We can re-define Canada’s health systems because we already have

Posted on August 1, 2021 in Health Delivery System

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TheStar.com – Opinion/Contributors
Aug. 1, 2021.   By Suzanne Shoush, Danielle Martin, Contributors

This is the first in a six-part weekly series, led by Dr. Danielle Martin and featuring a co-author expert woman physician for each article, that explores how to build back into a more efficient, accessible and equitable health system.

The COVID-19 pandemic swept into our lives bringing distress and chaos, but also many lessons.

As the third wave recedes from view, the impact will be tallied. Large public deficits loom, employment is down — particularly for women — and the effects of postponed medical appointments and post-pandemic mental health needs await.

Those who bore the disproportionate impact — including elders in long-term care, essential workers who are most often low-income and racialized, women carrying heavy responsibilities, and Indigenous communities — have a right to expect that we have learned something from their experiences.

There is talk of a “back to normal.” But as we have seen in health care, normal was not good enough. The recovery must focus on back to better. What does a better version of health care look like in Canada?

We know we can build better health care because we did. When the pandemic forced us to pivot, our health systems learned quickly. This must continue.

Early on we learned that health services must take into account how social conditions shape people’s options. We came to understand the absurdity of asking people to quarantine without making sure they have access to a safe home, food, job security. Protecting those around you is a privilege not everyone shares.

At hospitals and clinics across Canada, COVID-19 patients were connected to services to ensure their basic needs were met for a successful 14-day quarantine. Because public health depended on it, these questions moved from the margins into the mainstream. What a practical and concrete integration of health and social services. Why not do the same when recommending treatment for diabetes, high blood pressure, a healthy pregnancy?

A second learning was to allow community leaders, rather than hospitals drive, the delivery of services like testing and vaccination, bringing delivery of those services out of big institutions and into communities. Centuries of systemic racism and poverty have deeply affected both health outcomes and trust in the health system for many groups. Some groups and neighbourhoods were falling behind because, without overcoming that health-trust gap, we could not make needed progress.

When mobile and pop-up testing and vaccine clinics, led by local community leaders and ambassadors, started in areas with the lowest vaccination rates and the highest infection rates, we turned a corner in the pandemic.

Special clinics like Auduzhe Mino Nesewinong could meet the needs of specific cultural groups and communities. Healthcare providers went into homes to help those who couldn’t travel get their shot or test. What if we did the same for access to screening pap tests, mental health monitoring and well-child visits?

A third critical lesson was that virtual care can support, rather than exclude, the most vulnerable. Not every virtual visit needs to be done by video on a smartphone (though such options were also important for many). Throughout the pandemic, the Call Auntie Hotline supported Indigenous people who phoned in with questions, connecting them with resources on vaccination, access to food hampers, or helping with contact tracing.

The hotline’s staff are all Indigenous women or “aunties,” and it was so successful that it has expanded to include primary care and sexual health. Why can’t we grow more options like this — immediate and practical access, instead of an in-person appointment three weeks from now?

The best solutions are often the simplest, rooted in both evidence and common sense. We have seen care models that are trauma and culturally informed, offered by people who have roots in the community. We have seen a smarter use of existing resources, including a leveraging of virtual care.

We have seen collaboration across hospitals and regions to ensure that people could access critical care or surgery beyond their local hospital. And as the vaccine rollout reaches its most bespoke stage, we are appreciating the importance of primary care and the need to connect every single Canadian with a team that will be there for the next round.

The lessons abound. We know we can build better health care because we have. Let’s not lose the momentum.

Dr. Suzanne Shoush is a First Nations/Black mother, physician with Unity Health Toronto, and advocate. She is the Indigenous Health Faculty Lead with the Department of Family and Community Medicine at the University of Toronto. Dr. Danielle Martin is a family physician and executive vice president at Women’s College Hospital., and author of Better Now: 6 big ideas to improve health care for all Canadians.


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