Jane Toller, warden of the MRC Pontiac, has recently made multiple references to a letter she received from the Centre intégré de santé et de services sociaux de l’Outaouais (CISSSO) that states that Pontiac has the worst health outcomes in Quebec.
The references were made during remarks explaining her opposition to the current location of the proposed radioactive dump site at Chalk River. While her specific concern related to cancer rates in the Pontiac, she also emphasized that non-cancer related health outcomes in the region are poor.
“I am deeply concerned that the Pontiac has this reputation with the CISSSO,” said Toller.
The letter signed by the president-director general of CISSSO Josée Fillion, which Toller provided to THE EQUITY, states that health outcomes like life expectancy at birth, adjusted rate of mortality, rate for cancers and rates diseases in the circulatory and respiratory systems are worse in the Pontiac compared to the rest of the province.
The letter was sent to Toller in 2019 as a part of her ongoing efforts to bring a water gym to the Pontiac.
According to the CISSSO, the statistics that were referenced in the letter come from data gathered before 2010.
The numbers show that certain health indicators are “significantly” worse in the Pontic RLS (Réseaux territoriaux et locaux de services) than they are in the rest of the province.
“For example, for the period from 2008 to 2012, the adjusted all-cause mortality rate is estimated at 933 per 100,000 people in the Pontiac RLS compared to 746 per 100,000 people for the rest of Quebec,” said Camille Brochu-Lafrance, information officer for the CISSSO. “The adjusted mortality rate for cardiovascular diseases is estimated at 313 per 100,000 people for the RLS compared to 188 per 100,000 for all of Quebec.”
Life expectancy in general is also lower in the Pontiac when compared to the rest of Quebec-being 78.3 years in the RLS Pontiac compared to 81 years in the entire province, according to Brochu-Lafrance.
Other health outcomes are worse in the Pontiac according to numbers from 2008-2012, however they are not statistically significant. “For example, the adjusted mortality rate for tumours is estimated at 276 per 100,000 people in the Pontiac RLS compared to 254 per 100,000 people for the whole of Quebec,” wrote Brochu-Lafrance. “The adjusted mortality rate for diseases of the respiratory system is estimated at 74 per 100,000 people compared to 70 per 100,000 people for all of Quebec.”
Given that much of the concern over Chalk River is driven by fears that the proximity of radioactive material could be a contributor to cancer rates in the area, THE EQUITY attempted to obtain local cancer rates relative to the rest of the province.
However, cancer rates are not available on a regional basis according to the CISSSO, despite the fact that the 2019 letter CISSSO letter sent to Toller said they were the worst in Quebec.
“Currently the INSPQ (Institut national de santé publique du Québec) does not have cancer incidence data for the Outaouais region,” said Brochu-Lafrance. “However, work is underway to make the incidence results available by region and by territory by the summer.”
There were 2,465 cancer cases in the entire Outaouais in 2017, according to the Statistiques du Registre québécois du cancer. This is the most recent and local number found by THE EQUITY.
“I am very concerned about the high rate of cancer in the Pontiac and I hope to discover what is behind it,” said Toller.
Doctors, whom THE EQUITY spoke with, stressed that more data is needed before judgements can be made about whether the Pontiac has relatively higher cancer rates, and if so, what’s causing it.
Health Statistics
As of now, there is some data which suggests reasons why the Pontiac has relatively worse health outcomes compared to the rest of the province. This data points to three problem areas.
The first is the lack of access to healthcare in the Pontiac.
Around 2500 patients in the Pontiac don’t have a doctor right now, which contributes to worsening health outcomes according to Dr. Ruth Vander Stelt, family doctor at the CLSC in Quyon.
“People without a family doctor, or a primary caregiver such as a nurse practitioner don’t make out as well,” said Vander Stelt. “They die earlier and they don’t have as good quality of life.”
According to a report titled Portrait des inégalités d’accès aux services de santé en Outaouais (Portrait of inequalities) published in November 2021 by the Institut de recherche et d’informations socioéconomiques, equipment and services offered in Outaouais hospitals tend to be concentrated in Gatineau at the expense of areas like the Pontiac.
“You need a higher ratio of doctors and nurses and you need them to be available to the population,” said Vander Stelt. “Some of our sickest patients – that is, cancer patients – have to spend time and money to get down to the city for their treatments. It’s just preposterous. It only makes people poorer and sicker when they have to travel a long way for care.”
“Even if you have a fairly good socio-economic status, just the fact that care is not accessible makes your life expectancy go down,” she said.
The second factor contributing to worsening health outcomes in the Pontiac is economic.
According to the Portrait of inequalities, Pontiac residents have the average lowest disposable incomes in the Outaouais at $23,879 compared to $27, 318 in the Outaouais as a whole and $29,924 in all of Quebec.
The report goes on to connect the fact that residents of the Pontiac are relatively poorer with the poor health outcomes seen in the region.
“Having less money means that individuals and families have less means to take care of themselves,” said Vander Stelt.
A third problem contributing to the situation in the Pontiac is cultural factors.
The Portrait of Inequalities states that the number of smokers in Pontiac is significantly higher than the Quebec average, and also that nearly two-thirds of the population is overweight. The report correlates this with higher-than-average rates of diabetes, high blood pressure and arthritis in the Pontiac.
To begin addressing some of these negative health outcomes, Vander Stelt suggests that governments need to invest more in communities.
“You need to put in place different social programs and health programs to help people improve their status,” said Vander Stelt.
Two examples of these services she referenced are in STI prevention programs run out of CLSCs and affordable products offered by Maison de la Famille in Quyon. Both of these are initiatives that provide more affordable ways for people to live and preserve their health, according to Vander Stelt.
She also underlined the need for more healthcare professionals and said the main way to do this is to ensure that the pay and working conditions of healthcare professionals improves.
“We need to have a premium for Pontiac healthcare workers,” said Vander Stelt. “We will keep them here if we pay them properly.”
She also said that it is important to reduce the ratio of patients per healthcare worker, as that would not only significantly improve the working conditions of healthcare workers but also allow them to provide patients with a greater quality of care.
Vander Stelt concluded saying that the government needs to encourage more physicians to go into family medicine, because as of now, the high workload and lack of support given to family doctors persuades many medical students to go into other specializations.
Both the Portrait of inequalities and Vander Stelt also said that the decentralization of CISSSO would help address the lack of access to care, as it would enable smaller health units to have greater influence on distributing healthcare resources.
As of now, two new doctors have arrived or are arriving in the Pontiac this month.
Though how big of a dent this will put into reducing the 2,500 “orphaned” patients without a doctor is yet to be seen.
Brett Thoms
Pontiac May 6, 2022
