With the longest federal election campaign in modern history under way, many in the health community are lamenting the apparent lack of campaign interest in health issues. We’re four weeks into the campaign and health has not been included as a leader’s debate topic; there have been few significant health policy announcements from parties; and, the limited media coverage on health has largely focused on the fact that the health issue is missing from this election campaign.

So why isn’t health a major election issue? And for those trying to put health on the agenda, how do they make it one?

While the parties will undoubtedly make some health commitments before the campaign is over on October 19, it seems clear that health isn’t likely to become a top campaign issue in the 2015 election—and that’s for two principal reasons.

Health is not a top campaign issue in 2015 because it hasn’t been a top federal political or policy priority for many years. There was a time when health was a major issue for stakeholders and politicians alike in Ottawa, with robust policy debate and an activist approach to the health portfolio. That changed when the Conservatives came to power in 2006 with a very different view of the federal government’s role in health, firmly grounded in the constitutional separation of powers, which has had both policy and budgetary impacts at the federal and provincial level.

Over the past decade, the Conservative government has largely restricted its role in health to funding, through transfers to the provinces and territories and funding for health research, but, it has been widely criticized for both its leadership approach and reduced funding levels. The Conservative government has been reluctant to engage with the provinces on health care reform and other policy issues facing the health care system. In general, the Conservative government has limited its policy activity in health to “protecting the health and safety of Canadians,” by updating regulations for food and consumer products, better regulating toxic chemicals and creating a (controversial) anti-drug strategy, while deferring to the provinces on most other policy questions.

What happens between elections in Ottawa is an important indicator of how an issue will fare during a campaign. Starved of much-needed policy oxygen and political attention, health has dropped down the list of political priorities and now takes a backseat to other issues like the economy, child care and other pocketbook issues.

The second reason that health is not a top issue in this election is that the public hasn’t made it one. While polls show that Canadians put health at the top of their priority list, they haven’t made leadership on health an electoral imperative at the federal level. Until health becomes a ballot box question for Canadians in federal elections—not just provincial ones—federal politicians have little reason to pay it more attention.

While health is not a central focus in this campaign, that doesn’t mean it’s not possible to bring health back to the top of the political priority list.

We see health groups of all kinds and sizes working hard to make health an issue in this election—most notably the Canadian Medical Association which has launched a robust campaign effort. The efforts of these groups will undoubtedly help to build support, but the best way to ensure that health is a top political priority is to ensure that the public makes it one.

While public support has always been important in creating political support for an issue, never has that been more true than it today’s political climate. The reality today is that government decision-making and policy setting can be guided by public opinion and corresponding levels of public support in an unprecedented way. Where politicians once led, governments and political parties are now following the public’s lead on policies and priorities. Engaging the public and mobilizing supporters must be a top priority for those looking to influence election campaigns and government decision-making.

Many health groups are targeting political parties and leaders in this election campaign; those that will ultimately be successful are those that can mobilize Canadians in support of their agenda. If the health community wants to put health back on the federal government’s priority list, it won’t be enough to encourage political parties to show leadership on health—the public must demand it. Because when Canadians make health a top political priority, you can be sure that politicians will too.