New maps: Our fragile health care system

How we unintentionally built an under-funded health system, right before a global pandemic

Dear friends,

I’m so touched by the outpouring of kind comments and hi-fives for my first article of this series. It’s actually the first writing I’ve ever published, and I’ll admit to some incredible nervousness before pressing the ‘send’ button. So, thank you.

I’m excited to share Part 2, a reflection on the state of our health system. Enjoy the read!

-Kapil

We’ve always used maps to guide our collective journey. As the events of the last few weeks have revealed, the maps that we’ve been using for the last decade were wrong, and accidentally created a country that’s now in crisis.

As we navigate our way out of this crisis, we will need to build a new set of maps.

And there’s no more important map to start with than health care.

It has been heartwarming to see the outpouring of support for our front-line healthcare workers, who are risking their lives to keep us all safe. From social media posts, to applause for staff as they end shifts, to businesses that have re-tooled to make visors and masks — we are ‘all in’ with our support.

But, it’s also been tough to watch. Our health care system was already at a breaking point before this pandemic. I keep having flashbacks to working as a manager in cash-strapped public hospitals, constantly in crisis during even the mildest of flu seasons, because we didn’t have the funding to open more beds.

Everyone in health care knows this, but few outside the system do. The maps we’ve been using to navigate the last decade have led us on a journey of underfunding our health care, and public health systems to the point where they are incredibly fragile — and what’s been getting us through is the tireless dedication, and sacrifice, of staff on the front lines.

Let’s take a deeper look at the destination our maps have led us to.

Consider this: on a normal day, most major hospitals in Ontario are running at over 100% capacity. Meaning that there are more patients admitted to a hospital bed than there are hospital beds in operation. Sounds impossible, right? It’s sadly very true. Every hospital has patients who need a bed but wait in makeshift stretchers located in the Emergency Department — sometimes for days. In most large hospitals, these ‘temporary stretcher zones’ are permanent fixtures. And almost all these patients are elderly.

It sounds insane to run a health system that operates at over 100% capacity almost every day of the year, yet, that’s exactly what we do. Most hospitals struggle to make it through a normal flu season. I’ve worked in hospitals that have been pushed to the breaking point by a worse-than-normal flu season — resulting in crisis measures.

If you zoom out a bit further, the numbers get even scarier. Canada has 1.95 hospital beds per 1000 people. In the developed world, we are dead last, tied with Mexico.

And now, our hospital system, which can barely manage through a rough flu season, is facing a global pandemic.

How did we lose our way?

It’s simple yet deeply complex. We haven’t funded our health system to keep in line with the growth and aging of our population. Instead, every year, we’ve been asking our front-line health care workers — those very people we’re celebrating today — to do more with less, and less, and less.

Of course there have been plenty of flashy funding announcements over the years — but they have not been enough. Instead, they’ve masked a dangerous, systematic underfunding of our health care system.

So, can we point our fingers to someone who was supposed to be in charge, but instead steered us into this mess?

If only it were that easy. But this is a story about all of us, and the maps we’ve been using to navigate this last decade. Maps which have led us to this very moment — a massively under-funded and under-resourced health system.

The bureaucrats who run our health system — who are incredibly skilled, passionate, and experts in what they do — they work within the constraints of what’s politically feasible. They take their direction from the politicians, who take their direction from voters. Meaning, the signals that drive our health system come from all of us.

And over the last decade, the signals we’ve been sending are remarkably consistent: we value our publicly funded health system, but we’re not willing to fund it.

This isn’t about political parties. All parties, of all stripes, across all of our provinces, and at the federal level have had roughly the same approach over the last decade.

Ontario’s most recent budget proposed consolidating the number of Public Health units in the province from 35 to 10 and cutting $200m from their budgets by 2022. These would be the same units that, among other things, are responsible for infectious disease planning and prevention. The leaders of these units are the people you see on television, every day.

The map we’ve been using to navigate this last decade has led us to a health care system on the verge of breaking, only held together by the incredible passion and dedication of people on the front line.

And most of us never really realized that was what was going on. It’s not like anyone presented us with one map that said ‘well funded and stable, and another map that said ‘underfunded and fragile’, and we chose the latter.

Instead, it happened slowly, invisibly, and with the facts obscured by politics, announcements and other media.

And perhaps we weren’t paying such close attention.


I hope we can build a better health care map to navigate the next decade of our shared lives. It looks like this: we need to build a health care system that has spare capacity, so it can handle the ups and downs of an unpredictable world. It should be funded to reflect how our country is growing, and aging. Our health care system and public health units are led by experts, and we should listen to them when it comes to how the system is organized and funded. And we should be prepared to pay the costs of what it takes to run a health system that is efficient, high quality and has enough capacity.

For as this moment is reminding us: all we really have is our health.