moved:

That the House: (a) call on the Standing Committee on Health to undertake a study and report its findings to determine (i) the factors that contribute to significant disparities in the health outcomes of rural Canadians, compared to those in urban centres, (ii) strategies, including the use of modern and rapidly improving communications technologies, to improve health care delivery to rural Canadians; and (b) call on the government to work with the provinces and territories, and relevant stakeholders, to further address and improve health care delivery in rural Canada.

Mr. Speaker, it is an honour and a pleasure to get the chance to speak to my private member's motion, Motion No. 226, which relates to health care delivery in rural Canada.

As a representative of the Kenora riding, one of the largest rural ridings in Canada, which stretches from almost the American border all the way to Hudson Bay, I know this is probably one of the easiest ridings to use to explain what it means for an area to be remote and inaccessible, or accessible only by plane or a winter road when the lakes freeze over.

This is an important subject matter for all rural Canadians, because it is one of those issues all Canadians think about, which is their health care, the health care delivery and the ability of government to deliver health care products to all Canadians, particularly in the north. For these reasons, northwestern Ontario presents a unique case study in many ways. From infrastructure to environment, transportation and employment, the north forces us to think outside the box.

Health care can be approached from many different angles, including mental health treatment, health care providers and availability, prescription drug coverage and culturally appropriate care, just to name a few.

The 2016 Statistics Canada census data indicates that Canada's population was over 35 million individuals, of whom 16.8% live in rural Canada. The 2006 report by the Canadian Institute for Health Information entitled “How Healthy are Rural Canadians? An Assessment of Their Health Status and Health Determinants” found that rural Canadians have higher death rates, higher infant mortality rates and shorter life expectancies than their urban counterparts.

Health-related factors such as a higher proportion of smokers, lower consumption of fruit and vegetables, and obesity disproportionately affect rural residents. Additionally, the population in rural areas tends to be older than in urban areas.

The recruitment and retention of physicians and health care professionals are also a significant challenge. Throughout the years that I have been involved in this, it has never been easy to find enough professionals to work in rural Canada. According to 2016 data from the Canadian Institute for Health Information, there were approximately 84,000 physicians in Canada, of whom only 6,790, or 8% , practised in rural settings.

In 2006, the Canadian Institute for Health Information issued a report that found that populations living in rural areas had a shorter average life expectancy by almost three years for men, as well as higher smoking rates compared to their urban counterparts. These numbers are statistically significant, according to the report.

Mortality risk for diseases such as heart disease and heart attacks, as well as respiratory diseases like influenza and pneumonia, were also significantly higher in rural versus large urban areas. There is a variation in the levels of services available, as rural areas lack the population base to warrant the construction of extensive health infrastructure.

In addition, rural and remote communities face challenges in recruiting and retaining health care professionals. I will keep repeating that, because it is something we talk about in my riding almost weekly.

On the youth side, there is no process for measuring health disparities in Canada. If we look at the experience of rural children and youth in the health care system, we get a good idea of what is happening. Indigenous populations, particularly those that are rural and remote, are the most underserved communities in all of Canada.

I would like to take a minute to provide an example of health care delivery in the north so that we can see how different it is from the urban experience.

In September 2018, the Sioux Lookout First Nations Health Authority released “Our Children and Youth Health Report”, which represents the experiences of 31 first nations communities in the Sioux Lookout area.

Since 1991, the population of the Sioux Lookout area first nations has grown by 74%. The primary point of care for the majority of these communities is the local nursing station, and in many cases, emergency services are available only by plane. For example, women from Sioux Lookout first nations leave their homes and families and travel hundreds of kilometres to give birth at a hospital. Can members imagine being put in a situation like that? In these communities, basically for all the births, families have to fly out, leave for weeks when it is close to the due date, and then be prepared to spend weeks waiting for the child to be born.

The primary point of care for the majority of these communities is their local nursing station, and in many cases, emergency services are available only by plane. For example, women from Sioux Lookout area first nations leave their homes, as I said, and if infants need emergency care, they are transported out by medevac, because there are no emergency departments in these communities. Since 2012, there has been an 11% increase in the rate of emergency room visits for infants.

In the Sioux Lookout area, first nations youth attend the emergency room department for mental health reasons at a rate five times greater than the Ontario average. Between 2012 and 2016, the rate of emergency department visits for mental health increased by 123%.

