This article first appeared on Policy Options and is republished here under a Creative Commons licence.

In a world still reeling from the COVID-19 pandemic, Canada, like many peer nations, is facing a “polycrisis.”  

The historian Adam Tooze astutely describes a polycrisis as “economic and non-economic shocks entangled all the way down.” 

This helps capture what is currently unfolding in Canada at the intersection of end-of-life care, hospital crowding, rising health-care costs and climate change. Without a concerted effort to address this interconnection, resources will continue to be poured into each area without considering ways to harmonize efforts and deliver better services to more people. 

How are these issues, which appear to one degree or another unconnected, “entangled all the way down?”  

On average, more than 60 per cent of Canadians are hospitalized in their final year of life. At the same time, more than 80 per cent wish to receive end-of-life care at home. 

So why do terminally ill patients end up in hospital when most don’t want to be there?

In many instances, it is because hospitals remain the only realistic option. Just one in five terminally ill Canadians receive publicly funded palliative care in their final year of life and fewer than 10 per cent receive a home visit from a palliative care physician. 

Beyond the startling disconnect between what Canadians want and what our health systems offer, there are broad multi-sectoral implications.  

Health-care systems under pressure 

It can be easy to overlook that in the years leading up to COVID-19, hospitals’ capacity to handle their existing load already represented a central crunch point (e.g., hallway medicine).

Add to that the dramatic impact of the pandemic and the result is cascading crises from record wait times to backlogs and delayed surgeries, exams and procedures. 

Yet 17 per cent of all patients in acute care beds do not need to be there and are waiting for alternate levels of care. Add to that another stark statistic: 40 per cent of these patients are in the last 90 days of life. 

Many of them would prefer to be cared for at home in their final days if they could be provided with compassionate and comprehensive support. Unfortunately, the current approach to end-of-life planning often begins too late, leaving patients and caregivers with limited options, many of which either are unaffordable and/or add burdens to an already stressed system. 

Invisible impact on climate sustainability 

Health-care systems account for approximately five per cent of greenhouse gas emissions in Canada. To put that number in perspective, that’s more than the entire Canadian airline industry.  

Hospitals are resource-intensive environments where many more tests and procedures are performed compared with community clinics and other settings. This means more production of packaged, single-use tools and the need to dispose of them.  

Put together, this accounts for 60 per cent of all health-care emissions. Furthermore, hospitals are the third most energy-intensive commercial building type due to their high ventilation, heating and energy demands.  

Once a patient no longer requires acute care, the building and energy emissions produced by keeping them in a hospital are three times greater than if they were in a long-term care bed and significantly greater than if they were cared for at home. 

Naming the problem so it can be addressed 

The very idea of a polycrisis is contentious. Some argue it is merely new jargon describing what have been long-existing problems. (It doesn’t help that the term became a buzzword at the World Economic Forum — thus becoming a distracting irritant for many across the political spectrum.)  

But addressing intersecting issues through the lens of a “polycrisis” can be useful for building solutions that extend beyond existing silos.  

The issues are among Canadians’ biggest sources of concern. 

The Ipsos Global Trends 2023 Report found that 70 per cent of Canadians believed a climate disaster is imminent; wanted more control over decisions regarding their health; and expressed worry about governments’ ability to ensure continuing delivery of public services, especially in health care. 

Polysolutions needed 

The opportunity of a “quadruple win” is rare in public policy: In this case, that means an approach that provides optimal care for patients at end of life, supports the overall functioning of the health-care system, lowers costs and reduces environmental impact. 

Achieving this requires moving resources toward community options and providing comprehensive and easily accessible support for patients and their caregivers.  

End-of-life discussions need to happen early between patients and their families, and with the health-care professionals who know them best, so that when the time comes, the patient’s desire for care is followed.  

Getting there begins with a fundamental shift in thinking so that funding is directed in a way that recognizes that the need for often-intensive, acute care at the end of life is a symptom of a bigger problem which at first glance includes issues that appear unrelated, but in truth are “entangled all the way down.” 

Myles Sergeant is a family physician, assistant professor at McMaster University and executive director of the Canadian Coalition for Green Health Care.  Russell de Souza is an associate professor at McMaster University. He is a registered dietitian and nutritional epidemiologist. Areas of research include diet to prevent chronic disease throughout the lifespan. Fahad Razak is an internist at St. Michael’s Hospital and Canada Research Chair in Data-Informed Health Care Improvement at the University of Toronto. This article first appeared on Policy Options and is republished here under a Creative Commons license.