Alternative federal budget 2026-27: Health equity

This is from a larger publication, Alternative federal budget 2026-27: Bridge to independence

Introduction

Health inequities are differences in mental or physical health, associated with structural and social disadvantages, that are systemic, avoidable and unfair. Health inequities are rooted in social inequities: unequal social, economic and environmental conditions and power imbalances.¹

In other words, white-supremacist, colonial, patriarchal, cis-heteronormative, ableist capitalism manifests in harmful and rights-violating policies that make certain people—including Black, Indigenous and other racialized people; women and gender-diverse people; those with disabilities; and certain workers—sicker and die sooner than others.² In addition to being unacceptable and unfair, these health inequities are fundamentally inconsistent with Canada’s international human rights commitments.³

The root causes of health inequities transcend all public policy domains and sectors. Working towards health equity, where all people have fair access to, and can act on, opportunities to reach their full health potential, therefore demands a cross-government framework and approach. This chapter recommends a well-being economy, anchored in principles of dignity, fairness, nature, purpose and participation.

Overview

Root causes of health inequities

Social inequities manifest as inequities in sickness. Those most negatively impacted by unfair social and economic policies disproportionately end up in hospitals and other health care settings.

Under neoliberalism, the particularly harsh incarnation of capitalism that has been dominant globally since the early 1980s, the erosion of the public sector has meant that working conditions for many front-line workers, such as nurses, have become immensely more challenging in recent years. Improvements to working conditions, including pay, job security and workload, are necessary to support recruitment and retention—as well as the health and well-being—of front-line workers in health care and public health settings.

It is imperative to recognize that worsening health inequities and corresponding demands on health care systems reflect a failure to address the upstream reasons that people get sick in the first place: the conditions in which we live, work, and play.⁴ These conditions are unequally distributed due to public policy that is deeply unfair and exclusionary. For example, maintaining good health without stable housing is essentially impossible, a problem that is magnified for communities experiencing discrimination due to intersecting social identities. Housing inequities are caused by policy decisions that support financialization of housing, i.e., treating housing as an investment rather than a home. In the absence of regulation, this leads to practices like unaffordable rents and renovictions due to a general lack of affordable housing.

Housing is only one example of a much broader phenomenon. Under neoliberalism upstream determinants of health have been significantly eroded. Neoliberal policy, including in Canada, includes budget cuts and privatization of public services;^5,6 deregulation that weakens the guardrails that protect people (e.g., worker safety) and environments; and an erosion of redistributive mechanisms (tax and transfer policy) that has widened social and economic inequality and led to an increasing concentration of wealth and power.⁵ Collectively, this set of policies has severely worsened the conditions that all people, and our planet, need to be well. These conditions intersect with racism, sexism, ableism and other forms of systemic discrimination to create highly unequal—and avoidable—health damage.⁶

A policy-by-policy or sector-by-sector approach is insufficient to redress this wholescale erosion of upstream determinants of health because it is grounded in an overarching ideology that places the interests of big business and private wealth over public health. Working towards health equity demands identifying and shifting the purpose and goals of our economy and society. This includes working to overcome political and institutional challenges, including governance barriers and competing interests, to create equity-centred system transformation.

A cross-government approach to advancing health equity

We take inspiration from a growing international social movement working to advance a well-being economy: an economy in service of life.⁷ In contrast to (neoliberal) capitalism, a well-being economy is designed to serve all people and the planet, not the other way around. In a well-being economy, the rules, norms and incentives are set up to deliver quality of life and flourishing for all people, in harmony with our environment. This is done by default through budget decisions, taxation approaches, regulatory decisions, labour protections, public investments and so on. It is therefore highly consistent with an upstream approach to addressing health inequities and with renewed interest in well-being in the Canadian public health context.^10;⁸

A well-being economy first invites us to reclaim what “economy” means. We can redefine it as how we provide for one another, or even more simply, how we care for one another. It is by no means fixed and unchangeable. The rules, social norms and stories that underpin our current system were designed by people; therefore, they can also be changed by people. We are the economy.

A well-being economy next invites us to re-imagine what it means to have a prosperous society. Canada’s current vision of prosperity is deeply and narrowly grounded in economic growth measured by GDP—something that progressive economists have long insisted is deeply problematic.⁹ First, many activities that are harmful to human and environmental health, like fossil fuel extraction, are considered beneficial to GDP. Second, a narrow focus on GDP omits (and thus de-values) many activities that promote a healthy and thriving society, like unpaid caregiving and volunteering.¹⁰ Third, the recalcitrant, narrow focus on GDP is based on a false belief that economic growth will trickle down and benefit everyone. This is patently false. Indeed, “economic growth at any cost fails us all”¹¹ and results in many people being left behind.

A well-being economy framing allows us to think about different foundations for how we care for each other and the earth. It allows us to move away from relationships of competition, exploitation and extraction and then towards relationships grounded in reciprocity, solidarity and equity.

Several countries around the world are embracing well-being economy principles. In Canada, the federal government introduced a Quality of Life Framework intended to support moving “beyond GDP” in 2021¹² and created a cabinet committee dedicated to Quality of Life and Well-Being in 2025.¹³ Unfortunately, the two initiatives are not well connected and they are not shaping public policy in any meaningful way. While Canada participates in WEGo, the Wellbeing Economy Governments partnership, it has stopped short of joining as a full member.¹⁴ This raises questions about how serious the federal government is about the vision of a transformative well-being economy.

Below, we articulate some policy contours for Canada as a well-being economy, grounded in the pursuit of social and health equity. We organize the actions below using Scotland’s Manifesto for a Wellbeing Economy.¹⁵ It outlines policy options for meeting five needs that underpin the goal of delivering good lives for all people and protecting our natural environments, on which the health of all species ultimately depends: dignity, fairness, nature, purpose and participation.

