Once the envy of the world, Canada’s health care system has been in decline for several years, with strains on the system evident well before the pandemic. In public opinion polls, health care is consistently identified by Canadians as a major concern.
At Ivey’s The Future We See Symposium, Mahmood Nanji, Power Corporation of Canada Fellow at the Lawrence National Centre, led an engaging discussion with three prominent health care experts on ways Canada can rebuild a world-class health care system. Panelists included Dr. Heather Morrison, Chief Public Health Officer for Prince Edward Island, Dr. Jane Philpott, Dean of Health Sciences at Queen’s University and former federal health minister, and Dr. Kevin Smith, President and CEO of University Health Network (UHN).
Against the backdrop of a growing and aging population, the panelists discussed the daunting challenges facing the current system: capacity constraints, staffing pressures, and serving remote and disadvantaged communities. They also shared lessons learned from the pandemic and the benefits of adopting new technologies. Overall, they underscored the imperative of four priorities. These include (i) building a stronger primary care system that also addresses the special needs of vulnerable populations; (ii) using innovative approaches to overcome staffing shortages and improve overall health care delivery; (iii) effectively deploying new technologies, and; (iv) enhancing collaboration among governments.
Addressing the unfinished first floor: primary care
As the first point of contact for patients, primary care is considered the first floor of the health care system, encompassing many basic services, including preventative care. However, an estimated 6.5 million Canadians don’t have a family physician or nurse practitioner, according to the Canadian Medical Association Journal. And the situation is even more dire in Indigenous, racialized, and remote communities.
Dr. Jane Philpott warned Canada’s secondary and tertiary systems are in danger of becoming strained if primary care access isn’t addressed. “The root of the problem is that we've never fully built out the primary care system as a place for people to get preventative care and chronic disease management. And the result of that is it trickles down to every other part of the system.”
Pointing out that issues extend right through to “the basement,” Dr. Heather Morrison cited the need for health care policy to address the modifiable risk factors that contribute to major diseases, such as chronic obstructive pulmonary disease, cardiovascular disease, cancer, and diabetes. She told of New Zealand’s ban on the sale of tobacco to anyone born on or after January 1, 2009, aimed at creating smoke-free generations that could positively impact the health of its population.
“If health care is in a crisis situation, we need real courage as leaders to make some hard decisions that are looking forward many years,” she said.
Rebuilding the health care workforce
Canada’s health care staffing challenge is not unique. In fact, it is a global and complex issue. Statistics Canada recently reported 126,000 vacancies in the health care and social assistance sector – double that from two years ago. Attributing shortages to higher retirement rates, pandemic-induced burnout, and growing needs of the population, the panelists said current efforts, such as streamlined licensing of internationally trained professionals or creating more residency spaces, only fill some of the gaps. The panel highlighted three approaches to addressing the issue: improving health care workforce productivity, re-thinking medical education and training, and creating flexible work conditions for health care professionals.
Dr. Kevin Smith proposed that deploying the highest-skilled staff for the most complex tasks while other staff provide the additional essential services could result in significant productivity gains.
With respect to medical education and training, Dr. Philpott told how Queen’s University’s medical school has developed a family-medicine-focused program curriculum where candidates receive specific training in family medicine to fast-track their progression into delivering community care.
Dr. Smith called for a more interdisciplinary approach to medical education – one that emphasizes both a science-based curricula and problem-based learning that aligns with patients’ needs. He also advocated for broader acceptance of individuals with diverse backgrounds into medical programs.
“Let's not be so narrow-minded about who can go into medicine,” he said.
The panelists suggested burnout might be addressed through two avenues: addressing the rise of patient violence, and offering flexible work arrangements. They discussed that a recent Statistics Canada report revealed nearly 25 per cent of nurses intend to leave or change jobs within the next three years due to job stress and burnout.
“People who go into health care don’t do so because they want to be berated on social media or the subject of threats … We need to make sure we train them, but also look after them when they're on the other side,” said Dr. Morrison.
In addition to protecting health care workers from difficult situations, Dr. Morrison said flexible scheduling and opportunities to work in different settings can go a long way in creating an enjoyable environment.
“When they (health care workers) get a chance to do different things that they’re enjoying, we're going to keep them in the job for a longer period of time,” she said.
Innovative approaches
Cross-sector collaborations are another means to address major community needs and alleviate significant pressure on hospitals. Dr. Smith talked about how a new multidisciplinary program, the first of its kind, led by the Gattuso Centre for Social Medicine at the UHN, developed in partnership with the City of Toronto and United Way Greater Toronto, will prescribe social housing to those in need.
The first 51 modular units in the Parkdale neighborhood of Toronto are set to open imminently and will provide people from historically marginalized groups who are frequent users of hospital services with accessible, safe, secure, and affordable housing. The site has been designed with a unique approach, including strategies to address the social determinants of health – such as housing, food, financial security – and their long-term impacts on individuals' quality of life.
Innovative programs such as these have huge potential for managing health system capacity pressures and transforming our health care system for the future, ensuring we can provide necessary care for citizens in an effective and timely manner.
The path forward
While for many years there have been urgent calls to transform Canada’s health care system, the panelists said change has been slow, as evidenced by the weaknesses exposed during COVID-19.
They acknowledged the 10-year, $200-billion health care funding agreement reached between the federal, provincial, and territorial governments earlier this year is a promising start. It will help provide critical funding to address the surgery backlog, train new nurses and doctors, improve long-term care, and continue evolving mental health programs and digital infrastructure.
However, they stressed it’s now incumbent for federal, provincial, and territorial governments to work together to transform the health care system so that it supports both the well-being of Canadians and the nation’s economic competitiveness. They pointed to the collaborative leadership demonstrated during the pandemic as an example of what can be accomplished.
“We are desperately overdue for federal leadership on health in this country,” said Dr. Philpott.
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