Transcript ENID COLLINS - Jamaica Diaspora Canada Foundation

ENID COLLINS
RN,MSN, MEd., Ed.D
JDCF Health Forum. July 9 -11, 2014
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
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.
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
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”.
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
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,
Barriers to access & equity
Population groups :
 new immigrant groups
 ethno -cultural
 women
 racialized groups
Circumstances:
 low socio- economic status
 poverty
 homelessness
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
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
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.
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
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.
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
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,
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
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
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
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
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.
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