The Public Health Agency of Canada concludes that health is determined by economic status, social support, education, employment, nutrition, housing, the wider environment and access to quality health care.
Regrettably, Saskatchewan has serious health problems. In fact, by most indicators, Saskatchewan has the worst health outcomes in Canada. This is because our province is inadequately addressing the root causes of poor health.
If we are to get serious about improving people’s health, we must get serious about addressing the root causes of illness. My entire platform is about improving our health through building a healthy society; only a small part of that involves improving the health care system.
I have seen the great difference that health care workers can make in people’s lives. I have also seen the inefficiencies, the gaps in services, and the systemic shortcomings that allow too many to fall through the cracks.
The fight for Medicare was one of the most important achievements in the history of our party for our province and for our country. The gains made in that struggle have improved the lives of countless Canadians over the intervening years. The original spirit of universal access to health care for all is one we need to revive.
To build a healthy society we need to stop simply defending Medicare as it is, and look to expand and improve our universal coverage. It's time we set aside politics and look at the evidence-based, innovative solutions that we could implement now to improve the health of all.
In order to change our focus and address the social determinants of health, we must:
1) provide health services equitably. Right now those with the most need have the least access, particularly to good quality primary care. That is both unfair, and more costly in the long run, as it leads people to postpone visiting a doctor until their illness has become more severe and difficult to treat. (hear Ryan discuss medical hotspots on CBC's White Coat Black Art)
The expansion of the multi-disciplinary, not-for-profit community clinic model should be promoted and health professionals should also be given the tools to address health equity, along with a mechanism to connect people to appropriate social services.
2) bring the significant increase in medical care costs under control so that funds are available to address the upstream causes of ill health. This means examining our system closely to discover where efficiencies and the use of evidence-based guidelines for care. Limiting growth of health care treatment costs will allow for more funding of health-enhancing services like education.
Much of what will make the biggest difference in health outcomes for adults is already in the past. The greatest long-term impact on health outcomes will come from investing in the early years. These investments, through Early Childhood Education and by improving the standard of living of young families, are key to the development of a healthy society. As much as a society can ensure every child has a decent dwelling, a supportive home life, and a stimulating environment, the greater the benefit.
From a health services point of view, Saskatchewan has some of the worst child health outcomes in Canada including the highest infant mortality rate, the lowest ratio of pediatricians to children, and the lowest child vaccination rates in all of Canada. We need to explore models of care, such as the pediatric school-based clinic at St. Mary's School in inner-city Saskatoon, that make quality health services accessible to the children most in need.
The return on investment from support given to parents of small children with income and housing, early learning centres, and universal childcare includes reduction in crime, incarceration, teen pregnancy, increased productivity, better school experience and outcomes, and reduced mental illness and addictions. Putting kids first is the key to a healthy society.
One of the most neglected areas of health services is that of mental health. At least one in five Canadians will struggle with mental illness at some point in their lives, yet it remains a topic that is hidden from view. Despite significant increases in the prescription of anti-depressants, for example, the prevalence of depression increases every year. As such, We need to have a wider conversation about howmental health is viewed in Saskatchewan, working to eliminate the stigma and to ensure adequate access to services. This means building greater capacity among family physicians and psychiatric specialists, easing the transition from hospital to community care, as well as providing greater access to mental health services by expanding coverage to include outpatient visits with mental health professionals such as psychologists.
For patients and family dealing with mental illness, hospital and community support services can be difficult to navigate. A mental health advocate that can serve as an independent investigative body would be an excellent resource.
Rural populations have an increasingly difficult time attracting health care providers. We need to work with municipalities and health regions to ensure that short-term recruitment and retention is effective in maintaining health services in rural communities. But we need a long-term plan as well. By increasing the number of students selected from rural areas and trained in rural areas, students are more likely to develop relationships with smaller communities and return there to practice
Our province has a growing population of seniors. More and more residents are living in private personal care homes and publicly funded long-term care homes. Bed shortages are common and facilities are full of residents whose level of care is above that for which the facility is designed. While it will be necessary to have more long-term facilities, we also need to offer options to seniors who wish to remain at home and can do so safely with a little help. For those who wish to be caregivers to a loved one, we need to provide them with training and financial support. For others we need to provide them with formal caregivers. Homecare not only saves our province money, it more importantly allows our seniors and elders to age with dignity. There are also opportunities in the development of senior’s cooperative housing, as well as mixed care and progressive level housing developments, that can help keep elder couples and friends together longer, and closer to their families and communities.
Using technology to improve communication and care
Electronic Medical Records have begun to improve the efficiency and effectiveness of health care delivery. However, there are multiple systems being used, and each is limited to the facility using it. We should move beyond piecemeal use of Electronic Medical Records to a common Electronic Health Record, so that anywhere a patient presents, their records are available and complete on a system that is usable by the care provider. We must also provide training so that these records protect the privacy of patient information while allowing the maximum ease of access and communication for appropriate health professionals.
Drugs are one of the fastest growing costs in health care budgets, both to individuals and the public purse. Many patients decline to access prescription drugs to manage chronic illnesses due to cost. We need a comprehensive strategy to decrease medication costs. This could include reimbursing only generic drugs when available, another mechanism such as SaskPharm, or using the bulk buying and regulatory power of government to keep costs reasonable and provide people with the medications they need.
Waiting lists should be shortened through evidence-based practices and improvements in the public system. Long waiting lists for surgical procedures and specialist appointments are frustrating and lead to worse health outcomes. We should focus on techniques that work within the public system to reduce unnecessary waits such as:
a) ensuring that only evidence-based surgical procedures are performed. There are a number of procedures (eg. certain knee surgeries) that are regularly done that have been shown to be less effective than non-surgical measures, and Saskatchewan is among the worst offenders.
b) using group referrals (rather than referral to individual practitioners) and patient navigators to ensure more efficient matching of patients in need with capable providers; and
c) emphasizing general practice in training and funding. The more general practitioners available, the more they will be able to assess patients, meaning cases that don’t have to be seen by a specialist are taken care of with less expense, less travel, and wait times for specialist appointments are reduced.
By using an approach that addresses the social determinants of health to keep people well, and offers clinical services that are comprehensive, accessible and evidence-based, Saskatchewan can move from the bottom of the pack in health outcomes to become Canada's healthiest place to live.
Saskatchewan used to have a Children’s Dental Care Program. I remember going to school in my home town for check-ups and fluoride treatments. Since this program was dismantled by the Devine government, the oral health of all Saskatchewan children has suffered. Poor dental health is linked to many other health problems as adults
We can and should reinstitute this program. This requires a significant investment in equipment and personnel, but is overall an economical means of providing oral care.
In the meantime there is the dental sealant program, which is an inexpensive and effective means of preventing tooth decay. This pilot project, which operated in the Saskatoon Health Region, was recently cancelled. This is an extremely short-sighted decision. Improving health through a Children’s Dental Plan is something we could really sink our teeth into.
Please share your own ideas for improving the health care system below, or review and weigh in on other ideas that have been shared with us here.