Prosperity, Opportunity, Fairness

Alberta is entering a period of unprecedented prosperity. Strong economic growth, extraordinary resource revenues, and rapidly diminishing public debt herald an era of unlimited opportunity. This bountiful era however will be accompanied by another agenda - an agenda of equity and fairness. Policy makers in Alberta are already challenged by growing disparities in wealth, equitable access to medical diagnostic technology and the "pressure points" of an aging society, such as joint replacements. Strong economic growth will only fuel the resource allocation challenges associated with such realities. Equitable distribution of wealth across Alberta's generations, between "haves" and "have nots" and among its diverse communities promises to be a major challenge in Alberta's future.
 

Health Care and Marginalization

Alberta's health care system will bear the brunt of this challenge. Concepts such as "population health" and/or the "social determinants of health" underscore the reality that health accompanies wealth. Unfortunately, the reverse is also true - the absence of wealth inevitably leads to poor health. Aging begets a similar reality - health accompanies youth while the aging process is generally associated with physical limitations, reduced capacity, and loss of vigour. As Alberta's economy "booms" and its population ages, the Province's health care system will be increasingly challenged to address the health care needs of its most marginalized citizens.
 

Health Care, Government, and Community

Remediation of this marginalization and alleviation of its impact, however, lies beyond the capacity of Alberta Health and Wellness and its subsidiaries - the Regional Health Authorities (RHAs). In the case of the aged, for example, the provision of "hard infrastructure" such as continuing care beds can be realized through the Provincial health care system. However, the "soft infrastructure" of social connectedness and spiritual context necessary to the wellness of the aged arises from the community, not from the Provincial government.

Such "soft infrastructure" includes active voluntary organizations committed to community service at the local level. Similarly, the impact of disadvantages associated with poverty cannot be eliminated by Alberta's provincial/regional health care system. Mitigating the economic, social, cultural, and psychological factors associated with poverty can only be addressed through the social responsibility of local communities.
 

Two Definitions of Accountability

What the above discussion makes clear is that Alberta requires two distinct definitions of accountability in health care. A provincial definition is needed to distribute public dollars equitably across the Province. Funding formulas based on census data and adjusted for population differences are aimed at such equity. Supported by a provincial/regional system of governance, such formulas can assure equity in the distribution of health care resources.

But health and wellness are neither solely nor directly derived from health care expenditure, no matter how equitable its distribution. Health and wellness are outcomes which result not only from "social determinants" such as employment and housing, but also from cultural, psychological, emotional, and spiritual determinants. It is this latter group that determine the presence (or absence) of hope, faith, meaning, and purpose in life. For those disadvantaged by poverty, chronic disease, and/or disability such determinants are critical to maximization of health and wellness. Unfortunately, these determinants cannot be distributed by our provincial/regional health care system, nor can their accountability models assure equitable distribution of these most human of resources.
 

Community Based Accountability

Obviously a community-based definition of accountability rooted in social connectedness and spiritual context is necessary to complement the provincial/regional governance definition rooted in allocation of fiscal resources. The provincial/regional system is well suited to achieve fiscal responsibility and equity in public funding. However, a community-based system of accountability can best facilitate a community's expression of social responsibility and the altruism of its citizens.

Such a community-based system arises from the voluntary organizations who have created much of Alberta's health care system. Rooted in the altruism of Alberta's communities, voluntary organizations have a long track record in ministering to the most vulnerable and marginalized of Alberta's citizens. Services such as palliative care, pastoral care, and the development of medical ethics committees all have their origins in Alberta's voluntary, community-based health care system.
 

The Future of the Voluntary Sector

As Alberta enters an era of prosperity amid continuing pressures to reform its health care system, several points need to be made clear. First, Alberta's voluntary sector continues to make a substantial contribution to the Province's health care system. It remains a voice of advocacy, a vehicle of innovation, and a forum for social responsibility. Second, these contributions represent different achievements than those already recognized by the provincial/regional health care system. A distinct definition of accountability seems necessary to recognize and secure the future of these contributions. Third, unprecedented prosperity and unlimited public expenditure by themselves will never bring health and wellness to all Albertans. There will always be a need for a community-based, voluntary health care sector with its responsiveness to the marginalized and vulnerable in our society.