Life expectancy is shorter in the north. People in the North West LHIN region have a life expectancy of 78.6 years, compared to 81.5 years in Ontario. With life expectancy, even a fraction of a year makes a big difference in overall population health. For the sake of comparison, the life expectancy in Ontario as a whole hasn’t been as low as 78.6 years since the period of 1995/1997.[27]

People in the North East LHIN region also have a markedly lower life expectancy than Ontario overall, of 79.0 years, or 2.5 years shorter than the Ontario average.

To gain a broader perspective on health system performance, we can look at potential years of life lost, a way of measuring premature death by estimating all the years of potential life that are lost when someone dies prematurely (in this case, prematurely is deemed to be before age 75). Here are a couple of examples of how potential years of life lost is calculated:

• If someone died at age 25 by suicide, that would be equivalent to 50 potential years of life lost
• If someone died at age 74 of heart disease, that would be equivalent to one potential year of life lost

Potential years of life lost includes sudden deaths from accidents, as well as deaths from disease and illness. This performance measure is, in part, associated with the quality of health care people receive since disease prevention and management efforts can reduce the prevalence of early deaths from conditions such as diabetes and heart disease. Public health and efforts outside the health system will also play a large role in preventing illness.[28]

The two northern LHIN regions have the highest rates of potential years of life lost from people dying prematurely in the province.[29]

The North West LHIN region has nearly double Ontario’s number of potential years of life lost due to avoidable deaths, at 6,023 years lost per 100,000 people over a two-year period, compared to 3,243 years per 100,000 people in Ontario.

The North East LHIN region also has considerably higher potential years of life lost due to avoidable deaths than Ontario, at 4,763 years per 100,000 people.

We can look further into the potential years of life lost by causes of death that are avoidable, and are, to some extent, associated with how well the health system performs.[30] These performance measures also show worse results in the north.

Suicide is the leading cause of death due to injury in the north of Ontario and nearly two-thirds (61%) of deaths by suicide in the region were among people aged 20–54.[31]  The suicide rate among First Nations youth is about five to six times higher than it is among youth in the general population.[32] We do not have Métis-specific data on suicide. The ongoing suicide crisis among youth is one example of the profound impact that has spanned generations as a result of discriminatory policies, such as residential schools.[33] Communities are increasingly calling attention to the current plight of the youth in their communities: A state of emergency was declared in the Attawapiskat First Nation on James Bay in 2016 due to the youth suicide crisis.[34]

Looking at the overall potential years of life lost due to suicide in the two northern LHIN regions compared to Ontario, in the North West LHIN region, the potential years of life lost due to suicide among men is nearly three times that of Ontario at 1,092 potential years of life lost per 100,000 people, compared to 379 for Ontario. Potential years of life lost due to suicide among women, while lower than that of men, are also more than three times that of Ontario at 459 potential years of life lost per 100,000 people, compared to 138 for Ontario.

In the North East LHIN region the potential years of life lost due to suicide among both men and women are also much higher than that of Ontario at 577 potential years of life lost per 100,000 men, compared to 379 for Ontario, and 252 potential years of life lost per 100,000 women, compared to 138 for Ontario.

The same pattern repeats itself for potential years of life lost from circulatory disease, such as coronary artery disease (heart attacks) and strokes, and respiratory disease (such as chronic obstructive pulmonary disease, known as COPD, and lung cancer). Rates in the North East and North West LHIN regions are substantially higher than the Ontario rates among both men and women.

We have seen that people in the two northern LHIN regions are more likely to die prematurely than people in Ontario overall. One of the reasons for these higher rates of premature deaths is likely the higher rates of smoking, which is associated with developing serious illnesses and dying prematurely.[35] We do not have data on the effects of second-hand smoke.

The smoking rate in both the North East and North West LHIN regions is higher than Ontario overall. In 2014, the self-reported smoking rate was 26.0% in the North East LHIN region and 22.9% in the North West LHIN region, compared to 17.3% in Ontario.

A report on risk factors among Métis in Ontario indicates that smoking rates are higher overall in the Métis population compared to non-Indigenous Ontarians – 40% of Ontario Métis men and 34% of Métis women reported smoking cigarettes daily or occasionally, and even higher among Métis living in the north, where the combined men’s and women’s smoking rate is at 43%.[36]

For other health risk factors results are mixed, when comparing the North East and North West LHIN regions to Ontario. For example, in the North East LHIN region inadequate fruit and vegetable intake is significantly worse than Ontario, whereas physical inactivity is slightly better. Obesity is significantly worse in the North West LHIN (but not in the North East LHIN region) than Ontario overall.[37]

Note that the Canadian Community Health Survey (the source for this data) does not include on-reserve populations, and would not capture the rates of smoking, fruit and vegetable intake or obesity among First Nations peoples living on reserves.

