However, if we do want to develop a capacity to replicate some of the Determinants of Health Working Group's success stories on a larger scale, it will be critical to establish mechanisms at all levels of government to support multisectoral policy development and programming. In the early 1980s, the now defunct Ministry of State for Social Development had such a mandate at the national level. Ontario's Premier's Council on Health, Well-Being and Social Justice was a similar mechanism at the provincial level, though it did not oversee any spending. Some jurisdictions have also adopted a mandatory health impact assessment in the development of all public policies. Perhaps the best we can do at this stage is to continue experimenting with different ways of fostering intersectoral collaboration, while ensuring that an appropriate infrastructure is in place to produce, disseminate and analyze the growing body of information on population health.
Resources are too scarce and problems are becoming too complex to keep our old ways.
There is a constant debate in the Canadian health care system on whether it has enough money. This is hardly surprising, since there are tens of thousands of board members, managers and practitioners who are preoccupied with this question at regular intervals as they carry out their tasks. Furthermore, because the system is largely public, politicians and citizens turn their attention to this question on a formal basis as part of the electoral process. The question grows in importance when the funding environment shifts gears. Beginning in the late 1980s, and accelerating in the 1990s, governments have challenged the notion that the health sector budget should perpetually grow in real terms.