Better Health, a Better Canada
The Empire Club of Canada Addresses (Toronto, Canada), 6 Oct 2005, p. 62-72

Collins-Nakai, Dr. Ruth, Speaker
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Item Type:
Painting a picture of our health-care system in Canada. Cooperation across jurisdications, borders, and professions. How Canada is falling behind in some of the things that count the most, with some illustrative statistics. Unacceptable circumstances. Health care as the nation's number one priority. The shortage of doctors and nurses and what that means. A CMA poll of Canadians - the results. Some words to the politicians. Choosing to make a difference. Ways to make a difference.
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6 Oct 2005
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The speeches are free of charge but please note that the Empire Club of Canada retains copyright. Neither the speeches themselves nor any part of their content may be used for any purpose other than personal interest or research without the explicit permission of the Empire Club of Canada.
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Full Text
Dr. Ruth Collins-Nakai
President, Canadian Medical Association
Better Health, A Better Canada
Chairman: William G. Whittaker
President, The Empire Club of Canada
Head Table Guests

Lisa Baiton, Vice-President, Government Relations, Environics Communications Inc., and Director, The Empire Club of Canada; Meredith Austin-Appleton, Grade 12 Student, North Toronto Collegiate Institute; Reverend Canon Philip Hobson, Incumbent, St. Martin-in-the-Fields Anglican Church; Jan Kasperski, RN, MHSc, CHE, Executive Director and CEO, Ontario College of Family Physicians; Simon Ouellet, Director, Human Resources, McMaster University; Dr. Gerry Rowland, President, College of Physicians and Surgeons of Ontario; Dr. Gregory Flynn, President, Ontario Medical Association; Heather Ferguson, President, The Hearing Foundation of Canada, and Director, The Empire Club of Canada; Normand Laberge, CEO, Canadian Association of Regiologists; Gretchen Van Riesen, Vice-President, Global Benefits and Pensions, CIBC; Andrew Hind, Vice-President, Siemens Medical Solutions Division; and Kevin P. Dougherty, President, Sun Life Financial Canada.

Introduction by William Whittaker

Dr. Collins-Nakai is the first speaker in our luncheon series on the future of Canadian health care, sponsored by Sun Life Financial, a leading international financial-services corporation chartered in Canada in 1865. Ontario Minister of Health and Long Term Care George Smitherman will address us on Thursday, November 24 and Alberta Minister of Health and Wellness Iris Evans on Thursday, December 8. Invitations have been extended to others to participate in this series.

Our luncheon series comes at an important time in the debate over the future of Canadian health care.

Our health-care system has been an important and defining feature of what it is to be Canadian. However, it reflects a vision of health for Canadians that was articulated over 40 years ago with the creation of medicare, which was reaffirmed in the 1980s when Parliament enacted the Canada Health Act. Rex Murphy of CBC fame has described medicare and the principles it espouses--public funding and universal access--as Canada's Magna Carta and Declaration of Independence combined.

While it is appropriate to reflect with pride on what Canada has accomplished to date in health-care delivery compared to other nations, we have many new challenges to meet today:

a growing and aging population;
increased medical knowledge with corresponding advances in technology and research;
empowered health-care consumers; and
a broadening emphasis from curing illnesses to prevention and rehabilitation.

Public debate and input are essential to determine the future direction of our health-care system.

The recent Supreme Court of Canada ruling allowing private health insurance in Quebec and Alberta's discussion of a "third way" health-care system highlights the competing visions for the way health care in this country can be delivered. The upcoming federal election will only intensify interest among Canadians.

It is timely that our series begins with the views of the doctors, one of the most important groups in the health-care system. However, as a lawyer, I can't resist telling a doctor's joke: A mother was obliged to write a letter to her son's teacher to explain his absence from school. After delivering the note to his teacher, the son explained to his mother that the teacher had to squint and strain to read the note and said, "I can't read this; is your mother a doctor?"

While one of the stereotypes of doctors is bad handwriting, our guest today is not your stereotypical doctor.

Dr. Collins-Nakai, a pediatric cardiologist, graduated from the University of Alberta Medical School in 1972, and after interning at McGill, returned to Alberta to pursue her pediatric training.

