Introducing "Health for All"

Dean's Blog | 03 Apr 2024

Photo by Liz Cooper

Early in 2022, my husband and I had planned a trip to Uganda to visit our son, but we had to cancel our trip due to the Omicron outbreak. We were terribly disappointed and found ourselves with some unexpected free time. In a spontaneous decision, I decided to do some writing. I started writing about health systems, my experiences in them, and lessons learned over my career. I didn’t intend to write a book, but once I started, I couldn’t stop. Over the next year and a half, I would get up at 6 or 7 a.m. on weekends and holidays to spend four or five hours writing on my computer, a coffee by my side.

Health for all book cover — *"Health for all, a doctor's prescription for a healthier Canada" by Jane Philpott*

Fast forward to April 9. 2024 and my first book, “Health for All: A Doctor’s Prescription for a Healthier Canada,” will be available at bookstores everywhere. It is a bit surreal to hold it in my hands, but I am thrilled that it has come to fruition. In it, I present a vision for how our country can be healthier, including a reset of health systems that guarantees primary care access for everyone.

The book is about more than health policy. I outline the stories of many people who shaped my vision about primary care. I talk about how wellness starts with the social determinants of health; how the spiritual aspects of well-being—hope, belonging, meaning, and purpose—should be infused in our system; and I describe our overarching need for healthier politics.

I have many people to thank for their support. I want to thank the entire Queen’s Health Sciences community for inspiration and your work to create a healthier world. Many of the initiatives we are leading like our Queen’s Lakeridge Health MD Family Medicine Program, the Weeneebayko Health Education Campus, and the new Periwinkle Health Home are all exceptional examples of health care transformation in action.

With thanks to my publisher, Signal/McClelland & Stewart, I’m pleased to share with you a short excerpt from my book. I hope you enjoy it and I’m curious to know what you think—send me an email or reach out through my social media channels (on X, Facebook, Instagram) with your feedback.

Health for All: A Canadian Health Care Dream

Dr. Steven Brooks, an emergency room physician and Queen’s University faculty member, sent me a list of recent cases he’s seen, to illustrate what it’s like when people don’t have a place to go for primary care.

One man has worsening heart failure after years of uncontrolled hypertension.
A woman has a giant abdominal mass that was not assessed by another physician because the only option offered to her was virtual care.
A suicidal teen has no family physician and no other access to mental health supports.
An older adult has confusion triggered by drug interactions. She is on more than twenty medications renewed by various emergency physicians and walk-in clinic physicians, but she needs a medication review by a primary care clinician.
A man from a retirement residence has slowly declining cognition with no clear cause and requires the coordination of multiple assessments in the community.
A young person is on opioids for chronic pain. Her high-dose narcotics get reordered without consideration of alternative non-opioid strategies because she sees different physicians at walk-in clinics and the easiest thing to do is renew the prescription.

Why do these people show up in emergency departments? The answer, in part, is that they may have no other place to seek help and they legitimately require health-related services. They are not alone. A 2023 survey called OurCare, led by Dr. Tara Kiran and her colleagues, estimated that about six and a half million adults living in Canada (roughly 22 percent of the adult population) have no family doctor, and no other access to primary care¹.

Let’s be clear at the outset that health is much more than health care. The care part is only the tip of the iceberg. We talk about it a lot because it’s the part that is most readily visible. Health care includes hospitals, clinics, health professionals, prescriptions, medical devices, and other treatments. Some people suggest this collection of services should actually be called a “sickness-care system,” and not “health care.” Regardless of what name we chose, we begin here with the clinical perspective because it is easier and more straightforward to examine than the deeper factors that contribute to health. It might even be the part that is easiest to fix.

The positive news is that the stars are aligned to deliver the biggest disruption in Canadian health care since the introduction of medicare in the mid-twentieth century. The incentives have never been stronger: Journalists are sharing stories of people who have died because of inadequate access to care². Health workers are bearing witness as the care systems fail to meet the needs of patients. A restless public is pleading for action from politicians.

Winston Churchill said that one must never let a good crisis go to waste. He spoke those words during the darkest days of the Second World War, when he and others could have succumbed to despair but instead chose to forge new relationships and create better international structures for the future. Our circumstances are not the same as the fate of the Western world hanging in the balance, but these are indeed dark days for health care in Canada—and around the world. We must use this health care crisis for good, taking a page from the past by forging new relationships and creating better structures.

The first step in fixing the status quo is to agree—and admit out loud—that it’s malfunctioning. After a few years of assault from the COVID-19 pandemic, Canada’s health care systems ought now to be in recovery mode. But we’re not getting back on our feet the way we imagined we would. The pandemic exposed and exacerbated long-standing fault lines, and unless we do some hard work in the next decade to renovate our foundation, those cracks will widen.

Let’s start by reviewing how bad things are. As noted earlier, 22 percent of Canadian adults do not have a family doctor. Emergency departments are being closed with unprecedented frequency. Thousands of health care jobs are unfilled. Health workers are exhausted and demoralized. Patients are waiting years to see some specialists. There is no national commitment for guaranteed access to home care, palliative care, or mental health care. All of this results in countless cases of delayed care, leading to both health harms and increased costs for Canadians.

Until recently, Canadians spoke with great pride about our health systems. We have laws from the last century to ensure universal insurance for medically necessary care—at least when that care is provided in hospitals or by physicians. Over the years, we have boasted about universal access to publicly funded health care—even though it has never actually been universal in terms of what is covered, and even though what is covered is not always accessible. As the people and places associated with care delivery have changed over the past six decades, our health laws and policies have not kept pace. As a result, the cracks in our health systems were forced wide open by the COVID-19 pandemic.

The way out of this is not a mystery. Health policy experts have written dozens of reports, over many decades, describing our vulnerabilities and offering solutions. Unfortunately, most of those solutions were never applied. Political parties make promises about employing some of the recommendations, such as pharmacare. And people in power speak about how they hope the system will improve in areas such as home care and mental health care. But hope is not a strategy. Aspiration is not operation. It has been decades since Canada has seen any government transform promises and wishes into implementation with universal fulfilment. I will describe how some of that can be done.

We cannot fix all of the problems in health care overnight. We will have to prioritize, starting with a foundation based on primary care that has never been properly built in Canada. Simply put, we must make it a reality that every person living in Canada has a primary care home, just as every Canadian child has access to a public school.

The notion of a primary care "home" might not be familiar to everyone. It's not a home where you live, like a long-term care or retirement home, but a health care setting where you feel at home--a place where you belong.

I propose a system that guarantees everyone living Canada has such a place to go. This many seem ambitious, but it is doable. It is smart. It is fair. The end state is more than universal coverage. It must be authentic access to care.

Excerpted from Health for All: A Doctor’s Prescription for a Healthier Canada by Jane Philpott. Copyright ©2024 Jane Philpott. Published by Signal/McClelland & Stewart, a division of Penguin Random House Canada Limited. Reproduced by arrangement with the Publisher. All rights reserved.

[1] “OurCare Data Explorer,” OurCare, n.d., https://data.ourcare.ca/all-questions

[2] Tina Yazdani, “Estimated 11,000 Ontarians Died Waiting for Surgeries, Scans in the Past Year,” CityNews, September 15, 2023, https://toronto.citynews.ca/2023/09/15/11000-ontarians-died-waiting-surgeries/

Introducing "Health for All"

Health for All: A Canadian Health Care Dream

Related topics

Subscribe to the Dean's Blog

Explore Our Stories