ACCESS & EQUITY IN HEALTH: Canadian Perspectives

1. ACCESS & EQUITY IN HEALTH: Canadian Perspectives ENID COLLINS RN,MSN, MEd., Ed.D JDCF Health Forum. July 9 -11, 2014

2. 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

3. CANADA HEALTH ACT • Federal legislation (1984) Framework for Health care Underlying Principles: • Public Administration • Universality • Comprehensiveness • Portability • Accessibility Canadians generally express pride in their Health Care System, however there are challenges.

4. Whatdoes 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

5. 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”.

6. 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

7. Applying principles of SDH Health influenced by interrelated factors • Individual : age, sex, genetics • Lifestyle factors • Social & community networks • Living & working conditions i.e., income education, employment, food, shelter, housing • Political, economic,

8. Barriers to access & equity Population groups : • new immigrant groups • ethno -cultural • women • racialized groups Circumstances: • low socio- economic status • poverty • homelessness

9. 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, housing • Increased vulnerability to chronic diseases • Increased mortality rates

10. Effects of Poverty in Children • Child poverty rising in Canada over past decade • Low birth weight infants • Increase 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

11. 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.

12. 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

13. 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 groups • These groups have are powerless & have little ability to influence decisions that affect their life and health.

14. 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

15. 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,

16. 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

17. 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

18. 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

19. 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 Canada • Strides 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

20. References 1. “Certain Circumstances”: Issues in Equity and responsiveness to Health Care in Canada. www. hc-sc.gc.ca 2. Social Determinants of Health: the Canadian Facts/JuhaMikkonen 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