goal 2: addressing inequities
- The second major recommendation of the Closing the Gap in a Generation report identified the need to tackle inequalities in power, money, and resources.
- Given that inequity in daily living conditions is shaped by deeper social structures, including governmental policies and institutions, the report suggests the need to develop policies that promote equity
optimal healthcare inquities
Given that optimal healthcare systems are characterized by an equitable system that does not rely on an individual’s ability to pay for health care, there is a need for equitable health policies.
four main pillars that healthcare systems should be built on to have better outcomes
- Local Action
- Appropriate local action across the range of social determinants. - Primary Level of Care
- Emphasis on the primary level of care with adequate referral to higher levels. - Equitable System
- An equitable system not relying on ability to pay. - Prevention, Health Promotion, and Intervention
- Preventions and health promotions valued just as highly as curative interventions
HEALTH INEQUITY IN THE CANADIAN INDIGENOUS POPULATION
- Although the Canadian healthcare system is built on the four pillars of optimal healthcare systems, not every individual in Canada has equal access to health services, nor do they experience an equal quality of services. Specifically, individuals living in remote, Indigenous communities in Canada have less access to quality healthcare.
- In the 2015 Spring Reports of the Auditor General of Canada, Report 4 summarized Access to Health Services for Remote First Nations Communities in Manitoba and Ontario. The findings demonstrated that Health Canada was not providing enough support to First Nations individuals living in remote communities
The health inequalities that Indigenous communities face
- ACCESS TO QUALITY NURSING STATIONS
- In healthcare interactions, nurses provide primary care, typically acting as the first point of contact. Because of this important role, adequate staffing of nursing stations is extremely important for clinical interactions and client care services. Unfortunately, in many Indigenous communities, nursing stations are not adequately staffed. Additionally, according to Report 4 (2015), only one in 45 nurses working in First Nations communities have completed all five of Health Canada’s mandatory training courses. These findings are important because First Nations individuals in remote communities should have equal access to essential health services from qualified nurses who have the authority to provide these services.
- It is required that nursing facilities undergo an inspection every five years; however, Report 4 found that out of eight stations in First Nations communities, only five were inspected within the designated time period. Nursing stations that are non-compliant with health and safety requirements or building codes can put patients and staff at risk and may limit access to health services
Example of a Nursing Station
Many nursing stations are no larger than homes, much like this one in Old Crow, Yukon. This building houses a clinic, offices for staff, a visitor’s suite, two apartments, a furnace room, and a storage space. It is staffed year round by one “Nurse in Charge” and one full-time registered nurse, a receptionist, and a custodian. For better context, note that Old Crow has a population of 221
nursing stations definition
Clinics that are healthcare facilities which offer primary care for the local community. These clinics tend to care for outpatients, in contrast to hospitals which are larger and have the capacity and resources to admit inpatients. This is different from a nurses station, which is found in hospitals and other healthcare facilities, and is the designated area where nurses reside when not working directly with patients and when doing their administrative duties
ACCESS TO MEDICAL TRANSPORTATION
- Another issue experienced within remote Indigenous communities is a lack of proper and reliable medical transportation into bigger city centers which have more healthcare resources. Although medical transportation benefits exist, according to Report 4, Indigenous individuals who are not registered in the Indian Registration System can be denied the medical transportation benefit. In some communities, approximately half of the children are not registered.
- In addition to issues with accessing the medical transportation benefit, Report 4 identified that there was no transparency from Health Canada. Health Canada did not analyze the denied requests for medical transportation benefits to explain the reasons for denial. Further, Health Canada also failed to maintain sufficient documentation to demonstrate that medical transportation benefits were administered
Medical transport between 2 rural northern communities
Recall the small community of Old Crow. During medical emergencies patients are medevaced from Old Crow by air to Inuvik, Northwest Territories, the closest hospital to Old Crow. It takes just under four hours - depending on the weather - to medevac a patient to the Inuvik Hospital
Medical transportation benefits
Benefits that cover the cost of transportation for First Nations individuals so they can access medically required services
Medevaced
Transport of persons, especially by helicopter, to a place where they can receive medical care
VIDEO: CHALLENGES TO INCREASING MEDICAL TRANSPORTATION
Often when improving and increasing medical transportation, the focus is on improving ways that patients are taken from their communities to larger centres. However, rarely do interventions consider or address the challenges faced by medical professionals traveling to these rural and remote locations
SUPPORT ALLOCATION AND COMPARABLE ACCESS
- The report showed that Health Canada did not take into account the health needs of remote First Nations communities when allocating its support. Health Canada also did not establish specific and measurable criteria when comparing First Nations communities and other remote communities in terms of access to clinical and client care services.
