Opinion | Canada’s most overlooked health-care inequity is access to a simple breathing test

In the middle of a northern Ontario winter, people in the remote rural communities of Chapleau and White River braved snow and icy highways to breathe into a tube.

That tube is a spirometer, and what it measures can change the course of a life. A patient takes a deep breath and exhales as hard and for as long as they can while the device calculates how much air the lungs hold and how quickly they empty. It takes minutes. It is painless. And it is the test needed to confirm chronic obstructive pulmonary disease, or COPD—the second-leading cause of hospitalization in Canada, with almost 77,000 hospital stays in 2024, each averaging more than a week.

With an average price tag of $8,202 per hospital stay, COPD-related hospitalizations are estimated to result in ward care costs of more than $600-million. Canadians with COPD die at more than twice the rate of those without it.

Over three weeks, working with a registered respiratory therapist, Lung Health Foundation brought spirometry to both towns as part of its Mobile Spirometry Pilot Program. It tested 61 people, including those who identified as Indigenous and Black, with almost half tested meeting the threshold of ongoing lung abnormality. More than seven in 10 who booked an appointment showed up. That is not the behaviour of people indifferent to their health, but the behaviour of people who have been waiting for someone to come.

If you ask me what inequities exist in Canada’s health-care system, I would start there. Whether you receive a timely diagnosis for one of this country’s most common chronic diseases depends heavily on where you live, what you earn, and how well you can access care providers.

Consider the scale. Nearly 2.4 million—roughly one in 10—Canadians aged 35 and older live with diagnosed COPD. That’s only the people we have found. COPD is progressive, and lost lung function does not come back. Early diagnosis exists to slow decline before it ends in an emergency department. Yet, in Canada, spirometry is often not done until the disease is well advanced. Testing dropped sharply during the pandemic and never fully recovered, especially in the offices of family doctors, where early detection should happen.

For a patient in downtown Vancouver, Toronto, or Calgary, a referral to a specialist is an inconvenience. But for someone in a small northern Canadian town like Inuvik, it can mean hours of driving, a lost day of pay and a winter highway. Many never get tested at all.

Today, the Lung Health Foundation published the Canadian COPD Performance Index, the first of its kind, and it shows how uneven the picture is. About 17 per cent of Canadians have no regular primary care provider; in Prince Edward Island, that number is four in 10. Nunavut has the highest COPD prevalence, more than double the national rate, along with the highest hospitalization rate and the fewest respiratory therapists. Pulmonary rehabilitation is concentrated in cities, with major gaps across the North. Indigenous Peoples carry a disproportionate share of COPD, and of the barriers to care, yet COPD-specific, culturally safe care pathways are almost nowhere to be found. Lower-income Canadians face greater risk of poor outcomes.

Just as telling is what we cannot measure. There is no public data on access to spirometry, or on how long people wait for it, anywhere in Canada. We cannot say how many Indigenous, racialized, rural, or low-income Canadians are living with undiagnosed COPD because no one is systematically counting. A health-care system cannot close a gap it refuses to see.

The fixes are not mysterious.

Treat spirometry as a core part of primary care with equipment and trained professionals to deliver it.

Fund outreach that brings testing to people, including mobile clinics, telehealth, and virtual pulmonary rehabilitation.

Build Indigenous-led, culturally safe COPD care pathways designed with communities rather than for them.

Collect and publish equity-focused data on access, wait times and outcomes, so resources follow need.

Finally, commit to a national COPD strategy. A framework was proposed in 2008, and nearly two decades later, we are still waiting.

Canada ranks 17^th out of 45 countries on the Global COPD Index, despite having a publicly funded health-care system that should place us near the top. In Chapleau and White River, Ont., people braved winter roads for a minutes-long test. When access arrived, people came.

Somkene Igboanugo, MD, MSc, PhD, is director of programs and persons-centered care at the Lung Health Foundation.