The Paul Wells Show - Dr. Philpott's prescription for fixing healthcare

Episode Date: April 17, 2024

Canada’s healthcare system is facing some serious problems, and failing many Canadians, but former health minister Dr. Jane Philpott thinks it can be fixed. In her new book, Health for All, she shares her vision for a radical reset to how we think about and  organize healthcare. Dr. Philpott spoke to Paul at the Ottawa International Writers Festival.

How healthy is health care in Canada anyway? The front door of health care, primary care, is actually absent for about a quarter of the population. And it's really messing things up. Last week was the 40th anniversary of the Canada Health Act, which is supposed to guarantee public health care in Canada. It was also the day former Health Minister Jane Philpott was in Ottawa to release her new book about how to fix the system's current problems.

I spoke to her live at the Ottawa International Writers Festival. I'm Paul Wells, the Journalist Fellow-in-Residence at the University of Toronto's Munk School. Welcome to The Paul Wells, the Journalist Fellow-in-Residence at the University of Toronto's Munk School. Welcome to The Paul Wells Show. I'm a political journalist. You meet all kinds in this job. And I've always had a soft spot in my heart for politicians who, even though I'm a journalist, speak to me as though I was a person.

And so it was kind of fun to have Jane Philpott come to Ottawa, and we had the sort of interactions that a journalist and a politician does, but I would ask a real question and get a real answer at a time when that felt increasingly rare and precious. And ever since those days, it has always been good to see her again, and that's certainly true tonight. She is the Dean of Health Sciences at Queen's University, and she's had many adventures, and she has many more adventures coming, but tonight is a special night because it is the publication date of her first book, and I have some experience in knowing how that feels. The book's called Health for All, and let's get into it. Let's talk about it.

Jane Philpott, welcome to Ottawa. Thank you. Thank you. Thank you. Thank you. Thank you. Your book has elements of policy prescription, and memoir, and meditation. When did you decide it was time to write a book, and what were you seeking to accomplish? This is a collection of thoughts that had been scattered in my head. If you think that how it turned out seems like it's a bit, you know, up and down and here and there, you should have seen it when it was just scattered ideas in my brain. But I found that I wanted to

talk about how we can be a healthier country and a lot of the policy issues that a good chunk of the book talks about and that I feel extremely strongly about, but I felt that it wasn't enough to explain why I think we need to have a better health system in the country without sharing who I am, sharing where I came up with that conviction, and the roots of what got me to feeling that this is the time when Canada actually has to do something profound and important in terms of health care. So that's where I get into the digging in around spiritual determinants of health and social determinants of health, which is something, of course, most health policy people will talk about. And then the last part of the book is about the political determinants of health,

because none of that first part will ever happen unless we get healthier politics. And I felt like I needed to end there, because if anybody... Yay? and I felt like I needed to end there, because if anybody... Yay. If anybody felt hopeful by the beginning, and that was one of my goals, was that this would instill some hope in Canadians who are in a state of despair about health on most days,

we won't be able to do all that hard work unless we have healthier politics, and I needed to give a bit of a rallying cry around what I think politics should and could look like. So it's a book really about wellness, and its definition of wellness expands as you go, because I get the impression for serious practitioners, it's really hard to stop at institutional concerns, or even policy concerns, because at some point it's about people and you sort of decided not to artificially stop that contemplation but to indulge it in all of its facets. I felt that I had to indulge it because there are people that write books that

are entirely health policy and health systems and that's really interesting and I have lots of friends who are amazing researchers in the area of health policy and health systems but it would be naive to think that you can just create as you said the institutional structure around health care and think that we can be a healthier country by that alone because health is actually a part of every public policy and how we do all the other pieces of public policy contribute to whether or not we will be well. You know, that was obvious to me, but I didn't want to assume that everybody would understand that I understood that and needed to share some stories as well to amplify that because sometimes things like social determinants of health become a bit of a catchphrase and I wanted to tell some stories of how I had seen that when we focus on things

like housing or child welfare or the rights of people living with disabilities that those are as important or more important than actually having a health system even though that is of course essential. The book opens with a stark and surprising diagnosis which is that you're very worried about the state of Canada's health care system and we're good at self-congratulation sometimes in this country. There are industries devoted to self-congratulating ourselves about our health care and yet you are very concerned. How come?

