In A Long Walk to Freedom Nelson Mandela wrote that “the most discouraging moments are precisely the time to launch an initiative. At such times people are searching for a way out of their dilemma.”
Amid the worst pandemic of our lifetime, it is prudent to identify opportunities to strengthen health and social systems. Specifically, the emergence of COVID-19 has underscored the decisive need for action to reduce health inequities and bolster public health.
The COVID-19 pandemic has already had a profound impact on families and health systems worldwide. The world grieves for the devastating loss of many loved ones. In Canada, the strains on hospitals, front-line providers and health care supplies are intensifying. Current efforts are focused on the acute response to this growing public health threat and the mobilization of resources to ensure the safety of people and communities.
While we urgently try to secure adequate medical assets and equipment, the crisis has exposed fault lines in social systems, especially for the most vulnerable. Using the same resolve with which we rush to acquire personal protective equipment and ventilators, we must ensure that Canadians don’t fall through the socioeconomic cracks. Health professionals have highlighted the need for paid sick days to protect low-income workers. The need to enforce health standards and fairly compensate those providing essential services which we all rely on, from cleaners to grocery clerks and truck transport drivers, has been made clear.
The difficulties of physical distancing for vulnerable populations lead to an increase in depression and PTSD, as seen during the 2003 SARS epidemic, exacerbating the already increasing demand for mental health services. It is also very hard for homeless and underhoused people to physical isolate safely. Recently a homeless individual who was tested for COVID-19 was left to wander the city streets without proper supports for physical distancing. Our shelters are overcrowded and under-resourced, contributing to the spread of infection in a population that is already more likely to have chronic health conditions and worse health outcomes.
Though these health inequities are longstanding, they are receiving new public attention during the COVID-19 pandemic. We should seize the moment. Historically, global crises such as the 1918 flu pandemic and more recently SARS have accelerated the pace of positive change, creating an environment where political will is present and there is an openness to new ideas. In the years following 1918, international health systems saw a revolution in public health into what it is now: a social responsibility in the prevention and response to disease in all populations. Following the SARS epidemic, cross-jurisdictional response plans were established for influenza pandemics and biological agents.
Since the first case of COVID-19 in Canada, some policy innovations have already been implemented. In Ontario, the provincial government recently announced the waiving of the three-month waiting period for insurance coverage to ensure that COVID-19 screening is accessible to all.
Most provinces, including Alberta, British Columbia, and Ontario, have launched online self-screening tools to reduce in-person visits to assessment centres. A national site now exists as well. The swift adoption and adaptation of digital health tools will be one of the positive legacies of this tragic time. Going forward, these technologies will be essential in public health and primary care.
Most impressively, virtual care options, including telemedicine, telemonitoring, e-consults, e-learning, mobile apps, and more, are being leveraged extensively to improve access to services. Well beyond the peak of the pandemic these changes will improve health systems. Beneficiaries include patients with chronic medical conditions, who have to manage several appointments with multiple providers, and Canadians seniors, who will soon make up a quarter of Canada’s population. Initiatives to harness the power of remote care delivery will benefit Canadians living in rural, isolated and under-serviced areas. Most remote Indigenous communities are not yet seeing substantial improvements in access to care. In fact, the opposite may be happening. But they could benefit substantially if care can be delivered closer to home.
Selected services conducted by virtual care are now being covered under the Ontario and British Columbia health insurance and privacy concerns are being addressed at an unprecedented pace. An at-home COVID-19 screening program in Renfrew County, Ontario provides cellular-enabled medical monitoring equipment so results are linked directly to the healthcare team.
Until this crisis, widespread adoption of these tools had lagged. Scaling up digital health technologies so all Canadians can access these resources will require determination and coordination. Some have called for a national electronic health record network to address the inefficiency and dysfunction caused by the current fragmented muddle of digital records. A minimum first step should be seamless systems within provinces.
This is also the time to finally implement a national medical license to facilitate clinician mobility and deal with workforce shortages in underserviced areas.
These improvements will ease suffering for Canadians in these difficult times but cannot be viewed as temporary measures. The time is opportune to think boldly about solutions that respond to the acute COVID-19 crisis and sustainably improve the health of Canadians and our health systems for the future.
The authors would like to acknowledge Dr. Jane Philpott for her review, comments and input on earlier versions of this article.