The gap in mortality rates between people living in Ontario's vast north and those in the rest of the province widened significantly over two decades, according to a new report that makes plain how difficult it is to access everything from a doctor to fresh food in the province's northern hinterland.
The study found that Northern Ontario residents have shorter life spans than their counterparts in the south – they can expect to live between 2.5 and 2.9 years fewer, depending on where in the north they reside.
Northerners have a much harder time seeing a physician right away when they are ill. They are also likelier to smoke, and to die early of heart attacks, strokes, respiratory diseases and suicide.
The reality may be even worse than the bleak picture painted in the report, released on Tuesday by Health Quality Ontario, an agency that advises the province on how to improve the health-care system. That's because some of the report's data were drawn from Statistics Canada's Canadian Community Health Survey, which excludes Indigenous people living on reserves.
The figures on mortality rates, however, cover everyone in the province.
The study found that although overall mortality rates have fallen in Ontario, the relative gap between the north and the provincewide average increased from between 12 per cent to 17 per cent in 1992 to 30 per cent in 2012, the most recent year for which figures were available.
It is difficult to tease out how much of the disparity can be pinned on shortcomings in the health-care system, as opposed to underlying causes such as poverty and lifestyle choices.
"Probably a lot of [the mortality gap] has to do with these broader social determinants of health," said Joshua Tepper, the president of Health Quality Ontario. "When you look at smoking rates, when you look at obesity rates, when you look at access to healthy food and food security, these are some of the core issues."
The report looked at health data for the North West and North East Local Health Integration Networks, a pair of districts that cover more than 860,000 square kilometres or about 80 per cent of the province's land mass.
Larger than France and Britain combined, the two LHINs are home to about 800,000 people. That's less than one person per square kilometre. Toronto, by contrast, is home to more than 4,100 people per square kilometre.
Caring for so few people scattered across a large territory has inherent challenges, something Pierre Michel experienced first-hand before undergoing a double-lung transplant in 2009 that cured his severe emphysema.
Mr. Michel, now 72, lived in Nakina, a village of approximately 500 people and a four-hour drive northeast of Thunder Bay, until his deteriorating health prompted him to move his mobile home to Thunder Bay for better care.
In Nakina, Mr. Michel said, "there was only one nurse. You had to travel for everything." Routine blood tests required a drive to Geraldton, 60 kilometres away.
When Mr. Michel nabbed a spot on the transplant waiting list, he and his wife, Suzanne, had to move to Toronto for four-and-a-half months to await the organs. They stayed on for another four months while Mr. Michel recovered.
"I figure it cost me between $70,000 and $80,000," he said, explaining he had to sell his Florida trailer and raid his savings to cover the cost.
Ontario's north has further challenges in that so many of its residents are aboriginal, Métis or Francophone, populations that tend to struggle with poverty and language barriers.
Mae Katt, a Thunder Bay nurse practitioner and member of the Temagami First Nation, has observed how the health – particularly the mental health – of those living on isolated northern reserves has declined in the past couple of decades.
"I think things are getting worse just because the completions of suicides are among younger children. They're 10 or 12 years old," she said. "There are certainly more feelings of desperation and more feelings of being neglected by the broader Canadian population. Because of geography, they are so far removed from the mainstream that they seem to feel forgotten."
France Gélinas, the NDP's health critic and an MPP for the northern riding of Nickel Belt, said part of the blame for health-quality gaps between the north and south lies with the Liberal government's move to concentrate health services and surgeries in "centres of excellence" in big cities in the south.
"They have made those gains down south at the expense of us in Northern Ontario losing the little wee bit of access we had," she said.
Ontario Health Minister Eric Hoskins was not available for an interview, but his office said by e-mail that it is working to improve health care in the province's north by supporting Aboriginal Health Access Centres, beefing up telemedicine and mobile health programs and launching a new cardiovascular program at Thunder Bay Regional Health Sciences Centre.