Presentation on theme: "ACCESS & EQUITY IN HEALTH: Canadian Perspectives"— Presentation transcript:
1ACCESS & EQUITY IN HEALTH: Canadian Perspectives ENID COLLINSRN,MSN, MEd., Ed.DJDCF Health Forum. July 9 -11, 2014
2Goals of presentationDiscuss access & equity in health care within the framework of Canada Health ActIdentify some barriers to achieving equity in healthDiscuss some approaches to promote equity, undertaken by government, and citizen advocacy groups
3CANADA HEALTH ACT Federal legislation (1984) Framework for Health care Underlying Principles:Public AdministrationUniversalityComprehensivenessPortabilityAccessibilityCanadians generally express pride in their Health CareSystem, however there are challenges.
4What 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 CircumstancesThe 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.
5Social 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 healthRaphael, a health policy analyst who has researched and studied determinants of health for decades draws on the umbrella model.
6A 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
7Applying principles of SDH Health influenced by interrelated factorsIndividual : age, sex, geneticsLifestyle factorsSocial & community networksLiving & working conditions i.e., income education, employment, food, shelter, housingPolitical, economic,Canada’s universal health care system is designed to provide accessible and equitable health for all citizensBarriers to achieving this ideal arise from various circumstances among population groups.
8Barriers to access & equity Population groups :new immigrant groupsethno -culturalwomenracialized groupsCircumstances:low socio- economic statuspovertyhomelessnessFactors that create barriers and negatively impact health outcomes, overlap on many levelsFor 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
9CircumstancesPoverty affects health on many levels, much more than is recognizedResearch findings – Dr Dorman and colleagues Toronto, study found:Poverty is a major health problemAdults - decreased ability to achieve necessities essential for health, food, housingIncreased vulnerability to chronic diseasesIncreased mortality rates
10Effects of Poverty in Children Child poverty rising in Canada over past decadeLow birth weight infantsIncrease risk of chronic diseases, such as asthma , COPD, mental health problems, suicide , learning disabilitiesResearchers findings show that health outcomes improve with food and income supplementsChildren living in poverty, experience unhealthy environments, sub standard housing, exposure to dust, mites insects, even cockroaches thus increased insectbourne diseases. Decreased opportunity to participate in organized recreation and sports increased risk of exposure to negative influencessuch as crime or gang activity
11Number 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.
12HomelessnessEstimates of homelessness in Toronto 2013, --population growingTotal population 5,215, over 3000, living in shelters , over 4000 living on streetsHealth problems similar to those associated with poverty , plus others such as frost bites, trauma due to violenceDeterrent to accessing health care – no permanent address, unable to get health card
13Marginalized GroupsSpecific groups that are denied access to participate fully in Canadian lifeRecent 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.
14Barriers to access and equity in health Systemic forms of discrimination, based on race, gender, disabilityUnemployment and underemployment- many new immigrants unable practice skills/professions due to regulatory proceduresInability to access adequate income, housing,social & recreational resources
15Strategies to improve access & equity Collaborative approaches – governments health care agencies, professionals, community groupsHealth policy – changes to reflect changing demographics & diversityResearch – knowledge generation, inclusive government, academic, scientists - citizens voices,Determinants of health-Decreasing poverty – Evaluate & strengthen existing income supports i.e. child benefits, employment benefits,
16Strategies (cont’d)Housing - Policies & programs to end homelessness - decrease short tem solutions emphasize long term affordable housingInclusive team approach to housing – clinical social supports & mental healthEmployment – Policies that support healthy work environments, decrease racism & discriminationSupport to new Canadians to gain access to work in professions & trades
17Strategies (cont’d) Health Care Agencies Evaluate agency policy & procedures that create barriers e.g. bureaucracy, communication , physical plantInclusive service delivery models – recognize diverse client populations, - culturally sensitive approaches, language
18Strategies (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
19Citizen Advocacy: A Success Story Sickle Cell Association of Ontario (SCAO)Founded 32 years ago Lilly Johnson RN, 91 years pioneer & cofounderAssociation 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
20References1. “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.