Having multiple chronic conditions is associated with increased disability and premature death, as well as a higher rate of doctor visits, use of prescription medications and likelihood of being hospitalized.[38]

In the North East and North West LHIN regions, a higher percentage of the population than in Ontario overall report having two or more chronic conditions, such as diabetes, anxiety, depression and heart disease.

In the North East LHIN region, 25.3% of people aged 12 and older report having two or more chronic conditions, similar to the 24.5% of people in the North West LHIN region, which is significantly higher than the Ontario rate of 19.7%.

First Nations and Métis people in Ontario are disproportionately likely to have a host of chronic diseases and conditions, and are at significantly greater risk of disease and illness.[39,40] Métis people do not have the same level of access to primary and specialist care in Ontario compared to non-Indigenous Ontarians, which affects their broader health and wellbeing, particularly those living in the north. [41]

People in the north are less likely than Ontarians as a whole to report having a family doctor, nurse practitioner or other regular health care provider – 89.2% of people in the North East LHIN region and 83.8% in the North West LHIN region, compared to 93.8% of people in Ontario.[42]

In the North West LHIN region, the percentage of people over age 16 who report being able to see their primary care provider on the same day or next day when they’re sick is nearly half the Ontario rate – 23.8% compared to 43.6% in Ontario.

In the North East LHIN region, 28.2% of people over age 16 report being able to see their primary care provider on the same day or next day when they’re sick. This result may reflect a combination of geography and convenience. If someone has to travel far to see their primary care provider, they might decide to go to a walk-in clinic instead, if that option is closer. Or it might take them more than a day to get there, if the primary care provider is far away.[43]

People in the northern LHIN regions are also less likely to report being able to see a specialist within 30 days than Ontarians overall. About 30% of people in the North East and North West LHIN regions reported being able to see a specialist within 30 days, in 2014/15, compared to about 40% for Ontario.[44] Many of the specialists in the two northern regions are located in larger cities, which means people often end up waiting longer to see them.[45]

Primary care is different in the north. Most providers are involved in the delivery of medical services outside of office-based clinical care. Given the limited specialty supports in northern communities, primary care providers offer more holistic care, ranging from pediatrics to geriatrics, and including women’s health, minor procedures, long-term care, hospital care and mental health care.

Patients in northern Ontario are also distinct in language, culture, and social practices, and often have a higher health-risk profile. Primary care providers in the north often practice without the support of teams that can help address the complex needs of patients. There is, however, a movement to address this gap, which builds on interprofessional collaboration to offer care in a model that respects the social and cultural determinants that drive health in the north.

In the North East and North West LHIN regions, community-governed primary care organizations prioritize serving the needs of populations that have traditionally faced barriers accessing the services they need. For example, six of Ontario’s 10 Aboriginal Health Access Centres are in the north. These community-led organizations provide a range of health services for First Nations communities in the north, both on- and off-reserve. The centres offer traditional healing, chronic disease prevention and management, maternal and child health care, addictions counselling, mental health care and other programs to improve the health of First Nations communities.[46] They reflect cultural and traditional practices as the core of health and health care for First Nations peoples. Additionally, the Misiway Community Health Centre in Timmins focuses on serving First Nations peoples, and some other Community Health Centres in the northern regions prioritize their needs.

The Métis Nation of Ontario provides a range of culturally based programming, health services and supports for Métis and other Indigenous people in the north, through service centres in Kenora, Fort Frances, Dryden, Atikokan, Geraldton, Thunder Bay, Timmins, Cochrane, Sudbury, and North Bay. Programs focus on prevention, health promotion, addressing the determinants of health, health and social system navigation, supporting Métis family well-being, providing assistance with housing, medical transportation, home-based supports and community wellness.

There are also seven Community Health Centres in the two northern LHIN regions, five of which deliver services in French. These centres provide primary care services, health promotion, social supports and non-clinical interventions that address the determinants of health.

Interprofessional care teams – in which professionals from two or more professions collaborate to provide care — in the North East and North West LHIN regions improve access for people in remote, rural and northern communities. These include nurse practitioner-led clinics and Family Health Teams.