Actions

1. Dignity

As a foundation for health equity, everyone in Canada should have enough to live with dignity, free from the injustices of poverty and debt. Due to intersecting structures of oppression, health inequities stemming from poverty disproportionately affect certain populations: Black, Indigenous and other racialized people; women and gender-diverse people; people with disabilities; and others.

The AFB will support workers by supporting a much tighter labour market with lower unemployment (which drives up wages) that shifts benefits from corporate profits to workers’ wages. This will mean much better opportunities for workers, no matter their education levels.

The AFB will strengthen and insist on public ownership and delivery of services for essential needs, including transport, child care, social care, health care and education. This will ensure that people have more freedom in their lives and their daily living costs will be reduced.

The AFB will strengthen and co-ordinate income support programs so that they collectively provide a minimum income guarantee for Canadians who are unable to work, unable to find suitable work, or face additional costs due to ill health or disability.

2. Environment and nature

As a foundation for health equity, the AFB insists on an economy that operates within planetary boundaries. Climate change, biodiversity loss and pollution threaten the foundations of good health in highly inequitable ways, including disproportionate consequences for northern Indigenous communities.^19,20

The AFB will withdraw the Draft 2026–2029 Federal Sustainable Development Strategy and revise it entirely in accordance with the Well-being Economies Alliance for Canada’s¹⁶ submission, which urges the following:

Explicit recognition that Canada has an unsustainable ecological footprint.
Foundational economic reframing, to embrace a well-being economy that places human and ecological flourishing ahead of GDP growth.
Recognition that upholding and advancing the Sovereignty and Rights of Indigenous Peoples is foundational to ensuring a just and sustainable future.
Grounding in ensuring equity and justice for impacted communities and workers
Substantive linking to Canada’s Quality of Life Framework, which explicitly aims to move “beyond GDP”.
Enshrining in legislation a commitment to future generations.
Building and nurturing the strong public foundation required for policy and sustainable governance.

3. Fairness

As a foundation for health equity, the AFB will re-orient the economy to ensure a just distribution of income, wealth, power and time. The aim is to significantly reduce income and wealth inequality, which negatively affects health at the population level¹⁷ and disproportionately harms certain populations.

The AFB will meaningfully tax the wealthiest members of our society through a wealth tax and an excess profits tax for sectors like oil and gas.

The AFB will continue to support and expand democratic employee ownership in Canadian businesses.¹⁸ This will include providing seed grants to regional democratic employee ownership centres and development agencies through a new $10-million fund to be dispersed over three years. The AFB would provide a five per cent discount on the rate for democratic employee-owned firms and ensure that they are eligible for existing public investment funds and business support.

Towards intergenerational equity, and modelled on the Welsh experience,¹⁹ the AFB will create a new federal Quality of Life Act. This will give a legally binding common purpose for the federal government and for provincial/territorial governments via new and existing mechanisms. It will also introduce a new position of Quality of Life Commissioner, to be situated in the Office of the Auditor General and strongly connected to the Cabinet Committee on Quality of Life. Taking both a watchdog and advocacy role, the commissioner will provide advice and support to public bodies in taking a longer-term, equity-oriented and coherent view on all policy decisions ($5 million per year for three years).

The AFB will support leading public health organizations in convening Expert Advisory Committees on Equity with a mandate to ensure intentional, substantive and consistent application of an anti-racist and anti-oppressive stance throughout all cross-government policy. The committees will work closely with the Quality of Life Commissioner and will comprise communities most negatively affected by health inequities ($5 million per year for three years).

The AFB will fund a systematic, co-ordinated Canada-wide approach to health equity data. Informed by the Wellesley Institute’s Consensus Statement on Race-based Data for Health,²⁰ the AFB will fund efforts by organizations and governments to build or strengthen capacity for collection, interpretation, reporting and use of health data that is disaggregated by race, gender, ability, Indigenous identity, etc., and that is grounded in community governance ($5 million per year for three years).

4. Purpose and participation

As a foundation for health equity, the AFB will support efforts to ensure that the shape and purpose of the economy is determined by people’s active voices, is locally grounded, and elevates the voices of structurally marginalized and oppressed groups. This will include people directly affected by harmful state intervention: people who use drugs; people who are unhoused; criminalized communities; and Indigenous, Black and other racialized communities.

The AFB will support the Well-being Economies Alliance for Canada in co-ordinating an ongoing process of nation-wide community-based conversations about the future we want for our children, grandchildren and planet, grounded in an anti-racist and anti-oppressive stance, towards creating a new economic strategy for Canada that aligns with a well-being economy ($5 million per year for three years).

In collaboration with the Well-being Economies Alliance for Canada and towards visioning a well-being economy, the AFB will support the Quality of Life Commissioner’s mandate to include publishing annual reports and regular newsletters, holding cross-country town hall events, and being available to speak at public and non-profit events ($5 million per year for three years).

The Monitor

Our Schools/Our Selves

Alternative federal budget 2026-27: Health equity

Introduction

Overview

Root causes of health inequities

A cross-government approach to advancing health equity

Actions

1. Dignity

2. Environment and nature

3. Fairness

4. Purpose and participation

About the author

Alternative Federal Budget Working Group

Alternative federal budget 2026-27: Health care

Alternative federal budget 2026-27: First Nations

Alternative federal budget 2026-27: Health care

Alternative federal budget 2026-27: First Nations

Alternative federal budget 2026: Health equity

Budget fédéral alternatif 2026 : Équité en santé

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