Author: Samira Prasad

Dr. Tara Kiran spoke with the Ottawa Citizen about the launch of the OurCare final report, and how Canada’s primary care system needs to change. “We haven’t had the size of investments in primary care that are needed. If you look at the total health budget spent on primary care, Canada is much lower compared to peer countries,” says Dr. Kiran.

Following the release of the OurCare final report, CBC News Manitoba, spoke with Michael Redhead Champagne, who lead the OurCare roundtable with Indigenous youth in Winnipeg this past November. He shared that the youth explained how both they and their family members often get lower-quality care in the health-care system.

The Toronto Star spoke with OurCare national lead Dr. Tara Kiran and OurCare panelist member Sandra Epp in their coverage of the project’s final report. The report covers the findings of this cross-Canada initiative, and makes recommendations for improving the primary care system.

CBC News featured the findings and recommendations of the OurCare study’s final report. They also spoke with Dr. Tara Kiran, national lead for OurCare, about what she heard across the country and some potential solutions.

Dr. Tara Kiran spoke with The Canadian Press about the launch of the final national OurCare report that highlights patient-led solutions to the family doctor shortage crisis in Canada. This piece was also shared through The Globe and Mail and The Toronto Star.

Unity Health Toronto news release

A new national report led by researchers at Unity Health Toronto with input from close to 10,000 people in Canada highlights patient-led solutions to the worsening family doctor shortage and provides feedback from those directly affected on how to improve access to primary care across the country.

OurCare, the largest pan-Canadian conversation about the future of primary care, took place from September 2022 to December 2023 and engaged with Canadians through community roundtables, provincial panels and a national survey about their experiences and ideas for how to solve the crisis.

“We heard from almost 10,000 people across Canada who collectively spent about 10,000 hours engaging with us on how to improve the primary care system. People shared stories that were both heartwarming and heartbreaking,” said Dr. Tara Kiran, national lead for OurCare and a family doctor and scientist with the MAP Centre for Urban Health Solutions at St. Michael’s Hospital.

“And despite vastly different life experiences and backgrounds there was so much they agreed on. At its core, they felt strongly that every person deserves access to high quality primary care and that the system should be accountable to patients and the public.”

Data from OurCare showed the number of people across Canada without consistent access to a family doctor or nurse practitioner has risen from 4.5 million in 2019 to more than 6.5 million in 2023.

The OurCare survey heard from 9,279 people in Canada about their access to care, priorities, use of walk-in clinics, virtual care, primary care teams, medical records and ideas for system redesign. The data is publicly available at data.ourcare.ca.

Five provincial priorities panels engaged with 159 randomly selected people across Canada in deep dialogues about primary care in Ontario, British Columbia, Manitoba, Quebec and Nova Scotia.

Ten community roundtables also received in depth feedback from 192 participants from underserved communities including First Nation, Inuit and Métis people; African, Caribbean and Black communities; immigrants, refugees, migrant workers and other newcomers; LGBTQIA+ migrants; and people with disabilities.

Members of the public who participated in OurCare put forward key solutions to the attachment crisis affecting 22 per cent of Canadian adults without primary care access. These include:

• Scaling up community-governed interprofessional primary care teams.
• Growing and diversifying the workforce through more training and accelerated integration of internationally trained primary care professionals.
• Enabling patient access to their own health records.
• Expanding virtual care integrated with in-person care to improve access, especially in rural and remote communities.
• Orienting the system to promote wellness and addressing the social determinants of health.
• Ensuring health care spaces are safe and accessible for everyone regardless of identity, ability or the language spoken.
• Educating and empowering patients to navigate the system and play a stronger role in their care.

“As a parent to two children with complicated medical and mental health issues, I have found it such a struggle to seek and obtain adequate primary care,” said Sandy Epp, OurCare panelist from Manitoba.

“It is my hope that our recommendations will be heard and actioned, so that we can all work together to bring a consistent, reliable and timely standard of care to all Canadians in all areas of the country.”

Findings from all three phases of the OurCare initiative also led to the development of the “OurCare Standard” – six statements that summarize what participants felt everyone in Canada should receive:

1. Everyone has a relationship with a primary care clinician who works with other health professionals in a publicly funded team.
2. Everyone receives ongoing care from their primary care team and can access them in a timely way.
3. Everyone’s primary care team is connected to community and social services that together support their physical, mental and social well-being.
4. Everyone can access their health record online and share it with their clinicians.
5. Everyone receives culturally safe care that meets their needs from clinicians that represent the diversity of the communities they serve.
6. Everyone is served by a primary care system that is accountable to the communities it serves.

