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. 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
The above quote best explain the comprehensivenature of concepts (equity the right to high quality accessible and comprehensive heallth services...)
The same discussion goes on to say that Equity means fair and just distribution of resources. Not everyone gets the same, by resources are provided on the basis of need.

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”.
Canada’s health Systems subscribe to determinants of health. Many models to depict interrelationships of social determinants of health
Raphael, a health policy analyst who has researched and studied determinants of health for decades draws on the umbrella model.

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,
Canada’s universal health care system is designed to provide accessible and equitable health for all citizens
Barriers to achieving this ideal arise from various circumstances among population groups.

8. Barriers to access & equity
Population groups :
new immigrant groups
ethno -cultural
women
racialized groups
Circumstances:
low socio- economic status
poverty
homelessness
Factors that create barriers and negatively impact health outcomes, overlap on many levels
For Example, First nations people liked to be underserved b many live in rural areas, fewer health care services & personnel, high unemployment.
High rates of diseases such as diabetes, alcoholism, high infant mortality , high suicide rates.
New immigrant groups likely to be unemployed or under employed resulting in lower standards of living, housing , food.
Language and cultural factors as well diminished social networks

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
Children living in poverty, experience unhealthy environments, sub standard housing, exposure to dust, mites insects, even cockroaches thus increased insect
bourne diseases. Decreased opportunity to participate in organized recreation and sports increased risk of exposure to negative influencessuch as crime or gang activity

11. Number of People Assisted by Food Banks in Canada, 1989-2009 (March of each Year, in Thousands)
Source: Food Banks Canada. (2009). Hungercount 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/Juha Mikkonen and Dennis Raphael. Determinants of Health 3.The Blue print to end Homelessness in Toronto Why Poverty is a Medical Problem. R. Dorman, R. Pellizzari, M.Rachilis,S.Green.