Well I should start by saying that there are people in town I hear that like to say that everything is broken, and I'm not trying to say that everything about health care is broken. In fact, there's a lot of great history in Canada around health care, and doesn't it warm your heart to think that 40 years ago today, Monique Bégin was probably celebrating somewhere in town because her bill that she worked so hard to get across the line passed with unanimous consent in the House of Commons. That was a great piece of Canadian health care history. And because of that, every one of us has known that we had health insurance for doctor's care and for hospital care. And so that is is not nothing but it's not enough and so

we rested on our laurels and we sort of felt well we felt good about it we had a lot to feel good about but as health care has increasingly been delivered by much more than doctors and increasingly needs to be delivered outside of the walls of hospitals, we didn't adapt our laws and policies to be able to address that. And now we've reached a state where the front door of health care, primary care, is actually absent for about a quarter of the population. And it's really messing things up. So I needed to come up with a, well, I didn't come up with a solution, I needed to explain the solution and hopefully help build a collective vision for how we can do better. So the ground condition that you start from is that

too many Canadians don't have a physician, they don't have a person to approach to ask about health care concerns, to address health care problems and that that's a really weird place to run a country that likes to think it's in the vanguard of things how on earth are we going to fix that well the good news is i truly believe it's fixable and not just because i have magical thinking but because there is an enormous amount of international evidence that it is possible. So as you said, we have reached the point where about 22% writ large across the country of Canadians, adults, don't have either a family doctor or any other primary care provider that they can go to. So those people have nobody doing

their regular cancer screening. Now, of course, people are increasingly talking about people doing their own cancer screening, but ideally you should, people are increasingly talking about people doing their own cancer screening, but ideally you should have someone that helps you along that journey. They're not having anyone who's monitoring their high blood pressure and diabetes. They don't have someone to go to when they are having a mental health crisis. There are children by the thousands being born right here in this community that don't have a primary care provider. I mean, that is appalling. It's actually pretty dumb of us to let that happen because if

people are not having their illnesses detected or cared for at an early stage they end up the people that show up in the emergency departments with stage 4 cancer with advanced cardiovascular disease and it didn't have to be that way and I would not be surprised if there are people right here in this room that can tell you a story of a loved one who didn't get a diagnosis early enough. So we have to do a lot better than this. I believe that we can be a country, like many European countries, where every single person has in their neighborhood a primary care home. Not necessarily a family doctor only,

but a team of health professionals. And that is the place that they go to, that is the front door of the healthcare system. Everyone in that team knows their name, they share their electronic record. That's the vision that not just I, but many other health professionals share, and I'm happy to be able to put it down on paper.

So I'm not sort of rhetorically inventing my surprise here. I, as I read it, I was like, she wants to go from a point where a lot of people don't have a family doctor to a point where everyone has access to this super duper team of collegial specialists who greet them on their way in the door like norm and cheers yep um i i was like well she's ambitious first of all why a team and then secondly how a team so the why a team i think is relatively obvious but just to to say that you know family doctors are amazing people if I may say so myself being one. And those of us who have a family doctor often develop a very special lifelong

relationship with those people. But for many of the day-to-day things that you might need to see a health professional for, you don't necessarily need to see a doctor. There are many things that doctors can do that can also be done by nurses or dieticians or physiotherapists, certainly nurse practitioners and physician assistants. So we know that it works to put those people together in a team, they share an electronic health record, they triage people who arrive and determine who is the best person to treat them at that particular time. So the team makes a whole lot of sense. Obviously, fiscally it makes sense because doctors are the most expensive part of that

health human resource team. But it also means that, you know, sometimes the right person that you need to see isn't the doctor. How do we get from here to there? That is the more ambitious part. And it's not going to happen overnight. I think it will take a time frame but I really think we have to be ambitious we have to aim for 100% and I share in the book

this the metaphor of the public school that every child in this country will always be able to have access to elementary and secondary school that is publicly funded and you never need to worry about whether that's going to be possible when you move across the country and we would never say well if we got to 85 90 percent of our kids that could go to public school that'd probably be pretty good because it's better than 80 percent we would never say that that would be unconscionable so we have to aim for 100 every person in this country deserves to have a place to open the front door of the healthcare system and receive the care they need. Are there countries that are doing something similar enough that we could borrow from their example? Absolutely. There are many of them. You know, Norway, the Netherlands, Finland, the UK.

