Health Professional’s Role in Health Equity

October 12, 2012

2012 CAPA Annual Conference

Dr. Anna Reid, MD, CCFP-EM

What is Health Equity

Health equity exists when all individuals have the opportunity to achieve their full health potential.

Equity is undermined when preventable and avoidable systematic conditions limit life choices.

What causes Inequity? Differences due not to biological factors but to differences in

social advantage

i.e., social and economic factors known as the social determinants of health

Social Determinants of Health

In 2002 researchers decided on the following list:

Aboriginal status Disability Early life Education Employment and working conditions Food insecurity Health services Gender Housing Income and income distribution Race Social exclusion Social safety net Unemployment and job security

Health Consequences ofHealth Inequity

Social gradient of health: Those with higher income experience greater health status.

The steeper the gradient, the lower the overall health of the population.

Those in the lowest income group are 50% less likely to see a specialist or get care in

evenings/weekends; 40% more likely to wait longer for a dr’s app’t; 3x less likely to fill prescriptions; 60% less able to get needed tests because of cost

Financial Cost of Health Inequity

Utilization of health services follows a reverse social gradient with those with the lowest incomes using more health services

Those living in the most disadvantaged neighborhoods experience almost 20 years less disability-free life than those in the highest income neighborhoods

What Needs to be Done?

WHO’s 4 categories for action on the social determinants: Reducing social stratification

Decreasing the exposure of individuals/populations to health-damaging factors

Reducing people’s vulnerability to health-damaging conditions

Intervening through health care to reduce the consequences of ill health caused by the underlying determinants.

Health Equity: CMA Actions to Date

CMA expert panel on health care sustainability 

CMA/CNA Principles to Guide Health Care Transformation

GC 2011 – Policy discussion paper.

CMA Actions (Cont’d)

This paper was developed and approved by the Board for consultation in December 2011

Provides background and 4 areas for action: CMA and National-level Initiatives Medical Education Leadership and Research Clinical Practice

Health Equity:Opportunities in Practice

In developing the policy it became clear that there was limited published evidence on clinical interventions

CMA staff interviewed physicians identified as experts in this area.

November 2011: pilot interview Feb - April 2012: 30 physicians in 8 provinces, 2 territories

were interviewed

Health Equity:Opportunities in Practice

Clinical settings were primarily family practice, but ER, pediatricians, psychiatrists and public health were also interviewed

Populations included rural and urban, inner city, Aboriginal, child and youth, mental health, women’s health and northern health

Many interventions identified could be done by various members of the health care team

Most Common Interventions Identified

1. Linking patients with supportive community programs and services

2. Asking questions about a patient’s social and economic circumstances

3. Integrating considerations of social and economic conditions into treatment planning e.g., cost of medications

Most Common Interventions Identified (Cont’d)

4. Advocating for changes to support improvements in the social and economic circumstances of the communitye.g., advocating for reductions in child poverty

5. Undertaking advocacy on behalf of individual patients e.g., letters about the need for safer housing

Most Common Interventions Identified (Cont’d)

6. Adopting equitable practice design e.g., flexible office hours, convenient practice location)

7. Providing practical support to patients to access the federal, provincial/territorial programs for which they qualify

Most Common Barriers

1. Payment models (100% fee-for-service in particular)

2. Attitudes that lead to stigmatized environments and prevent public action

3. Lack of clinically oriented information about programs and services available for patients

Most Common Barriers (Cont’d)

4. Lack of time to address these issues

5. Lack of integration between health and community-based services

6. Lack of knowledge and skills for this type of work

7. Practice design

Most Common Barriers (Cont’d)

8. Lack of services and supports in the community (especially in rural and remote communities)

9. Lack of evidence and research on effective interventions for health care providers

10.Personal attitudes that include powerlessness in the face of patients’ social and economic barriers

Most Common Facilitators Identified

1. Clinical training about how to do this type of work (e.g., service learning programs in medical school and residency training)

2. Interdisciplinary team-based practice settings

3. A relationship with community services and programs

Most Common Facilitators (Cont’d)

4. Clinically relevant resources about the programs and services that were available for patients

5. Supportive compensation models (i.e., salary, billing codes for complex patients)

6. Continued research that demonstrates efficacy in the clinical environment

7. Finding a like-minded community of practice

Possible Areas for Action

Advocacy and Communications

Develop a network of health equity physicians

Develop an advocacy strategy for health equity

Develop an advocacy map/tool for clinicians

Health equity leadership & advocacy training resources for physicians

Compensation Identify effective compensation models for health

equity practice in Canada

CMA and National Level Initiatives

Possible Areas for Action (Cont’d)

Education Further integration of the social determinants and health equity in medical schools and residency training

Develop an accredited continuing medical education programs for practising physicians

Research Continued research on physician interventions

Assemble evidence base and best practices and facilitate knowledge translation

Possible Areas for Action (Cont’d)

Clinical Practice

Health equity/social determinants of health assessment tool

Clinical practice guidelines to integrate social and economic factors into medical care

Resources for physicians on programs/services for patients

Resources for physicians on accessing provincial/territorial and federal programs

Plain language resources for patients on chronic disease management

General Council 2012

Health Equity a major theme at General Council in Yellowknife

There were an education session, a strategic session and a special lecture by Professor Sir Michael Marmot

Delegates were passionate and enthused about the topic

Next Steps

CMA staff are currently developing a work plan for health equity

CMA will be reaching out to other health care provider associations to identify areas for action within the health care sector

Next Steps (Cont’d)

The ultimate goal is to develop:

A policy position on the impact of various social and economic conditions on health

Advocacy efforts with the government, including the development of policy recommendations

Information for the public on how social and economic factors influence health

Tools for health providers to use in clinical practice