"Better Health - Better Canada"
Dr. Ruth Collins-Nakai
President
Canadian Medical Association
Toronto, October 6, 2005
Honourable Minister, Dr. Flynn, my colleague and president of the Ontario Medical Association, head table guests, ladies and gentlemen. Merci de votre présence aujourd'hui.
Mr. President, thank you for your kind introduction.
Listening to the number of positions I have held, it occurred to me that some of you might wonder whether I am capable of holding down a job! The one job that I have had — the one job I still love more than any other — is the one called cardiologist. It was what I was trained to do. It is what I love the best. For me, there is no greater reward than to hear the steady, strong heartbeat of a tiny infant. That strong heartbeat says to me, to the world: “I am alive. I am a fighter. I am with you.”
Thinking about that and thinking about what I wanted to share with you today, I thought of a story that paints a picture of our health care system, the system that means so much to Canadians and to me.
The story begins with a blue baby, only four days old.
It was urgent this tiny bundle received immediate medical care and he did — initially. . .. But as he grew other problems arose and at one point, he had to leave his home province and travel to Ontario because they didn’t have the equipment he needed in Alberta. Later on, he even needed care outside Canada – at the Mayo Clinic.
To arrange this care I started making phone calls — many phone calls — my anxiety climbing with each message left, with each “you will have to obtain approval from...” In the end, we were able to move him, his heart was repaired and he had a chance at a normal life. I was very relieved and very happy. But I can tell you that I was not happy – and I remain unhappy – that something like that could happen in a nation as bountiful and blessed as Canada.
Our health care system — like the nation itself — depends on cooperation across jurisdictions, across borders and across professions.
There is a child like the one I described in every city and town, in every province, in every region of Canada. But it is not just heart problems. You probably have a loved one or friend who needs some kind of health care today. Every child, and every parent, every patient — deserves better. They deserve a country that gives back certain important things to them, just as they give to their country. They deserve the best education we can provide as a society. They deserve to be safe in the community where they live. They deserve the chance to earn a living, and to contribute to the greater good. They deserve to be healthy, and they deserve our help when their health is not as good as it could be, or should be. Those essential things are entitlements of citizenship in this, what all of us know to be the greatest nation on Earth.
But — and you knew there would be a "but," didn't you? There often is.
Canada, which at one time was the most attractive place on Earth to live, is falling behind. I cannot say it more simply than that.
As a Canadian, as a parent, as the president of an association representing 62,000 Canadian doctors I believe we are falling behind in the things that count the most. We are no longer what we once were. We are certainly no longer what we could be, and should be. Canadians are known for both our courage and our commitment to community. We have gotten where we are today by confronting difficult truths, head-on, and working collectively to change them. When I look around me now I see many troubling things. Perhaps you do, too. For example, we have all heard a lot about the “social deficit” lately, because it is growing. Canadians who deserve more are getting less and less.
Did you know our infant mortality rates are rising, not falling, in relative and absolute terms?
We have tumbled from our top-five ranking in the 1980s — to where we are today. In the twenty-second spot out of twenty-seven OECD countries.
Did you know one million Canadian children live in poverty — enough to fill the 50,000 seats in the SkyDome Rogers Centre, just down the street, twenty times over?
Did you know we have the second highest pre-school obesity rate in the world?
That, as the Ontario Medical Association warned in its new report just this week, we are facing an “obesity epidemic” among our children?
Did you know that an Aboriginal teenager has a greater chance of committing suicide than going to university?
Simply put, we are failing to care adequately for those who need our help the most.
It is shocking. It is appalling. It is simply unacceptable.
In these circumstances, what do the overwhelming majority of Canadians rank as their number one priority? I am sure you know: health care. Not Gomery, not federal-provincial rows, not the environment, not even security. Health care, health care, health care. And, out of that group who see health care as number one, what is the number one issue? Access to doctors and nurses. Canadians want and need more doctors and nurses. It is just that simple.
Values into action
We have a widespread shortage of doctors and nurses in this country. If you look at physician-to-patient ratios around the industrialized world, we rank way back – a dismal number twenty-sixth out of thirty countries.
What does this mean? I'll tell you. It means that nearly four million Canadians — just about the population of the Greater Toronto Area — cannot find a G.P. or family physician, no matter how hard they try.
If a first minister were right here, right now, listening to this litany of shortcomings, they might tell you: “Well, we signed a health care deal a year ago! Governments are working together better! We are spending more money on health than ever before!" Those things might all be true, and all of us could certainly imagine a politician saying them, couldn't we?
Canadians – the Canadians doctors talk to, every day in waiting rooms and hospital wards – don’t want more words from politicians. They want action – and they want it now. Right now.
Last week the CMA polled Canadians, and I am releasing the results today. I don’t want to talk statistics, but I can tell you that eight in ten Canadians agree with us that national performance goals need to be established. The same number agree that a new federal fund should be created to cover the cost of patients and their families who have to travel to get timely access to needed health care services.
The numbers don’t lie. They tell me – they tell all of us – that our political leaders need to be doing better. Here, then, is my message to you as individual Canadians and through you, to our political leaders: join Canada’s doctors in our call to action.
To the politicians, I say: the clock is ticking, and it is ticking ominously, on the Supreme Court of Canada's historic decision in the Chaoulli case. But some politicians haven't heard the wake-up call. They prefer to hit the snooze button — yet again — until the next election. Meanwhile, Canadians are getting tired of waiting for the health services they pay for. Some of them are getting sicker as they wait. They — all of us — want, no demand, action.
To the politicians, I say: you talk about Canadian values all the time. Well, I say – we say – it is time to ensure that those values mean something. Canadians need to pull together. That means helping one another when we need help. Governments, both federal and provincial have said that they take wait times seriously. They are not taking them seriously enough.
