Holiday wishes for our beleaguered health-care system

My biggest wish for the health-care system this holiday season is that we find the courage to move from talking to action. The path forward has been laid out. We know the priorities and what needs to happen, yet we are stuck. The longer we remain stuck, the more people suffer – Canadians dying on wait lists, suffering from diseases with treatments, and providers struggling with the moral injury of not being able to care for their patients to a standard that meets their own. Let’s find the courage to get on with it – the only way forward is to start.

My big wish for the health-care system is that we prioritize addressing systemic health inequities with the goal of improving health outcomes. It is unacceptable that your life expectancy, quality of care and access to care can differ depending on the color of your skin, your country of origin, your income or your postal code. We are beyond proving that these inequities exist and should be continually working to reduce and eliminate them. I believe it is the job of each and every one of us in health-care to understand that unequal allocation of power and resources (including goods, services, societal attention) is a fundamental root cause of health inequity we can address.

My one “magical” wish for the health-care system would be easing the burden of work for our health-care workers. It’s been an incredibly stressful time with very high rates of burnout. We’ve struggled with crowded emergency departments, hospitals and clinics where infrastructure, processes and cultures are extremely hard to change without the time to step back and really improve our approaches to care. Our health-care workers need the time to enjoy the work they do and the reason why many of us are in health care to begin with – to help people.

My holiday wish is that every single Canadian has access to pharmacare. As it is, Canadians are paying some of the highest prices amongst high income countries for their prescription medicines. We know that one in 10 Canadians struggle to pay their prescriptions; 3 million don’t even fill their prescriptions at all. We know that 8 million people have no drug coverage. When we think about our universal health-care system, the fact that it does not include prescription coverage means that many people do not get the access to health care that they need and deserve. As a physician who spends a lot of time providing health care for people who experience structural vulnerabilities like poverty and homelessness, I see the devastating impacts of a lack of universal pharmacare in this country every day.

If I could make one wish for our health-care system this holiday it would be for the immediate moratorium of all private, for-profit health care (across all its forms, including acute care, long-term care, homecare, etc.) alongside increased investment in public health care. The ongoing expansion of predatory profiteering during the pandemic is being felt by Canadians day in and day out. Whether it be delayed medical treatment, preventable death, negligence or malpractice, it is clear the incorporation of the profit motive into public health care hurts Canadians while enriching profiteers by way of short-sighted and ill-informed politicians.

My wish for the holidays is for people in rural communities to have equitable access to both acute and primary care. Emergency department closures have been a huge issue this past year and this predominantly impacts smaller centres, forcing patients to drive further and further for care and overloading the remaining emergency departments that must take on a higher burden. I wish we could reverse this trend and restore every rural emergency department to the staffing and resource level it was at just a few years ago. And since acute care is backed up by primary care (which is key to keeping patients out of the hospital), I also wish that rural communities like mine didn’t need to struggle with worsening family physician shortages and huge unmet needs for essential primary care services. Finally, from the bottom of my heart, I wish every rural generalist physician at least ONE day this holiday season with a long and restful sleep-in, a completely empty inbox, and an absolutely delicious and decadent meal with the people they love the most!

I wish that public health officials and provincial governments would face the evidence-based biomedical research, health-system indicators and reduced life expectancy that show COVID-19 is placing severe and increasing strain on health systems and population health, and implement a “vaccines-plus” strategy: Educate the public on how to reduce SARS-CoV-2 transmission as an airborne pathogen that can cause acute and long-term multi-system harm (including increased risk of stroke and heart attack); legislate indoor air quality standards; encourage and increase access to testing; distribute free respirators to the public and require universal masking in congregate settings and public places when transmission is high; protect patients and health-care workers by retaining universal masking in health care year round; increase and improve education about the importance of staying current with vaccination to reduce risks associated with acute and long-term complications.

This holiday season, my one wish would be for our governments to start working together to transform our eldercare system in Canada.

Currently, our health-care system is not designed to care for our aging population. Compared to other OECD (Organization for Economic Cooperation and Development) countries, Canada grossly under-funds community-based eldercare supports. Inadequate home care, long-term care and palliative care are major contributors to our overcrowded emergency departments and the ALC (alternate level of care) crisis. Without action, as our population continues to age this crisis is only going to get worse. Given the devastation that we’ve seen throughout the COVID-19 pandemic, which continues to disproportionately impact older adults, it’s time for a well-funded national eldercare plan with transparent, measurable and mandatory enforceable conditions. It’s time to finally provide our elders with the life they actually deserve.

What I want for our health-care system is actually two things that relate to the same dynamic. First, I want continuity of care. Second, and somewhat connected, is I’d like folks to stop being excluded from different parts of our health-care system for arbitrary reasons.

In terms of continuity of care, we need everybody in the system to stop only acting in their own best interests and really ensure that folks’ well-being is prioritized within the health-care system.

That means really looking at whether virtual care is achieving the same goals as in-person care, particularly for folks that are less connected. It means ensuring that information is being shared appropriately between the different folks that are involved. It means moving away from walk-in clinics as the only answer for people where there’s basically no accountability, and incredibly poor quality of care.

In terms of exclusion, I’m desperate for our health-care system to stop excluding people. We think we have a universal system, but we don’t. Different people are excluded for all kinds of reasons. For example, people are excluded from long-term care facilities if they drink alcohol or have substance use issues, if they’re experiencing homelessness, or any number of other issues. Never mind that if you’re undocumented, you’re excluded from the whole system.

Finally, if you’re not documented, the only place where you can access care is in the hospital. We don’t exclude people from emergency care, but we exclude them from accessing any health-care services that would prevent them from going to the emergency department – which is silly. There’s no efficiency or cost savings in that whatsoever. In fact, it’s just burdensome.

My one wish is for our policymakers to invest in the underpinning of our health-care system, which includes primary care, public health and long-term care. As a clinician in Ontario whose primary practice is in acute care hospitals, I think the majority of the challenges we face, such as surges and overcrowding in the emergency department, as well as delays in discharging patients who no longer require acute care to long-term care facilities, can be traced back to lack of access to primary care providers and the long waiting list to get a bed in a suitable long-term care facility. These challenges, root-causes and potential solutions and strategies have been identified across Canada. Public health functions to promote and protect the health of Canadians and their communities against illnesses and injuries. Chronic under-investment in public health can mean we cannot help those in our society who need our help the most. A key lesson we ought to learn from the pandemic is that population health and economic productivity are tightly intertwined. Hence, my one wish is that policymakers will invest in system-level improvements for Canadian health care.

My wish for the health-care system would be a greater focus on health promotion instead of  solely disease treatment. I wish there would be funding (from government and private payers like employee health plans, health insurance companies) for exercise physiologists, dietitians and behavioural psychologists who could help people create healthier habits and lifestyles. I wish hospitals and public spaces would get rid of vending machines that offer pop and junk food and instead have healthy food options at an affordable price. I wish for greater regulation of the food industry to prevent them from “health-washing” our foods and mandate higher quality, affordable, real food options for Canadians in place of our highly processed food environment.

My one wish for the health-care system, hands down, would be for everyone to have a family doctor or a nurse practitioner to advocate for them. Over the past two years, I’ve seen too many people in the emergency department who tell me they feel anxious, helpless or desperate about the uncertainties, inefficiencies and bad outcomes that arise when you don’t have access to good primary care.