“The OurCare Standard describes what every person in Canada should expect from the primary care system. It’s a distillation of all that we heard,” said Kiran, who is also Vice-Chair of Quality and Innovation in the Department of Family and Community Medicine at the University of Toronto.

“Now it’s up to those of us with any power in the system to act on the priorities people in Canada have so clearly articulated.”

Also launching today is a new interactive OurCare website where people in Canada can compare their own care to the OurCare Standard and see how different provinces are measuring up.

“As a woman with a disability, the state of the health care system is essential to my well-being,” said Tara Slade Hall, OurCare panelist from Quebec. “This project has been a once in a lifetime opportunity for me to have my voice heard and contribute in a meaningful way.”

OurCare researchers are calling on governments, health care organizations and health care leaders to act on these findings, work to adopt the new national OurCare Standards and address the worsening crisis in primary care access before it’s too late.

“I strongly advocate for the swift implementation of recommendations by government and health authorities, starting with the establishment of community health care centres in the most underserved areas – specifically rural and northern communities,” says Elly Grabner, OurCare panelist from Kamloops, B.C.

“These centres would ensure that everyone has access to a doctor when they need it, addressing critical health care disparities. Immediate action on these recommendations is vital to improve health care access and outcomes for all Canadians.” 

By: Adam Miller, Unity Health Toronto

Recently officials in Belleville declared a state of emergency, after paramedics responded to 23 drug overdoses in a span of just two days. It’s another deadly chapter in the ongoing opioid crisis in the province, and country. Dr. Carolyn Snider spoke with TVO’s The Agenda about what is needed moving forward.

Federal funding for HIV self-testing kits is coming to an end. Dr. Sean Rourke spoke to The Canadian Press about why the program he’s helped lead has been so important and that stopping it doesn’t make sense.

In celebration of Black History Month, MAP Manager of Research Programs and Partnerships Christina Salmon sat down with Denese Frans-Joseph to talk about Denese’s role as MAP’s Research Equity Specialist, her goals for the institution, and her advice for young Black professionals.

Christina: Hi Denese, It is wonderful to have this time to speak with you today. I want to highlight that you are MAP’s first research equity specialist, and we are also incredibly lucky to have you on our team at Li Ka Shing and at MAP. Could you tell us a little bit about your roles here?

Denese:  My role as Research Equity Specialist is to co-develop and lead our equity, diversity, and inclusion related initiatives for the research institution and community. Within my responsibilities, I co-lead the Research Equity, Diversity, and Inclusion Task Force (REDI) at the Li Ka Shing Knowledge Institute, and I also co-lead the Anti-Racism and Equity Advisory (AREA) at MAP. I get to work with you, which I am so grateful for, and I get to work in collaboration with some really wonderful folks at MAP and the Li Ka Shing Knowledge Institution. I am really grateful to be in this space because I am surrounded by a lot of beautiful ideas and passion, and a real drive to create change here. So I am really happy to be here.

Christina: Tell us more about your vision for MAP’s Anti-Racism and Equity Advisory (AREA)?

Denese: I really envision AREA as a space to continue to develop and cultivate a culture where diverse voices are valued here, and a place to create meaningful change for both staff and the community being served through the research done here at MAP. I’m hoping to strengthen our capacity for work around anti-racism and social justice, and to be a leader here to influence the work we do.

Christina: Can you tell us a little bit about what attracted you to a career in anti-oppression and anti-racism?

Denese: I didn’t have a specific goal to end up in research, but I know that the passion for this work is in my blood! I come from family of powerful women who are passionate about community and social justice. I was really inspired by my grandmother who was a public health nurse and midwife back in Jamaica. That really trickled down to my mom, my sister and myself. My mom worked as a social worker, and worked with newcomers, youth, and the unhoused. She always had a passion for helping the community, and especially our community, the Black community, because she really knew the barriers to surviving and thriving that people face in Toronto, and in Canada. We have always had conversations in our home about anti-racism and anti-oppression, so I am passionate about helping my community thrive, as well as those who experience marginalization due to the systems we live in.

Christina: Do you have advice for young Black professionals who are entering or considering a similar career? What has helped you along the way?

Denese: My pathway to this career wasn’t linear. I originally thought I wanted to be an obstetrician, and there wasn’t much conversation while growing up around what else I could do. So my advice is find your passion, which is a luxury that you don’t always have while growing up in an immigrant family. I had to try many things and volunteer many places to find my passion for health equity and research. Find what really inspires you, and that will lead you to where you are supposed to be. I would also encourage folks to find a mentor, find people that support you and speak up for you – it is really important to have guidance. I would also suggest building a network – a network of people who have the experience you are looking to gain, who will invite you to the table, and create the tables you want to sit at.

