New report highlights Northern health challenges

TORONTO—A new report issued by Health Quality Ontario paints a damning picture of the health of Northern Ontario residents. While it has long been given that Northern Ontario residents have many poor health indicators, the April 18 report notes that those trends have done little to abate.

“A lot of what is in the report comes as no surprise,” said Manitoulin Health Centre CEO Derek Graham. “We have known about these findings from a variety of sources for some time.”

But that does not mean the report doesn’t provide a useful purpose.

“They are providing the very broad definition of quality, which I like,” he said. “The report explores things like access. It is encouraging they are looking at health though that lens.” By identifying the deficiencies in access to services across the region, the report could pave the way to developing targeting strategies to deal with those deficiencies, he pointed out.

The Health Quality Ontario report notes that life expectancy rates for those living in Northern Ontario continue to be lower and that mortality rates are higher than the rates found in the province overall. “Despite many improvements in health and health care across the province in recent years, there are stubborn and persistent inequities in the care people receive in the north, and in their health outcomes,” said Dr. Joshua Tepper, president and CEO of Health Quality Ontario in a release announcing the report.

The ‘Health in the North’ report delves into the geography and the health of people in Ontario’s two northern regions to shed light on the differences between people in Ontario’s two northern Local Health Integration Network (LHIN) regions and those living in the rest of Ontario, and what attempts are being made to address those inequities.

The report focuses specifically on the area of the North East and North West LHIN regions that extend north of Lake Huron (including Manitoulin) to Hudson Bay and James Bay and from the Quebec border in the east to the Manitoba border in the west.

The region covered by the report encompasses nearly 80 percent of Ontario’s landmass, and has a combined population of over 800,000.

Among the key findings in the report are that people in Ontario’s North have a much shorter life expectancy than those in the province overall, living shorter lives by as much as 2.9 years in the North West LIHN region and 2.5 years shorter in the North East LHIN region of which Manitoulin is a part. People in the North are more likely to die prematurely (that is before age 75), with the main factors influencing that lower rate being suicide, circulatory disease and respiratory disease.

Compounding factors are people in the North are much less likely to report being able to see a family doctor, nurse practitioner or other regular health care provider when needed and that Northerners are more likely to report having multiple chronic conditions.

The report attributes many of these inequities “to systemic challenges faced by health care professionals and the many challenges involved in serving a population spread over such a wide area with a low population density, including many fly-in communities.”

These inequities are also the result of many variables beyond the health care system, those factors known as “the social determinants of health.”

The report illustrates the situation facing Northern residents through the example of “Pierre,” 71, a double-lung transplant recipient who lived in Nakina, a village north of Thunder Bay with his wife Suzanne. It personalizes the issues by relating how tough it was for Pierre to travel for the health care he needed, and to pay for accommodation and medication expenses.

“I had to move to Thunder Bay and travelled five or six times back and forth to Toronto,” Pierre says in the report. “My wife drove there. It took about 20 hours every time. Twenty hours when you’re sick was really tough.”

The report also details the specific challenges indigenous and francophone populations face in the North, pointing out that nearly one in five people (18.3 percent) identify as indigenous in the North West LHIN region and more than one in 10 people (11 percent) in the North East LHIN region, compared to 2.4 percent in Ontario overall.

The report points out that “over the last several decades in Ontario (and across Canada), indigenous peoples have faced discriminatory policies that have affected health, including forced relocations and residential schools.”

Another factor are the differences in the way health care is funded and delivered for First Nations, Métis and Inuit people in Ontario, which means performance measures may not represent their experiences as well as they do for the general population of the Northern regions.

“The solutions to the inequities facing people in the North need to be found in the North by those who live and work there,” said Dr. Jennifer Walker, Canada Research Chair in Indigenous Health at Laurentian University and a member of the Six Nations of the Grand River in the release. “Solutions cannot simply be imported from the southern part of the province. The landscape—social and cultural as well as geographic—is totally different.”

There are some lights appearing at the end of the tunnel, however, as there are several region-specific efforts underway to improve access to care for people living in the North. The report cites Aboriginal Health Access Centres that provide a place of safety and belonging for First Nations, Métis and Inuit people; the development of an action plan by the North East LHIN in response to the Truth and Reconciliation Commission report; that some Community Health Centres focus on, or prioritize, the needs of indigenous peoples and of francophones; a range of health services and supports offered by the Métis Nation of Ontario.

Also on a positive note are telemedicine and virtual critical care services that help people manage disease and critical illness, along with mobile services that deliver care to patients where they are. As well, the provincial travel grant program helps patients get to the care they need when it is unavailable in their local communities (at least 100 km).

There are language services to enable doctors, nurse practitioners and other health providers to effectively communicate with patients who speak other languages.

Rounding out those positive initiatives are: personal support services to assist patients after discharge from hospital and help with everyday tasks, and focused medical education. That the Northern Ontario School of Medicine (NOSM) recruits students from indigenous and francophone populations as well as from small communities across the North—the bonus is that the majority of NOSM graduates remain in Northern Ontario to practice, adds the report.

“These initiatives demonstrate the commitment of all of those working in the North to find solutions to the unique challenges they face,” said Dr. Walker in the release, going on to point out that Health Quality Ontario has developed a Health Equity Plan to encourage everyone involved in providing health care to consider equity prominently when developing plans to build a safe and patient-centred system. This plan includes support for the development of a health equity strategy specific to Northern Ontario.