Pope Francis will visit Canada, likely next year, to meet with Indigenous peoples. We must not squander this opportunity to make major strides along the path of truth and reconciliation.

The details of the Pope’s visit have not been announced, but we can expect that he will visit one or more former residential schools and meet with survivors and their descendants. He will also likely apologize for the involvement of the Church in the residential school system.

When the Pope visits Canada, it will be powerful to witness him meeting with survivors, asking for pardon, and striving to facilitate a brighter future. Knowing how Pope Francis carries himself, with humility and simplicity, he will likely provide a measure of comfort and consolation to those who suffer from the wounds inflicted by the residential school system.

The Pope’s visit has the potential to be a turning point for Canada. For this moment to translate into headway for truth and reconciliation, at least three key ingredients must be present.

First, more Canadians must acknowledge the deep injustices and devastating ripple effects stemming from the creation and operation of residential schools. To those who still roll their eyes at this topic, I invite them to consider a few questions.

How would you feel if your children were taken from you, robbed of their language and culture, in some cases abused, and located far from home when they fell fatally ill? If your children survived, how do you think they would be faring today? If you were the survivor, how would you be faring? 

It is entirely legitimate for survivors and their families to pursue accountability for what happened within those walls and for the decision to build them in the first place. If you were in their shoes, you would too.

Second, politics must be out of the picture. Justin Trudeau should not underline his Catholicism during the Pope’s visit, as he has done more than once in expressing disappointment over the Church’s role in the residential school system. Trudeau openly rejects many tenets of the Church’s core moral teachings. The sudden and short-lived visibility of his religious identity when speaking about residential schools smacks of pandering and virtue signalling. In any event, he is in no position to scold others on this topic after an attempted clandestine vacation on the inaugural National Day for Truth and Reconciliation.

Some may wish to use the Pope’s visit as a platform to litigate the future of Catholicism. But there is nothing inherently liberal or conservative about a Pope apologizing for the wrongs committed by the Church. Contrition and atonement do not lend themselves either to progressive or traditional theological agendas. The Pope’s visit is fundamentally about taking responsibility, seeking forgiveness, and healing wounds. It must not become a field for political contestations, inside the Church or out.

Third, Indigenous peoples should not view the Pope’s visit only as a moment to share their trauma and express their anger. They should of course speak candidly about these matters when the Pope is here. I expect many survivors will have the chance to tell him their stories face-to-face.

But Indigenous Canadians—indeed all Canadians—should approach this papal visit with an eye to the future. Compared to laws and policies, grassroots efforts at cultivating solidarity and abolishing prejudice are far stronger engines of reconciliation. We must renew our efforts at changing hearts and minds not the day after Pope Francis leaves Canada, but today.

The words of Pope Francis during a visit to the United States in 2015 are worth contemplating in view of his upcoming visit to Canada. Our response to division and polarization, he said, must be “one of hope and healing, of peace and justice”. Where we see the “effects of unjust structures and actions”, our efforts to undo these effects must “aim at restoring hope, righting wrongs, maintaining commitments, and thus promoting the well-being of individuals and of peoples.” We must “move forward together, as one, in a renewed spirit of fraternity and solidarity, cooperating generously for the common good.”

To move forward together in the context of reconciliation, words are important—but deeds are too. In September, the Catholic bishops of Canada unequivocally apologized for the “grave abuses” committed by members of the Church at residential schools. After the revelations earlier this year of unmarked graves at some of these sites, the legal wrangling that freed the Church from having to make further efforts to pay the remainder of its share of the Indian Residential Schools Settlement Agreement—around $21 million—garnered fresh scrutiny. It is heartening that the bishops recently launched an initiative to raise $30 million for Indigenous peoples. Now it is up to Catholics, myself included, to answer this call.

The Pope’s visit will come into sharper focus when a delegation of Indigenous Canadians meet him at the Vatican in December. This will be an opportune moment to lay the proper groundwork and set the right tone for a meaningful papal visit to Canada.

The Pope’s visit, whenever it happens, must not be a time for opportunism, partisanship, or mockery. It must not—in any way, shape or form—be a spectacle. I believe the Pope will come with his heart set on truth and reconciliation. I also believe that we can do the same. And, if we do, this will be a transformative moment for Canada.

The National Health Expenditure Trends 2021 report from the Canadian Institute for Health Information (CIHI) has just been released, and the data provides a much-awaited, macro level first look at what happened to health spending during the COVID-19 pandemic. At first glance, the numbers are what one expects—and quite sobering.

Canada is expected to spend a new record of $308 billion on health care in 2021. That is $8,019 per Canadian. It is also anticipated that health expenditure will represent 12.7 percent of Canada’s gross domestic product in 2021, following a high of 13.7 percent in 2020.

In terms of composition, hospitals (25 percent), drugs (14 percent), and physicians (13 percent) continue to account for the largest shares of health dollars (more than 50 percent of total health spending) in 2021.

