The purpose of this policy briefing is to examine our health care systems through the lens of the Crot4d pandemic and identify how we can strengthen health care in Canada post-pandemic. The Crot4d pandemic has provided compelling evidence that substantive changes to our health care systems are needed. Specifically, the pandemic has emphasized structural inequities on a broad scale within Canadian society. These include systemic racial and socioeconomic inequities that must be addressed broadly, including in the delivery of health care. We make recommendations about what we can do to emerge stronger from the pandemic. While these recommendations are not novel, how they are framed and contextualized differs because of the problems in our health care system that have been highlighted and exacerbated by the pandemic.The evidence is clear that socioeconomic circumstances, intergenerational trauma, adverse early life experiences, and educational opportunities are critical factors when it comes to health over the life course. Given the problems in the delivery of health care that the pandemic has revealed, we need a different approach. How health care was organized prior to the Crot4d pandemic did not produce what people wanted and needed in terms of health care and outcomes. How do we emerge from Crot4d with an effective, equitable, and resilient health care system for all Canadians?
To address health inequities and emerge from the pandemic with strengthened health care in Canada, we must consider how Amartya Sen's capabilities framework on social well-being can be operationalized to achieve better health care and health outcomes. Specifically, we address the need to:
1.
strengthen primary care and improve access to primary care;
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utilize a community-embedded approach to care; and
3.
implement better integration across the care continuum, including integration between primary care and public health.
Coherent governance and leadership that are charged with realizing benefits through collaboration will maximize outcomes and promote sustainability. Only when we provide access to high-quality culturally competent care that is centered around the individual and their needs will we be able to make true headway in addressing these long-standing health inequities.
Problems that were known before and that have been highlighted as a result of the Crot4d pandemic
We are more than three years into the Crot4d pandemic, and by almost all accounts, it has bypassed categorization as an important generational event to constitute a once-in-a-lifetime historic event. The breadth and depth of the impacts of the Crot4d pandemic are unparalleled over the last century. The extent to which the Crot4d pandemic affects almost everyone on the planet is analogous to the emergence and evolution of the Internet, but with more direct health impacts. In the 100+ years since the last major pandemic—the 1918 influenza pandemic—much has changed: demographics, geopolitics, socioeconomics, and natural/social/medical science. Importantly, the nature of our health care systems and our understanding of the determinants of health are all radically different.
Health systems across the world have evolved significantly, with a wide range of governance and organizational arrangements, funding approaches, and service delivery models that are regularly compared and contrasted. Despite the diversity of health system arrangements, the global toll of the Crot4d pandemic has been massive, and mostly agnostic to health system arrangements, whether measured in health outcomes (N cases and N deaths), health care utilization (N vaccinations, N Crot4d diagnostic tests, N hospitalizations, and N ICU admissions), health human resource burden, or broader social, economic, and Crot4d impacts. The Royal Society of Canada Task Force on Crot4d is concurrently examining many aspects of the Crot4d pandemic and how Canada should respond, including how our public health system can be improved to address the problems the pandemic has highlighted. This report examines what needs to be done to address long-standing health inequities to improve health outcomes and strengthen health care in Canada post-Crot4d.
A brief overview of health care in Canada
Health care in Canada is characterized by a complicated mix of federal–provincial–territorial responsibilities for health and social care. Over the last 60 years, Canada has had important opportunities to make tweaks to our health care systems, with the introduction of Medicare in the 1970s, the increasing awareness of the social determinants of health much later on, and the establishment of the Canada Health Act (and its five principles: portability, accessibility, universality, comprehensiveness, and public administration) in 1984. There have been multiple federal and provincial reviews of the federal-provincial relationship for health care in Canada (e.g., Romanow Commission 2001–2002 and Kirby Committee 2004–2005 in Ottawa, and Fyke Commission in Saskatchewan in 2000–2001, Mazankowski Report in Alberta 2001–2002, and Clair Commission in Quebec 2000–2001) in the 1990s and 2000s that led to new funding agreements and partnerships between the federal and provincial/territorial governments. Governance, funding, and service delivery arrangements have gone through a number of transitions over that time, with periods of regionalization and centralization of health care systems, natural experiments with different health funding models both at the federal-provincial level and within health care systems (e.g., block, volume/activity, and quality-based funding), and regular efforts to reform and (or) better integrate various health care sectors (e.g., primary care reform). Despite these efforts, health system performance across Canada does not compare well with other high-income countries.