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Former Canadian Health Minister Jane Philpott discussed obstacles for reform to the United States and Canadian health care systems during a Monday talk at the Harvard School of Public Health.

The discussion, moderated by HSPH professor Margaret E. Kruk, centered on differences between the two countries’ health care systems in structure and philosophy.

“The only country that looks worse than Canada is the U.S.,” Philpott said. “We both need to take a really hard look at how we do things, how we’ve established our structures, where we’re spending our money, where we’re prioritizing decisions, and look to other countries that are doing better.”

The talk was also offered in a webinar format, during which event organizers provided supplementary statistics in the chat.

According to one such statistic, both countries lag in health equity and outcomes behind other members of the Organization for Economic Co-operation and Development, an intergovernmental economic body. This disparity only grew during the Covid-19 pandemic: In 2020, physicians provided almost 8 percent fewer health care services in Canada compared with the previous year, according to the Canadian Institute for Health Information.

Philpott, director of the School of Medicine at Queen’s University, said the U.S. remains a global leader in health research.

“The whole world looks to the U.S. for that kind of investment in science and benefits,” Philpott said.

Despite a large quantity of research, both countries lack investment implementation and have been slow to action, she added, even as Canadian health care is free at the point of delivery for citizens.

“Everyone has access to health insurance for what's deemed ‘medically necessary care,’” Philpott said of Canada’s system. “Which sounds really fabulous until you get into the underneath of that and realize that, actually, that definition of medically necessary care is pretty narrow.”

Philpott raised concerns about a lack of access to physicians in Canada, citing staffing shortages in medical facilities around the country. In data that Philpott cited, about 22 percent of adults in Canada do not have a family doctor, a primary care nurse practitioner or any other front door to the county’s health care system.

To combat this shortage, Canada has implemented a program reserving a subset of seats in Canada’s medical schools for those seeking to practice family medicine to expand the number of residents in that field.

Only about 40 percent of Canadians reported easy access to primary care after hours, according to polling from the Commonwealth Fund. Per Ipsos, the percentage of Canadians rating the quality of their health care as “good” has fallen 12 percentage points since 2020.

Kruk then asked Philpott who should bear responsibility for national health, pointing to countries like Norway, where the right to health care is codified into federal law.

“We don’t have the kind of accountability built into our systems in ways that we see in European countries,” Philpott said, noting that much authority over public health decision making is delegated to Canada’s provinces, rather than the national government.

Philpott, who also served as Canada’s minister of Indigenous services, said Canada’s First Peoples often face poor health outcomes due to a systemic denial of rights.

“The path forward on this is a hard one and we’ve only just begun in Canada to do the work that’s necessary to both recognize, respect, and implement the rights of Indigenous peoples,” Philpott said.

Philpott stressed that good health care requires efforts by scholars and professionals across a wide variety of fields.

“Care should not be delivered just by doctors. It needs to be delivered by a whole range of disciplines,” Philpott said. “Care happens in communities, not in hospitals, and if we don’t do care in communities well, then people do end up in hospitals.”