When it comes to access to health care, northern Canada faces some challenges shared by rural or remote communities: low population density means travelling long distances to point of care, geographic isolation present barriers to supplying facilities, recruiting and retaining talent. 

Recently, a doctor friend pointed out an article that points to a nation-wide problem: the death of family medicine. Our current health care system relies on a system where a network of family doctors first see a patient and then makes the medical call on whether to refer the patient to specialists. According to Dr. Warsh’s article, this system relies on at least a 50:50 ratio of family doctors to specialists. The sad trend is that interest in studying and eventually practicing family medicine is at an all-time low. There is and will be even more of a shortage of family doctors as practicing doctors reach retirement. The impact of declining numbers of practicing family physicians will be felt especially for northern communities far from large medical centers and specialists. And that’s on top of the challenge of recruiting talent to remote communities in the first place. 

A second difficulty is getting equal health access is perhaps less obvious. In northern communities where minority ethnic populations are concentrated, access to services (necessity of relocation to larger centers aside) such as transplantation or the emerging advances of personalized medicine is more limited. Bone marrow, stem cells, and organ donors are predominately of European ancestry. This presents a problem because biological matching, which is essential for transplantation success, depends highly on the ethnic background of the donor and recipient. This means that the low representation of ethnic minorities in donors directly relate to a lower proportion of people from these groups who can benefit from treatment.  In recent years, donor participation from Asians, Hispanics, and Africans have seen an increase, but participation from Aboriginals has remained low.

As technology around personalized medicine become cheaper and more common, disease diagnosis and treatment may become more accurate and specific than ever before. However, the benefit to ethnic minority groups is currently limited because many of these treatments relies on comparing individual genomic data to databases in which ethnic minorities are underrepresented. The reasons for underrepresentation are many, but in the Indigenous population, a added factor is an understandable mistrust of outside authority, given the generational trauma inflicted by a history of colonization. 

One potential solution is education. Training locals to take on leadership positions in science and medicine may simultaneous address the problem of declining numbers of primary care practitioners and help rebuild trust to enable their participation and benefit from the newest medical advances. However, without trust, even education and establishing local leadership may be challenging. Aboriginal leadership must come from within these communities. Perhaps what we as outsiders can do is work on re-establishing trust: to approach these people as equals, not authorities.

Further Reading:

  • Warsh, F. The Death of Family Medicine. (link
  • Indigenous People and Genomics: Starting a Conversation. (link)