April 06, 2021, the day that marked the completion of my first graduate course (Foundations of Health Systems in Canada). An accomplishment attributed to thirteen weeks of curated content and online forum discussions surrounding a variety of health-related topics ranging from the Canada Health Act to the future of health care, and everything in between. A key trend among these topics that really resonated with me was the lack of inclusivity within our health care sector, specifically as it related to vulnerable populations and the social determinants of health. The COVID-19 pandemic seemed like the perfect fit to test this theory and therefore I decided to focus on this key health issue in Canada as a means to integrate my learning throughout the course.
COVID-19 in Canada
January 25th, 2020, another important milestone in my life, and in Canadian history. On this day in 2020 the first case of COVID-19 in Canada was announced to the general public, an announcement that set in motion a chain of events that Canadians are still being affected by today. What were meant to be temporary measures such as lockdowns, physical distancing, mask mandates, and gathering restrictions, have now become a societal norm resulting from Canada's tiring efforts to try and curb the spread of the deadly COVID-19 virus. Yet despite our efforts over the past year, new variants of the virus continue to emerge, and now the same measures that have been implemented by the government to keep us safe, have caused our economy to crumble and our citizens to suffer with increasing mental health concerns. As a Registered Nurse employed by a hospital located in one of Hamilton’s lower-income neighbourhoods, I have always been passionate about how social determinants of health affect patients everywhere, and specifically, what role the Canadian government plays in addressing and/or exacerbating these inequities. Therefore, I decided to focus my exploration of the current COVID-19 pandemic on 4 key areas of learning throughout this course: the roles of the federal and provincial governments in Canada in the management of the current pandemic, the correlation between social determinants of health and more severe viral outcomes, the marginalized groups in Canada and their corresponding rates of mental illness as a result of the COVID-19 restrictive measures, and to conclude, a brief summary of the lessons learned and possible future directions of our health care system.
Federal and Provincial Pandemic Response
In Unit 2, I learned that the federal government in Canada oversees the funding of health care services based on provincial and territorial compliance with the Canada Health Act, while the provincial and territorial jurisdictions are primarily responsible for the administration and delivery of said health care services. Since the Canada Health Act was formed in the 1980s, our health care system in Canada has been faced with many issues and challenges. Petrucka (2009) did a great a job of further categorizing these challenges as either cost accelerators or as cost associated with trying to provide equal care and access to care for all" (p. 25). For years, Ontario has been dealing with a health care system under stress, one where hallway medicine, nursing shortages, and ever-increasing hospital capacity issues have been ignored, and now to make matters worse, we are faced with a pandemic. Although COVID-19 has changed the way that people all over the world interact, learn, work, and consume, the measures that have been imposed by the Canadian government have lasted far longer than those in most other areas across the globe. According to the COVID Misery Index, a comparative tool developed by the Macdonald-Laurier Institute in Ottawa, “Canada was ranked 11 out of 15 countries assessed” based on the “the misery caused by the government’s response to the virus, the misery caused by the economic impact of that response, and the misery caused by the virus itself” (Robertson, 2021). Canada’s overall goal for responding to the COVID-19 pandemic has been identified as an attempt to “minimize serious illness and overall deaths while minimizing societal disruption” (Government of Canada, 2020). The federal government’s role in reaching this goal has been to focus on “issues like international border closings/travel restrictions and managing federal stockpiles of personal protective equipment, testing kits, and ventilators,” while the provincial government has “primarily determined strategies for containment and mitigation” (Detsky & Bogoch, 2020, p. 743). According to the Government of Canada website, “while these measures have been successful in reducing the incidence of COVID-19 in Canada, the restrictive nature of many of these measures have had some negative health, well-being, and societal consequences” (2020).
