Summary of resources on determinants of health in BC and initiatives to address them

This week I am curating resources about determinants of health in BC and Canada. I will summarize some of the main points in a few of the resources I found this week.

There are many health inequities present across Canada. One that is well-documented is the disparity of health between Indigenous and non-Indigenous Canadians. In December of 2015, the National Collaborating Centre for Aboriginal Health (NCCAH) hosted a gathering of people from diverse national and provincial Indigenous organizations to discuss and review current evidence related to the social determinants of Indigenous health (NCCAH, 2017). Some conclusions that came from the meeting were that in order for Indigenous people to continue to move forward and heal, there must be reconciliation for the past (NCCAH, 2017). This reconciliation includes Indigenous rights to self-determination and the eradication of poverty (NCCAH, 2017). Minister Carolyn Bennet spoke at the meeting about how doctors had reported that it was difficult to treat a patient in a clinic, and then send that patient straight back into the same conditions that made them sick (NCCAH, 2017). She gave the example of the H1N1 outbreak in 2009 where Indigenous people were treated for H1N1, then sent back to overcrowded housing situations without running water. She further stated that in order for the health gap between Indigenous Canadians and non-Indigenous Canadian’s to close, “Indigenous people can no longer be left behind” including women who have been missing and murdered, and needed/need critical attention (NCCAH, p. 7, 2017).

"Take a Second Look” is a paper that looks at how gender, sex and diversity affect inequities in health in BC. The paper explains that BC has been shown to have some of the best average health outcomes out of all the provinces in Canada, however those positive health outcomes are not uniform throughout the province (Chasey, S., Pederson, A. & Duff, P., 2009). Health inequities take place when a population of people has worse health outcomes compared to others because of health barriers that are unfair and avoidable (Chasey, S. et al., 2009). It is well known that health inequities exist between lower and higher socioeconomic groups, however there are also health inequities along other gradients such as gender, age, ethnicity and disability (Chasey, S. et al., 2009). Single mothers have been found to have the highest poverty rates in BC, with 37% of them living in poverty compared to less than 10% of two parent families (Chasey, S. et al., 2009). There is also still a large gender income gap in Canada, with full time working men making on average, $51,700 per year compared to women who on average earned $36,500 per year (Chasey, S. et al., 2009). There are a number of factors that have led to this income gap, including unpaid care giving and housework, and lower wages in female dominated industries such as teaching and healthcare (Chasey, S. et al., 2009). Given that poverty has a direct negative impact on health, women have worse health than men (Chasey, S. et al., 2009). Poverty also limits options, which can lead to increased exposure to abuse and violence (Chasey, S. et al., 2009).

The future directions of BC health care were outlined in a paper put out in 2014 called “Setting Priorities for the BC Health System.” The four future strategies are as follows.

“1. Providing effective health promotion, prevention and self-management to improve the health and wellness of British Columbians.

2. Meeting the majority of health needs with high quality primary and community based health care and support services.

3. Ensuring high quality hospital care services are available when needed.

4. Improving innovation, productivity and efficiency in the delivery of health services. (Ministry of Health, p. 17, 2014)”

The first strategy is focused on chronic disease prevention by preventing or delaying the onset of disease through healthy living initiatives (Ministry of Health, 2014). One example is supporting parents with resources that encourage activity and healthy eating (Ministry of Health, 2014).

The second strategy seeks to improve the capacity of community care and provide better continuity of care between hospital and home (Ministry of Health, 2014). This will improve the health of those that do not require hospital services, however do require support, such as frail elderly people and people with mental health issues (Ministry of Health, 2014). Another way the second strategy is being carried out is through the establishment of the First Nations Health Authority, which is focused on promoting and improving health in BC First Nations Communities (Ministry of Health, 2014).

The third strategy is providing quality hospital care, which includes the reduction of wait times for surgeries, improved access to diagnostic imaging services, and improved patient flow through the emergency department (Ministry of Health, 2014).

The fourth strategy is to be more efficient through innovation for example, through the development of eHealth, which makes health care information more accessible, and through the development of the BC services card (Ministry of Health, 2014).

The minister of health is responsible for improving the health care system while ensuring the best value for dollar for taxpayers (Ministry of Health, 2014). The report concluded that one of BC’s main focuses is to prevent hospitalization through promotion of health and prevention of chronic disease, and as well, providing quality secondary and tertiary interventions for people with addictions or mental health issues (Ministry of Health, 2014).

There are many stakeholders in the conversation of health inequities in BC and this includes the BC nurses Union. In a position statement in 2015, BCNU expressed their goal for equity of all people. In saying this, they acknowledged as well that good health is based first on social, economic, and environmental health (BCNU, 2015).

‘Health determinants in Canada’ is a topic that involves many stakeholders and has to be researched and viewed through many lenses to fully realize the impact. Health equity in Canada is a goal our health system should constantly work towards and it was encouraging this week to research the many initiatives focused on improving these inequities.

References

BC Nurses Union. (2015). Social determinants of health. Retrieved October/14, 2018, from https://www.bcnu.org/AboutBcnu/Documents/position-statement-social-determinants-of-health.pdf

Chasey, S., Pederson, A. & Duff, P. (2009). Taking a second look: Analyzing health inequities in BC with a sex, gender and diversity lens. Retrieved October/14, 2018, from http://www.phsa.ca/Documents/takingasecondlook.pdf

Ministry of Health. (2014). Setting priorities for the BC health system. Retrieved Oct/12, 2018, from https://www.health.gov.bc.ca/library/publications/year/2014/Setting-priorities-BC-Health-Feb14.pdf

National Collaborating Centre for Aboriginal Health. (2017). Transforming our realities : The determinants of health and indigenous Peoples. Retrieved October/14, 2018, from http://0-www.deslibris.ca.aupac.lib.athabascau.ca/ID/10094282