Misdiagnosis: Drummond’s Health Care Prescription Misses Equity

The Drummond Report’s emphasis on reform and innovation in the way health care is organized and delivered is vital. The objectives of long-term planning, a shift to home and community care, prevention, and integration of health services are right on the mark. But a huge element is missing: equity. Equitable access to services, equitable outcomes and improved population health must also be fundamental goals of reform.

The report highlights that a small proportion of patients with complex needs account for a high proportion of overall health system costs and emphasizes that preventing ill health and controlling chronic diseases is crucial moving forward.

Good so far, but the distribution of ill-health is not random; a crucial element is the well-documented social gradient of health — the risk and burden of many chronic conditions and poor health more generally is far higher for marginalized populations, such as people with low incomes.

Innovation and reform are essential in the pursuit of high quality, responsive and patient-centred care, as well as system efficiency and sustainability. But we need to ensure that that the massive reforms being contemplated do not make access to health care less equitable or worsen the health of marginalized populations.

The Commission’s report emphasizes patient-centred care, and this is excellent. But equity in patient-centred care means ensuring that all Ontarians have access to high quality care. The report also highlights the importance of primary care. An equity approach would ensure that expanded family health teams, community health centres and other key reforms are concentrated in under-served and higher need areas to reduce inequitable disparities in access.

The report rightly points to the need for coordination and integration of services. We need to think broadly here. Discharging a patient into overcrowded or unsafe housing means that they are likely to end up back in the hospital, thereby undermining the savings and efficiencies the Commission is looking for.

Beyond Health Care

We completely agree with the call for a powerful twenty year vision for “a superior health care system.” But health is far more than health care, as the report acknowledges. The real determinants of health lie far beyond the health care system–in people’s employment, living conditions and opportunities. Poverty, economic inequality, deteriorating community infrastructures, lack of access to good public services, racism and social exclusion are the conditions that create and perpetuate health disparities in our province.

As a practical example, it is crucial to ensure equitable access to high quality diabetes treatment. But diabetes and other chronic conditions are tied to poverty and concentrated in poor neighbourhoods and marginalized communities. If we don’t improve access to good housing, adequate food, and safe neighbourhoods we will not be able to reduce these preventable diseases.

Drummond’s prescription for limited investment in social programs and reductions in other areas poses a real danger. Reducing vital support for affordable housing, safe communities, transportation, and other community infrastructure will undermine the foundations of strong and healthy communities. This will have an adverse impact on overall health and will increase health inequities — in turn, putting more pressure on the health care system.

The Wellesley Institute will continue to analyze and report on the Drummond Report in the days ahead.