In the News

The importance of early intervention

June 4, 2015

It’s time for a rethink of how health and social services are provided, James Hughes says.

We have all been reading a lot recently about student demonstrations, forced classroom closures and student strikes. Student activism has sought to reverse the provincial government’s “austerity” budget. Though not fully articulated, the students believe something is very wrong in Quebec and that deep reform is necessary.

Health Minister Gaétan Barrette’s Bill 20, which imposes patient quotas on doctors, among other measures, had been intensely criticized by many medical students in particular.

Is it possible the students and government, at least respecting Bill 20, are both right?

Canada and Quebec’s social safety net was built over the last 70 years as a system of late intervention. The sense that individuals and families should take care of themselves and that government should only intervene as a last resort combined to drive public spending toward emergency services as a general rule.

Over the decades, politicians have been cautious about spending tax revenue on services that don’t address immediate risks and dangers. This is the logic of scarcity. With limited resources, public funds have been spent to a large extent on those most in need. Thus, most public funding in child protection foes to protecting kids in imminent danger. Most healthcare spending foes to hospitals. Most anti-poverty funding goes to social assistance. Most homelessness dollars go to homeless shelters. And so on.


The problem is these multi-billion dollar late intervention systems are not working very well. The students, like many of us, witness long wait times at the emergency room, long lineups for social housing, horrific stories of school bullying, thousands of people trapped in welfare, stubborn levels of poverty and bulging homelessness. It’s no wonder they call for change. But what change?

Research is now showing that there is an alternative to how we manage health and social services today. It is based on the idea that emergencies most often start as smaller and more manageable problems. It’s called early intervention.

In child protection, we now know that intervening with a family the first time there is a report of a problem, before the children are at imminent risk of danger, improves the children’s chances of success and lowers the government’s overall cost by reducing both foster care and legal bills. In many areas of health care, such as mental health, stroke, cancer and even dementia, we now have evidence that intervening early with the right treatment as soon as symptoms are apparent can improve the quality of life of the patient and allow the government to save precious health resources. Early intervention has also been shown to work and produce servings or avoided costs to government in such areas as autism, school violence, poverty reduction and homelessness. Early intervention does not mean the end of emergency services; it just means we need a lot less of them. Early intervention is simply a more effective way to design our human services that the current approach.


Barrette wants us all to have easier access to a GP. This is good early-intervention thinking, as it promotes holistic care and can divert many patients from needing a hospital visit. None of us know whether it will work and there is legitimate worry that it may have the opposite impact. Testing the approach is a smaller and more discrete way over a few years to generate the evidence of both patient and cost effectiveness might have been a good idea, but the overall approach seems right.

Is it possible Bill 20 includes some of the change the students seek?