People often look at me and say, oh, the UK, the National Health Service is not great, I heard. But it's actually pretty amazing. I mean, sure, it's not perfect. And the docs often think, like doctors in most countries, that they could be paid more. But when you move to the UK, you go on the internet and plug in your postal code and somebody tells you where the address of your clinic in your neighborhood is and it's fantastic they share a record an electronic record that you can access still 20 years later and they somebody in the national health service knows the care that you have had and whether you have been screened for all the appropriate conditions you should be screened for i my vision is that we can do better than all those countries,

but let's first of all catch up to them and then we'll go beyond. I bet it would cost a mint. No. It actually would. I feel like I... This is... You planted... This is what we call a lob.

Yes. A lob. So almost all of those countries that I talked about pay about the same as we do per capita, writ large for health care. Some of them actually pay less than we do per capita, but they all, every one of those countries that I talked about, has better health outcomes than us. In fact, a group called the Commonwealth Fund that may be known to some of you does studies every year of they picked 11 OECD countries that they monitor and they monitor things like access to care and health quality and cost of care and consistently for the last few times that they've put out a scorecard out of those 11 countries Canada's 10th and you can guess who's 11th, and that's our neighbor to the south,

and they spend far more on health care than we do and get worse outcomes than any of their comparator countries. So this is not expensive. Everybody in this room is smart enough to know that, you know, is it more expensive to treat somebody for high blood pressure and diabetes when it's easy and manageable, or is it more expensive to treat them for high blood pressure and diabetes when it's easy and manageable or is it more expensive to treat them when They're in the cardiovascular intensive care unit for several days because they've had a severe heart attack So doing the right thing proactively We all learned a long time ago that an ounce of prevention is worth a pound of cure and it's still the case Are these ideas that you were batting around when you were the health minister or did they come to you later? That is a good question. There are people who say yeah you were there in Ottawa

you were like two years you were a health minister why didn't you do this then? Fair enough. Partly we were legislating medical assistance and dying and cannabis and all sorts of other things and it wasn't on my mandate but I will actually say as well, I didn't feel as strongly about it then as I do now, in part because I have seen things deteriorate over the last 10 years. And there is a bit of reflection that happens once you leave and you think,

I learned actually how government works when it works well and how you can build a vision and get that vision into reality and so I'm actually thankful for the last few years where I've had a chance not only to see some of the realities of the front lines of care and how you build a health workforce through the post-secondary sector but also to start to say all of those things I learned about how government works if we use those tools of government in a slightly different way we could actually shift the front lines of care so I will be the first to admit that I didn't think of doing this while I was there. Now your book actually talks about concrete lessons specific lessons from your time in government, including a job that you began at

the same time that you began as health minister, but ones that folks like me paid less attention to, which was you had a cabinet committee responsibility. Remind everyone about that. Well, I tell the story in the book. This is like a, I don't tell a lot of Ottawa secrets in the book. So if anyone wants to buy it to read about secrets of, you know, what happens in Ottawa, you might be disappointed. But I do share this story of what was on the agenda of the first cabinet meeting that I went to, which was on November the 4th, 2015. I will always remember that day. And one of the things was related to the long-form census. I can tell you this now because it kind of happened a long time ago. The second was that there was an ad hoc committee on Syrian refugees that was being established.

And lo and behold, as the prime minister announced who was going to be on his cabinet committee around Syrian refugees, after he named all of the other cabinet ministers, he looked across the table at me and said, and this ad hoc committee is going to be chaired by Jane Philpott. And I thought, I just arrived here. I don't know how you chair an ad hoc committee on Syrian refugees. But there was another part of me that thought, wow, that is such a huge opportunity and honour and that he thought I could do it was thrilling.

And that whole issue of Syrian refugees and the promise that we had made in that campaign about bringing 25,000 of them to Canada was something that really mattered a lot to me and it was an incredible way to start my career in Ottawa because I got to see what happens when government puts all its energy behind a big job and all of the machinery, the incredible talents of the public service when they've been given a job and they want to figure it out. They delivered and we missed the deadline by a couple of weeks but we brought 25,000 Syrian refugees to Canada in a few weeks' time.

Pretty cool. Absolutely. Syrian refugees to Canada in a few weeks time. Pretty cool. Absolutely. So what are the characteristics of that environment that permits policy success that you hope could be recreated on this new idea? So I use that as an example of how government can do big things.

