Introduction
Health equity means that everyone has fair access to, and is enabled and empowered to act on, opportunities to reach their full health potential. Health is not just about physical sickness or its absence, it is a holistic concept that includes physical, mental, and social well-being.1National Collaborating Centre for Determinants of Health, “Glossary of essential health equity terms,” NCCDH, St. Francis Xavier University, 2022.
The word “health” leads many people to think about access to medical care. While this is important, it is an incomplete picture. Who gets sick in the first place has far more to do with our living and working conditions, and the economic, political, and social factors that shape them. Health inequities are “the result of a toxic combination of poor social policies and programs, unfair economic arrangements, and bad politics.”2Commission on Social Determinants of Health, Closing the Gap in a Generation: Health equity through action on the social determinants of health, World Health Organization, 2008. Due to systemic oppression, health inequities disproportionately affect certain populations, including Black, Indigenous, and other racialized people.
Building on some of Canada’s historical commitments to equality embodied in redistributive policy and a strong public sector,3Lars Osberg, From Keynesian consensus to neo-liberalism to the Green New Deal: 75 years of income inequality in Canada, Canadian Centre for Policy Alternatives, March 2021. this chapter lays out the AFB’s vision for social and health equity. Here we unify the equity-centred and public-driven policy discussed in other AFB chapters, such as housing policy that foregrounds affordability, immigration policy that guarantees equal rights and access to safe employment, and climate policy that centres a just transition. These are all examples of an economy and government that prioritize the health and well-being of all people and the planet.
Overview
A vision of health equity requires a coherent, whole-of-government approach. Crucially, this must be grounded in a critical perspective that foregrounds inequities of power, which are the root cause of inequities in health. Health inequities are fundamentally rooted in the political economic system of neoliberal capitalism, its ideological underpinnings, and the policies and practices it supports across government departments and ministries. An alternative paradigm is a well-being economy, “an economy in service of life.”4Wellbeing Economy Alliance, https://weall.org.
The notion of a well-being economy is anchored in a guiding principle of people and planet over profit. The previous federal government engaged with this idea by introducing a Quality of Life Framework for Canada in Budget 2021.5Government of Canada, Budget 2021, Annex 4: Gender, Diversity, and Quality of Life Statement, April 19, 2021 (archived). The framework is explicitly grounded in a “beyond GDP” perspective, and centres on five domains of well-being (prosperity, health, environment, society, and good governance) and two cross-cutting lenses (fairness and inclusion, and sustainability and resilience) developed through broad consultation. Implementation to date includes leadership from Statistics Canada around measurement,6Department of Finance Canada, “Toward a Quality of Life Strategy for Canada,” April 19, 2021. and budget impact reports, which describe the primary Quality of Life domains that each budget measure is expected to advance.7Government of Canada, “Budget 2024 Impacts Report”, https://budget.canada.ca/2024/report-rapport/gdql-egdqv-2-en.html. The framework might offer an overarching vision for health equity,8Lindsay McLaren, “A quality of life strategy for Canada could be life changing,” Think Upstream, May 14, 2021, https://www.policyalternatives.ca/news-research/a-quality-of-life-strategy-for-canada-could-be-life-changing/. but additional work is required to ensure that this vision is applied in government decision-making.
Signalling some intention to continue that earlier work, in May 2025 the government established a Cabinet committee on Quality of Life and Well-Being.9Office of the Prime Minister, “Cabinet Committee Mandate and Membership,” May 13, 2025, https://www.pm.gc.ca/en/cabinet-committee-mandate-and-membership. Coupled with the government’s decision to issue a single mandate letter to all ministers, reflecting a “unified” cross-government mission,10Office of the Prime Minister, “Mandate Letter,” May 21, 2025, https://www.pm.gc.ca/en/mandate-letters/2025/05/21/mandate-letter. this committee provides an opportunity to articulate how the government’s activities in this space could be expanded and leveraged towards a bold vision of social and health equity.
Actions
1. Create the structure, mandate, authority, and political leadership for a well-being economy transition
The AFB will create a Well-Being Economy Mission Collaborative that includes the new Cabinet committee on Quality of Life and Well-Being. The stated mandate of the new Cabinet committee will change to “provide political leadership for engagement, visibility, implementation, and accountability towards a well-being economy, including its embodiment in bold, coherent, cross-government, public-driven, and equity-centred public policy.” This mandate will include applying policy mechanisms such as ownership, regulation, and conditional transfer payments across sectors that serve public interests and that are consistent with social and health equity; and engaging in regular, broad, and visible communication with the public: $2 million/year for three years.