I am appealing to each and every one of you in this room as individual Canadians and as leaders in your community.
We must all ensure that the timelines for doing so are met. Our patients expect and deserve no less.
The Supreme Court of Canada has said politicians must take wait times seriously, by taking meaningful and lasting action. The first deadline — December 2005 looms large. It cannot be missed. The Prime Minister of Canada has appointed Dr. Brian Postl as Senior Advisor on Wait Times. We see this as a very positive move, and the doctors of Canada will continue to support his efforts by bringing all parties together to reduce wait times. We must all strive to put the Canadian back into Canadian health care. A universal system where no one gets left behind means just that. We cannot and must not accept that people living in different provinces will have quite different access when it comes to medically-required care.
In the coming weeks we will be sharing more details about how you can get involved. Right now, today, I ask you to choose to make a difference. Write to your MP or your MPP or MLA. Write a letter to the editor. Talk to your colleagues and neighbours or find a political candidate who wants to make a difference too. We must pull together, or we will simply be pulled apart.
Canadians must oar in together
Good government — like good business, as everyone along Bay Street knows — needs vision. Vision must also be values-based since values drive behaviour. Behaviour, in turn, drives performance. So it is with health and social policy. Health is the ultimate accountant for a country’s social and educational policies. Our performance is clearly lagging behind other countries. In order to improve our performance we must change our behaviour to fit our core values as a country. These changes are needed now.
Canada’s physicians work with — and serve — you, our patients, every day in examining rooms, hospital wards and in homes, right across this land. We now want to work with you to lift up this nation’s health care system — and, in so doing, help lift up the nation itself. Each of us here today must come together to ensure that all Canadians have access to the quality health care they need, at the time and to the extent that they need it. We must ensure that access to medical care is based upon medical need, and not upon the size of a pocketbook.
There are things that give CMA, and all of us, cause for optimism. There is a consensus on national benchmarks — performance goals — benchmarks put together by the Wait Time Alliance, members of which I am proud to say have joined us today.
The WTA is a group of national organizations representing specialist doctors. With the CMA, they have worked hard to develop maximum, medically-acceptable wait times. Doctors, nurses and other health care providers have also worked together to address the critical shortages of health care personnel, right now.
Health care providers and Canadians, have united around the need to develop national health goals to encourage health-improvement programs, and to help us make informed decisions about funding — when, where, how.
But there are also things that worry me greatly.
The Wait Time Alliance Final Report was released in August and greeted by silence even though it gave all governments a set of tools on a silver platter to reduce wait times in their own priority areas. Right now, right away. The Wait Time Alliance has sought meetings with the Council of the Federation to move ahead on wait times, only to be frozen out. Canada’s health care professionals remain frozen out of the upcoming meeting of federal, provincial leaders in ten days because our leaders want to change the channel and move on from health.
Provinces each want to establish their own wait times for health care services. That is not good enough. Canadian citizenship means getting the care you need, when you need it, wherever you live. Provinces need to come together to make this so.
Politicians talked a good game about solving personnel shortages with the ten-year plan on health last September, but one year later they haven’t even released their preliminary work plan. Governments can do more, should do more, must do more.
Let me give you an example.
Many of today's medical students graduate with mortgage-sized debt loads of about $120,000. The 2004 National Physician Survey showed us that huge debt loads have a big impact on the type of practice pursued by young doctors — and, significantly, where they practice medicine. As a consequence, rural and family doctors are on the endangered species list even as many Canadians who want to study medicine have to leave their country to do it. Governments need to make medical education more accessible to more young people. Repayment of Canada Student Loans even while still pursuing residency training is simply unjust.
I call on Prime Minister Paul Martin to change this now!
Before I close, you may wonder why I haven’t addressed the issue of private insurance for health care in Canada, given the media coverage of this summer’s Supreme Court decision.
I decided NOT to talk about it because CMA’s position has not changed. Our policy is to do everything we can to support and improve publicly-funded medicare in Canada.
Private health care is not a panacea for the ills of our system.
However, if the public system fails, we must determine how best to protect patients. The CMA is looking at these issues right now as it works to develop a research paper on the relationship between the public and private health care systems in Canada.
Our focus is on improving the system we have by meeting the timelines for pan-Canadian wait-time benchmarks and by increasing the numbers of doctors and nurses and other personnel.
Health care providers are doing their part. We want to work with anyone and everyone willing to fix the system. And we want to work with you!
Conclusion
When I started this speech, I may have left you with the impression that the youngster I mentioned was a combination of many of children I have seen over the years.
Actually, his name is Ryan and he is very real.
I am also proud to say that Ryan is here with us today.
Recently, I had the great, great pleasure of seeing him again. He told me that he is now a medical student at McMaster University — a future colleague in training!
Ryan – the future face of Medicare – persevered through his ordeal as an infant, as a child and as a teenager and is now seeking to give back.
Ryan knows about not taking your eyes off your goals.
I ask you to join me acknowledging Ryan — for his commitment to medicine, for his commitment to making a great country even greater. For simply being with us.
I asked Ryan to come here today because I wanted you to see what I and other doctors see.
There are real people behind the statistics, with real-life problems.
Real people who are owed real solutions, and not more words.
We owe that to the many thousands of Canadians sitting in hospital waiting rooms right now, this afternoon, in every corner of Canada. They’re wondering if they will get the timely care they need. We have to be able to get patients to the right place for the right care, when they need it. We owe that to ourselves, as a nation. Canada should not be falling behind in the things that count.
If we are to be a great nation once again, we all have a responsibility to one another. We urge you to join with us — so that Canada may once again claim greatness for Ryan, and for all like Ryan, who need our help — they have no more time to wait. Merci. Thank you.
Thank you. Merci.
