Chapter 4: The Chief Public Health Officer's report on the state of public health in Canada 2008 – Access to health care
Social and Economic Factors that Influence Our Health and Contribute to Health Inequalities
Access to health care
Access to health care is fundamental to health. Approximately 80% of the Canadian population reports visiting a regular family physician and 64% report being in contact with a dental professional.392, 393 More women than men report that they have contacted a medical doctor in the previous year and that they have a regular family physician.392
Not only do people seek treatment through Canada’s publicly funded health care system, they benefit from a number of disease prevention and health promotion services. These services are generally integrated into front-line care (sometimes referred to as ‘primary care’) and range from childhood vaccinations to disease screening to advice on healthy living and mental health counselling.
Unfortunately, some people face barriers to health care services including physical inaccessibility, socio-cultural issues or the cost of non-insured health services (e.g. eye and dental care, mental health counselling and prescription drugs).394, 395 A Canadian study on immigrant women’s health reports that while immigrant women view health and prevention in similar ways to Canadian-born women, a difference exists in their ability to access the resources needed to stay healthy.396 Reasons include: language difficulties experienced by immigrants from countries of origin where French or English is not a primary language; a lack of cultural sensitivity among health-care providers – especially for women clients; and the fact that many immigrant women who are employed work long hours in low-paying jobs, while struggling to maintain households and care for young children.397, 396, 398 Social supports are also often lacking. These challenges can lead to a deterioration of health, as can emotional distress caused by feelings of displacement and isolation.396
Access to health care is also an issue for Aboriginal populations who live off-reserve, as they are less likely than the overall population (77% compared to 79%) to regularly visit a physician, and more likely to report having unmet health care needs (20% compared to 13%).402 First Nations adults living on-reserve cite barriers to accessing the health care system ranging from extensive wait times, services not covered by benefits, a shortage of doctors/nurses in the area and the cost of transportation, to complaints that services provided were inadequate or not culturally sensitive.161
Canadians in remote communities also face difficulties accessing the health care system. Looking at the Northwest Territories, both Aboriginal (59%) and non-Aboriginal (76%) populations report lower rates of contact with a health care professional than the general population (79%).402 Both populations (49% and 22%, respectively) are also more likely to use available nursing services compared to the general Canadian population (10%) indicating the vital role nursing stations play in the health of remote communities.402
Improving Access to Care
Toronto's Mobile Health Unit
A unique pilot project was created in 1981 to bring health services to immigrant women who could not afford time away from their jobs to take care of their own health needs.399 Today, Toronto's Mobile Health Unit – part of the Immigrant Women's Health Centre – is still providing women in factories, shelters, community centres and other locations with the opportunity to receive primary care at no cost from female health care providers experienced in cultural and gender sensitivity and the challenges facing immigrant women.400 The project was launched after discussions with immigrant women revealed that, although they looked after their children's health care needs, their own needs were often unmet due to a number of barriers.401 These included an unwillingness to take unpaid time off work, lack of child care, language issues and discomfort with male health-care providers.396 In response, the Mobile Health Unit can be called in, preceded by a team of counsellors who visit the work site in advance and talk to the women in their native languages about a range of health care issues like pap tests and breast exams.399, 401 Once comfortable, the women will often seek more information (e.g. birth control, mental health). Then appointments are booked for the day the unit will be on site. At work sites visited by the unit, employers report experiencing lower employee absenteeism caused by health issues and off-site medical appointments.401, 398 The need for accessible and culturally sensitive health care continues to be an issue for all regions of Canada where immigrants and refugees settle. The Toronto unit, for example, currently has a three- to four-month waiting list and constantly fields calls from employers and organizations outside of the city limits that it cannot serve.401
TeleHomeCare in Prince Edward Island
West Prince TeleHomeCare program began in 1999 as a pilot project in TeleHospice. The pilot project was created to compensate for a shortage of nurses in the area, increasing the ability of existing staff to monitor terminally ill patients living in rural and isolated areas of the community who wish to stay at home. Due to its success, the program has been expanded to include patients with complex health needs such as mental health, diabetes, congestive heart failure, and chronic obstructive pulmonary disease.403
Through the use of an innovative video-conferencing system, nurses can provide care, instruction and education to patients through a telephone line and two-way video screen. Blood pressure, heart rate, weight and blood oxygen levels can be monitored through attachments. Patients like the service because they stay at home, with little disruption to their lives, but can consult with medical staff as required. Though care is facilitated through technology, patients like the interactive component and feel personally connected to providers that they can see and hear in real time during their daily exchanges. Caregivers also appreciate the ability to consult with nursing staff. Since launching the tele-hospice service, the West Prince Health region has seen a 73% reduction in days of hospitalization, 15% fewer emergency room visits, 46% fewer hospital admissions and a 20% drop in doctor's office appointments among clients.404
It has also garnered national and international recognition as a model for the cost-effective use of technology to address the health-care needs of persons living in rural and remote locations.405
Summary
To address health inequalities, the WHO states that countries must make addressing the ‘structural’ stratification of their societies a priority. This means reducing the gap between those at the highest and lowest income levels through actions that will eradicate poverty and increase opportunities for employment, education and early child development among the entire population. That, in turn, will help to reduce the health inequalities currently found among the Canadian population.
The successful interventions profiled in this chapter are a beginning. They reinforce that public health partners representing all sectors of society are making inroads in identifying and implementing effective interventions that are making a measurable difference in Canadians’ lives. These successes provide a starting point from which to draw inspiration, think, plan and act.
What follows is a discussion of Canada’s efforts, as a country, to address health inequalities with an eye to where future efforts may be directed.
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