The AFB will add the minister of finance to the new Cabinet committee’s membership. The committee’s previous omission of the finance minister signalled that its work exists at the periphery of government, which is contrary to its new, strengthened mandate to provide political leadership towards a vision that centres the well-being of all people and the planet. The finance minister will share committee leadership with the named chairs (the current and former ministers of environment and climate change). Canada’s Quality of Life work began in the Department of Finance in 2021; finance ministry leadership of the new Cabinet committee will revive and strengthen that leadership and give the committee “teeth.” The minister of health, who is already a member of the cabinet committee, will be responsible for identifying implications for health services and mechanisms of implementation (e.g., the Canada Health Transfer): $0; included within existing budgets.
The AFB will significantly expand the scope and authority for well-being economy–oriented activities. Using the Welsh government’s Well-being of Future Generations legislation as a model, the AFB will create a new federal Quality of Life Act. The Act will give a legally binding common purpose for the federal government and for provincial/territorial governments via new and existing mechanisms. It will set out key responsibilities and reporting relationships among the various actors in the Well-Being Economy Mission Collaborative and among governments more broadly. The act will also introduce a new position of Quality of Life Commissioner, situated in the Office of the Auditor General, which will serve as political leadership for the collaborative. The commissioner will have both a watchdog role and an advocacy role to provide advice and support to governments and public bodies in taking a longer-term, equity-oriented, and coherent view on policy decisions. In Wales, this action has been significant in advancing equity-oriented social and environmental policy.11Stan Houston, Lindsay McLaren, and Rebecca Graff-McRae, “A well-being economy in practice: spotlight on Wales and Nanaimo,” CCPA Monitor, January 3, 2024. As part of broad and intentional public communication and engagement towards an equity-centred vision, the commissioner’s mandate will include publishing annual reports and regular newsletters, holding cross-country town hall events, and being available to speak at public and non-profit events: $9 million per year for three years.
The AFB will create a new Senate standing committee on Quality of Life and Well-Being as part of the Well-Being Economy Mission Collaborative and under the political leadership of the Quality of Life Commissioner. The Senate committee will scrutinize bills and examine spending proposals to ensure they align with the vision of a well-being economy. It will thus play a key role in ensuring that public policy, including spending, is bold, coherent, cross-government, public-driven, and equity-centred: $5 million per year for three years.
The AFB will create specific mechanisms to ensure that the work of the Well-Being Economy Mission Collaborative includes intentional, substantive, and consistent application of an anti-racist and anti-oppressive stance. This is imperative to ensure that inequities of power, which constitute the root causes of health inequities and which are usually hidden, are illuminated and addressed. To do so, the AFB will support leading public health organizations in convening Expert Advisory Committees on Equity with a mandate to support the collaborative in designing and implementing coherent, equity-centred policy. The expert committees will consist of 1) the communities most negatively affected by health inequities under neoliberal economic and social policy, including Black, Indigenous, and other racialized peoples, 2SLGBTQ+ people, migrant workers, and others and 2) critically oriented researchers and scholars engaged in articulating and advancing an alternative, equity-centred political economy. This work will build on previous public health sector experience with intersectoral policy for health12National Collaborating Centre for Healthy Public Policy, “Health in All Policies,” https://ccnpps-ncchpp.ca/health-in-all-policies/. and with a well-being economy perspective13Lindsay McLaren, “Wellbeing budgeting: a critical public health perspective,” National Collaborating Centre for Healthy Public Policy, March 24, 2022. while also providing an opportunity to strengthen the equity focus of that work which has been limited to date:14Lindsay McLaren and Temitayo Famuyide, “What can we learn from Québec’s Health in All Policies approach,” Canadian Centre for Policy Alternatives, Think Upstream, February 15, 2023. $5 million per year for three years.
2. Substantive investment in research, evaluation, and policy development
To further support the work of the Well-Being Economy Mission Collaborative, the AFB will make a substantive investment in high-quality research, evaluation, and policy development with a coherent cross-government, equity-centred orientation.