Social Determinants of Health & Viral Outcomes
In Unit 3, we discussed the idea of redefining the concept of health to try and make it more inclusive. In my forum post that week, I alluded to the fact that with current conceptualizations of health having major implications for the Canadian health care system today, it is more important now than ever to revisit the archaic definition that continues to be used around the globe to drive health care policy and the nature and scope of professional practice. To recap, in 1948, the World Health Organization (WHO) defined the concept of health as “a state of complete, physical, mental and social well-being, and not merely the absence of disease or infirmity.” Despite significant shifts to the medical priorities of Canadians, and people (of all nationalities), over the last several decades and during the COVID-19 pandemic, many key health concepts have been presented but this definition has not changed, a fact that is definitely reflected in the government's pandemic response today.
Although we are all going through this pandemic together, it is affecting every one of us differently. Working parents want kids to go back to school because school closures directly impact them, health care workers want a full lockdown because increasing hospital capacity issues and COVID cases directly impact them, small business owners want to carry on as normal because lockdowns directly impact them, and so on and so forth. Our situations with COVID-19 are all different, but one thing is clear, Canadians have not been impacted equally. The unfortunate reality is that many of our neighbours are at higher risk of contracting the virus for already pre-existing reasons out of their control, another concept that was made very clear during Unit 3. According to the Government of Canada, “emerging evidence indicates that social determinants of health, including low-income status, adverse physical environments, precarious housing, and race/ethnicity, among others, correlate with increased risk of COVID-19 infection” (2020). That is why the restrictive nature of our current pandemic measures are in some ways, especially as they relate to financial loss, adding to the problem. Statistics Canada (2020) adds that Canadians who identify as minorities are at an increased risk of COVID-19 infection and mortality because many of these population groups “have higher poverty rates, are over-represented in socio-economically disadvantaged neighbourhoods, are more likely to live in overcrowded housing conditions, and are more likely to work in occupations associated with greater risk of exposure to the virus.” Inserting a pandemic into this reality has only exacerbated the existing inequities that these poor people were already facing, and now we are desperately scrambling to find band-aid solutions to systemic issues that should have been addressed years ago, at the expense of the mental and physical health of our most vulnerable populations.
Vulnerable Populations and Mental Illness
According to the Center for Addiction and Mental Health (CAMH), mental illness is the leading cause of disability worldwide and “one in two Canadians have, or have had, a mental illness by the time they reach 40 years of age” (2021). Despite the fact that the mental health crisis in Canada has been around far before the COVID-19 pandemic, resources are still extremely lacking. An article published by the Hamilton Spectator sadly noted that “the very best our so-called universal, equal-access medical system can do is put thousands of patients on wait lists that offer treatment...eventually” (Martinuk, 2020). In Unit 6 we touched on this topic slightly when we explored how geography, current and historical injustices, and mental and physical health conditions affected vulnerable groups such as our Indigenous populations in Canada. Right away it became very clear how vastly the experiences of these marginalized groups differed from that of the rest of the population, especially from a health care perspective. Similarly, in my blog about anti-Asian discrimination and COVID-19, I shared that the Statistics Canada website (2020) highlighted that “Chinese, Korean, Southeast Asian and Black participants, and Indigenous women were among those who were much more likely to report having experienced discrimination or been treated unfairly during the pandemic,” a statistic which often lead to higher rates of mental health issues and COVID-19 infection and mortality. Although race-based data relevant to COVID-19 in Canada is limited, evidence suggests that racialized people are more likely to experience negative mental health outcomes, and that these groups “are struggling with fear and uncertainty about their own health and their loved ones’ health, concerns about employment and finances, and the social isolation that comes from public health measures such as quarantining and physical distancing” (CAMH, 2020). Once again, most of these fears can be attributed to the health inequities that our vulnerable populations in Canada are facing, inequities that have only been amplified over the course of the last year. It shouldn't have taken a pandemic for us to acknowledge this data, but now that Canada has admitted that there is a problem, we must not waste this opportunity to do better.
