Health care does not mean health

May 11, 2015 - The vast geographic area and great distances between communities pose significant challenges for the delivery of many services in rural and northern regions of Ontario.  The delivery of health care services is no exception.  There has been much research and several provincial reports that clearly show the health care services received in the north are not equivalent to those available in the south.  With so few large urban centres, access to specialized healthcare services for cancer and other serious conditions requires northerners to travel on a regular basis.

Even accessing basic healthcare services can be a challenge.  The distribution of physicians, nurse practitioners and other healthcare providers is disproportionately concentrated in southern urban areas. These major differences in the distribution of resources combined with the realities of geography has led many policy makers to rethink how services in the north need to be conceptualized.  The focus needs to be on quality of care with a made-in-the-north solution to delivery and resource variation.  This has led to creative ways and means of providing services in remote areas utilizing technology and maximizing the scopes of practice of various healthcare providers.  With necessity being the mother of invention, there have been many creative initiatives to help improve access to health care for northern Ontarians.  For example, the North East Local Health Integration Network has started a new program in telehomecare[1] linking patients with heart failure and chronic obstructive pulmonary disease (COPD) to trained registered nurses who provide remote monitoring and regular health coaching sessions. Not only might this program prove to increase access, but it is anticipated that it will also have the added benefit of being cost effective.

From a health policy perspective, we need to continually strive to recommend new and community specific solutions for the local healthcare issues faced by northern communities.  Provincial governments need to be continually reminded that one size does not fit all.  However, the reality is that regardless of how much the provincial government supports recommendations for health care policies specific to the north, no matter how much we improve access to doctors, hospitals and other health care services, it is highly unlikely that focusing on healthcare alone will actually improve the health of the population.  Simply put, healthcare does not mean health.  Northern Ontarians continue to have lower levels of overall health status than those found in Southern Ontario.  A recent report from Statistics Canada[2] indicated that Sudbury was the second most obese city, not only in Ontario, but in all of Canada.  As easy as it would be to simply say that people in Sudbury simply need to eat better and exercise more, the picture is far more complicated.

The key determinants of health[3] include factors such as poverty, education, social supports, housing, sanitation, nutrition, genetics, the environment and even culture.  The issue of obesity in Sudbury is likely more reflective of employment, food security, transportation infrastructure, social support and education, than simply gym memberships and video games.

The Sudbury and District Health Unit developed a video[4] called “Let’s Start a Conversation About Health…and Not Talk About Health Care At All,” which does a good job at demonstrating all the various pieces that fit together to improve health.  After watching the video, I think it is easy to understand how decisions made about policies in a seemingly unrelated area can have a profound impact on population and individual health.

The problem is that governments and policy makers still only think about things in silos without necessarily considering how decisions in one area have a knock-on effect in others.  Things are far more interconnected with each providing a piece of the puzzle in the overall picture of health.  The policies we create for the north concerning employment and labour, natural resources development, housing, social programs, education and economic development all have potentially profound impacts on the determinants of health.   As we move forward with policy initiatives across all these various areas, we need to continually reflect on how what we decide to do in one area may impact the health of our communities.  After all, we don’t have anything if we don’t have our health.

Authored by Dr. Elizabeth Wenghofer, Fellow in Rural and Northern Health with Northern Policy Institute

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