lecture 8: organization, public health, equity, SDoH

Leigh Chapman

no, there are 14 single payer, universal and public systems

1984

Canada's federal legislation for publicly funded health care insurance

primary objective: protect, promote and restore the physical/mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers

insure that all eligible residents of Canada have reasonable access to insured health services

public administration: defined as responsibility of province, nonprofit basis

comprehensiveness: specific provincial health care insurance plans must cover all insured health services

universality: all residents are entitled, no discrimination

portability: ppl temporarily out of their home province must continue to be covered

accessibility: no discrimination, compensation to doctors

federal: funding, health care for specific groups, standards + administering, tax support

province: medically necessary services provided

First Nations ppls living on reserves

inuit

serving members of Canadian forces

eligible veterans

inmates in federal penitentiaries

some groups of refugee claimants

health emergencies

reports to parliament through minister of health

prevalence of chronic diseases is increasing faster in Quebec

50% of pt seen in primary care have 5+ chronic diseases

RUIS

CIUSS/CISSS

CLSC

GMF/Clinique Réseau

Réseau universitaire intégré de santé

▸  Facilitate specialized care, medical education, and

medical research throughout the province’s many

regions

▸  Favoring complementarity and integration of care

▸  Mandate to institute a culture of collaboration

The delivery of health care, health education, and health information services via remote technologies

811

◉ ✔ Provides access to the same quality care and services as those offered during appointments in person

◉ ✔ Ensures access to specialized health care or the continuity of services in close proximity

◉ ✔ Reduces travel as well as travel-related stress and expenses

centre local de series communautaires

Wide range of services (in different settings):

▹  Routine health and social services

▹  Preventive or nursing services

▹ Rehab/Reintegration

▹ Public health activities

family medicine group

▸ Groups of family physicians (6-12) who are responsible of a large group of patients (1000-2200) and work in collaboration with nurses and other professionals.

Goals:

▸ Improve access to Family MD and hours available▸ Improve quality, patient follow-up, and continuity of care

▸ Decrease unnecessary visits to ER

An act to modify the organization and governance of the health and social services network in particular by abolishing the regional agencies

▸2003/05: Various mergers to create 95 CSSS ▸Goal: improve accessibility, continuity, integration,

and quality of services.▸Two principles were foundational:

1- Shift from ‘service-based’ to ‘population-based’ approach2- Hierarchy of services (1-2-3)

but change is hard, lots of reorganization, budget changes

santé Quebec

primary: 1st point of consultation (check ups, Tx, preventative care)

secondary: often referral to specialist

tertiary: complex care (surgery, ICU, cancer care, palliative)

quaternary: experimental Tx

obesity

patient safety

access to care

stroke mortality

perceived health status

avoidable admission: asthma

The organized efforts of society to keep people healthy and prevent injury, illness and premature death. It is a combination of programs, services and policies that protect and promote the health of all Canadians.

◉ Health Protection

◉ Health Surveillance

◉ Population Health Assessment◉ Disease and injury prevention◉ Health Promotion◉ Emergency preparedness/disaster response

Primordial:

Initiatives that prevent the conditions that would enable the risk factors for disease from developing’ – Often related to Healthy Public Policy

Primary:

-Risks of illness, disease, and injury are eliminated.

-Prevents the occurrence of disease.- ‘interrupt the chain of causality’

Secondary

-The disease process is suspended before Sx occur. Causal factors are not eliminated, but permanent sequelae is prevention through early detection or public health programs to control the disease.-Detect and stop disease development in those at risk

Tertiary

-The impairment from the disease process is halted- Reduce the - effects once a disease has established itself

Quaternary

- Actions to identify ppl at risk of overmedicalization.

prevention and mitigation: risk reduction, disease prevention

preparedness: ethical, legal, education

response: care

recovery and rehab: long term

◉  Fair distribution of society’s benefits and responsibilities, and focuses on eliminating the root causes of inequities

◉  Leading to degree of equality of opportunity for health that a society provides for the population

◉  It involves the political, social and economic structures of a society (a choice of a society)

◉  Fair distribution of resources for health

◉  The absence of systematic disparities in health between groups with different levels of wealth, power or prestige.

