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ACCESS & EQUITY IN HEALTH: Canadian Perspectives

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Presentation on theme: "ACCESS & EQUITY IN HEALTH: Canadian Perspectives"— Presentation transcript:

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


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