Dr. Andrew Boozary is Executive Director of Social Medicine and Population Health at the University Health Network. He is also a primary care physician at his clinic in Toronto, which treats many of the marginalized patients bearing the brunt of Canada’s ongoing medical crisis.
—A story told to Ali Ahmad
In hospitals, code blue is the most urgent call Alert medical staff about critical patient emergencies. Our healthcare system has been in a chronic state of Code Blue for years.
In December 2020, I faced the tragic consequences of this organizational failure. That winter, Canada was in the midst of another deadly wave of the pandemic, so I decided to volunteer in the Aged Care Unit at Scarborough Hospital, which experienced the COVID-19 outbreak.
Nothing in my years as a doctor prepared me for what I witnessed.By the end of the outbreak, 80 patients had died. I personally treated many of those patients, but I could do nothing to help them. I remember driving home after a long shift at Christmas. All that came to mind were the faces of the people I dealt with who didn’t live to celebrate the holidays with their families.
I was left with so many “what ifs”: What if there were more staff available to treat them? What if we had personal protective equipment?
Eighteen months later, little has changed in our broken healthcare system. We’ve all seen the headlines. The waiting time in the emergency room is up to 20 hours. A dying patient in the hallway. Nurse shortage and burnout syndrome. Hospital closures are becoming more frequent.
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It is not easy to explain why we are facing these problemsI’ll start by observing the struggles of the individuals I treat each week. I work for Inner City Health Associates, an organization that provides health care to the homeless and marginalized in Toronto. One of about 200 doctors and nurses. At my clinic in downtown Toronto, I test and screen patients, make referrals and prescribe medications. I treat patients of all ages and backgrounds, and many face the same challenges.
Think of the marginalized patients across the country who are stuck in emergency rooms and intensive care units because of inadequate health systems and social safety nets. To treat these patients, health care providers must divert staff and other resources while coping with relentless waves of pandemics and decades of government underfunding.
This leads to poor health care outcomes, preventable deaths of patients, poor and wealthy, marginalized and not, and overworked and underpaid nurses and personal support workers. It leads to burnout syndrome. These issues existed before his COVID-19, but the stress caused by the pandemic has exacerbated their effects.
Some have described the pandemic as a death knell for Canadian health insurance, while also advocating for the privatization of our healthcare system. Dr. Brian Day, medical director of the for-profit Cambie Surgery Center in Vancouver, has long been a prominent voice calling for the privatization of Canada’s healthcare. Earlier this month, Ontario Health Minister Sylvia Jones said her government was considering privatization as a solution to exacerbating staff shortages and emergency department closures. But the data show that privatization is not the silver bullet its proponents claim.
Read: I’m on a waiting list of nearly 100,000 people in Nova Scotia looking for a family doctor
In 2016, the state of Saskatchewan attempted a pilot initiative to offer privately-delivered MRIs to those willing to pay to reduce wait times for MRIs. The pilot backfired. Instead of shortening, MRI latency increased. And is there a better case study of the dangers and failures of the for-profit healthcare model than long-term care and nursing homes? Surprising differences in mortality and health status between nursing homes and nursing homes are outlined. Residents of private facilities were consistently shown to be at increased risk of dying from COVID-19.
Instead of abolishing health insurance and taking the dangerous and unfair path of charging people to save lives and protect their health, we need to reform the current system. This starts with rethinking how healthcare is delivered.
Traditionally, our health care system has been structured around hospitals and doctors who work for themselves in urban neighborhoods and rural communities. We need to move from rigid structures to a more dynamic, team-based approach. Instead of forcing patients to deal with a siled healthcare system that divides services into different locations or departments, each with its own procedures and cumbersome formats, primary care doctors, nurses , professionals, and social workers move together as a mobile unit in one setting or underserved community. Healthcare can then be delivered collaboratively in a much more time- and cost-effective approach that benefits providers and patients.
An integral part of this team-based approach is investing in more community health workers. Community health workers, who are typically trained and employed in community health centers, tend to be local people who can share their life experiences and act as guides and advocates for the community. For my immigrant single mother patient, a local health care worker who speaks the same language is an ally who can enroll her with her family doctor and help ease the burden of her daily life.
During the pandemic, we have witnessed several examples of the success of team-based healthcare and community health workers to fill gaps exposed by overwhelmed hospitals and primary care clinics.Only in Toronto But community health centers such as Black Creek and Parkdale Queen West, to name a few, regularly set up clinics within the parks to provide HIV treatment to hundreds of marginalized locals over the past two years. We provide many services such as examinations, cancer screenings, etc. Dental care, harm reduction, counseling, etc. These efforts are the future of healthcare.
While modernizing healthcare delivery, Systemic discrimination embedded in funding methods must be eliminated. Governments do not adjust for poverty or socioeconomic status when funding primary care. Physicians charge the same for each patient, regardless of the complexity of the individual case. However, research shows that there is a link between wealth and health. The richer you are, the less likely you are to get sick. Diabetes, cardiovascular disease, and cancer rates all tend to be higher in less affluent neighborhoods. This has created a situation where primary care clinics are often located in wealthier neighborhoods, with patients who typically have simpler and less severe medical problems. There is no incentive to take on more complex cases in poorer neighborhoods. Without adequate primary health care in their areas, marginalized and impoverished people rely on underfunded community health centers such as Black Creek and Parkdale Queen West to fill the gap.
Integrating poverty and socioeconomic status into primary care funding can eliminate this discrimination. But to highlight that discrepancy, we first need more health equity data. Unfortunately, this data is scarce in Canada. Early in the pandemic, Ontario’s then chief medical officer, David Williams, said the state was collecting race-based data related to the pandemic because all Ontarians were “equally important.” I said no. But it was precisely the data that revealed that racialized newcomer communities experienced up to five times higher COVID-19 positivity rates than wealthy white communities. The “universality” of the healthcare system is sadly a mirage.
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These reforms require investment from all levels of government and the political will to make them happen. For those who say these investments are unfeasible, the cost of doing nothing or maintaining the status quo outweighs the costs of these investments that dramatically improve health and create a more equitable society. The state costs $6,600 a month for a bed in a shelter and $10,000 to $20,000 for a patient’s overnight stay in a hospital. By comparison, it is estimated that it will cost only $2,400 per month to provide adequate permanent housing for homeless and precarious Ontarians.
But reforming our healthcare system should not be about the end result. Access to quality health care is essential for a well-functioning society that treats all members with respect and dignity. Health considerations should be embedded in all major economic and political decisions. Our government avoids responsibility by acting in such a way that the health of voters is not affected by these decisions.
Then a miserable December Back in 2020, I have been inspired to drive these reforms and the meaningful changes they represent. Yet somehow, as the next federal and state elections approached, health care reform seemed to be pushed aside. .
If we allow the status quo, the deaths of many people who could have been prevented during the constant Code Blue Crisis would be in vain. These tragedies are alarming us. We have all been affected by these systemic failures. Many of us have personally experienced the consequences of overburdened staff and underfunded hospitals. That is why we must continue to pressure policy makers until they can no longer ignore the systemic moral failures in front of them.
We’ve relied on the heroism of our healthcare workers for two and a half years, but increasing burnout and staff shortages are evident. This dependence is not sustainable.
We cannot continue to disappoint healthcare workers, the patients and families they serve. we know the solution. What we need now is social mobilization to implement them. This is not about political allegiances or dollars and cents. This is about life and death. It is about the society we want to create and pass on to future generations. It’s about what matters most to us – the health and well-being of our loved ones and fellow humans.
How to fix a broken healthcare system
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