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SOMBA K'E/YELLOWKNIFE
Over the past year, Yellowknife physician Dr. Anna Reid has been travelling the country, raising awareness about what she calls the growing problem of health-care inequality in this country - a problem that is perhaps more visible on Yellowknife's downtown streets than it is in most places in the country.

Dr. Anna Reid recently returned to her job as an emergency physician at Stanton Territorial Hospital after serving as president of the Canadian Medical Association for one year, where she sounded the alarm on "abysmal health outcomes" for marginalized populations. - photo courtesy of the Canadian Medical Association

One of her main goals during her one-year stint as president of the Canadian Medical Association (CMA) was to spark a national conversation about this problem.

"One of the reasons why I decided to run for the job was really wanting to highlight some of the issues that people living in rural and remote and Northern communities face, and in particular issues surrounding health inequities and focusing on aboriginal health," she said.

"Aboriginal people have quite abysmal health outcomes compared to other Canadians and the rates of certain illnesses are so much worse up here - the mental health issues, diabetes, cardiovascular diseases, you name it. A lot of these rates are many, many times the national average."

For Reid, one of the main problems is the federal government's reluctance to fulfill its legal obligations of responsibility for aboriginal health.

"They are constitutionally and legally responsible for aboriginal health, and yet when we try to engage with the federal government, we're told this is a provincial and territorial responsibility - which is not true with respect to (aboriginal health) and with respect to public health," she said.

"It has been difficult to try and engage the federal government on this issue but there is an election coming up in 2015 and our goal has been to put that pressure on."

Another focus for Reid during her presidency was raising awareness about the social determinants of health care - systems outside of medicine that impact health outcomes.

These include poverty, lack of housing, poor early childhood development, nutrition and racial status.

"We know that most of your health outcomes are determined by these social determinants," said Reid. "It has nothing to do with genetics, your biology or the health system itself.

"We realized that if we're actually going to improve health outcomes ... we need to start as physicians trying to lobby to government and Canadians in general that we need to consider these factors or we'll end up having an unsustainable health-care system, as well as a very unstable economy in the future."

The link between healthy populations and a healthy economy is well proven, said Reid. The healthiest countries in the world are also the countries with the smallest gap between rich and poor.

This is bad news for the future of health care and the economy in North America, where the gap between the rich and poor is growing, said Reid.

"And the more that gap grows, you get more marginalized populations and they cost the system a lot of money," said Reid.

According to the Public Health Agency of Canada, governments spend more than $200 billion in health care every year in this country. One in five of those dollars spent on things that are directly attributable to social determinants of health.

"That means we're spending $40 billion on health care that if we looked upstream and spent that money on things causing detriments to health in the first place, we would have a much more sustainable health-care system," she said.

Although the federal government may not have been receptive to the CMA's lobbying, Reid said the highlight of her year was talking to people outside of the health system on these issues. The CMA held a series of town hall meetings on how it can address inequalities in the health-care system. This research culminated in a report issued in July titled What Makes Us Sick?, which presents 12 recommendations to the federal government on how to fix the health-care system.

On Saturday, Reid had her first shift back in the emergency ward at Stanton Territorial Hospital since her presidency concluded in August.

She said she's happy to be back in the North where she is surrounded by "optimism and passion that we can actually make changes up here." She is also glad to be back working with her patients.

Before taking the year-long hiatus, Reid spent four years working as a physician in Yellowknife.

During that time, she has seen an organizational shift within her department.

"There is an increased coming together of like minds to say, 'There are serious problems we need to really address,'" she said.

However, on the front lines ,changes are coming more slowly.

"I haven't yet seen any big improvements on the street - except that we have a day shelter now, which, as an emergency physician, has made a big difference in the winter time. We don't have as many people needing to come into emergency basically to get in out of the cold. But that's really just a Band-Aid solution."

Mental health and addictions present major challenges in all Northern and aboriginal communities, and Yellowknife is no exception, she said.

Addressing these issues will take more than health-care providers, although the new mental health strategy being developed by the department is a positive step. It will take people on the ground in communities getting involved, she said.

"If we're going to get a handle on these very, very, very complex issues, it needs to be done with a multifaceted approach with community government support, provider support, and we're going to need to have communities look inside and take responsibility for problems."

Two first steps in addressing the public health issues on Yellowknife streets is fixing the housing shortage in NWT communities and lowering unemployment, said Reid.

"We have great difficulty providing housing out in the communities for a lot of our patients and so many end up in Yellowknife because there is nowhere actually for the patient to go back in their community - there's nowhere for them to stay," she said. "Then they come down here and there's nowhere here for them and they end up on the street for different reasons."

On the unemployment issue, there are also programs being developed within the territorial government, such as the development of an economic diversification strategy.

"I'm not saying yea or nay to development, but we know that people thrive when they have employment and don't thrive when they don't have employment," she said.

"We're not going to solve a lot of these problems unless we take a look at those two issues: housing and employment."

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