A ray of hope in the national health-care crisis

It may seem impossible right now to most people, but there are a few glimmers of hope amid the health-care crisis currently raging across Canada.

It’s hard because we are besieged every day by news of patients dying on stretchers in hospital hallways; of millions of Canadians who can’t find a family doctor; of hospital emergency departments closed due to lack of staff; and of demoralized, burnt-out doctors and nurses.

“In my entire career as a physician and health policy researcher, I’ve never seen it this dire,” says Dr. Andrew Boozary, a primary care physician and founding executive director of the Gattuso Centre for Social Medicine at Toronto’s University Health Network.

Despite all the gloom, though, Boozary sees signs of hope in one key of health care. Namely, in how doctors are starting to approach a more just and humane health system. He’s hopeful because he sees young physicians taking a major interest in issues such as equitable health-care delivery, social justice, homelessness and poverty — and how they impact our entire medical system.

A few weeks ago, the graduating students at the University of Toronto’s medical school voted to ask Boozary to deliver a keynote address at their convocation. It was a huge honour for the doctor, who works with Toronto’s homeless populations in his role as executive director of the Gattuso Centre. The fact that the students invited him to speak gave him much hope that a shift is emerging in our approach to health care.

“This student cohort spent half of its training during the pandemic,” Boozary said over lunch. “Unlike previous cohorts, they had a front-row seat to all the inequities in our communities. They witnessed things such as racism, homelessness and how they affected people’s health and overall wellbeing.

“In short, they got a crash course in the social determinants of health.”

These social determinants are non-medical factors that influence health outcomes. They include such things as income, education, unemployment, food insecurity, housing, working conditions, early childhood development and more.

In his speech, Boozary told the young doctors that existing structural barriers and chronic government neglect contributed to “who got COVID, who lived and died.” The students saw “the systemic inequities in our health system and our social systems play out wave after wave, in the two- to three- to fourfold difference of COVID on Black, brown, Indigenous and refugee newcomer communities.

“This wasn’t any failure on individuals or communities,” he said. “This was about chronic deprivation and the structural barriers that were not allowing people to stay home, or to seek health care.”

Boozary told the young physicians they will meet people “who tell you that none of this hardship that you’ve seen is actually in your lane, whether it’s police brutality, gun violence, truth and reconciliation with Indigenous peoples, systemic racism, or the chronic neglect of our elders and seniors in long-term care.

“This is squarely in the physician’s lane,” he said.

Doctors must “push back and upend this thinking, acknowledging how we are underserving patients as both health and social systems,” he added.

Boozary told the students he’s hopeful they “will be the class that will continue to push us past these boundaries and barriers for us to build that more just and humane health system.”

Amid the health-care crisis, a sign of hope indeed.