federal government should not cave in to these unwarranted provincial demands.

It is entirely within the federal government’s constitutional authority, despite what the provinces are saying, to play all kinds of roles in the health sector. The provinces never object to the billions of dollars the federal government pours into health research every year. But many of the provinces are still in the dark ages when it comes to collecting and making available for crucial health-services research the kinds of data essential to understanding how well health care is being delivered.

Car dealers and airlines have for years had far better computer systems to keep track of the health of your car and every airplane seat in the world. The big tech software companies not only collect humongous volumes of data on many of us; with their real-time technologies, they are continually doing experiments to see what will induce us to click more on their sites and advertisements.

Yet our public-health authorities are having difficulties even connecting our COVID-19 tests, our vaccinations and any hospital visits, as in many cases these software systems are completely separate silos.

So what’s wrong with the federal government saying to the provinces, if you want more cash, you first have to implement decent real-time data systems? Indeed, the Constitution expressly assigns jurisdiction for statistics to the federal government, hence the authority to play a strong leadership role in health-data systems in the provinces.

The federal government has to be accountable to us in our role as federal taxpayers, not only as provincial taxpayers. It is incumbent on the federal government to ensure that any monies it transfers to the provinces are used for the purposes intended.

If the transfer is for health care, a province cannot use the cash received to finance tax cuts. If the transfer is to push the provinces to improve the generally awful state of long-term care, then it is entirely reasonable for the federal government to impose requirements on the ways the provinces spend the money, including collecting data and other reporting to ensure that provincial promises are more than rhetoric.

These requirements are more than just reasonable; they are based on the federal government’s constitutional authorities for the spending power, and for peace, order and good government. More than the legalities, they derive from the fundamental needs for Canada to be able to act as a nation, more than a simple collection of provinces.

At the same time, the federal government sorely needs to up its game. For example, the most recent speech from the throne committed the federal government to take the lead in developing national standards for long-term care. But one has to wonder how this can be achieved when there is virtually no nationally comparable data on one of the most crucial aspects of long-term care quality — staffing.

The federal government was negotiating the purchase of COVID-19 vaccines many months ago; that should have been more than sufficient lead time to ensure there would also be a national system in place when the vaccines started arriving, to track how the vaccine rollout was progressing.

Yes, it can and should be left up to each province to decide vaccine allocation. But with the current hodgepodge of computer, fax and email systems, there is no way to keep track in real time of what’s being done across the country. There’s also no way to connect vaccinations to rises and falls in outbreaks at the level of detail needed to inform lockdown policy.

Health care and public health are quintessentially knowledge industries. It should be obvious that they should be provided by organizations that learn from experience. But it is impossible to learn from experience if you have no way of knowing just what you are experiencing.

Proper data collection and analysis are essential.

It is long past time that the federal government stiffen its spine and, in addition to saying it will work collaboratively with the provinces, put some muscle into meeting nationwide concerns.

Michael Wolfson is a former assistant chief statistician at Statistics Canada and a member of the Centre for Health Law, Policy and Ethics at the University of Ottawa.