In 1977, Dr. Collins-Nakai joined the Faculty of Medicine and Dentistry at the University of Alberta, serving in various academic positions including Professor of Pediatrics and Associate Dean of Medicine. She introduced ultrasound of the heart, helped establish an infant heart surgery program, and was the first doctor to perform many innovative interventional catheterization procedures in Western Canada. Dr. Collins-Nakai was highly regarded as a mentor and professor, earning the honour of Teacher of the Year in Pediatrics in 1988 and 1997.

In 1987, Dr. Collins-Nakai became the first woman elected president of the Alberta Medical Association. She was also the first woman and first Canadian to chair the Board of Governors of the American College of Cardiology, and most recently served as the first woman president of both the Canadian Cardiovascular Society and the Inter-American Society of Cardiology.

Dr. Collins-Nakai has a long history of involvement with the Canadian Medical Association whose mission statement is to "serve and unite the physicians of Canada and be the national advocate, in partnership with the people of Canada, for the highest standards of health and health care." She was elected the 138th president of the C.M.A. this past August.

Please join me in welcoming Dr. Ruth Collins-Nakai, President of the Canadian Medical Association.

Ruth Collins-Nakai

Honourable Minister, Dr. Flynn, my colleague and president of the Ontario Medical Association, head table guests, ladies and gentlemen.

Mr. President, thank you for your kind introduction.

Listening to the number of positions I have held, it occurred to me that some of you might wonder whether I am capable of holding down a job! The one job that I have had--the one job I still love more than any other--is the one called cardiologist. It was what I was trained to do. It is what I love the best. For me, there is no greater reward than to hear the steady, strong heartbeat of a tiny infant. That strong heartbeat says to me, to the world: "I am alive. I am a fighter. I am with you."

Thinking about that and thinking about what I wanted to share with you today, I thought of a story that paints a picture of our health-care system, the system that means so much to Canadians and to me.

The story begins with a blue baby, only four days old.

It was urgent this tiny bundle received immediate medical care and he did--initially. But as he grew other problems arose and at one point, he had to leave his home province and travel to Ontario because they didn't have the equipment he needed in Alberta. Later on, he even needed care outside Canada--at the Mayo Clinic.

To arrange this care I started making phone calls--many phone calls--my anxiety climbing with each message left, with each "You will have to obtain approval from..." In the end, we were able to move him, his heart was repaired and he had a chance at a normal life. I was very relieved and very happy. But I can tell you that I was not happy--and I remain unhappy--that something like that could happen in a nation as bountiful and blessed as Canada.

Our health-care system--like the nation itself--depends on co-operation across jurisdictions, across borders and across professions.

There is a child like the one I described in every city and town, in every province, in every region of Canada. But it is not just heart problems. You probably have a loved one or friend who needs some kind of health care today. Every child and every parent, every patient deserves better. They deserve a country that gives back certain important things to them, just as they give to their country. They deserve the best education we can provide as a society. They deserve to be safe in the community where they live. They deserve the chance to earn a living, and to contribute to the greater good. They deserve to be healthy, and they deserve our help when their health is not as good as it could be, or should be. Those essential things are entitlements of citizenship in this, what all of us know, to be the greatest nation on Earth.

But--and you knew there would be a "but," didn't you? There often is.

Canada, which at one time was the most attractive place on Earth to live, is falling behind. I cannot say it more simply than that.

As a Canadian, as a parent, as the president of an association representing 62,000 Canadian doctors, I believe we are falling behind in the things that count the most. We are no longer what we once were. We are certainly no longer what we could be, and should be. Canadians are known for both our courage and our commitment to community. We have got to where we are today by confronting difficult truths, head-on, and working collectively to change them. When I look around me now I see many troubling things. Perhaps you do, too. For example, we have all heard a lot about the "social deficit" lately, because we have one and because it is growing. Canadians who deserve more are getting less and less.

Did you know our infant mortality rates are rising, not falling, in relative and absolute terms? We have tumbled from our top-five ranking in the 1980s to where we are today. In the twenty-second spot out of 27 OECD countries.

Did you know one million Canadian children live in poverty--enough to fill the 50,000 seats in the SkyDome Rogers Centre, just down the street, 20 times over?

Did you know we have the second-highest pre-school obesity rate in the world? That, as the Ontario Medical Association warned in its new report just this week, we are facing an "obesity epidemic" among our children?

