When you look up a very basic definition of public versus private goods or services, you will find that ‘public’ references things that we consider to benefit society, and ‘private’ generally suggests acts and services that we view as individual responsibility.
At least, for the most part, this is what they want us to believe.
Our definition of what is considered a public service is highly political, ideological, and as many of us know, often excludes critical services that require equity considerations, accountability, and shared responsibility not found in the private realm.
A key component of shared Canadian identity centres on our public health care system. We tend to hold a collective understanding that individuals deserve health care based on need, and not their ability to pay. Healthcare is considered a public good, rather than a private responsibility. Values of equity, accountability, and shared responsibility are embedded into the way that we understand the health care system to work; they are so deeply ingrained, that we tend to forget that this has not always been the case.
Lessons from Medicare
As we near the 60th anniversary of the creation of our public health care insurance program, it is timely to reflect on the history of our systems to celebrate the important advancements that have been made, while still acknowledging the work that remains today.
When public healthcare insurance was first introduced in Saskatchewan in the 1960s, it was not welcomed or understood in the way we view it today. There was an immediate strike against the system transformation when 90% of doctors in that province believed they should have retained the ability to continue profiting off individuals’ need for health care. The strike lasted for three weeks; but within 10 years, a similar system was adopted across Canada that would eventually go on to become what we now understand as our public health care system.
This is important to remember as we think about the proposed transformational changes that we’re talking about to Early Learning and Child Care and the public push back from commercial operators at this stage of the process. To undergo a meaningful shift in how we understand system delivery and public provision requires a radical revisioning of responsibility. It’s not just the system that requires transformation, but our own understanding of health, well-being, and community.
Public provision is about quality, equity and accountability
If we want to build policy that works for everyone, we need to ensure that it is provided to communities in equitable ways, based on their needs, that is high quality, and accountable to the community in democratic and transparent ways.
As was outlined in the Social Policy Framework for Nova Scotia, we know from research that public provision moves us towards quality, equity, and accountability in this way. Public provision is important and is one of the principles underlying the framework because:
The quality of our services varies depending on who is providing them, and that inconsistency should not be determined by affordability or by profit seeking.
Reliance on the private sector moves us away from equity. It not only exacerbates disparities with who has access or not based on affordability and the responsiveness of services to community need—but contributes to shaping narratives around who deserves and is worthy of access.
With public provision, also comes public accountability. Decisions that drive public spending are democratically determined and require transparency and collaboration to be responsive to public need—not to profit margins or access to patchwork funding and grants.
Public services and quality of life
Further to these considerations, research has consistently shown positive correlations between public spending and rising GDPs, and the health of societies. And we know that a healthy, resilient, socially, and politically engaged society is critically important to building sustainable communities that meet quality of life indicators.
It is troubling, therefore, that in response to a survey on quality of life in Nova Scotia, 48% of respondents feel that programs and services by governments have not made much of a difference in their lives.
Perhaps that response is easier to understand when we read it alongside other data in the survey: one in five Nova Scotians shared that they could not pay their bills on time, another one in five Nova Scotians reported eating less because they did not have access to enough food, and over a quarter said they did not have enough money to buy the things they needed—not to mention over 60% provide unpaid care to community, and one in five provide unpaid care to children.
Meaningful investment in robust policies and programs that address community needs is needed to provide services that are truly universal, publicly responsive, and equitable to all.
How we have determined what is and is not public responsibility has largely been decided in a way that disproportionately fails to protect women, gender-diverse, Black, Indigenous, disabled, immigrant, and other marginalized communities.
Collective responsibility not individual burden
Ideas about what ought to be public versus what ought to be private responsibilities are the result of political worldbuilding and decades of shaping narratives towards neoliberal policies and austerity that pressures families and individuals into taking on the responsibility and burden themselves.
When governments make cuts to social programming in the name of austerity or refuse to acknowledge and prioritize responding to basic human needs through meaningful investments into anti-poverty initiatives—we know that the need does not just disappear—it is just transferred onto individuals and communities to pick up the slack.
The belief that markets would provide adequate housing has failed. The belief that care work is an individual responsibility, has led to a child care sector failing to meet the needs of children and families, built on the backs of a low-wage, largely female workforce. The belief that addiction, grief, and mental health are private responsibilities has led to communities and individuals suffering alone and in silence.
No matter what way we look at it: the belief that social program cuts, austerity, and decreased public provision are good for the economy has proven false time and time again and leads to avoidable harm and violence in our communities.
Perhaps we need to start viewing the economy as a verb instead of a noun, as we shape policy built for communities.
The economy is not something that exists outside of us, but it is a process that we all generate with our participation.
There is power here to reshape how we view collective versus individual responsibility. We must radically change our vision for the action and accountability that we must demand from government.
If we are ever going to move towards a society that privileges and provides space for social, economic, and political justice it is going to happen with us working together and demanding adequate systems be built. These systems must be core funded and properly resourced, and that are publicly accountable to the ever-changing needs of our communities.
Public provision is not something that can just be handed down from above. It requires continuous and ongoing dialogue between decision-makers and communities, significant financial investment, and radically reimagining collective responsibility so we can all move forward together.
We know that publicly-provided services are more accessible and affordable, are higher quality and are more accountable to the public.
Governments need to assume responsibility and lead the way for this transformation and system building to happen.
Nikki Jamieson is the Coordinator of Child Care Now Nova Scotia and an MA student in Political Science at Acadia University.
Note: A few weeks ago, Nikki Jamieson gave a presentation on one of the key principles in the Social Policy Framework for Nova Scotia: public provision. This blog is based on that presentation. You can view the video for the advocacy day that includes presentations on all the principles.