A new spending category—COVID-19 Response Funding—makes its debut, and consists of the federal direct and provincial/territorial government–sector spending to combat the pandemic. This includes money for treatment costs, testing and contact tracing, vaccination, medical goods, and other related expenses, and is a separate category from the standard ones used. Overall, it constitutes 7 percent of total health spending.

As reported by the CIHI, total health spending is expected to have increased by nearly 13 percent between 2019 and 2020, a rate of increase not seen in more than 30 years and triple the growth rate experienced from 2015 to 2019 (which was steady at approximately 4 percent per year). This historic spending increase took place alongside a contraction in the economy that was due in part to the ongoing pandemic. However, 2021 is expected to see a moderation of spending growth down to 2.2 percent as COVID-19 response support drops from $30.6 billion in 2020 to $22.8 billion in 2021, a decline of 25 percent.

While total health spending is up, it remains that the closing of outpatient departments and postponing of medical visits and procedures during the height of the pandemic meant a reduction in some aspects of health service provision and health spending. According to CIHI’s own analysis of COVID-19’s effect on hospital care services, from March to December 2020 overall surgery numbers fell 22 percent compared with the same period in 2019, a drop of 413,000 surgeries.

Indeed, once one starts to examine spending both including and excluding the COVID-19 response spending provided, as well as adjusting for inflation and population growth, the picture looks more variable depending on the categories examined and the financing sector considered. The public sector accounts for three quarters of Canadian health spending, with provincial and territorial governments alone responsible for about two-thirds of health spending in Canada. Other public sector spending accounts for about 9 percent, with the remaining 25 percent coming from private sector spending (mainly out of pocket and private insurance).

Figure 1 presents annual real per capita health expenditure growth rates for the years 2019, 2020, and 2021 (the latter two being forecasts) for total Canadian health spending (public and private sector), provincial-territorial government spending, and private sector spending calculated using the CIHI data. In 2019, real per capita total health spending in Canada grew about 1 percent and soared to 7.2 percent in 2020 but is expected to rise barely one-tenth of one percent in 2021. However, when the COVID-19 response spending is removed it turns out that real per capita health spending (net of COVID) in 2020 declined 3.6 percent but is expected to rebound by 3.1 percent in 2021.

Variable spending across the provinces

Meanwhile, when provincial-territorial governments alone are examined, their real per capita total health spending in 2020 rose 8.1 percent. However, once the COVID-19 response is factored out, their spending declined by about 1 percent, though it is also expected to rebound in 2021. Hardest hit in provincial-territorial health spending in 2020 in terms of percentage declines in real per capita spending were physicians (-5.8), other professionals (-6.1), drugs (-2.3), and hospitals (-0.5). These results are not unexpected given the decline in surgeries and physician visits brought about by the pandemic. Meanwhile, public health grew 4.1 percent, other institutions (including long-term care) grew 1.2 percent, and capital spending grew 10 percent.

Moreover, real per capita spending growth net of the COVID-19 response funding was also variable across provinces in 2020. Newfoundland and Labrador, Prince Edward Island, New Brunswick, Quebec, Manitoba, Saskatchewan, and Alberta saw a decline in real per capita spending net of COVID-19 response funding. On the other hand, Ontario, British Columbia, and Nova Scotia saw small increases, with Ontario the largest at 1.2 percent.

New Brunswick, Quebec, and Alberta saw the biggest declines in real per capita health spending at -3.3, -3.5, and -3.6 percent respectively. This demonstrates that during the health system disruption of the pandemic, the decline in service provision, at least as measured by real per capita spending, was greater in some provinces relative to others.

The impact of COVID-19 was exceptionally severe on elective and discretionary health expenditures as borne out by the private sector impact, driven particularly by spending on private physicians, dentists, and optometrists. Real per capita private health spending in Canada in 2020 dropped by 11 percent. It is only expected to rebound by about 1.6 percent in 2021. Real per capita private sector physician spending declined 24 percent in 2020 while that on other health professionals fell 22 percent. For hospitals this was down 13 percent, and for drug spending this was down nearly 5 percent.

Future consequences

In the end, the impact of COVID-19 on Canadian health spending was not simple. While overall spending grew dramatically in 2020 in response to the pandemic, there was a displacement effect as spending on surgeries and other treatments fell with cancellations and postponements. This hit provincial government health spending hard, but private sector spending was hit even harder. The postponement of so many treatments and surgeries will have health consequences for years to come.

In terms of the implications for future health spending, this snapshot needs to be placed in the context of the longer-term trends in health spending, which has generally grown both in terms of real per capita spending and as a share of GDP. The 2010s saw a moderation in spending growth rates which led some to conclude that the health cost curve may have finally been tamed. Part of the moderation may have been a provincial response to the end of the six percent growth rate of the federal health transfer in 2017 and the new formula restricting the growth of federal transfers to GDP growth subject to a minimum of three percent.

However, there was also a moderation of cost drivers during this period, such as technological extension and the onset of new pharmaceutical products, and that may be coming to an end given that the pandemic has been a catalyst for pharmaceutical development. Combined with the concerns about health human services shortages in health care and the need to reinvest, the pandemic may indeed be the trigger event that starts a new cycle of rising health expenditures.