Question Period Note: Disparities in rural health - children mental and physical aspects

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• Family health services form the foundation of high-performing health systems. Situated at the nexus of individual and population health, family health providers and teams play a meaningful role in children’s physical and mental health and social needs.
• Canadians living in rural communities, including children, have a harder time accessing high-quality family health services and mental health care in a timely manner.
• The COVID-19 pandemic has had significant impacts on access to family health services and the mental health of children and youth. Concerns about the virus itself have been compounded by impacts on school, routines, and social activities, isolation, and decreased access to services and supports, particularly in rural areas.
• The Government of Canada recognizes that Canadians living in rural communities, including children, have a harder time accessing timely high-quality family health services and mental health care and that rural communities face unique challenges in delivering these services.
• We are committed to addressing these barriers and ensuring that children across Canada have equitable access to care. To that end, we are making targeted investments to increase the number of doctors and nurses in rural communities.
• These include increasing the maximum amount of Canada Student Loans for rurally-based doctors and nurses by 50%, and investing $100 million over three years to promote the mental health of those most affected by the pandemic, including youth.

IF PRESSED ON ADDITIONAL BARRIERS TO ACCESS CARE IN RURAL AND REMOTE COMMUNITIES…
• Budget 2022 commits to provide $26.2 million over four years and $7 million ongoing to increase the maximum amount of forgivable Canada Student Loans for doctors and nurses who work in underserved rural and remote communities.
• This will mean up to $30,000 in loan forgiveness for nurses and up to $60,000 for doctors working in underserved or remote communities.
• Innovation, Science and Economic Development Canada has announced a $2.75 billion Universal broadband fund to support high-speed internet projects in rural and remote communities throughout Canada.
• Increased broadband access can have an incredibly positive impact in these parts of Canada, particularly for Indigenous communities, where digital health technologies that rely on stable internet connections, such as virtual care, can make a significant difference in people’s lives.
• Going forward, the Government of Canada will continue to work with provinces and territories, providing targeted support as they bolster their own family health services and mental health systems, particularly those for children in rural communities, following the disruption caused by the COVID-19 pandemic.

IF PRESSED SPECIFICALLY ON MENTAL HEALTH…
• In response to the global public health challenge of COVID-19, in April 2020 the Government of Canada launched an online mental health and substance use support portal, Wellness Together Canada.
• As a virtual tool, the portal provides access to all individuals living in Canada regardless of their location.
• Recognizing that many Canadians do not have reliable internet access, confidential chat sessions with social workers, psychologists and other professionals can be accessed by phone and text, including for children aged 5 and older
• The Government of Canada is also providing funding to Integrated Youth Services Networks (IYS-Net), a pan-Canadian initiative that builds health implementation tools to improve the integration of youth mental health services.

Family health services form the backbone of high-performing health care systems. They serve a dual function in the health care system as the direct provision of first-contact services and a coordination function to ensure continuity across health care settings. However, Canadians, including children, continue to struggle to access family health services. In 2021, 14.5% of Canadians 12 years and over lacked a regular health care provider. These disparities are felt more acutely by rural Canadians, with the distribution of family physicians to rural communities decreasing over time (13.1% in 2016; 12.8% in 2020), while it increases slightly in urban environments (86.7% in 2016; 86.9% in 2020). Additionally, Indigenous people living in both rural/remote and urban communities, on and off reserve, have been shown to be less likely to be attached to a family health services provider. In Canada, Jordan’s Principle commits that all First Nations children living in Canada should have access the services and supports they need, including health services, when they need them.

Mental health issues can impact any population and children and youth are no exception. In fact, two thirds or more of mental health disorders emerge before the age of 25. It is estimated that mental health issues affect over 800,000 Canadian children and youth annually. The COVID-19 pandemic has had significant impacts of this population. For example, the percentage of Canadians aged 12-17 who reported their mental health as “very good” or “excellent” decreased from 74.1% in 2018, to 61.2% in September 2021/February 2022. Moreover, rural populations are in a particularly vulnerable position due to the lack of availability and accessibility of mental health services and supports, and family health services within their communities.

