Ottawa and the provinces have all the money and all the power, but it is cash-strapped municipalities and their partners in the non-profit sector that are tackling the tough issues in health care.
Case in point: the Calgary Poverty Reduction Initiative.
Earlier this week, Calgary city council, at the urging of dynamic mayor Naheed Nenshi, adopted a resolution that commits it to cut poverty in the city by 50 per cent over the next decade.
Cynics will say this kind of talk is cheap and plentiful. But unlike many other bold political promises, Calgary's plan is realistic, affordable and well-articulated, and has a champion in Mr. Nenshi.
The plan is based on recommendations in a report entitled "Enough For All," which was prepared after a broad public consultation, a joint initiative of the City of Calgary and the United Way.
The cornerstone is a belief in the power of community or, if you prefer, community building – tapping into people's sense of belonging and neighbourliness.
This echoes the philosophy of John McKnight, guru of the asset-based community movement, which believes, essentially, that a strong society is built by using people's strengths rather than relying on soulless institutions.
The Calgary plan has a lot of this talk. The rallying cry is: "My neighbour's strength is my strength." This is not everyone's cup of tea; many believe more formal structures and institutions are required to tackle issues like poverty.
But in the current fiscal environment, there is not going to be a massive influx of cash. One of the strengths of the Calgary plan is that it requires very little additional spending; rather, it intends to reorganize, spend smarter.
The emphasis is on prevention, on nipping poverty in the bud. The city plans to use existing resources such as community centres to create "community hubs," moving municipal services closer to where people live and breaking down silos.
From there, the plan is to create personal support networks around individuals and families who have fallen into poverty. In other words, adapt social programs – whether they are provided by government, not-for-profits or private initiatives – to people's needs and get those agencies working in concert rather than at cross-purposes.
Finally, a determined effort will be made to talk more openly about poverty in public discourse, to underscore its impact on the whole community.
"Poverty is a complex problem that requires a multi-faceted solution," Mr. Nenshi said.
Some will say poverty is not a health issue and that municipal government should concern itself with practical matters like fixing potholes.
But low income is the single biggest predictor of poor health for individuals, and inequality (the gap between the richest and poorest in a society) is the best single measure of the overall health of a population.
In Canada, inequality is on the rise, and that should be of great concern to politicians and policy-makers.
Poverty is a blight on our cities and our economy, and Ottawa and the provinces have been derelict in their response. So municipalities and non-profits are jumping in.
So too is the Canadian Medical Association, the group representing the country's 76,000 physicians. It is staging cross-country town hall events about poverty, and the socio-economic determinants of health more generally.
As CMA president Anna Reid likes to note, socioeconomic factors like poverty determine 50 per cent of all health outcomes.
Poverty is a killer. And money is, by far, the best drug we have.
But back to Calgary's plan to cut poverty by half to create a healthier city.
On the surface, Calgary is an unlikely champion of a social issue like poverty. It is, after all, a prosperous city with a strong economy, the highest average income and lowest unemployment rate in the country.
Yet, even in the midst of such wealth, there is significant inequality and struggle. An estimated 114,000 Calgarians live below the poverty line – one in 10 residents – and many more struggle around the margins, weighed down by high housing and food costs.
Poverty costs us all. A recent report estimated the annual cost of poverty at between $7.1-billion and $9.5-billion in Alberta alone. To get a sense of the national impact, multiply that by 10.
But monetary calculations do not fully capture the damage. Poverty is isolating and soul-destroying. It creates dependence. Poverty robs cities – and Canada more broadly – of the talents and strengths of many, and needlessly so.
As the Calgary report states quite eloquently, our wealthy society has "enough for all" – enough money, enough food, enough work, enough challenges, enough health – but the abundance of resources we have need to be distributed more smartly, more fairly.
André Picard