Did you know that an Aboriginal teenager has a greater chance of committing suicide than going to university?

Simply put, we are failing to care adequately for those who need our help the most.

It is shocking. It is appalling. It is simply unacceptable.

In these circumstances, what do the overwhelming majority of Canadians rank as their number-one priority? I am sure you know: health care. Not Gomery, not federal-provincial rows, not the environment, not even security. Health care, health care, health care. And, out of that group who see health care as number one, what is the number-one issue? Access to doctors and nurses. Canadians want and need more doctors and nurses. It is just that simple.

We have a widespread shortage of doctors and nurses in this country. If you look at physician-to-patient ratios around the industrialized world, we rank way back--a dismal number twenty-sixth out of 30 countries.

What does this mean? I'll tell you. It means that nearly four million Canadians--just about the population of the Greater Toronto Area--cannot find a G.P. or family physician, no matter how hard they try.

If a first minister were right here, right now, listening to this litany of shortcomings, they might tell you: "Well, we signed a health-care deal a year ago! Governments are working together better! We are spending more money on health than ever before!"

Those things might all be true, and all of us could certainly imagine a politician saying them, couldn't we?

Canadians--the Canadians doctors talk to every day in waiting rooms and hospital wards--don't want more words from politicians. They want action--and they want it now. Right now.

Last week the CMA polled Canadians, and I am releasing the results today. I don't want to talk statistics, but I can tell you that eight in 10 Canadians agree with us that national performance goals need to be established. The same number agree that a new federal fund should be created to cover the cost of patients and their families who have to travel to get timely access to needed health-care services.

The numbers don't lie. They tell me--they tell all of us--that our political leaders need to be doing better. Here, then, is my message to you as individual Canadians and through you, to our political leaders: join Canada's doctors in our call to action.

To the politicians, I say: the clock is ticking, and it is ticking ominously, on the Supreme Court of Canada's historic decision in the Chaoulli case. But some politicians haven't heard the wake-up call. They prefer to hit the snooze button--yet again--until the next election. Meanwhile, Canadians are getting tired of waiting for the health services they pay for. Some of them are getting sicker as they wait. They--all of us--want, no demand, action.

To the politicians, I say: you talk about Canadian values all the time. Well, I say--we say--it is time to ensure that those values mean something. Canadians need to pull together. That means helping one another when we need help. Governments, both federal and provincial, have said that they take wait times seriously. They are not taking them seriously enough.

I am appealing to each and every one of you in this room as individual Canadians and as leaders in your community. We must all ensure that the timelines for doing so are met. Our patients expect and deserve no less.

The Supreme Court of Canada has said politicians must take wait times seriously, by taking meaningful and lasting action. The first deadline--December 2005--looms large. It cannot be missed. The Prime Minister of Canada has appointed Dr. Brian Postl as Senior Advisor on Wait Times. We see this as a very positive move, and the doctors of Canada will continue to support his efforts by bringing all parties together to reduce wait times. We must all strive to put the Canadian back into Canadian health care. A universal system where no one gets left behind means just that. We cannot and must not accept that people living in different provinces will have quite different access when it comes to medically required care.

In the coming weeks we will be sharing more details about how you can get involved. Right now, today, I ask you to choose to make a difference. Write to your MP or your MPP or MLA. Write a letter to the editor. Talk to your colleagues and neighbours or find a political candidate who wants to make a difference too. We must pull together, or we will simply be pulled apart.

Good government--like good business, as everyone along Bay Street knows--needs vision. Vision must also be values-based since values drive behaviour. Behaviour, in turn, drives performance. So it is with health and social policy. Health is the ultimate accountant for a country's social and educational policies. Our performance is clearly lagging behind other countries. In order to improve our performance we must change our behaviour to fit our core values as a country. These changes are needed now.

Canada's physicians work with--and serve--you, our patients, every day in examining rooms, hospital wards and in homes, right across this land. We now want to work with you to lift up this nation's health-care system--and, in so doing, help lift up the nation itself. Each of us here today must come together to ensure that all Canadians have access to the quality health care they need, at the time and to the extent that they need it. We must ensure that access to medical care is based upon medical need, and not upon the size of a pocketbook.

There are things that give CMA, and all of us, cause for optimism. There is a consensus on national benchmarks--performance goals--put together by the Wait Time Alliance, members of which I am proud to say have joined us today.