Health is a shared responsibility in Canada, with the federal government and the provinces and territories having distinct roles. While primary responsibility for delivery of health care services to Canadians falls within provincial and territorial jurisdiction, the federal government sets and administers national standards for publicly insured health services through the Canada Health Act, and provides funding support for provincial and territorial health care services through the Canada Health Transfer. Therefore, the department continues to work closely with FPT partners to advance family health services and mental health priorities, with a particular focus on rural communities.

Health Canada has been collaborating with provinces, territories and other partners to identify ways in which the family health service system could be strengthened to:
• Ensure every Canadian has timely access to a family doctor or family health team, and
• Leverage virtual care to support access to and delivery of high-quality health care, including within the context of family health services.

Timely access to family health services for all Canadians, including children, is a Government of Canada priority:
• The 2021 Liberal platform promised $3.2B to provinces and territories (PTs) for hiring 7,500 new family doctors and nurse practitioners, and $400M for virtual care.

The fall 2021 Mandate Letter to the Minister of Health included directives to:
• Support provinces and territories to hire new family doctors, nurses and nurse practitioners;
• Expand virtual care, helping to cover digital infrastructure and other system improvements so that Canadians can access virtual medical consultations or remote monitoring;
• Expand the number of family doctors and family health services teams in rural communities and work to give rural communities greater access to a full suite of health and social service professionals; and
• Invest in the study of the long-term health impacts of COVID-19, including the effects of long COVID on different groups, including children.

Budget 2021 announced $100 million over three years to promote the mental health of those most affected by the pandemic, including youth. Funded projects are expected to begin in spring 2022 and to reach diverse populations across Canada. Projects will support mental health promotion and mental illness prevention interventions, in addition to initiatives that build the capacity of service providers to deliver programming in safe, effective and trauma-informed ways.

Budget 2022 committed to strengthening the health care system and ensuring it delivers the care that Canadians deserve by:
• Increasing the number of doctors and nurses; and,
• Building on the success of increased virtual care;

In March 2022, Minister Duclos outlined five pillars for health to address systemic challenges to enhancing access to high-quality, integrated care. These include:
• Better access to family doctors and teams;
• Reducing backlogs and growing our health workforce;
• Using modern health data and digital health effectively;
• Improving mental health and substance use services; and,
• Helping Canadians age with dignity, closer to home.

• Remoteness is an important determinant of socioeconomic and health outcomes. In 2020-2021, children living in rural and remote communities were more likely to visit the emergency department and to be hospitalized for mental health concerns (1,780 and 482 per 100,000, respectively), than their urban counterparts (1,135 and 401 per 100,000, respectively).
• However, there are fewer health human resources available in those communities. For example, there are three psychiatrists per 100,000 population in rural areas, compared to 17 in urban areas, and there are 37 nurses practicing in mental health and addiction per 100,000 population, compared to 76 in urban areas (2017).
• While just under 1 in 5 Canadians live in rural communities (17.8%), only 8% of physicians and 3% of psychiatrists practising in Canada serve these areas.
• Indigenous communities tend to live in some of the most remote areas of Canada, and tend to be younger than their non-Indigenous counterparts. Access to health care challenges in rural and remote areas are expected to disproportionately affect Indigenous children.
o In 2016, 19.2% of Indigenous people reported that they did not have a primary family health care services provider compared to 15.8% of the non-Indigenous population.
o In 2018, more than 25% of all First Nations children between the ages of 0-11 years have been diagnosed with one or more chronic health conditions.
• Recent budgets have included a focus on access to family health and mental health services in rural communities.
o Budget 2021 announced $100 million over three years to promote the mental health of those most affected by the pandemic, including youth
o Budget 2022 announced an increase to the maximum amount of Canada Student Loans by 50%, as a means of addressing the shortage of doctors and nurses in rural communities.
• In March 2022, the Minister of Health outlined five pillars for health system transformation to address systemic challenges and enhance access to high-quality, integrated care, which again speak to the priorities of access to family health services and mental health services. These include:
o Better access to family doctors and teams;
o Reducing backlogs and growing our health workforce;
o Using modern health data and digital health effectively;
o Improving mental health and substance use services; and,
o Helping Canadians age with dignity, closer to home.