It's election season in Ontario and that usually brings health care issues to the forefront. The parties vying to form the next government will pledge to deliver better, faster and more efficient care. However, the region with the greatest need for health care reform is typically the one with the least attention paid to it, even during an election.
In northern Ontario, two million people live each day with substantially worse health care access and resources than their Southern Ontario compatriots, refuting the Canadian fairy tale of universal health care. Geography is a major determinant of health in this country; if you live far from a large, southern Ontario city, your health is worse and your life is shorter than that of your fellow Canadians.
Universality is the core principle of our health care system, and consequently we must consider the needs of the overlooked North and demand a clear and capable plan from our political leaders. Here are four key questions about northern health reform to ask the parties stumping for your votes this June:
1. How will you address health resource equity?
Equity is enshrined in the Canada Health Act, yet there is massive geographic disparity in every measurable health resource. Doctors are in short supply, long distances separate northern communities from medical centres, specialized diagnostic and treatment facilities operate almost exclusively in the south, and rural hospitals are increasingly being forced to eliminate services or close altogether. Meanwhile, studies show the connection between long travel to access care and poor overall health.
Provincial policies have at times only deepened the inequity. In the name of efficiency, both Liberal and Conservative governmentsdirected decades of hospital consolidation — the merging of hospitals that typically removes services from rural communities and ships them to the cities. Small towns are left with a shrinking basket of accessible services and must rely on ever-longer travel, not just for highly specialized treatments, but also for basic needs like maternity care.
The government and major parties lack a focused strategy to address northern poverty.
At the same time, a multitude of monetary incentives have been offered for individual physicians to sign a commitment to an under-serviced region. In this election we are hearing about using tax credits to attract doctors northwards. Yet we see mixed results from the data on using incentives to boost physician numbers. Most critically, if physicians have nowhere to work because health care infrastructure has been dismantled, a tax credit is purposeless. As well, working in a resource-poor and under-supported region can lead to physician burnout and cause closure of medical practices.
2. Is an approach to poverty part of your health plan for the North?
Poverty has a well known impact on health and is intimately connected to other social determinants like addiction, mental illness and discrimination. The North has a much higher burden of poverty, meaning disproportionately more people facing food insecurity, precarious housing and violence. People with low income are also less able to pay for medications or unlisted services like physical therapy, counselling and dental care. And while we envision our health care system as single-tier, there is clearly a bottom rung for people not able to pay out of pocket for health services or medications. Poverty bars access to that higher tier of care, and it's clear from the evidence that better access equals better health.
The government and major parties lack a focused strategy to address northern poverty, whether through guaranteed basic income, improved social services or economic supports to reduce unemployment. Yet without incorporating an approach to poverty, no health care platform for the North can be considered realistic or purposeful.
3. How do you plan to improve Indigenous health?
Whereas only 2.4 per cent of Ontarians overall identify as First Nations, Inuit or Metis, 18.3 per cent in the North West LHIN region and 11.0 per cent in the North East LHIN region are Indigenous. Funding for Indigenous health services is a complex, jurisdictional "patchwork" of federal and provincial funding, with multiple holes where people fall through the cracks. Life expectancy in this population is 15 years shorter than that of non-Indigenous Canadians. Indigenous communities deal daily with the historical impact of colonialism and the more recent travesties of forced relocation and residential schools.
As part of the ongoing work of reconciliation, the downstream impact of centuries of systemic racism upon Indigenous health must be addressed, including continuing disproportionate violence and incarceration. The Ontario government has recently made good on a promise to increase health resources and autonomy for Indigenous communities, however the suicide crisis continues in part due to "non-existent" mental health services, and the shameful lack of clean drinking water is endemic throughout Canada.
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4. How will you support connected health technologies?
Key to any future success in northern health is using technology to bridge the vast Canadian landscape. It starts with integrated electronic health records, which would improve the quality and efficiency of care throughout the province, but particularly in the North, where continuity of care is lower due to high numbers of temporary physicians flying in for short stints.
Newer technologies like eConsult allow physicians to reach out to a multitude of specialists province-wide for a rapid medical consult. In-person assessments by a specialist are not always necessary to arrive at the best course of care, and in rural areas this can mean months or years of waiting and long travel. Often rural generalists can ably manage complex medical issues on their own with the guidance of a specialist. Physicians in the North have already been accessing remote specialists via on-call phone support and connected imaging between hospitals. eConsult represents the evolution of that technology to a wider platform.
It's up to voters to hold our politicians to account this election, and demand better for the peoples of the North.
A forward-looking government committed to improving northern health will finish the job on integrated records and invest in the connected services that mitigate our geographic disparities.
Ultimately, no party can claim a bold vision for northern Ontario health care unless they have clear answers to these four questions. It's up to voters to hold our politicians to account this election, and demand better for the peoples of the North.
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