◉ Equity in health is an ethical principle and closely related to human rights principles.

◉The improvement of daily living conditions

◉Tackling the inequitable distribution of resources

◉Increasing the public’s awareness of, and health

professionals’ training in the SDoH as foundational to good health and the structural action necessary to address them

50% your life

25% your healthcare

15% your biology

10% your environment

these are Canada's SDoH

- Health inequities exist- There are underlying causes of poor health that are at various socio-

ecological levels- To improve health, one needs to think at a community-population level and take health equity into account- Social justice is a guiding principle underlying our professional nursing conduct- All healthcare settings are opportunities to ensure equitable access to quality healthcare and engaging with upstream determinants of health

disability

race

income

housing

education

food insecurity

gender

geography

unemployment

Indigenous ancestry

increasing minimum wage

boosting assistance levels for those unable to work would provide immediate health benefits for the most disadvantaged Canadians

improving working conditions and limiting profit making that impacts on employee well-being and income

◉Ask

○  Sensitivity and caring

○  Food security, violence, discrimination, literacy, immigration issues, etc...

○  ‘Do you ever have difficulty making ends meet at the end of the month?’

◉Refer and advocate for

○  “Social Prescribing”

○  ‘Referral to community-based support groups reduced patient anxiety and

improved perception of overall health...’

○  Benefits, tax-credits, etc...

◉Remove barriers to care –

Improve access for vulnerable populations

○ What are barriers to health care? ○ Patient engagement

◉Patient navigators

◉Physicians (AND HCP/NURSES) “need not confine their activities to the clinic or hospital but can also serve as effective health advocates and valuable resources for the community”

◉Partnerships and intersectoral action!!◉Advocate for social change with clinical experience and research

◉Get involved in community needs assessment-health planning

◉Engagement, empowerment and changing social norms

○  You as a Catalyst for change

○  Cultural safety training

○  Addressing structural racism

In the field of public health it relates to the ability of an individual to

influence, motivate, and enable others to contribute towards the effectiveness and success of their community and/or the organization in which they work.

It involves inspiring people to craft and achieve a vision and goals. Leaders provide mentoring, coaching and recognition. They encourage empowerment, allowing others to lead”

1. System Transformation

2.Achieve Results

3.Lead Self4.Engage Others

5.Develop Coalition

◉  Knowledge translation

◉  Understanding of how to guide change

◉  Systems and critical thinking

◉  Innovation/Creativity

◉  Advocate for and guide change

◉  Drive/Motivation

◉  Forward thinking

◉  Adaptation to changing systems

◉  Use understanding of power and influence and operational expertise to mobilize people to meet strategic goals

◉  Garner support and momentum towards upstream solutions

◉  Personal vision (explicit, clear, and compelling)

◉  Anticipate and take advantage of leadership opportunities

◉  Champion public health principles, actions and interventions

◉  Assess effectiveness and success in terms of population health

◉  Abide by ethical codes

◉  Critically examine role within the organization and regulatory systems

◉  Evidence-informed decision making

◉  Lifelong learning and self-development

◉  Accountability

◉  Emotional Intelligence

◉  Self-Aware and reflective

◉  Reflexivity and flexibility in response to criticism

◉Leverage communication tech for effective communication ◉Credible, responsive, accessible, engender respect, rapport, and trust

◉Transdisciplinary knowledge of multiple professions◉Tailor communication◉Empower and enable others by providing strong, unwavering support

◉Build capacity through modelling-mentorship for leadership in others

◉Promote healthy workplace culture◉Share power (horizontally+vertically)◉Effective mediation and negotiation skills◉Recognize and encourage contributions of others

◉Demonstrate cultural awareness

◉Demonstrate ability to guide health public policy

◉Recognize public health’s role in political influence◉Ambassadors of quality evidence-informed practice◉Foster engagement with communities

◉Catalyst for partnership building◉Promote visibility and awareness of practice

◉Contribute to cross disciplinary understanding of public health practice◉Leverage partnerships to broaden the scope and impact of public health practice