The AFB will create and resource a Well-Being Economy Transition Fund. This fund will be housed in the Department of Finance and fall under the authority of the collaborative. Modelled on previous initiatives,15Government of Canada, “Primary Health Care Transition Fund: Summary of Initiatives,” https://open.canada.ca/data/en/info/9da6098a-65c1-44be-9ade-3ce3a3cc6179. this fund will support policy development among stakeholder groups around a transition to an equity-centred well-being economy, focusing on strengthening coordination and enhancing policy coherence: $20 million per year for three years.
Leveraging the new capstone research funding organization (announced in Budget 2024), the AFB will dedicate funds specifically to upstream, equity-oriented research, for which precedent exists,16Canadian Institutes of Health Research, “Catalyst Grant: Moving Upstream: Structural Determinants of Health” (archived), https://cihr-irsc.gc.ca/e/53883.html. to inform the overarching mission of a transition to an equity-oriented well-being economy.17Sandra Lapointe, “’Mission-driven’ is not a bad word,” University Affairs, May 29, 2025. Work that substantively incorporates such a critical orientation is imperative for meaningfully engaging with inequities of power that obstruct transformative change: $15 million per year for three years.
3. Strengthen and raise the visibility of health equity reporting
The AFB will strengthen investments in sustained and robust health equity data collection, interpretation, reporting, and use. The lack of health data that are disaggregated by social axes like race, sex, gender, and employment was made very clear during the COVID-19 pandemic and must be strengthened and sustained.18Emily Thompson, Rojiemiahd Edjob, Nicole Atchessi, et al., “COVID-19: A case for the collection of race data in Canada and abroad,” Canadian Communicable Disease Report, July/August 2021.
In previous federal budgets, funds were allocated to Statistics Canada to develop a Quality of Life Hub, which brings together data for 91 indicators spread across the domains of the Quality of Life framework along with three central indicators: life satisfaction; sense of meaning and purpose; and future outlook.19Statistics Canada, “Quality of Life Hub,” https://www160.statcan.gc.ca/index-eng.htm. The AFB will continue this work, expanding it to 1) strengthen the capacity to report disaggregated data, to assess inequities by race, gender, and other social axes; and 2) draw direct connections to equity-oriented policy levers. Under the authority of the Well-Being Economy Mission Collaborativewith strong guidance from the Expert Advisory Committees on Equity, this work will complement the existing practice of producing Quality of Life Budget Impact Reports20Government of Canada, “Budget 2024 Impacts Report,” https://budget.canada.ca/2024/report-rapport/gdql-egdqv-2-en.html. by identifying policy that would improve each indicator, thus contributing to the original (2021) intent of deepening the framework’s integration into policy development. The AFB will also fund efforts by Statistics Canada, in collaboration with the Well-Being Economy Mission Collaborative, to significantly raise the visibility of this work so that it is as familiar to everyday people as traditional economic information like interest rates or market trends: $4 million per year for three years.
The AFB will fund and help to coordinate a systematic, coordinated, Canada-wide approach to health equity data gathering, reporting, and use. This will include the development and implementation of a Health Equity Scorecard to strengthen broad public communication and enhanced visibility. Under the authority of the Well-Being Economy Mission Collaborative, and informed by the Wellesley Institute’s Consensus Statement on Race-based Data for Health,21Wellesley Institute, “Consensus Statement on Race-Based Data for Health,” March 18, 2025, https://www.wellesleyinstitute.com/consensus-statement-on-the-collection-use-and-governance-of-race-based-data-for-health/. the AFB will fund efforts by organizations and governments, including health care and public health systems, to build or strengthen capacity for collection, interpretation, reporting, and use of health data disaggregated by race, gender, ability, etc., that is grounded in community governance. While important initiatives exist (for example, Nova Scotia is collecting race and language data through their health care renewal process22Government of Nova Scotia, “News release: Fair Care Project improves data collection to offer better care,” October 25, 2022, https://news.novascotia.ca/en/2022/10/25/fair-care-project-improves-data-collection-offer-better-care.) it is far from comprehensive. The AFB will also support the federal government in leading by example by establishing an Office of Health Equityto guide data collection, interpretation, reporting, and use in areas with federal responsibility for health, including First Nations reserves, corrections, military, and veterans. All of this has become even more urgent in the context of the February 2024 decommissioning of the Canadian Institute for Health Information’s Health Inequalities Interactive Tool:23Canadian Institute for Health Information, “Trends in income-related health inequalities in Canada,” 2015, https://www.cihi.ca/en/trends-in-income-related-health-inequalities-in-canada. $15 million per year for three years.