And I should first of all say, and I believe I say this in the book as well, that while bringing tens of thousands of Syrian refugees to Canada is complicated, it's not remotely as complex as trying to design health systems where everyone has access to primary care. But the principles, I think, are the same. And I go through some of them in the book that we had a national vision people were fired

up about this right and and all orders of government were on the same page the prime minister had made the promise in the campaign and of course the provinces were on board because they knew that this was a serious humanitarian crisis and remember how municipalities and you know community groups neighborhood groups everybody got on board and they all knew what we were aiming for and everybody was rowing in the same direction and as I say the public service got on board and we figured things out and figured out how we could do things faster than we'd ever done it before as I say this is a microcosm of what would be necessary but if we're going to actually create a national health system where everyone has access to a primary care team

that is publicly funded, we're going to have to all get on the same page. And that's part of what I hope the book will do is be that rallying cry. I'm not the first person that came up with this idea, but I got the amazing opportunity to write it down in a book. And so let's share this idea. Let's believe together what we can do better in Canada. And I think once we get enough people that say, this is what we can do, that's when politicians

start to pay attention and they start to make promises and hopefully deliver them. It feels like a beginning of mandate project rather than an end of mandate project. It feels like the sort of thing you do when you've just burst into the ballroom and the cops haven't arrived yet to kick you out. Is that a question? Maybe in Ottawa I should be sparse with my reference to cops. Anyway, it was a metaphor. I can see that it is much harder as governments' mandates kind of move along, but that's not to say that governments can't refresh their mandate and refresh their vision.

It's a bit harder to do, but I refuse to believe it's impossible, and there is nothing, I don't think there's anything as important to people as the well-being of their families, right? I talk in the book about a house of proverb, which means that health is the mother of everything, and if we don't have health, really very little else matters to us, and so I think a government, whether they are brand new, or have been around for a while, whether it's a federal or a provincial government, I think could catch a vision like this that would be of the will of the people that is a nonpartisan vision that would capture the attention of

the public and be doable. So we have just finished discussing about the first quarter of Dr. Philpott's book. There's a what, what she thinks government should do. There are elements of a how and there's a strong argument for why access to interdisciplinary health teams should be right of citizenship for all Canadians. Then you continue on to the next large chunk of the book which is really about the who and the question it addresses is which is really about the who, and the question it addresses is, who is Jane Philpott to be preoccupied with all of this stuff? You've only got another half hour, but begin to answer that part of the question to me, please.

I had this nagging thing at the back of my mind as I was writing about the clinical services of health, and of course I was going to write about the social determinants and the political piece which was necessary but I had this nagging sense that there was something missing and I realized as I was trying to put this all together that I was missing the deep inner spiritual mental soul of health and that that was actually why it all mattered to me and that if if I didn't talk about that it would potentially not be understandable why I was so passionate about health for all and because I feel like that's a piece that's missing to our health structures anyways we've become so clinical and so preoccupied with the physical and we kind of tag on mental health as if it's an add-on when actually if you don't have mental

well-being and I call it spiritual well-being then all of the other stuff feels empty and so I wanted to talk about the insides of us as individuals and the insides of us as a country. I wanted to talk about our souls. And to do that, I realized as I thought about concepts like hope, belonging, and purpose, it suddenly came to me that the best framework for that was a framework that I was taught by a number of amazing Indigenous leaders, including Carol Hopkins of the Thunderbird Partnership Foundation. And she and her colleagues put together something called the First Nations Mental Wellness Continuum Framework. And I still remember the day that Carol Hopkins sat in front

of me when I was Minister of Health at the, we used to call it the Black Tower of Power in Tunney's Pasture. An astonishing building. I don't know whether you're allowed to call it that, but anyway, that's what people in the building called it. I've heard it called many words, Whitney. Anyway, I was sitting around the table there and Carol Hopkins came in with others and she presented to me the First Nations Mental Wellness Continuum Framework. And it's this incredible framework, which if you don't know it, I hope you'll look it up.

And they spent years working with elders and children and youth and First Nations leaders, and they came up with this framework. And at the very center of this very detailed framework are hope, belonging, meaning, and they came up with this framework. And at the very center of this very detailed framework are hope, belonging, meaning, and purpose. And I will never forget the moment that she showed me that, and I said, that's it. That's the center of who we are. And if we don't have those elements in our lives, then we're not well. And so this formed a framework for me to be able to think through those things,

what I had learned about them. And my book is very personal, and I describe personal experiences and stories that helped me to find those things for myself, and that I hope will point a path for how we can collectively work on all of those. You devote most of a chapter to the horrible day 34 years ago when your young daughter died in Africa.