These are examples of just some of the issues faced by rural and remote communities when it comes to health care delivery. I am here to talk about how we can find a way to deal with the challenges that rural communities face in making sure that their health care and their standards are equal to the health care standards of urban centres.

Jurisdictional issues pose one of the largest roadblocks to providing quality health care in the north. What is the role of our levels of government in this game of what I would call jurisdictional football? The federal government is responsible for the delivery of health care to certain population groups. Of course, the provinces are responsible for the general population of the province.

Section 10 of the Canada Health Act stipulates that each province's health insurance scheme must be universal, which means that it “must entitle one hundred per cent of the insured persons of the province to the insured health services provided for by the plan”. What does this mean? It boils down to the need for a collaborative approach. Rather than working from the top down, we need to approach these communities and regions to establish their unique needs and find those solutions.

Simply put, there is no cookie-cutter answer, and what works for one community may not work for another. The bottom line is that we need to listen to those who live and work within the system every day to make sure that we understand how to deliver health care in rural Canada.

When we have these discussions, sometimes it is hard for people to compare apples and apples or oranges and oranges, so I spent some time doing some comparisons between Canada and Australia. Like most developed countries, Canada and Australia have publicly funded, universal health care coverage. The two countries have similar population densities and geographic areas. As of June 2018, just under 25 million people resided in Australia, and 11.4% resided in remote or rural locations. The Australian federal government is playing an active role in addressing health disparities between urban and rural or remote populations.

The Australian government provides funding to incentivize physicians to work in rural or remote areas and to encourage the uptake of telemedicine technology in those areas. Like rural Canada, rural Australia is under-serviced with respect to the number of physicians. However, the Australian government also realizes that to change that, it needs to have a solution. This is what Australia is doing, and it is something that I think Canada should consider.

Like rural Canada, rural Australia is under-serviced, so in 2009, the Rural Health Standing Committee of the Australian Health Ministers’ Advisory Council was asked to develop a national strategic framework for rural and remote health. It was published in 2011, and then updated in 2016.

In 2014, the Australian government implemented the indigenous Australians' health programme to improve access to health services that are culturally appropriate, throughout Australia.

In June 2017, the Government of Australia passed legislation to establish a national rural health commissioner, as part of the government's efforts to reform health care in rural and remote Australia. As in Canada, the indigenous population in Australia is more likely than non-indigenous Australians to have respiratory diseases, mental health problems, cardiovascular disease, diabetes and chronic kidney disease, as well as reduced life expectancy.

In the private members' business we are in, it is always good to try to do this from the perspective of making sure that it is non-partisan and that it crosses party lines. Last month, I was pleased to second Bill C-451, an act to establish a children’s health commissioner of Canada, which was put forward by the member for Simcoe—Grey. Bill C-451 puts priority on the well-being, health, security and education of children and youth by recognizing that every child has the right to enjoy a standard of living that allows for the child's physical, mental and social development to flourish. To help see these measures through, the bill seeks to establish an independent commissioner to report, advise and provide recommendations to Parliament.

To complement Bill C-451, my motion seeks to shed further light on the health care delivery gaps between rural and urban Canadians. This area needs to be studied, because current evaluations of the health status of rural Canadians are very limited. Because we do not have the population density to build some of the health infrastructure necessary to deliver adequate services, we must look at existing, new and emerging technologies to address this service gap. This particular type of study has never been undertaken in Canada, so I look forward to working with all parties to see that it takes place.

In my riding, we are working on an all nations hospital. We are looking at health care delivery in our region from the perspective of an all nations hospital health care system, to include everyone in the region. We have included all governments and the local communities to look at how best to deliver those kinds of services. This is a potential way forward.

I think that working together, as we did last week with the Minister of Indigenous Services when we announced our government's support for the all nations hospital health care system, we can find ways to better deliver health care in rural communities.

In conclusion, no matter whether a person is rich or poor, young or old, living in a rural or urban setting, Canada's public health care system must provide equal access and care to all. I believe very much that this government and this Parliament have a role to play in making sure that we do the right assessments and find the right structures to put in place good health care.

My last point is that if people are to be allowed to live their lives in rural Canada, including as seniors throughout their retirement years, we are going to have to find the right health care system to make sure that this takes place. Otherwise, as I hear from all my colleagues, a lot of seniors move to urban centres because they have few choices for places to live in rural Canada.

I thank the House for the opportunity to say a few words about this motion.

Bob Nault

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