The Drummond Report’s emphasis on reform and innovation in the way health care is organized and delivered is vital. The issues it highlights – from quality and patient-centred care, through better integration of health services and long-term planning, to a welcome emphasis on prevention — are crucial directions for creating an effective health care system. And the report correctly argues that there are many opportunities for reform – and many underway across the system that can be built on. But Drummond’s prescription for reform will not be achieved because of a fatal flaw. The report totally ignores equity.
For example, it emphasizes that preventing ill health and controlling chronic diseases is crucial, but ignores their well documented inequitable gradient of risk and burden. The incidence and impact of diabetes and other chronic diseases is far greater for lower income people and others facing social inequality and exclusion. Providing better information on the importance of good nutrition is hardly relevant for those forced to live in food desserts or survive on social assistance. Improving the quality of care is never purely clinical, but has to involve addressing systemic barriers such as language and literacy. In all these ways, equity needs to be a driving principle of health reform, every bit as important as efficiency, quality and innovation. If equity isn’t built into reform, there is real danger that access to care will become even worse for disadvantaged populations and health outcomes will become even more inequitable.
These notes are from a talk to the Toronto Hospital Collaborative on Marginalized Populations. The Collaborative is a shining example of the potential of provider networks coming together to plan and address pressing equity issues. It has been the forum where Toronto hospitals have discussed their equity plans and addressed common issues such as care for the uninsured, collecting equity-relevant data, embedding equity into indicators and addressing the wider social determinants of health.