Lessons Learned and Future Directions
According to the Canadian Global Affairs Institute (2020), factors such as "an aging population, insufficient medical personnel to deal with rapid surges in demand, infrastructure limitations and a shrinking workforce as a percentage of the overall population" are having immense impacts on hospital capacity in Canada (Fetterly, p. 10). The COVID-19 pandemic has amplified how incredibly underfunded our health care sector is and the current "toolbox of government initiatives now being deployed to cope with a pandemic that is already underway is a poor solution for a system that has been under stress for years" (Clarke & Abdool, 2020). We must not repeat the mistakes that we made with SARS, and we must look at our current situation as an opportunity to finally invest in the future of health care in Canada. From a funding perspective, with better investment in to the growth and sustainability of our health care capacity, we can better prepare for future surge-capacity issues so that we never have to resort to such restrictive measures again when the next pandemic hits. I also stand by one of my previous statements in this course in that health promotion and disease prevention are arguably the key to reforming our health care system. I believe that if we stopped viewing the Canadian health system as solely illness driven (we only need it when we are sick), we might actually start investing in better health promotion strategies for Canadians, which might also help to eliminate some of the health inequities that our most vulnerable populations face every day. Investment in virtual care is also critical, especially during times like these when in-person medical appointments have become less feasible. Looking to the future, Ontario’s health care system faces numerous pressures and growing costs. Kronfli (2020) summarizes this issue well by stating that "in addition to COVID-19, the province of Ontario is experiencing a backlog in non-essential surgeries, a rise in chronic conditions, a potential echo pandemic due to mental health issues, and an aging population. Meanwhile, the landscape is changing with shifting patient expectations and the desire to access quality care quickly using modern technology" (p. 24). But it will only continue to get worse and that is why we must bite the financial bullet and act now for hope of better preparedness in the future.
References
Center for Addiction and Mental Health. (2020). Mental health in Canada: COVID-19 and beyond. Retrieved
from https://www.camh.ca/-/media/files/pdfs---public-policy-submissions/covid-and-mh-policy-paper-
pdf.pdf
Center for Addiction and Mental Health. (2021). The crisis is real. Retrieved from https://www.camh.ca/en/dri
Clarke, H., & Abdool, I. (2020). 4 crucial health-care lessons Canada needs to learn from COVID-19. Retrieved
Detsky, A. S., & Bogoch, I. I. (2020). COVID-19 in Canada: Experience and response. Journal of the American
Medical Association, 324(8), p. 743-744. doi: 10.1001/jama.2020.14033
Fetterly, R. (2020). Planning for after the COVID-19 pandemic. Retrieved from https://d3n8a8pro7vhmx.clou
dfront.net/cdfai/pages/4425/attachments/original/1589400700/Planning_for_After_the_COVID-
19_Pandemic.pdf?1589400700
Government of Canada. (2020). Federal/provincial/territorial public health response plan for ongoing
management of COVID-19. Retrieved from https://www.canada.ca/en/publichealth/services/diseases/201
Kronfli, C. (2020). Realizing the full potential of virtual care in Ontario. Retrieved from https://occ.ca/wp-
content/uploads/COVID19-Policy-Brief-Virtual-Care-final.pdf
Macdonald-Laurier Institute. (2021). COVID misery index. Retrieved from
Martinuk, S. (2020). Canada is mishandling the mental health crisis. Retrieved from https://www.thespec.com
Petrucka, P. (2009). The Canadian health care system. In J. C. Ross-Kerr, & M. J. Wood (Eds.), Canadian fundamentals of nursing (pp. 18-25). Location: Elsevier Canada.
Robertson, B. (2021). The pandemic has made Canada one of the world's most miserable countries. Retrieved
Statistics Canada. (2020). COVID-19 mortality rates in Canada's ethno-cultural neighbourhoods. Retrieved
Statistics Canada. (2020). Experiences of discrimination during the COVID-19 pandemic. Retrieved from
World Health Organization. (2021). What is the WHO definition of health? Retrieved from
https://www.who.int/about/who-we-are/frequently-asked-questions
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