ACCESS & EQUITY IN HEALTH: Canadian Perspectives
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Transcript of 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