Paul Martin increased infant mortality rate inequality, study suggests

Is Paul Martin's time as finance minister in the 1990s to blame for a rise in regional inequality in infant mortality rates? That's what a new analysis of epidemiological data and government spending implies.

The study, published online on Wednesday in the journal BMC Public Health, is titled "Regional disparities in infant mortality in Canada: a reversal of egalitarian trends." The researchers -- Ling Huang, Susie Dzakpasu, and Catherine McCourt of the Public Health Agency of Canada's maternal and infant epidemiology section; as well as Dalhousie University perinatal epidemiologist Dr KS Joseph -- prefaced their work by describing the economic and political upheaval of the Canadian federal government's deficits in the 1990s.

They wrote:

"Idealistic rhetoric notwithstanding, the health care system in Canada suffered a serious fiscal crisis in the 1990s as the federal government addressed the problem of a soaring budget deficit by reducing its financial commitment to provincial health insurance plans and related social programs [6-7]. Federal transfers declined from $8.2 billion in 1992 to $6.3 billion in 1996 (then increased to $8.8 billion in 2001). Public health care expenditure declined from 74.1% of the total health care expenditure in 1992 to 70.8% in 1996 and was 70.1% in 2001 [7]. This had a profound effect on hospital and related sectors with a substantial reduction in hospital care, despite the continued pressures of population aging and population growth. Spending on hospitals and physicians which comprised 40.6% and 15.6% of health care spending, respectively, in 1987 fell to 33.6% and 14.5% of health care spending, respectively, in 1997 [6]. Social programs were similarly affected."

The man most directly responsible for the cuts, of course, was Paul Martin, who was named finance minister in Jean Chrétien's cabinet in 1994. Mr Martin's campaign for prime minister earlier this decade, as you may recall, capitalized heavily on his purportedly successful financial management of the deficit through a series of restrictive budgets and spending cuts.

But, as Dr Joseph and his epidemiology coauthors demonstrated in their new paper, Mr Martin's economic conservatism during the 1990s may have had a profound effect on the integrity of the nation's public health system as well as the economy. The paper explained:

"Correlations between infant mortality rates in 1985-89 and 2000-02 among live births [greater than or equal to] 500 g and [greater than or equal to] 1,000 g suggest that the fiscal constraints of the 1990s contributed to an increase in health disparities in Canada. These results were corroborated by a second analysis of regional disparities which showed an increasing infant mortality rate ratio between provinces/territories with the highest vs the lowest infant mortality rates."

Mr Martin is likely not the only reason for the rise in regional disparity in infant mortality rates, the authors noted. "It may... be unfair to attribute the reversal of the trends in regional disparities solely to federal fiscal policy in the 1990s."

In the end, however, Dr Joseph et al concluded that Canada's low rate of infant mortality can be attributed "substantially" to government health and social services programs designed in the 1950s and 1960s -- such as the 1967 implementation of universal medical insurance, presumably -- while "the original commitment to egalitarian goals diminished in the 1990s."

The study's analysis is fairly complex, so I'll let you examine it yourself if you're interested in delving into the data in more depth. The abstract is available here and the full text is here as a PDF file.

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