I'm going to answer it.
In 1989 my colleagues from Queen's and I produced the first atlas of the elderly population, funded by Health and Welfare Canada's review of demography and its implications for economic and social policy, better known to some of you as the Demographic Review.
What that atlas did was open the eyes of policy-makers and academics to the fact that the older population of Canada needs to be understood, not just at the national level or the provincial level, but at the local level, when we try to think through the services required to treat chronic diseases and the access to those services required by older people to manage their chronic health problems. Having read through many of the presentations that you've already received, I feel this point deserves as much emphasis today as it did in 1989.
Canada is a complex geography of communities, where the needs of those with chronic diseases and the services required have to be thought about in their local context, whether we're discussing the older population of your riding, Madam Chair, or of the ridings of each of the honourable members of this committee.
My graduate students and I are now in the final stages of a project funded by the Social Sciences and Humanities Research Council of Canada. Our project asks how close did we come in our forecast in 1989 to how the older population would look in the first decade of the 21st century.
Our forecasts from 1989 turned out to be fairly accurate in terms of the local geographies of the older population. What we did not, however, foresee—and indeed I have seen very little in previous testimony that takes this into account—is that the older population of Canada today is a much more ethnically diverse older population than it was in 1989.
Why is this critically important to take into account? Coupled with my first point, ethnic diversity of the older population is very much a phenomenon of our largest cities, but not so much in small towns and rural Canada. Although there have been a very small number of studies published on the challenges that older Chinese Canadians and South Asian Canadians face in accessing services for their chronic health issues, we only have a rudimentary understanding of how older people's life experiences affect how they understand and manage their chronic diseases. I might add that we have few examples of culturally sensitive models of service delivery that actually work.
You might also note that I draw a distinction between Canada's largest cities and small towns in rural Canada. In other research my group and others are doing, we find there are unique challenges in living with chronic diseases in small towns and rural areas in Canada. The research shows that small towns and rural areas already have amongst the highest percentage of older populations in Canada. Many already have populations where the older population is well above 25% of the total, and will have even higher percentages in the future.
In other words, when we talk about 25% of the population being over 65 some time between 2031 and 2036, this misses the point that in many small towns and rural areas, the percentage of the population that is 65 and over will be much higher. In absolute terms, the numbers are and will be small, and the distances that either older people or service providers have to travel in rural areas are far and on average will be far greater than in urban areas. The implications for providing services, either for treatment or management of chronic diseases, are that models that might work in larger urban areas, predicated on large numbers of older people and, relatively speaking, short travel distances and times, might not be relevant in small towns and rural areas of Canada.
Parenthetically, I might add that there's already indirect evidence that the private sector is not prepared or is unwilling to provide services in small towns and rural areas for these very same reasons. Even the voluntary sector is challenged by these issues in small towns and rural areas.
There are two issues raised by previous witnesses to your committee, to which I'd like to add some comments and perhaps provide some additional insights.
What research there has been on the particular challenges of providing services to treat and manage chronic diseases in small towns and rural areas generally emphasized, as I have done, the small numbers of older people and the distances that need to be travelled by older people and service providers alike. This research emphasizes the demand side of the equation.
Other witnesses who represent professional associations and consumer organizations have talked to you about increasing the supply of geriatric and gerontological professionals. No provincial government has found an effective way to solve this problem, to address the lack of geriatric and gerontological professionals in small towns and rural areas. In fact, the supply issue in small towns and rural areas is far more profound and critical than in the areas of primary, secondary, tertiary, chronic, and home care. Without first addressing the supply issue, we are likely to fail to find ways to encourage professionals in the care and management of chronic diseases. We failed to do this in the past, and we are currently failing Canadians living in small towns and rural areas.
Coming from the university sector, I'd like to suggest that to address the supply issues I've raised, the federal and provincial governments will need to work together on structural issues found in Canadian universities and colleges, which train young people for jobs that focus on the young instead of jobs that focus on the older population. I'd like to give you one example.
In Ontario alone there are 13 faculties of education graduating thousands of students each year as qualified teachers. According to one national website approved by the Ontario College of Teachers, there were only 26 teaching jobs available in all of Canada last week. With all respect to my colleagues in the faculties of education, I do not question the quality of their work, the training they provide, or their commitment. But we cannot address the supply issue for geriatric and gerontological professionals if we continue to train young people for jobs that do not exist today and will not exist in the future, while we claim a shortage of resources to train young Canadians in areas of demand such as services and management of chronic diseases in the older population.
The other issue I'd like to address is the need to take into account the older aboriginal populations. It is still the case that most health researchers that focus on aboriginal populations are working on critical health issues of young aboriginal populations. There's only a small group of researchers focused on the older aboriginal populations. Yet the older-age cohorts of the aboriginal population are the fastest growing. By the middle of the century, the older aboriginal population will be in double digits as a percentage of the aboriginal populations. The older aboriginal populations will have many of the same service and management issues as the non-aboriginal population. In addition, they will have many service and management problems related to chronic diseases unique to their particular life courses and geographies. We need to prepare now and not make the mistake of waiting and then trying to catch up, which has brought us all here today to discuss the aging population and chronic diseases.
As someone who has spent more than 30 years carrying out research on access to health services, much of it related to Canada's older population, I'd like to comment on two issues that need much more attention than they currently receive. First, much of our research is constrained by our inability to designate levels of severity and to design service delivery models that differentiate between those living in the community with chronic diseases and those who need more intensive modes of treatment and management of their chronic diseases.
Second, we have at best a poor understanding of the transitions from living in the community with chronic diseases to moving into residential care settings. In other words, when is the optimal time to leave home and move to a residential care setting? To answer this question, CIHR in general, and the CIHR Institute of Aging in particular, needs more resources as well as assurances that long-term research investment such as the Canadian longitudinal study on aging will be supported now and sustained over the next 20 years.
To sum up, I respectfully urge the committee to emphasize in its final report the importance of complex local geographies of Canada, the diversity of the older population, and the growing older aboriginal population. Leadership in changing the structure of Canadian universities and colleges is required to shift resources to train young people in the fields required to address the needs of the older population who live with chronic diseases. Support for research on the older population with chronic diseases needs to be increased and then sustained.
Thank you for the opportunity to speak to you today.