Tell us what you can about that. So that is in the chapter about meaning because that was, I would say, the time in my life that I had to most struggle to find the meaning of something horrible that had happened. And, you know, the reality is every one of us has awful things that happen, either to ourselves or to people we love. We don't often talk about them very much, but life has pain. And for me, the most painful experience of my life was the death of our daughter, Emily, when we were living in Niger in West Africa. It's a story that you can't tell quickly. So it is, as you say, kind of a longish chapter. I wrote about it in part to honor her

because her life and death changed me. And the meaning of that for me was to understand the world in a way that I had understood intellectually but hadn't really understood in its wholeness. And the meaning of her death and the fact that it showed me how deeply unfair this world is and how horrible things happen to people like families living in Niger was a really

important lesson to me and what I hoped it would show is that you know I I'm sure everyone in the room has lost loved ones, and sometimes we get over that easily, and sometimes it's really hard to get over it. But when we do get through it, it gives our life, I think, a greater meaning and perspective and an opportunity to be able to share what we've learned with people around us. The people in the community where you were living at that point

kept saying to you, there is only patience in such a circumstance and you were not sure how heavily to lean on that council but you came to see some of the wisdom in that. Yeah it was she died very unexpectedly from meningococcemia. And unfortunately, our other daughter, who was a baby at the time, also had meningococcemia and was on the verge of death, really, in the hospital as all of this happened. And yeah, I describe in the book the moment when a long stream of villagers came to greet us. And I can remember it like it was today. I had never heard the greeting before,

but people would say to us, they would come and they would sort of very respectfully bow their heads and shake our hands. And they said, Yi Hankuri, Sei Hankuri. And that meant there is only patience. And I just remember thinking as they were doing it it was so moving and so healing for us but I thought like how can these people be patient you know I knew the women had lost many of them a lot more than one child and how could they be patient I don't know whether I still really fully understand

what they meant by that but it got me thinking about the fact that there are people in this world that are extraordinarily patient and we're not very patient in this country we probably need to be a lot more patient but most of all we need to know that there are women who don't have the privileges and opportunities that I have had and they persevere somehow and they keep caring for their families and they continue to contribute to their communities and if they can do that then I can do that and I can work alongside them to try to make the world fairer than it is now. Through that terrible time, as before and often since then, you were sustained by your religious faith, something else we don't talk about too often in our politics.

You talk about it a lot in your book. It was something that I felt needed to be said because I believe that our faith or our belief systems are a part of how we are well. And that's not to say everybody has faith in a spiritual sense. Sometimes people's faith is in humanity. But there are a lot of people in this country who have a very deep spiritual faith.

They believe in a higher power, and it matters to them, and it actually helps them to be well. But we've gotten to a place in society where we've stopped talking about that and it somewhere along the way over the decades became taboo to talk about religion first and that meant that we also tossed out faith and we tossed out belief and we tossed out conversations about what matters to us most. And we tossed out conversations about what matters to us most. And it's the most important part of my life to recognize the blessings that I've received from a power that is beyond what this earth can prove.

And I needed to talk about that because it matters to me and because I think we all need to talk about that. to talk about that because it matters to me and because I think we all need to talk about that and this is a day and a time in our world where issues of what people believe actually tears countries and nations and regions apart and I you know it's too simplistic to say that talking about it would fix things but we have to find a way to talk about these things in a peaceful, respectful, honest way. And I hope in the book, as I talk about that, people will recognize that spiritual matters are a part of our well-being. That seems like only one part of the entire work of the book, which is to integrate various experiences you've had, various influences on your thought,

and the book ends up being essentially an act of making yourself whole and working through how all of that fits, which is a hell of a lot to chew on for any first-time author. Well, I think you're being very generous and you're making it sound more sensible perhaps than it was, but I'm happy that it came out that way. Anything that's between two covers and has your name on it is a pretty good day at the office.

Thank you, Jane Philpott, for sharing your thoughts, for writing this book, and for coming back to town to talk about it. My pleasure. Thanks, everybody, for being here. Thank you. That was The Paul Wells Show. Thanks to the Ottawa International Writers Festival for hosting this event.

The Paul Wells Show is produced by Antica in partnership with the University of Toronto's Munk School of Global Affairs and Public Policy. Our producer is Kevin Sexton. Our executive producers are Laura Reguerre and Stuart Cox. Our opening theme music is by Kevin Bright and our closing theme music is by Kevin Bright, and our closing theme music is by Andy Milne.

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