We are in a health crisis. Our life expectancy is decreasing. Climate change is impacting our health. Our sedentary lifestyles are leading to an epidemic of obesity, diabetes and heart problems. Increasing pollution is increasing cancers and dementia. Mental health problems and substance use deaths have spiralled. We are struggling with COVID-19 while experts are saying we need to prepare for another pandemic. And our health systems are struggling. Whether we look at family doctor shortages, hallway medicine, shuttered ERs or surgical wait times, things are not going well.
We urgently need a coherent Ontario health strategy that equips us to deal with the crisis.
Government responses so far have been piecemeal and focus on building more capacity for treatment. That is the aim of allowing pharmacists to prescribe and nurses to take on some of the work of doctors, promoting private health clinics and hiring someone to lead a new strategy for primary care. If properly implemented, these tactics could lead to improvements in access to care. But they are bound to fail in the long term.
This is not because every tactic Ontario has proposed is bad, but simply because the scale and speed of increases in health problems linked to climate change, lack of exercise, pollution, pandemics and stress will outpace our response. Add to this population growth, baby boomers who are getting older and sicker than we expected and the provincial desire to rein in health costs and it becomes clear we will not be able to afford the level of increased health services we need. And even if we could we will not be able to increase capacity fast enough. We need to consider alternative approaches to dealing with the health crisis.
In health, an ounce of prevention is worth a tonne of cure. Ontario should find a way to use illness prevention and health promotion to deal with the crisis. If we decrease the number of people getting ill, we decrease the need for expensive medical interventions.
In November 1986, the world came together in Ottawa to discuss a charter for health promotion. The outcome, the Ottawa Charter, is a landmark document which is cited and used worldwide. Building healthy public policy, strengthening community action on health, creating healthy environments and re-orienting health services towards promoting wellness were some of the issues covered. These are all issues we should revisit to help us deal with climate change, fight pollution, increase exercise and develop a coherent strategy for pandemic preparedness.
Reconsidering the Ottawa Charter could be the first stage of creating a new health vision and strategy for Ontario. We need a proper, considered, evidence-based plan which is ambitious enough to meet the challenges we face. We would need to build consensus across Ontario’s diverse populations and get cross-party support. It would need government ministries to work together and consider how they can leverage municipal and federal governments as well. The aim would be to supplement growth in services and improved efficiencies with action on the social factors we know could impact the need for care and the rates of illness.
We could continue as we are with a piecemeal approach to system improvement. But that would be folly – it will never be enough to deal with the problems we face.
We are accepting failure if we do not come together to produce a new health strategy. We will see life expectancy continuing to decline and our services will be brought to the brink under ever-increasing demand for care. The time for isolated tactics is over because we are running out of time. But a renewed evidence-based, cross-society strategy that does the hard work of building consensus could still build a future we can be proud of.