BY STEWART G. DICKSON & ARUN K. GARG
SURREY is at once at a confluence of rivers and cultures; a distillation of Canada’s multicultural mosaic. It was fitting then that CINI 2018 – the Canada India Network Initiative’s signature conference –was held in the “city of the future”: a jewel of multiculturalism, home to technology start-ups and prestigious institutions of higher education.
CINI 2018 was geared to the future: it was not merely an effort to link leaders in healthcare practice, technology and theory from Canada and India, but a concerted effort to create a collaborative exchange whereby Indian and Canadian healthcare leaders can learn and influence each other to improve the health of the populations they serve. Both India and Canada share many similarities and have much to offer each other in the pursuit of creating health systems that are patient-centred, holistic, equitable and sustainable. Both nations enjoy freedom of religion, are multicultural, have multiple official languages, share a similar colonial history, and grapple with issues of scale: Canada, geographically as the second largest nation on Earth and India demographically being the world’s second most populous nation. These shared attributes position India and Canada as excellent partners for an exchange of ideas and practice as each also has unique strengths to offer the other. Both nations acknowledge the need to develop leaders that can shape the healthcare systems of the future.
India, for instance, has fully embraced aspects of integrative medicine, creating the Ministry of AYUSH dedicated to the optimal development and spread of naturopathic healing practices such as yoga, meditation and ayurvedic healings. Similarly, India has managed to strike a balance between offering high quality healthcare at a fraction of the costs of other developed nations – even when wages are adjusted — and has leveraged technology to increase access to healthcare in rural locations and save costs. Canada, meanwhile, devotes an average $6640 per patient on healthcare costs with almost 20% in government general expenditure spent on healthcare. Canada offers India a model for robust universal public healthcare and is a leader in allopathic and acute medicine, which has resulted in Canada being ranked as the 17thhealthiest country in the world on Bloomberg’s 2017 World Health Index compared to India’s 154. Canada’s schools of nursing in particular offer India a model for improvement, as Canada has almost 10 highly qualified and specialized nurses per 1000 people while India but two nurses or midwifes to per 1000, many of whom suffer from low wages, unsafe working conditions and poor training.
Increasingly the social determinants of health are penetrating the consciousness of the Canadian healthcare system that has often been preoccupied with traditional, clinician directed care. As noted at CINI 2018, some physicians opined about the futility of healing someone only to send them right back to the conditions that made them unwell in the first place. Integrative medicine puts the patient at the centre: services are meant to address a patient’s physical, emotional, mental, social and spiritual illnesses. Integrative medicine requires collaboration and leadership of an entire health system. As a guide to developing collaborative leadership, Canada’s LEADS framework—defining the qualities of leadership needed to create reform—was of significant interest to Indian participants. The LEADS framework has built in contextual links to Indian leadership values despite being developed in Canada. The principles of quality, professionalism, and ethics through leadership are critical to India’s continued development; and CINI 2018 proved that the LEADS framework can be easily attuned to the Indian system.
CINI 2018 stands as an example of both the need for and power of integration: how collaboration and the exchange of strengths can lead to cost-effective and comprehensive healthcare, both in Canada and India. Integrative health combines conventional, traditional and holistic approach to health promotion, illness prevention and disease management. This is critical to lowering the burden of the chronic disease tsunami and bringing innovation in community based care. Patients must manage their care better; providers must be pro-active in creating patient-centred service delivery models; and healthcare leaders must lead rather than follow in shaping the systems of the future.