1. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SOCIAL WORK IN CANADA An Introduction Third Edition Chapter 9: Social Work and the Health of Canadians

2. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Social Work & the Health of Canadians  Health and Inequality  History of Health Policy  Medicare Under the Microscope  Canada’s Health Care Spending  Universal Public or Privatized Health Care?  Community Health Centres  Medical Social Work Practice  Mental Health and Social Work  Social Work and HIV/AIDS  Addictions and Social Work  Aboriginal Health

3. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Health and Inequality  Health Gap – Growing divide between rich and poor in terms of health and well-being, despite universal public health care  Only 47% of low-income Canadians rate their health as excellent  73% of high-income Canadians rate their health as excellent

4. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. History of Health Policy  Universal public health care in Canada took time to evolve  First Canadian medical school founded in 1824  First health directive dealt with the quarantine of immigrants infected with cholera  British North America Act, 1867, established jurisdiction of federal and provincial governments in delivering health services

5. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. History of Health Policy  From 1880 to the 1950s there were a variety of pre-payment health plans  By 1934, there were 27 hospital-sponsored pre- payment plans in 6 provinces

6. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. History of Health Policy

7. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. History of Health Policy Federal Involvement  1942: Heagerty Report proposed federally funded, two-stage health insurance scheme  1945: Royal Commission on Dominion Provincial Relations produced series of proposals, which included health care  1957: Hospital Insurance and Diagnostic Services Act passed  Under the Act, the federal government agreed to finance 50% of the cost of provincial hospital care

8. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. History of Health Policy Medical Care Act, 1968  1964: Hall Report disclosed that 7.5 million Canadians did not have medical coverage  Recommended that a publicly administered universal health service plan be implemented  Report received massive grassroots support  Medical Care Act was passed in 1968  Provided for equal federal-provincial cost sharing

9. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Medicare Under the Microscope From Hall to Romanow  2002: Final Report of the Romanow Commission released  Romanow guided by two things: Canadian values of fairness, equity, and solidarity, and the evidence  Report has been the backdrop for major debates between the federal and provincial governments

10. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Medicare Under the Microscope Recommendations of Romanow Commission  47 detailed recommendations  Premised on three main themes:  Strong leadership needed  More responsive and efficient  Both short-term and long-term strategies

11. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Canada’s Health Care Spending Medicare: Publicly funded and universal health insurance in Canada delivered through hospitals, private physicians, and other health care providers

12. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Canada’s Health Care Spending Five Principles of Medicare:  Public administration  Comprehensiveness  Universality  Portability  Accessibility

13. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Canada’s Health Care Spending

14. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Universal Public or Privatized Health Care? Threats to the public system:  Privatization  Comprehensiveness  Contracting out

15. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Universal Public or Privatized Health Care? Advantages of public system:  Spreads costs of health care  Financing through taxation is efficient  Encourages Canadians to seek preventative care services  Government can cut costs as single buyer of supplies/services

16. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Community Health Centres Community health centres (CHCs) provide primary care, health promotion, and prevention services using salaried primary health care professionals.

17. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Medical Social Work Practice  Setting is the hospital  Almost every hospital in Canada has social workers  Most medical social workers have a graduate degree in the field  Primary role is discharge planning

18. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Medical Social Work Practice Interdisciplinary teams  Teams of health care professionals, including social workers, doctors, psychologists, etc.  Address patient’s physical, psychological, social, and cultural needs

19. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Medical Social Work Practice Hospice (or Palliative) Care  Hospice social work involves one or more of the following services:  Pain management  Symptom management  Social, psychological, emotional, and spiritual support  Caregiver support

20. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Mental Health and Social Work “Mental health is the capacity of each and all of us to feel, think and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections, and personal dignity.” The Public Health Agency of Canada

21. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Mental Health and Social Work Social workers in the mental health field deliver the following services:  Program management  Teaching and research  Policy analysis  Social action  Direct services  Case management  Community development  Administration

22. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Social Work and HIV/AIDS Services that social workers deliver for people with HIV/AIDS include:  hospice care  support groups  family support  advocacy  public education and prevention initiatives  primary care  hospital care  home care

23. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Addictions and Social Work  Treatment of addictions is a growing concern  Social workers and social service workers increasingly called upon to address problems  Social workers at forefront in developing innovative ways to help  Many use a harm-reduction approach

24. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Addictions and Social Work  Insite – first legal supervised injection site in North America  Example of a harm-reduction approach  Facility is accessible to injection drug users  Since opening in 2003, Insite has been a safe place where people can go to inject drugs and connect to health care services

25. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Aboriginal Health  Federal government is obligated through treaties to fund 100% of the cost of First Nations health care  In general, the health status of Aboriginal people is much worse than that of the average Canadian

26. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Aboriginal Health  First Nations leaders wish to see an integrated, holistic, inter-departmental & inter-organizational strategy to address inequities

27. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Websites  Health Canada Online www.hc-sc.gc.ca  Canadian Health Coalition www.healthcoalition.ca  World Health Organization www.who.int  Public Health Agency of Canada www.publichealth.gc.ca

28. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Questions for Discussion In what ways has federalism shaped Canada’s health care system?

29. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Questions for Discussion What are some ways social workers can be involved in addressing the rising rates of obesity in the Canadian population? Why is obesity an important issue for social work?

30. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Questions for Discussion The federal government funds 100% of First Nations health care. What are some of the reasons for the increasing health gap between First Nations people and the non-Native Canadian population?

31. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Questions for Discussion What are some of the benefits of the community health centre model in the delivery of health care services? What are some of the challenges?

32. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chapter 9: Social Work and the Health of Canadians Social Work In Canada Copyright © 2010 Thompson Educational Publishing, Inc. Questions for Discussion What are some of the ways that socio-economic status/ethnic background/migration status/Aboriginal status shape health status? Pick one of these factors to discuss with your neighbour.