Thank you very much. I appreciate this opportunity.
I will give my presentation mostly in English, but I can answer your questions in French if you wish me to.
I practice in the Outaouais region, on the Quebec side, about an hour from here. So I am the closest from Ottawa.
The Society of Rural Physicians is a national organization that brings together physicians who share a common style of practice and common challenges across rural Canada and northern Canada. They recognized some years ago that by sharing their stories they were able to have a larger voice than their individual voices in their communities.
What they have been able to articulate are some common themes about the populations they serve. Those of you who represent rural communities will know that Canadians in rural Canada are older than the average, they're engaged in riskier activities, they're more isolated, more sparsely distributed, and therefore more difficult to serve. They're more economically disadvantaged, and those of you familiar with the principles of population health will know that's a major determinant of their health status. And from the cross-sectional studies that have been done, they're in poorer health to begin with and have significant challenges to overcome. Some indicators of well-known risk factors such as smoking and obesity are very present in rural Canada and in some--particularly first nations--communities, they have devastating health consequences.
That's the portrait of rural populations, and it's the reason I think this committee is interested in rural health issues. There are major challenges in a country the size of Canada--much as my colleague, Dr. Strasser, discussed about Australia--on how to organize the system and how to give it the appropriate support in order to be able to achieve what is perhaps not best described as equal access, but equitable access, to services.
This requires action at many different levels. If the last 20 years is any indication, there have been actions at different levels, but I would characterize them as being somewhat disconnected and certainly not part of a national rural health strategy. There are elements of a strategy, but they lack the strategy for which they are an element of, if one can put it that way. And one of the things that is required for us to move forward is to identify the critical elements of a national rural health strategy that would allow us to move forward.
There clearly are many players. Many of the levers to improve rural health are economic in nature. Many of them are social or societal. Many are educational. Many of the things are out of the sphere of the health care system. So many government departments are involved.
With respect to access to services from a community level, what I hear most often from communities is a discussion about the challenges of health human resources. In health human resources in Canada--particularly in rural areas--there are shortages at the physician level, there are shortages at the nursing level, and there are shortages in all the other professional levels. Communities are struggling to outbid each other with incentives and the attractiveness with which they present their communities. It's a lose-lose proposition for many rural communities who start off with few resources and are forced to use them as incentives.
That really begs the question for me, because my experience in rural Canada is that if you have a workforce that understands the challenge, that is appropriately trained, that is appropriately exposed, they will work in rural communities willingly. If the model is ever-larger incentives, which are clearly part of the package, they aren't the fundamental thing that will improve things in rural Canada.
We need to pay attention to the messages coming from our communities. We need to understand the kind of health worker we need, we need to understand the kinds of teams we need, and we need to understand how those teams can be trained. If we are to seriously address the issues facing the distribution of this workforce, we need to mandate some organizations to actually have some authority to get the training done at the appropriate level for the long-term solution.
If we continue to depend on individual interest and the size of the incentives, we will be continually faced with putting out fires and band-aid solutions, and we won't have a durable infrastructure that can solve the problem in the long term.
I'd encourage the committee to use the expertise that does exist in rural Canada at many levels. There is a great deal of understanding of their communities and a great willingness to come together to produce recommendations for consideration by the different levels of government. The different levels of government must be encouraged to work together to find solutions that are long term in nature and not stopgap.
The Society of Rural Physicians has been working in this community-focused way for 20 years and will continue to do so. Hopefully we'll be able to provide you with assistance and recommendations as we go along.
Thank you.