access & equity in health: canadian perspectives

ACCESS & EQUITY IN HEALTH: Canadian Perspectives

ENID COLLINSRN,MSN, MEd., Ed.D

JDCF Health Forum. July 9 -11, 2014

Goals of presentation

Discuss access & equity in health care within the framework of Canada Health Act

Identify some barriers to achieving equity in health

Discuss some approaches to promote equity, undertaken by government, and citizen advocacy groups

CANADA HEALTH ACT

Federal legislation (1984) Framework for Health care

Underlying Principles: Public Administration Universality ComprehensivenessPortabilityAccessibility

Canadians generally express pride in their Health CareSystem, however there are challenges.

What does access and equity mean?

“All residents in Ontario have the right to high quality, accessible and comprehensive health services, regardless of age, gender, level of functional ability, language, ethno-cultural origin or geographical location.... Accessibility should be understood to include psychological, social and economic aspects”.

Ref: Panel on Health goals for Ontario cited in

Certain Circumstances

Social Determinants of Health

According to the World Health Organization

“ Social determinants of health are the conditions in which people are born, grow live, work and age. These circumstances are shaped by the distribution of money, power and resources at global national and local levels”.

A Model of the Determinants of Health

Source: Dahlgren, G. and Whitehead, M. (1991). Policies and Strategies to Promote Social Equity in Health.Stockholm: Institute for Futures Studies. Cited in Mikkonen &Raphel p.9

Applying principles of SDH

Health influenced by interrelated factorsIndividual : age, sex, genetics Lifestyle factors Social & community networksLiving & working conditions i.e., income

education, employment, food, shelter, housingPolitical, economic,

Barriers to access & equity

Population groups : new immigrant groups ethno -cultural women racialized groups

Circumstances: low socio- economic status poverty homelessness

Circumstances

Poverty affects health on many levels, much more than is recognized

Research findings – Dr Dorman and colleagues Toronto, study found:

Poverty is a major health problem Adults - decreased ability to achieve

necessities essential for health, food, housingIncreased vulnerability to chronic diseases Increased mortality rates

Effects of Poverty in Children

Child poverty rising in Canada over past decade

Low birth weight infantsIncrease risk of chronic diseases, such as

asthma , COPD, mental health problems, suicide , learning disabilities

Researchers findings show that health outcomes improve with food and income supplements

Number of People Assisted by Food Banks in Canada,1989-2009(March of each Year, in Thousands)

Source: Food Banks Canada. (2009). Hungercount 2009. Toronto: Food Banks Canada.

Homelessness

Estimates of homelessness in Toronto 2013, --population growing

Total population 5,215, over 3000, living in shelters , over 4000 living on streets

Health problems similar to those associated with poverty , plus others such as frost bites, trauma due to violence

Deterrent to accessing health care – no permanent address, unable to get health card

Marginalized Groups

Specific groups that are denied access to participate fully in Canadian life

Recent immigrants, Canadians of Colour, First nations people, some women, people

with disabilities, racialized groupsThese groups have are powerless & have

little ability to influence decisions that affect their life and health.

Barriers to access and equity in health

Systemic forms of discrimination, based on race, gender, disability

Unemployment and underemployment- many new immigrants unable practice skills/professions due to regulatory procedures

Inability to access adequate income, housing, social & recreational resources

Strategies to improve access & equity

Collaborative approaches – governments health care agencies, professionals, community groups

Health policy – changes to reflect changing demographics & diversity

Research – knowledge generation, inclusive government, academic, scientists - citizens voices,

Determinants of health -Decreasing poverty – Evaluate & strengthen

existing income supports i.e. child benefits, employment benefits,

Strategies (cont’d)

Housing - Policies & programs to end homelessness - decrease short tem solutions emphasize long term affordable housing

Inclusive team approach to housing – clinical social supports & mental health

Employment – Policies that support healthy work environments, decrease racism & discrimination

Support to new Canadians to gain access to work in professions & trades

Strategies (cont’d)

Health Care Agencies Evaluate agency policy & procedures that

create barriers e.g. bureaucracy, communication , physical plant

Inclusive service delivery models – recognize diverse client populations, - culturally sensitive approaches, language

Strategies (cont’d)

Building strong communities: - Community Health Centres (CHCs),

strengthen funding & resources, multidisciplinary teams, staff that reflect populations served

- Citizen advocacy & leadership - Faith Based group

Citizen Advocacy: A Success Story

Sickle Cell Association of Ontario (SCAO)Founded 32 years ago Lilly Johnson RN, 91 years

pioneer & cofounder Association has worked tirelessly to get SCD on

health agenda in CanadaStrides in research, treatment, screening, education

are now possible through years of advocacy.Most recent achievement – Education of Health

Professionals: Humber college commits to including content on SCD in health sciences curricula. Credit for spearheading initiative goes to Tiney Beckles, professor

References

1. “Certain Circumstances”: Issues in Equity and responsiveness to Health Care in Canada.

www. hc-sc.gc.ca2. Social Determinants of Health: the Canadian

Facts/Juha Mikkonen and Dennis Raphael. www.nsgamingfoundation.org/.../Report/Social Determinants of Health

3.The Blue print to end Homelessness in Toronto. www.wellesleyinstitute.com/...-blueprint

4. Why Poverty is a Medical Problem. R. Dorman, R. Pellizzari, M.Rachilis,S.Green.

www.oma.org/resources/document