I would also say to not be afraid to speak up. Being in the research world is challenging, and the work we are doing is unconventional. We are focusing on deconstructing the world as we know it, decolonizing, and that change doesn’t happen unless you speak up.

Lastly, I would say take care of yourself. This work will require a lot from you. Find joy, because you can’t pour from an empty cup, so you have to fill yours first.

Christina: The theme of 2024 Black History Month is “Black Excellence: A Heritage to Celebrate; a Future to Build”. What do you think academic institutions could be doing more of, to help clear the pathways for Black excellence and futures?

Denese: I think that academic institutions need to prioritize a few key areas to support the development and excellence of Black students and researchers. Representation matters, it matters to see someone who looks like you doing the work you want to do. Institutions need to provide supports tailored to the needs and challenges of Black students, and create opportunities for Black students, which we are doing here with our MAP Summer Student Program. Institutions also need funding for programs, mentorship, and career advising that is culturally safe and competent. Often the support that Black students receive is insufficient, and they are funneled into non-academic programs or stereotypical careers. Institutions also need to ensure that their curriculum is diverse, with diverse histories, and to include contributions from successful Black individuals across all disciplines. Doing this would really challenge the stereotypes that exist for us. You can’t always know what you can achieve unless you can see the possibilities, and you can learn about the possibilities.

Academic institutions need to create spaces that celebrate the diversity of the students they are supporting, and they need to embody and operate from an anti-racist framework. They need to focus on actively fighting against racism and discrimination that occurs in their space, and that means committing to trainings, education, and building accountability measures – which something we are wanting to do with AREA for this institution. So I think committing to these things would create spaces where Black students and researchers can really thrive and feel valued, respected and supported.

Christina: Thank you so much for everything you’ve shared so far, and I’ve loved hearing more of your story and teachings. I think it is also really important to also acknowledge that despite racist people and systems, we are also thriving, we are great – and those things are not mutually exclusive. You can be powerful and do this work, but also be thriving. So with that being said, what does Black joy mean to you?

Denese: Black joy is powerful – powerful ability to thrive in the face of adversity. Finding moments of happiness and celebration despite the systemic barriers and injustices we often face. Black joy is laughter shared between friends and family, it’s the food and the music and dance. It is the strength of our communities, it’s a form of resistance against the forces that try to limit our potential, which is something we have had to deal with for centuries.

I also feel that embracing our Black joy is finding moments of happiness in our everyday lives, as we defy the stereotypes that often seek to define us by our pain and struggle. That is something that I learned from Saidiya Hartman, she talks about how Blackness is often tied to pain and struggle, and that is something I want to move away from.

Black joy is our communities, our place of comfort and authenticity, and knowing that we have home with each other, in our cultures, in our traditions. Black joy is really tied to our radical self-love, and our defiance and our liberation. It is our unwavering love for each other; it is strength, empowerment, and beauty. It is all these things in a world that seeks to silence us, Black joy is the light in the darkness.

Denese Frans-Joseph (she/her) identifies as Canadian – Ghanaian – Jamaican and is a wife and mom to an amazing toddler. She is a womxn’s health advocate, passionate about health equity and community capacity building. With over 10 years of experience in health promotion, program evaluation, project management, and community-based research and development, her work is centred on an anti-racist and anti-oppressive framework and is dedicated to addressing individual, social and systemic factors that impact the health status of racialized and marginalized folks, both locally and internationally. Denese holds a Master of Public Health and is committed to reducing the impact of barriers to health equity. For the last 6+ years, Denese has led the coordination of innovative national, provincial, and regional HIV/AIDS projects and initiatives dedicated to addressing the barriers to HIV testing, support and care for marginalized communities.

Christina Salmon (she/her) was born and raised in Toronto and identifies as Jamaican, African- American, Native American and English and is a Mom to two incredible children. She has worked at SMH since 2005, with the majority of her career being at MAP where she is now the Manager of Research Programs and Partnerships.   Christina is deeply invested in anti-racism and anti-oppression work at the organization, research institute and centre level.  She is a member of the Council on Anti-Racism, Equity and Social Accountability, Research EDI Taskforce, Patient and Community Engagement in Research Committee and AREA. Christina’s expertise is in managing the business operations of large research centres and a programs while always embedding equitable practices. 

By Samira Prasad