- Report 4 highlighted a lack of effectiveness in the established committees towards developing workable solutions to the interjurisdictional challenges that negatively affect First Nations individuals’ access to health services
ADDRESSING SUPPORT ALLOCATION AND COMPARABLE ACCESS
Accommodating the unique needs of each rural and remote community, Indigenous or not, is a complicated but achievable task. Recently, several new initiatives were created and are currently being implemented to help increase access to healthcare in remote and rural communities
Telehealth
Programs such as Telehealth (or sometimes referred to as TeleMedicine) allow for long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. In many locations, Telehealth is free for all users, and is often offered with translation support for more than 300 languages
NOSM
The Northern Ontario School of Medicine (N O S M) is a medical school in Ontario, created through a partnership between Laurentian University and Lakehead University. N O S M is mandated to both educate doctors and to contribute to care in Northern Ontario’s urban, rural, and remote communities. All medical students complete various placements in Aboriginal or Métis communities throughout the four-year program, which has led to the establishment of a close relationship between the school and various communities and First Nations throughout the region
ACTIONS TO ENHANCE HEALTH EQUITY IN INDIGENOUS POPULATIONS
- In 2015, the Truth and Reconciliation Commission (T R C) of Canada compiled a report that highlighted calls to action to the government to close inequality and inequity gaps.
- The T R C’s suggestions regarding Indigenous healthcare included:
- Recognizing the Indigenous health care rights enshrined in international and national law.
- Establishing a dialogue with Indigenous peoples to identify and eliminate health care inequities.
- Acknowledging, respecting, and addressing the distinct health needs of Métis, Inuit, and off-reserve First Nations Peoples.
- Providing sustainable funding for existing and new Aboriginal healing centres to address the harms caused by Residential Schools.
- In collaboration with Indigenous healers and elders, recognizing as medically legitimate the value of traditional healing practices.
- Hiring and retaining Indigenous health care professionals, as well as ensuring that all staff have cultural competency training
EQUITABLE HEALTH POLICIES
Given that optimal healthcare systems are characterized by an equitable system that does not rely on individuals’ abilities to pay for health care, there is a need for equitable health policies. Equitable health can be determined by a number of government and economic factors including finance, education, housing, employment, transportation, and health itself. To address this issue from a government perspective, it is essential that policies across departments align in their goal to produce health equity
Policy for High Fat and Sugar Foods
If a trade policy encourages the free production, trade, and consumption of high-fat and high-sugar foods, this would contradict a health policy which recommends consuming relatively little high-fat and high-sugar foods and encourages the consumption of fruits, vegetables, nuts, and seeds. A trade policy that promotes the production and trade of fruits and vegetables would be better aligned with the health policy and make such products more accessible to all consumers, likely reducing the consumer costs on healthy products
INTERSECTORAL ACTION FOR HEALTH (ISA)
- Aligning health policies across a number of government departments to promote health equity is called intersectoral action for health (I S A). It implies the inclusion of several sectors, in addition to the health sector, when attempting to design public policies meant to address health outcomes.
- I S A is crucial because most of the decisions that impact the health of a population lie beyond the health sector. The health sector must work with other sectors of government and society to address the S D Hs. Canada has played an important role in intersectoral approaches. The Public Health Agency of Canada (P H A C) and W H O have been working collaboratively since 2006 to establish effective intersectoral approaches.
Equitable Health Outcomes
- Education
- Health
- Trade
- Industry
MARKET RESPONSIBILITY
Industry, or the market, can have a large impact on health. The market can bring health benefits through new technologies, and goods and services. However, it can also adversely affect the social determinants of health through economic inequalities, resource depletion, environmental pollution, unhealthy working conditions, and the circulation of dangerous goods. There are three main aspects of market responsibility that can be optimized for health.
Three aspects of market responsibility that can be optimized for health.
- Social goods should be governed by the public sector.
- Legislation should promote gender equality.
- Promote political empowerment
SOCIAL GOODS GOVERNED BY THE PUBLIC SECTOR
- Commercialization of education, healthcare, and other basic human and societal needs produces health inequity. Thus, it is advisable for these social goods to be governed by the public sector.
- As an example, the video highlights the transition of water services in some regions of the world to public governance. For this to be effective, public sector leadership is required for national and international regulation of products, activities, and conditions that damage health. Additionally, the assessment of impact of market regulation and all novel policies should be conducted on both a national and international scale.
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