After Donald Trump criticized our health system in the second presidential debate, Canadians took to social media to defend our national treasure. After all, our health system is better than that of the USA. We see this to be self-evident, but it is also backed by data. In the most recent assessment of the quality of 11 international health systems, the USA came last. But we should pause and take a deep breath because Canada came second last. Perhaps while we focus on comparisons with the USA we miss the fact that other health systems are improving and outperforming us. Looking up at these other systems rather than looking down at the USA may help us deliver better health across Canada.
Canada rated especially poorly on equity. The best overall health system – the UK – performed best worldwide on this front.
In my experience, equity in Canada’s health systems is discussed a lot, but that seldom translates into effective action to ensure equal access and equal outcomes for all people regardless of their race or culture. Provinces rarely have a person who is in charge of health equity; lacking health equity plans or targets. As my mother would say, “If you don’t have a plan; you plan to fail.” And that is what happens in most parts of the health services, whether it is access to cancer screening or treatment, cardiac surgery or diabetes care. It is especially pronounced in my specialty; mental health.
Working with the Mental Health Commission of Canada in 2008 a consortium of researchers led by my group at CAMH found that there were increased rates of psychosis in Caribbean origin groups in Canada. Despite this there was poorer access to care. There were increased rates of post-traumatic stress disorders documented among refugees, but in most provinces no plan to offer specialized services that we know can cure it; and, South Asian origin groups had increasing rates of suicide and substance abuse across the generations with no prevention strategies.
No province or territory had a strategy in place to improve mental health services for ethnically diverse populations. And so the Mental Health Strategy for Canada, released in 2011, called for better services for immigrant, racialized, ethnocultural and refugee groups.
Five years later there had been next to no progress, and so the Mental Health Commission of Canada devised the Case for Diversity with CAMH and Wellesley Institute to make it easy for health officials to build equitable mental health services. It assembles all the information they need—literature reviews, the most promising practices in Canada and across the world—as well as making the economic case for more equitable services.
The economic case is compelling. Our economic competitiveness is linked to our brains, not our brawn. We cannot out manufacture low and middle-income countries. Our worth is in our brains. Our vital mental capital includes our IQ, our emotional intelligence, and our mental health. An investment in mental health is an investment in our economy.
Mental health problems and illnesses cost Canada over $51 billion a year. Much of this cost is linked to days off sick, days supporting family members, and the decreased effectiveness of people at work because of mental health problems.
The rates of mental illness are at least the same, if not greater in many immigrant groups in Canada but service use is lower. In Ontario, for instance, we spend three times less on a person’s mental health if they are born in a South Asian country than if they are born in Canada. People of South Asian origin are therefore at higher risk of being off sick or working ineffectively because of untreated mental health problems.
Offering accessible mental health services decreases the chance of medical leave, increases productivity and builds mental capital.
And, because our workforce is increasingly comprised of newcomer, immigrant and racialized groups, ensuring they thrive is vital to Canada’s economy.
And what about fairness?
Colour- and culture-blind approaches to service provision lead to poorer outcomes for minority groups. Adaptation of services to make them more accessible and easier to use improves outcomes, is more efficient and is fair.
If each province read the Case for Diversity, produced a plan with targets and identified someone as responsible for its implementation that would go some way toward building a stronger Canada.
It is often said that there is no health without mental health, and we increasingly understand that our wealth relies on good mental health. To succeed as a nation we cannot afford, economically or morally, to leave parts of the population behind.
Dr. Kwame McKenzie is CEO of Wellesley Institute and Director of Health Equity at CAMH. He also serves as a commissioner on the Ontario Human Rights Commission.