Does Philpott have the cure for province’s medical data deficiency?
On occasion, Dr. Jane Philpott has been appalled. When she became Canada’s minister of health in 2015, it wasn’t just that the path of opioid overdoses was hard to follow; the federal government couldn’t even track how many people were dying.
And when Philpott rushed to Participation House in Markham in April, when the home for adults with severe disabilities was being overrun by COVID-19, she found 90 of 100 staff missing, and people were just trying to survive. Patients had fear in their eyes; staff were trying to soldier on.
And as residents who had lived there for decades died, staff had to scrawl information on handwritten spreadsheets to track the outbreaks day after day, until the paper curled at the corners, before faxing them to public health. It was a small, broken thing in a place where people dying felt like family.
“The trauma on those workers was tremendous, and it will take them a long time to unpack the emotions that had to be set aside to do the job each day,” says Philpott. “It’s a huge burden.”
Thursday, Philpott was announced as the lead on the Ontario government’s effort to fix its endemic health information problems. She will serve as the special adviser on the government’s Ontario Health Data Platform, a wouldbe Rosetta stone for medical data in a province that is absurdly antiquated and fragmented. And she will chair a distinguished 15-person panel that will give advice to Ontario Health Minister Christine Elliott and Treasury Board President Peter Bethlenfalvy.
The province still lacks a single credible and clear voice on public health and epidemic response, and it is unclear how the advice of the province’s health command group and this advisory group will fit.
But at least Ontario is trying to put puzzle pieces together. As testing lagged, Ontario Health CEO Matt Anderson was tasked with fixing that system; it took until the start of June for Ontario testing centres to finally be told not to turn away people with possible COVID symptoms.
And now Philpott will tackle data, and hopefully add good advice. The former Liberal cabinet minister will become dean of Queen’s University’s faculty of health sciences in July; she was defenestrated for standing on principle but feels she can work with a Conservative provincial government that hasn’t always valued good public health.
“I know that they are very serious about wanting to get things under control as far as the pandemic goes,” says Philpott. “I think it’s been a big wake-up call to everyone, and I believe that they asked me to do this job with the very best interest of the public in mind.
“And I hope that they have figured me out well enough to know that I will push them, and give advice fearlessly, and if I’ve been asked to do the job I will not hesitate to speak up about where we can do better.”
Our data system has been shown to be a broken, wooden thing: pages of faxes with thousands of names sent to Toronto Public Health so they can be contact-traced; no easy and direct link between front-line doctors and public health, which has been starved of resources.
Those are front lines, and that’s part of why Ontario is still chasing Quebec as Canada’s worst-performing province against COVID-19. Data released by Toronto Public Health last week shows it is disproportionately affecting the working poor, the homeless, new Canadians. Which means Canadians of colour are being hit the hardest, in a province that still doesn’t collect health data by race, but which recently allowed local public health units to do so.
She was proactive on data while minister of health, and Philpott has always cared about vulnerable populations. It’s one way her appointment on this two-year unpaid contract could matter.
“Our failure to measure has been the wilful blindness to the racial and social pathologies that we have allowed to persist,” says Dr. Andrew Boozary, the executive director of social medicine at University Health Network, a son of Iranian immigrants who grew up in St. James Town apartment buildings.
“Sometimes it’s easier to say we’re not the U.S., we’re a universal health-care system, nobody’s being turned away at the hospital based on race or income. But we have to dive deeper and realize that there are very complex and multiple factors in how one accesses the health-care system, and more importantly, how one attains health.COVID has ripped back the curtain, but none of this data was surprising.”
“We can’t manage what we can’t see,” says Dr. Sacha Bhatia, the chief innovation officer at Women’s College Hospital, and its chief of cardiology. “And it’s been the same thing when you talk about testing for COVID, and deaths in long-term care, or in fighting other infectious diseases. The thing that always helped us was always knowing what we were fighting against, and this data is no different.”
“This pandemic is an infectious disease that whether it’s in the Black community, the homeless community, it still affects the rich,” says epidemiologist Dr. Nitin Mohan, who teaches public and global health at Western University, and who co-founded a public health consulting firm called ETIO.
“Without knowing, everyone is at risk: the well-to-do, business owners. To us, that was the tipping point. It wasn’t because oh, we need to help these people; it’s without this we can’t move forward economically.
“The people who have been asked to restart the economy are essential workers, and they’re the most vulnerable workers out there. And the economy isn’t benefiting everyone: it’s hurting those who are most vulnerable.”
“It absolutely matters to me,” says Philpott, “because the reality is that whether we were ready for it or not, if we don’t focus our attention on vulnerable populations, they will be the worst hit, and everybody suffers. So the data is one of the good ways to be able to focus on those issues: socio-economic data, race-based data, geographic data, in as granular a format as possible, is critical. And some of that is happening, but it is patchy.”
We’ll see how this latest kingdom is allowed to work. What governments do with better data will be a long-term question; better data to help fight the coronavirus was a shortterm necessity three months ago. It can’t be done immediately, but at least the work is starting.
“We will be in and out of this pandemic for at least the next two years,” says Philpott, “and while there’s some urgency for better systems to be built immediately, what gets built now has to get built properly, so that it will actually be functional.”
Dr. Philpott is in. She’s not in charge of everything, and maybe she should be. But she knows what we don’t know, and that’s something we need.