This is my first column for rabble.ca since October 2023 and I’m happy to be back. A lot has happened in eight months. Last fall, I wrote about the problem of assuming that more money could solve the various healthcare problems in Canada. I stand by that opinion.
What we did not know last fall was that Canada’s population would exceed 40 million in June of 2024. It is already 41 million and has grown by over 3,000 in the last 24 hours. And it is expected to continue to grow to 50 million by 2030 or 2031. Providing healthcare services to this number of people cannot be sustained under the current illness- and hospital-centric system we have.
Another thing we did not know was that COVID would continue to be a significant issue among the population. Although the number of deaths from COVID has decreased dramatically since it was first identified in early 2020, Canadians are still dying of COVID.
Across Canada, there were 30 reported deaths attributed to the virus during the week of June 23-29, the latest weekly data available.
For the same period, there were over 4.5 million cases of COVID across the country. About half of them are cases of two new variants under the Omicron strain. Think about it: that’s almost 1-in-10 Canadians.
There have now been eight different COVID vaccines made available to the public. Yet there is still vaccine hesitancy.
Vaccine resistance applies, too, to prevention for childhood and adult-onset diseases. Canada’s immunization rates for a range of childhood diseases dropped during COVID, but are slowly increasing again. Unfortunately, rates are still not high enough to protect all children from otherwise preventable disease and, occasionally, death.
The rise in cases of measles is a prime example of this. Measles was eliminated in Canada in 1998 because of vaccinations. In 2024, 78 cases have occurred in Canada, with one leading to death.
More bad news. Lyme disease is no longer the only tick-born disease we need to protect ourselves from when outdoors. New ticks are coming to Canada. This author is not a fan of anything with more than two legs that is smaller than one-inch or 2.5 cm. For the curious, and to know what to avoid, TickTalk is a website with current Canadian information.
Another change since the fall of 2023 is that we are now dealing with more significant climate issues than ever before. This includes unusual weather patterns like el niño and la niña. Depending on where you live in Canada, these two weather systems have delivered either warmer/hotter or colder temperatures and attendant snow, rain and winds.
There are more hurricanes, more cyclones, more draughts and more floods than previously recorded. More forest fires, too. And these weather disruptions are arriving earlier and lasting longer. Contradictory as this seems, the two ends of the weather range do not seem to offset each other. And each one of them has health consequences.
With extreme heat, for example, children, older adults and the immunocompromised are advised not to spend time outdoors. What better indoor activity, then, than writing a column for rabble.ca?
In some respects, the challenges facing the Canadian healthcare system have changed little since the fall of 2023. Yes, there has been an increase in funding from the federal to the provincial and territorial governments. But it has been targeted funding, for specific programs and services. True, too, is that Canada finally has a Dental Care program, after talking about one for many years. It began with coverage for seniors and children and will ultimately cover all Canadians.
The same is true of the first steps related to Pharmacare. The Pharmacare Act was introduced in February 2024. Initially, it will provide coverage for diabetes and contraceptive medications. The plan is that the provinces and territories will receive funding to establish single-payer insurance for these, and other, future, prescriptions.
We can only hope that evaluation of these programs is built into the system, so that the parameters can be tweaked to ensure the public truly benefits from these additional healthcare services and the money is well-spent.
The challenge here is that the provinces and territories welcome the funds. But they are not pleased that the money comes with strings attached. At the time of writing, the premiers are meeting in New Brunswick to discuss the federal government’s role in healthcare. The message of the premiers is clear to the Prime Minister: “Stay in your own lane” summarizes their concerns that the federal government is overstepping.
But back to October 2023.
Taking a breather from rabble.ca did not mean that I no longer followed healthcare topics in Canada. Truth be told, healthcare policy and strategy are in my blood, no pun intended.
Since the fall, Canada is facing a two-fold challenge regarding the state of the healthcare system. First, it is recovering from COVID. This has meant returning hospitals and other institutions to “normal,” despite the continuing presence of COVID and the shortage of staff due to burn-out and retirements.
The staffing issue is no longer news. The Canadian Medical Association acknowledges that some 6.5 million Canadians do not have primary physicians These people use either walk-in care centres or local emergency rooms when they need help. Neither of these options leads to comprehensive healthcare nor to developing a patient-provider relationship.
Increasing enrolments in medical, nurse practitioner and other provider schools is a partial solution, but one which will not help solve the problem for many years. Expanding scopes of practice can also help.
Continuing to reimburse solo-practice physicians on a fee-for-service basis does not work well. Family doctors are not paid sufficiently for administrative work and for overhead. The preferred method is to work in healthcare centres staffed with a variety of physicians and other healthcare professionals, where reimbursement is on a roster basis.
The concept is not new, but it is still the minority situation in Canada. As have others before her, Jane Philpott, former federal Minister of Health, describes the benefits of this type of community-based, multi-provider care in her recent book, Health for All: A Doctor’s Prescription for a Healthier Canada. It is worth a read.
The second major issue facing healthcare in Canada is the continuing focus on hospitals and sickness. The creation of the Canadian Dental Plan and the Canadian Pharmacare Plan are beginning to broaden the scope of our national healthcare service. But they are just the beginning.
Until Canada shifts some of the healthcare emphasis from acute care to preventive and community-based healthcare, the obstacles will remain. For another column.
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Nick Seebruch, editor