The Ontario Telemedicine Network offers patients in Ontario’s north a way to avoid travelling long distances to reach specialists and other providers, many of whom are based in larger urban centres such as Thunder Bay, or even elsewhere in Ontario outside the northern LHIN regions.

Launched in 2014, the North East LHIN’s Virtual Critical Care program leverages Ontario Telemedicine Network software to manage care for critically ill patients at local hospitals. Using two-way videoconferencing technology and electronic medical records, the program can prevent patients from having to transfer out of their local hospital, allowing them to stay close to family and friends.[47]

The North West LHIN launched a similar program in 2015 called the Regional Critical Care Response, connecting 11 community emergency departments and intensive care units to critical-care trained doctors, nurses and respiratory therapists at the Thunder Bay Regional Health Sciences Centre.[48]

Ontario Telemedicine Network works with First Nations communities in the north to provide services for mental health and addictions, diabetes, primary care, oral surgery and oncology. The culturally competent services are managed and governed by First Nations in remote and fly-in communities.  

The Métis Nation of Ontario offers limited access to tele-mental health services for Métis and other Indigenous clients in the north (and also elsewhere in Ontario), who are experiencing difficulty in accessing required psychiatric services and other supports. A partnership with Queen’s University and Providence, this program is available in more than 30 communities across the province via the Ontario Telemedicine Network.

L’Accueil francophone de Thunder Bay, through project funding with Health Canada, developed a program of interpretation services through the Ontario Telemedicine Network. This service allows francophone patients in the North West region to receive professional service from an interpreter, through the Ontario Telemedicine Network during medical appointments. The goal is to improve access to health care services in French for francophones living in rural and isolated communities in the North West LHIN region. L’Accueil francophone recently received core funding from the Ontario Ministry of Health and Long-Term Care to continue offering this service on a wider scale.

There are several mobile health units travelling throughout the northern areas of Ontario. A mammography van, an eye exam van and other mobile units for diabetes check-ups and chronic obstructive pulmonary disease all seek to reach people in rural areas who do not have easy access to specialized health services. This type of service could be one of the reasons why the two northern LHIN regions have better rates of diabetes eye exams than the Ontario average.[49] An interprofessional primary care team with the Community Health Centers have developed mobile services to provide better access to primary care.[50]

The Northern Health Travel Grant program was implemented in recognition of the challenges of accessing health care services in northern Ontario. The program helps people living in the north cover travel-related expenses when they access medical specialist or health care facility-based procedures unavailable in their local communities within a radius of 100 kilometres.

The program helps cover travel-related expenses for one travel companion per patient. In addition, under the program, there is a provision that ensures financial travel assistance is provided for French-speaking patients to travel to French-speaking medical specialists in the event that they cannot express themselves in English.

For many in Ontario’s north, English is not their first language. In the North East LHIN region, more than one in five people identify as being francophone and may hesitate to get the care they need if they don’t think they’ll be able to access health services in French. The population of francophones in the North West LHIN region is smaller, but there is also much less access to services in French, so the situation holds true in the North West LHIN region as well. Although no substitute for linguistically appropriate services, technology can sometimes diminish the language barrier. A community organization that offers interpretation services for clients in the North West LHIN region, l’Accueil francophone de Thunder Bay, created a short-term solution to address the needs of the francophone population in their region. The Interpretation Guide for Heath Care Professionals provides French equivalents for medical terms and phrases commonly used in various medical contexts. Recently, a dynamic mobile application called MED INTERPRET was created to access the contents of the interpretation guide.

Other apps or services also offer language services for Indigenous peoples and recent immigrants. In the North West LHIN region, the Sioux Lookout Meno Ya Win Health Centre offers an interpreter program for the three main Anishinaabe languages.

The Priority Assistance to Transition Home (PATH) program in several communities, such as in the Temiskaming area (north of Sudbury and North Bay), is a good example of a program that helps patients over age 55 transition home smoothly after a hospital stay. The partnership between the Canadian Red Cross and the Temiskaming Home Support group arranges for a personal support worker to travel home with the patient after they are discharged. They settle them in by doing everyday tasks such as laundry and picking up medications and groceries.

Founded in 2005, the Northern Ontario School of Medicine (NOSM), recruits applicants from northern Ontario, who go on to practice in their home communities. About 150 NOSM-educated family doctors practice in the northern regions, caring for nearly 180,000 people. Read our story on NOSM below.