The WTA is a group of national organizations representing specialist doctors. With the CMA, they have worked hard to develop maximum, medically acceptable wait times. Doctors, nurses and other health-care providers have also worked together to address the critical shortages of health-care personnel right now.

Health-care providers and Canadians have united around the need to develop national health goals to encourage health-improvement programs, and to help us make informed decisions about funding--when, where, how.

But there are also things that worry me greatly.

The Wait Time Alliance Final Report was released in August and greeted by silence even though it gave all governments a set of tools on a silver platter to reduce wait times in their own priority areas. Right now, right away. The Wait Time Alliance has sought meetings with the Council of the Federation to move ahead on wait times, only to be frozen out. Canada's health-care professionals remain frozen out of the upcoming meeting of federal and provincial leaders in 10 days because our leaders want to change the channel and move on from health.

Provinces each want to establish their own wait times for health-care services. That is not good enough. Canadian citizenship means getting the care you need, when you need it, wherever you live. Provinces need to come together to make this so.

Politicians talked a good game about solving personnel shortages with the 10-year plan on health last September, but one year later they haven't even released their preliminary work plan. Governments can do more, should do more, must do more.

Let me give you an example.

Many of today's medical students graduate with mortgage-sized debt loads of about $120,000. The 2004 National Physician Survey showed us that huge debt loads have a big impact on the type of practice pursued by young doctors--and, significantly, where they practice medicine. As a consequence, rural and family doctors are on the endangered species list and many Canadians who want to study medicine have to leave their country to do it. Governments need to make medical education more accessible to more young people. Repayment of Canada student loans even while still pursuing residency training is simply unjust.

I call on Prime Minister Paul Martin to change this now!

Before I close, you may wonder why I haven't addressed the issue of private insurance for health care in Canada, given the media coverage of this summer's Supreme Court decision.

I decided NOT to talk about it because CMA's position has not changed. Our policy is to do everything we can to support and improve publicly funded medicare in Canada.

Private health care is not a panacea for the ills of our system. However, if the public system fails, we must determine how best to protect patients.

The CMA is looking at these issues right now as it works to develop a research paper on the relationship between the public and private health-care systems in Canada.

Our focus is on improving the system we have by meeting the timelines for pan-Canadian wait-time benchmarks and by increasing the numbers of doctors and nurses and other personnel.

Health-care providers are doing their part. We want to work with anyone and everyone willing to fix the system. And we want to work with you!

When I started this speech, I may have left you with the impression that the youngster I mentioned was a combination of many of the children I have seen over the years.

Actually, his name is Ryan and he is very real. I am also proud to say that Ryan is here with us today.

Recently, I had the great, great pleasure of seeing him again. He told me that he is now a medical student at McMaster University--a future colleague in training! Ryan--the future face of medicare--persevered through his ordeal as an infant, as a child and as a teenager and is now seeking to give back. Ryan knows about not taking your eyes off your goals. I ask you to join me in acknowledging Ryan for his commitment to medicine, for his commitment to making a great country even greater. For simply being with us.

I asked Ryan to come here today because I wanted you to see what I and other doctors see. There are real people behind the statistics with real-life problems. Real people who are owed real solutions, and not more words.

We owe that to the many thousands of Canadians sitting in hospital and waiting rooms right now, this afternoon, in every corner of Canada. They're wondering if they will get the timely care they need. We have to be able to get patients to the right place for the right care when they need it. We owe that to ourselves as a nation. Canada should not be falling behind in the things that count.

If we are to be a great nation once again, we all have a responsibility to one another.

We urge you to join with us so that Canada may once again claim greatness for Ryan, and for all like Ryan, who need our help; they have no more time to wait.

Thank you.

The appreciation of the meeting was expressed by Heather Ferguson, President, The Hearing Foundation of Canada, and Director, The Empire Club of Canada.

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Better Health, a Better Canada

Painting a picture of our health-care system in Canada. Cooperation across jurisdications, borders, and professions. How Canada is falling behind in some of the things that count the most, with some illustrative statistics. Unacceptable circumstances. Health care as the nation's number one priority. The shortage of doctors and nurses and what that means. A CMA poll of Canadians - the results. Some words to the politicians. Choosing to make a difference. Ways to make a difference.