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Steps Toward the Future: The Path to Health Equity

  • Jennifer Beaudry
  • Jul 28, 2018
  • 6 min read

Health and Health Equity

What is health? What contributes to one's overall health? What are ways to improve health for individuals and for communities? The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” and goes on to state that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” (World Health Organization, 2014, p.9). Complete health is nearly an impossible goal for many to reach, and this is especially true for those who live with a chronic disease. If this definition is adhered to then complete health would be a nearly unattainable goal. It may be time to redefine this definition and begin to think of health as a multidimensional system that includes physical, mental, and social health (Huber, 2011).

Beginning in 2008 the Winnipeg Regional Health Authority (WRHA) committed to a focus on health equity within the region and in 2012 released an operational glossary to define what health equity really means (Winnipeg Regional Health Authority, 2012). The definition used describes health equity as the allocation of resources to groups which are proportionate to their needs, and in a culturally appropriate manner (Winnipeg Regional Health Authority, 2012). Equity in health care ensures that care is provided based on needs, not based on social advantage or disadvantage (Winnipeg Regional Health Authority, 2012).

Determinants of Health

Although health is seen as a fundamental right for all human beings (WHO, 2014) there are many disparities when it comes to health equity. Medical treatments and lifestyle choices are only part of the story, the determinants of health play a key role in improving health (Mikkonen and Raphael, 2011) . To provide equitable health care for all there must be some thought put into the determinants of health and how they affect vulnerable populations such as Indigenous communities. For example, high rates of unemployment, low income, and higher rates of those requiring welfare assistance directly impacts the health of First Nations people, families, and communities (Southern Chiefs Organization, 2016). There is a need to reform policies on Indigenous health and healthcare at both the provincial and federal levels to promote equity for this population (Richmond and Cook, 2016).

When looking at health equity among various populations we must keep in mind the determinants of health. These factors play a key role in how equitable care is distributed. The determinants of health as described by Health Canada (2018) include:

1. Income and social status

2. Employment and working conditions

3. Education and literacy

4. Childhood experiences

5. Physical environments

6. Social supports and coping skills

7. Healthy behaviours

8. Access to health services

9. Biology and genetic endowment

10. Gender

11. Culture

The Social Ecological Model

The determinants of health can be classified into levels of influence by using a multilevel model such as the Social Ecological Model (SEM). The SEM (figure 1) highlights the relationship between the multiple factors influencing health outcomes for patients, and the dynamic relationship between all levels (Stokols, 1996). The levels begin with the individual at the core and can include factors such as behaviour, knowledge, and attitude (Stokols, 1996). Expanding from the core level is the interpersonal level which can include support systems such as family and friends, as well as cultural dimensions and social cohesion; and moving up is the community level which includes support groups, and resource centers within the community; this expands into the organizational level (Centre for Disease Control, n.d.). The policy level is the highest and includes policies and funding allocations (Center for Disease Control, n.d.).

Figure 1: The Social Ecological Model of Health as described by the Centre for Disease Control (n.d.)

Bridging the Gap

When looking at how to bridge the health equity gap for the Indigenous populations we must begin by looking at access to services. Indigenous people represent 17% of the population in the province of Manitoba, and 11% of the population living in Winnipeg (Statistics Canada, 2014). In 2015 the Truth and Reconciliation Commission of Canada (2015) release ninety-four calls to action which included the call to "identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities" and went on to list indicators which included the availability of appropriate health services (p. 2).

Access to services may be an obstacle for many reasons. Physical access may be an issue for patients with mobility issues, as is common for patients with osteoarthritis (MacDonald, Sanmartin, Langlois, & Marshall, 2014). Resource availability can be an obstacle as some services such as physiotherapy and occupational therapy may not be fully funded; and medication can be costly and must be paid out of pocket until a minimum deductible is met (Manitoba Health, Seniors, and Active Living, 2018). For many remote communities consult appointments or treatment can mean traveling long distances to attend a 15 minutes appointment.

In the last few years Manitoba has focused on improving access to care for rural settings by expanding its telehealth network. Manitoba telehealth (MBTelehealth) was established in 2001 and provides secure link videoconferencing for healthcare services, continuing education, and family meetings. Benefits to using this platform for communication between patients and physicians include: reduced time away from work or home, reduced travel associated costs, increased access to services, and the ability for family members to be present for appointments (MBTelehealth, n.d.). Before the development of MBTelehealth patients would have to travel long distances to receive may health services, now through MBTelehealth patients are able to connect with specialists from 60 specialty areas 158 sites across the province (Government of Manitoba, 2016). For many this means travelling to the nearest nursing station or clinic instead of hours of travel. Recent data indicates that more that 18,000 patient's appointments occurred with the use of telehealth which has reduced or eliminated the need for patients to travel long distances and has resulted in an estimated savings of over five million dollars in travel-associated costs (Government of Manitoba, 2016).

