From salt in food to transfer payments: Here's what Ottawa has power over when it comes to your health

Most Canadians know it's a provincial or territorial health card they carry in their wallets, not a federal one.

Still, the election April 28 does present an opportunity to have a say on certain aspects of health care the federal government controls, and to hold lawmakers — and would-be lawmakers — to account, health policy experts say.

Medical sociologist Amélie Quesnel-Vallée, Canada Research Chair in Policies and Health Inequalities, says the federal government can "play an important role in aligning our various health systems, especially as we are facing an aging population with increasing needs and burdens."

Although tariffs and annexation threats stemming from the U.S. have eclipsed health care as a major campaign topic, it remains a pressing issue for Canadians, especially the roughly 6.5 million of us who are without a family doctor or nurse practitioner.

Here's what you need to know about the role the federal government plays in our health care system, and how the major parties propose to address the doctor shortage and other challenges Canadians face accessing care.

On a basic level, the federal government's responsibility is to pay for our health care through the Canada Health Transfer (CHT), using funds collected through general taxation, says Quesnel-Vallée, who is also a professor at McGill's School of Population and Global Health in Montreal.

The provinces make most of the decisions about how to spend that money and how health-care services are delivered.

Sometimes, however, the feds earmark funds for particular initiatives, as they did for the COVID-19 response, says Dr. Aaron Jattan, a family doctor and assistant professor at the University of Manitoba's department of family medicine.

"If the party that you're supporting, they value certain things like mental health, substance use [initiatives], they do have the opportunity to provide additional funds to the provinces with direction on how those funds are used to support the patients that are most vulnerable," said Jattan, who is also acting chief medical officer for the Winnipeg Regional Health Authority.

The federal government directly administers health care for First Nations and Inuit peoples, the armed forces, veterans, the RCMP and inmates in federal penitentiaries.

It's responsible for food and drug safety, too; medications available in this country must first be approved by Health Canada.

In October 2024, the federal government's Pharmacare Act came into force. In its first phase, the act provides free or low-cost access to contraception and diabetes medication.

Through the Public Health Agency of Canada — in partnership with the provinces, territories and regional health authorities — the federal government also monitors the spread of infectious disease.

That's particularly relevant now given that Canada currently has the highest number of measles cases recorded since the disease was eradicated in Canada more than 25 years ago.

The federal government will have to increase its infectious disease monitoring capacity to account for sweeping cuts at the Centers for Disease Control and Prevention in the U.S., who will no longer have robust data to share with Canada and other nations, says Quesnel-Vallée.

Likewise, cuts to the U.S. Food and Drug Administration mean Canada won't have access to the same amount of pharmaceutical data.

The Canada Health Act, established in 1984, has five main principles, says Quesnel-Vallée: public administration, comprehensiveness, universality, portability and accessibility.

"Under these principles, there is the important principle of funding medically necessary care," she told Dr. Brian Goldman, host of CBC podcast The Dose. Though "medically necessary" sounds all-encompassing, the reality is more limited. The act equates medically necessary care with access to physicians and hospital services, says Quesnel-Vallée.

The main objective at the time the act was established was to ensure Canadians don't encounter user fees while accessing doctors and hospitals, says Quesnel-Vallée. The act can be described as having carrot-and-stick qualities, she says — the carrot being the funds provided by the federal government, and the stick being the rules the provinces and territories must abide by in order to receive full funding.

The federal government has the right to claw back money from the Canada Health Transfer if provincial or territorial governments allow private clinics to charge for services that should be covered by the public purse.

Because the Canada Health Act is focused exclusively on doctors and hospitals, it's up to individual provinces and territories to decide how to fund most other services related to your health.

"If you've ever had a condition, you know that there are other health professionals that are very critical to your well being and to your recovery," said Quesnel-Vallée, "so folks like physiotherapists, for instance, people who provide mental health care."

"Provinces can pick and choose among the rest of the health-care basket."

That could mean your elderly relative's access to publicly funded home care could be better in one province than another.

Quesnel-Vallée notes the act isn't particularly geared toward an aging population, either. "Remember, this whole health system started when we had far more younger folks than older adults."

The most recent Statistics Canada data show that about one in five Canadians were 65 or older as of July 2023; that number was one in 10 back in 1984.

Health law expert Bill Jeffery, executive director of the Centre for Health Science and Law in Ottawa, says the act could use an update toward more preventative health services.

"Certainly it makes sense to have nutrition counselling services covered," he said. As things stand, said Jeffery, who is also a health law instructor at Carleton University, "basically, you have to have a heart attack in order to get some kind of insured coverage by a dietitian."

The fact that preventive services like these are not generally covered by the provinces has created opportunities for private clinics to provide them for a fee.

Jeffery says it's also necessary to think about prevention in a broader sense. "Lots of prevention efforts don't have to do with clinical services; they have to do with changing the way food and alcohol are labelled or taxed."

For instance, he was part of a group that tried to organize support for a bill that would have required food companies to disclose in their labelling if the product did not meet voluntary targets for sodium levels.

Training doctors, including the family physicians in such short supply, is handled by provincial and territorial governments.

The Canadian Medical Association has proposed a pan-Canadian license that could give docs more flexibility to move where they're needed most.

Quesnel-Vallée says the federal government could provide the leadership to make that agreement between the provinces happen, but would also need to take steps to prevent an exodus of doctors from poorer resourced areas of the country to those that pay the best.

This has already happened to some degree, given British Columbia raised family physician pay in 2023 as part of a recruitment and retention strategy.

"You need a systemic view about this and not just the kind of free-market perspective that health care providers should be able to move anywhere and everywhere," said Quesnel-Vallée.

Likewise, the federal government could use immigration mechanisms to make it easier for foreign-trained doctors to work here, she said.

However, it's up to the various colleges of physicians to help remove barriers related to licensing. And the residency programs so essential to getting started here as a doctor are controlled at the provincial level by hospitals and universities.

In Manitoba, Dr. Aaron Jattan said the federal government could use its influence to send the message that the universities that train doctors should extend that training "beyond the larger urban centres that they're primarily centralized in."

CBC Radio's White Coat, Black Art spoke to representatives from the five major federal parties about their health-care platforms, including their plans to address the dearth of primary care providers.

The Bloc Québécois say they want the federal government to stay out of provincial personnel issues and instead address funding shortages.

The Conservatives support a pan-Canadian medical license, and removing barriers for international medical graduates. They want to consistently partner those graduates with Canadian physicians for practice-ready assessments.

The Green Party wants to see salaried primary care clinics composed of primary-care prescribers (pharmacists), nurse practitioners, nurses and family physicians.

The Liberals say they, too, support a pan-Canadian license. They want to make federal funds conditional on ensuring access to a physician, and implement a $52-million foreign credential recognition program.

The NDP also wants to see team-based care and expanded scope for nurse practitioners and pharmacists, plus train more doctors from northern and rural communities and increase health transfers by one per cent.

Outside the scope of the Canada Health Act, the federal government is in charge of a range of other things that affect our health, from the ingredients in packaged foods to industrial chemicals we may encounter at work, but none of these things are what usually come to mind.

"I'm not sure that they fully appreciate the extent to which the burning of fossil fuels is contributing to ill health, and certainly the concerns about exposure to toxic chemicals and pesticides," said Jeffery, noting part of the problem is these are largely invisible.

"Occasionally there's a news story about, you know, forever chemicals or some kind of pesticide that's on the market, but people don't really have a kind of quantified understanding of how much that's affecting their day-to-day life, and I think if they did, they would demand more from lawmakers."