I'd like to therefore address what I would refer to as an inextricable triad. When we look in northern remote populations we should be discussing not just health human resources but the contribution of the health care system, of the health system itself. I'll provide you some brief details. I will discuss disease and illness burden, and how that influences our ability to provide care, but the centre of that triad should be considered the patient and the community.
Regarding health human resources, the circumstances have been very well described historically and the current situation regarding health human resources has been unfortunately accurately predicted. I would reference very specifically the Royal Commission on Health Services, or Hall commission, in 1965, in which in volume two Justice Emmet Hall had a very lengthy subset of his commission and that of his commissioners regarding health human resources in northern populations.
This was followed on a number of occasions, but very explicitly by a report of Barer and Stoddart. Many of you are aware of the report of 1991, but they also did a report for a precursor of this committee in 1999 that looked at the determinants of health human resources and recruitment and retention for northern and remote populations. Both of those documents, and many others, predicted the deficit that we face. The deficit we face in health human resources now is not only absolute in numbers, but has very significant deficits in terms of the relative mix of health human resources and providers, and there is also a substantial deficit in skill set, which I'll return to.
The determinants of recruitment and retention are also very well and historically documented. There is a four-pillar approach to recruitment and retention that speaks to the personal interest of health providers and their background, their appropriate training, the attributes of communities in which they work, and the working conditions within those communities.
The solutions that we must have to address these deficits in health human resources are increasingly clear. They've been articulated before in fora such as this. There must be a clear emphasis on collaborative and inter- and intra-professional approaches to care. By that I mean working together, whether we're members of one profession or members of another profession. We must have innovative strategies in the undergraduate and postgraduate education of health professionals who wish to serve underserved populations, principally focusing on regulated health professionals.
There have been some creative strategies. There is a very innovative approach in the University of California, Los Angeles, called UCLA PRIME. There's another innovative approach that's been supported by your government and that of the provincial government in Manitoba called the Manitoba Northern and Remote Residency Program. We must also focus on the creation of a supportive competency-based and integrated community workforce. I'd be pleased to address questions in that regard.
Regarding the disease and illness burden, which I trust you spoke of or remarked upon in your previous meeting this week, it is clear that there are evolving patterns of illness in northern remote communities and they are profound determinants of a capable workforce. There are descriptions of the epidemiology, or the pattern of disease, and these unfortunately are following a predicted pattern of evolution.
We are seeing emerging new infectious diseases, but tragically we're also seeing a resurgence or a reawakening of previous infectious disease outbreaks. We're seeing chronic disease in numbers we have never seen before. We've seen increasingly social maladies in northern and remote communities, regardless of the ancestry of people of those communities, and those maladies embrace spiritual and mental health issues. They embrace issues of addictions. They embrace issues of self-harm and interpersonal violence.
Superimposed on the disease burdens are the broadest determinants of health, whether they be housing, employment, or education. Perhaps there's a genetic propensity to illness, but all of these impact communities and often intensify the disease issue, resulting in a profound illness burden, meaning the manner in which or the degree to which individuals face their disease.
The third component of the triad I discussed, or introduced, is inextricably bound to those first two: the health system. Quite tragically, the health system in northern remote settings is often and very accurately described as fragmented, under-resourced, and subject to jurisdictional complexity, ambiguity, and resultant neglect of populations.
There is clearly a need for aggressive so-called “system engineering”, a term that was first used in industry but is now extensively embraced in the Canadian and American health care systems, as articulated by the Institute of Medicine in the United States. Those approaches to aggressive system engineering need to address the contributors to what has now been called in the literature, “clinical inertia”. This is a manifestation of the fact that we may know what to do about disease either at the personal level or community level, but for one reason or another we just don't seem to get moving. The term “clinical inertia” is increasingly used in a very appropriate description of northern remote communities.
I very humbly think we need to revisit the Hall commission of 1965. Justice Emmett Hall and his commissioners in fact wrote quite clearly about the challenges of northern remote populations, and I would admit that in the last 45 years there has been a change in linguistics but a change in the need to address it, and system resources must be brought into play such that we can address the evolving patterns of illness.
Last but not least, I would say that patients and the communities always need to be engaged and empowered so that we can move along to address the challenges, the tragedies, and the predictable outcomes in northern remote populations.
Thank you very much.