Video from DoctorsManitoba Feb 24, 2015

Looking to the Future

Access to services is only one determinant that puts the Indigenous population of Manitoba at a disadvantage when it comes to equity. After the tragic death of Brian Sinclair in 2008, who died after waiting thirty-four hours in an emergency room waiting area; a number of Indigenous organizations, community members, and Brian Sinclair's family called for a public inquiry (Out of Sight, 2017). They wanted to address broader issues of systemic racism that impact Indigenous people in the healthcare system, taking into considerations the historical background of how healthcare is provided to Indigenous people and communities, the negative consequences of racism and discriminatory health services, and recommend best practices for health care providers (Out of Sight, 2017).

Current health policies in Canada reflect the historic relationship between Indigenous people and Canada and is failing to meet the health needs of Indigenous peoples (Richmond and Cook, 2016). The Indigenous population of Manitoba are significantly underserved in many areas including income and income distribution, which in turn affects many other factors (Richmond and Cook, 2016). The Southern Chiefs Organization represents 32 of Manitoba's southern First Nations and they have highlighted the lack of adequate financial resources as one of the key detriments to maintaining a holistic quality of life (Southern Chiefs Organization, n.d.). Acknowledging the disparities in health equity that vulnerable populations face is the first step towards improvement. Increasing access to health services is only the beginning and must continue to improve, however there is still much work to be done.

References

Centres for Disease Control, Colorectal Cancer Control Program (CCRP). Retrieved June 15, 2018 from https://www.cdc.gov/cancer/crccp/sem.htm .

DoctorsManitoba. (2015). MBTelehealth Connecting Healthcare to Communities. Retrieved from https://www.youtube.com/watch?v=MgRqsh7rU0A&feature=youtu.be

Government of Canada. (2013). Report on Equality Rights of Aboriginal People. Cat. No. HR4-22/2013E-PDF. Retrieved from http://www.chrc-ccdp.gc.ca/sites/default/files/equality_aboriginal_report.pdf

Government of Canada. (2018). Social determinants of health and health inequities. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Government of Manitoba. 2016. Province Announces More Telehealth Sites to Serve Rural Manitoba Residents. Retrieved from http://news.gov.mb.ca/news/index.html?item=37254

Health Canada (2018). Social determinants of health and health inequalities. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Huber, M. (2011). Health: How should we define it? British Medical Journal, Vol. 343, (7817), pp. 235-237. Retrieved May 31, 2018 from http://www.jstor.org/stable/23051314

MacDonald, K.V., Sanmartin, C., Langlois, K., Marshall, D. A. (2014). Symptom onset, diagnosis and management of osteoarthritis. Health Reports 25(9), 10-17.

Manitoba Health, Seniors, and Active Living. Retrieved June 27, 2018 from https://www.gov.mb.ca/health/mhsip/

MBTelehealth. (n.d.). Retrieved July 23 from http://www.manitoba-ehealth.ca/prog-mbtelehealth.html

Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts Toronto: York University School of Health Policy and Management. Retrieved June 1, 2018 form http://www.thecanadianfacts.org/

Out of Sight: A summary of the events leading up to Brian Sinclair's death, the inquest that examined it and the Interim Recommendations of the Brian Sinclair Working Group (2017). Retrieved from http://libguides.lib.umanitoba.ca/ld.php?content_id=33973085

Richmond, C.A.M., & Cook, C. (2016). Creating conditions for Canadian aboriginal health equity: The promise of public health policy. Public Health Reviews, 37. doi: 10.1186/s40985-016-0016-5.

Southern Chiefs Organization (n.d.) Factors affecting determinants of health for Manitoba's 32 Southern First Nations. Retrieved from http://scoinc.mb.ca/wp-content/uploads/2016/05/SCO-Determinants-of-Health-Overview1.pdf

Statistics Canada. (2016). Aboriginal peoples: Fact Sheet for Manitoba (Catalogue no. 89-656-X2016008). Published by authority of the Minister responsible for Statistics Canada.

Statistics Canada (2014). Retrieved June 22, 2018 from https://www150.statcan.gc.ca/n1/pub/82-625-x/2015001/article/14178-eng.htm

Stokels, D. (1996). Translating Social Ecological Theory Into Guidelines for Community Health Promotion. American Journal of Health Promotion 10 (4), 282-298.

Truth and Reconciliation Commission of Canada: Calls to Action (2012)/ Truth and Reconciliation Commission of Canada, 2012. Winnipeg, Manitoba http://www.trc.ca/websites/trcinstitution/File/2015/Findings/Calls_to_Action_English2.pdf

Winnipeg Regional Health Authority. (2012). Promoting Health Equity Operational Glossary. Retrieved from http://www.wrha.mb.ca/about/healthequity/files/HealthEquityGlossaryandRefsOct26_2012FINAL2.pdf

World Health Organization. (2014). Basic Documents: Forty-eighth edition (2014). Retrieved from http://apps.who.int/iris/bitstream/handle/10665/151605/9789241650489_eng.pdf;jsessionid=D30167E0851E636926B52BAA0790B437?sequence=1


 
 
 

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