Canada's Chief Public Health Officer Theresa Tam responds to a question during a news conference in Ottawa on Nov. 10, 2020.Adrian Wyld/The Canadian Press
Most people consider universal health care to be a quintessential Canadian value. But the COVID-19 pandemic is revealing cracks in the system.
Not only is the pandemic having a disproportionate impact on this country’s most vulnerable citizens, it’s also exposing some uncomfortable truths about how publicly funded medical care fails marginalized people.
The public health system is supposed to be open and accessible to all who live here, but that’s not always people’s lived reality. Vulnerable groups, including Black people, Indigenous people, people of colour, the poor, seniors and LGBTQ2+, often face systemic barriers that compromise their health.
Whether it’s unfair treatment in hospital emergency rooms, assumptions about substance abuse or having symptoms disbelieved by doctors, such inequities lead to substandard health outcomes for marginalized people. There are many lessons to be learned from this pandemic. A key one is that our universal health care system is being compromised by stigma and discrimination.
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Let’s not delude ourselves; we will pay a collective price for inaction. Allowing these inequities to persist will increase health care costs, undermine the economic recovery and erode public trust in our medical professionals.
“Ageism, ableism, racism, stigmatization and discrimination [against] people that we perceive as different, the ‘them’ and the ‘us,’ is pervasive in any society,” said Dr. Theresa Tam, Canada’s Chief Public Health Officer, during an interview for The Globe and Mail’s Restoring Confidence podcast.
“And Canadians have to recognize that it is within the Canadian fabric of society as well."
We already know that vulnerable citizens, including the elderly, racialized Canadians and the poor, are being unduly affected by COVID-19 in hot spots such as Toronto. This troubling trend underscores the reality that health outcomes aren’t strictly a medical issue because they are also influenced by factors such as job security, poverty, crowded living and stigmatization.
“Public health is complicated,” Dr. Tam said. “Addressing health equity and levelling out the playing field – that’s how I always try to think of it.”
Unfortunately, the challenge of creating a more inclusive health care system involves a lot more than mitigating the impact of COVID-19 on vulnerable people. The mistreatment of Indigenous patients, for instance, is not new but federal, provincial and territorial legislators are finding themselves under renewed pressure to combat the problem.
Earlier this fall, public outrage was sparked by a video that captured the dehumanizing abuse that Joyce Echaquan, a member of the Atikamekw Nation, endured at a Quebec hospital before her death on Sept. 28.
The video, which was livestreamed on Facebook, shows the 37-year-old mother of seven screaming in pain near two health care workers. One of them tells her in French, “You’re stupid as hell.”
Anguish over her death prompted the federal government to convene an emergency meeting on systemic racism in health care last month. There are also plans for a follow-up session in January.
For her part, Health Minister Patty Hajdu has already conceded that the health care system not only “turns a blind eye, but implicitly endorses and reinforces this behaviour many times over.”
If so, why have legislators allowed the problem to fester?
Let’s not forget that 12 years ago, Canadians were expressing similar horror over the preventable death of Brian Sinclair. The 45-year-old disabled Indigenous man died of a treatable bladder infection after he waited 34 hours for treatment at a Winnipeg hospital. An inquest into his death found he was neglected in part because health care workers assumed he was drunk.
Black Canadians, meanwhile, have long complained that doctors and nurses routinely dismiss their complaints of pain because even highly educated medical professionals perpetuate stereotypes about drug use.
This is particularly problematic when Black patients seek emergency treatment for serious health problems, including sickle cell disease. The red blood cell disorder is hereditary and disproportionately affects people who trace their ancestry to sub-Saharan Africa.
It’s no wonder then that some people mistrust the health care system. Stigma not only results in poorer health and shorter life expectancies, but it may also help explain why Canada, a rich country, still fails to achieve basic goals such as meeting its national targets on vaccination rates.
It’s distressing because Dr. Tam, who has served as Canada’s top doctor for more than three years now, began sounding the alarm on stigma and discrimination in health care before the pandemic.
In fact, she has long warned our legislators that health equity has broader social and economic implications. Her 2019 report on public health was prescient as it focused on this very topic, addressing stigma and discrimination in the medical system.
So what can be done to create more inclusive health care? For starters, we need a national database of race-based health information. Provincial and territorial hospitals should be required to provide this information to Ottawa.
Common sense also dictates there ought to be stiffer penalties for medical staff who mistreat patients.
Dr. Tam, meanwhile, advocates several solutions, including disease prevention, sick leave for workers and targeted investments to better protect vulnerable people.
Canada must act now to create a truly inclusive universal health care system. Our ability to manage the next public health crisis depends on it.
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