The provincial government has announced plans to build a new hospital in the Cowichan Valley. The current facility, which opened in 1967, is vastly overcrowded and, for structural reasons, cannot be expanded.
With the local population having doubled in recent years, the project makes sense. Few details have so far been provided, but it’s expected the new hospital will be roughly three times the size of the existing facility. Completion is timed for 2024.
But here some difficult questions arise. The well-being of any community is determined by social and economic factors that affect the health of its residents. By most measures, the catchment area around the new hospital has some of the worst scores in the province.
The number of children in care is three times the provincial average. Illicit-drug use is high. Large numbers of people are admitted to hospital for alcohol-related conditions.
The teenage pregnancy rate is triple the level in Greater Victoria. The percentage of young children who receive dental surgery to remove rotting teeth is double the provincial average. That’s of particular concern, because these operations are conducted under full anesthetic.
In a recent survey throughout the region, more than half of the women who should be getting regular pap smears and mammograms reported they did not. There are serious air-quality problems in the valley, because many residents burn wood for heating. That leads to large numbers of hospital admissions for respiratory diseases.
There is one additional problem. Normally, high income levels are an indicator of better health. And indeed, median family incomes in the Cowichan region are higher than in Greater Victoria.
However, the reason is that there are two very affluent neighbourhoods, around the shores of Cowichan Lake and in Arbutus Ridge. Their high income and employment levels help boost the region’s profile.
But Cowichan also has numerous pockets of serious poverty. And that is the problem. In societies with large gaps between the richest and poorest, public health usually suffers. In Cowichan, the gaps are enormous.
The question is how building a new hospital, as much as it might be needed, will address these challenges. One important aspect will be to engage the region’s Indigenous community.
There are eight First Nations in the catchment area, including the Cowichan Tribes, which is the largest First Nation in the province. It is essential that the new facility deliver culturally sensitive care, and that can only happen if Indigenous leaders are involved in its planning.
But it is also vital that hospital managers and care providers are aware of this need, and form a bond of trust with the community. That trust has not always been present.
Even so, hospitals are supposed to be a last resort when dealing with illness. The new facility will soon be as overcrowded as the old, unless preventive steps are taken to improve the health of the surrounding region.
Poverty is the overriding issue, and the most difficult to tackle. The place to start is with school-age children. High-school graduation rates are low in the region. That has to change. And more apprenticeship training is a necessity.
Again, the high rate of teenage pregnancies means many young women end up struggling to make ends meet. Some are too young or inexperienced to fully understand the demands of motherhood.
Beyond that, far more outreach is needed. That means developing greatly increased ambulatory services for patients with chronic ailments such as diabetes or respiratory problems.
It means helping children and teens achieve strong mental, emotional and physical wellness, and empowering them in the choices they make.
It also means employing more public-health nurses who can assist with maternal care, offer counselling and advise on child nutrition.
But how much effort and money will be devoted to facing these challenges is by no means clear. True, the new facility is still in the early planning stages. There is certainly time to ensure the design of the hospital supports outreach services by incorporating clinic space for that purpose.
But hospitals have a way of consuming every dollar in sight. Three new hospitals have already been built on Vancouver Island in recent years — at Comox, Campbell River and the new Patient Care Centre at Royal Jubilee in Victoria. Added to the cost of the Cowichan project, that comes to well over $1 billion.
A fraction of that amount spent on community-based services would go a long way to improving the quality of health in the Cowichan Valley. But will it be spent?
Two years ago, the province’s medical health officer, Dr. Perry Kendall, declared a public-health emergency to draw attention to the developing fentanyl crisis. Kendall’s aim was to gain a higher priority for efforts to combat the epidemic.
It might be time to consider a similar strategy in Cowichan. Clearly, there is a community health crisis in the region — indeed throughout the Alberni-Cowichan-Nanaimo corridor.
It is long past time to recognize this for what it is — a public-health emergency.
