The Wellesley Institute’s Michael Shapcott joined hundreds of community leaders at a forum at Markham Civic Centre on August 11 to support a new community health centre for Markham and Richmond Hill sponsored by the Social Services Network and the Association of Ontario Health Centres. The principal focus of our work at the Wellesley Institute is health equity – the fundamental differences in health among different parts of our population – and we know that community health centres are both effective and innovative in tackling health equities.
The Wellesley Institute’s Bob Gardner is a leading expert on building equity and diversity into the core of community-based primary care and health promotion. His short ‘elevator speech’ on health equity boils down complex policy and social challenges into snappy and popular language
There is a growing body of evidence locally and internationally that demonstrates that there are profound and systemic differences in how healthy people are and how long they live. For instance, a major research report that we released in December of 2008 titled Poverty Is Making Us Sick’ used the most comprehensive health and social data and found that the poorest one-fifth of Canadians, when compared to the richest twenty percent, have:
- more than double the rate of diabetes and heart disease;
- more than three times the rate of bronchitis;
- nearly double the rate of arthritis or rheumatism;
- a 358% higher rate of disability;
- 128% more mental and behavioural disorders;
- 95% more ulcers;
- 63% more chronic conditions; and,
- 33% more circulatory conditions.
Here are excerpts from the Wellesley Institute’s speaking notes prepared for the Markham meeting:
The overall health of the population is related to a series of complex and dynamic relationships among a number of issues and factors. We know, for instance, that most immigrants arrive in Canada healthier than resident Canadians, but the Wellesley Institute’s immigrant health practice – and the work of many others – shows that this health advantage quickly erodes and that after five years, recent immigrants face a heavier health burden than resident Canadians.
The fundamental roots of these health disparities lie in social and economic inequality – the effects of inadequate housing, poverty, employment barriers, social exclusion and other broader social determinants of health. Another key factor is inequitable access to health care. Many countries and a growing number of local communities have developed comprehensive policies and programs to tackle health inequality, and community-based providers across Canada and around the world are working hard to address health disparities on the ground.
Which brings us to the proposed community health centre for Markham and Richmond Hill. Community health centres in a number of locations throughout Canada and internationally have proven to be both successful and innovative models delivering a number of benefits. My colleague Bob Gardner, the Wellesley Institute’s Director of Policy, is recognized locally and internationally as a leading expert on health equity and access to health care. I have brought along a backgrounder that includes some of his recent work in this area.
Here is a summary of three key evidence-based findings on the critical value of community health centres:
- Community health centres deliver excellent, patient-centred health care that takes the full range of people’s specific needs into account. Access to primary health care is particularly important for those facing harsh health disparities, and enhancing access to primary care is widely seen as one of the most effective ways to address health disparities. Targeting primary care to health disadvantaged populations is a critical part of a comprehensive health equity strategy. Community health centres are critical to this work.
- Increasingly, in Canada and abroad, community health centres are pioneering new hub models of integrated care that combine primary and preventive health care with a range of other social services that directly affect individual and population health. This collaborative approach not only benefits the individuals who require support and services, but has also been demonstrated to be cost-effective for the health and social services sector.
- Community health centres can be effective in developing equity-driven service models that explicitly meet the needs of diverse populations within the overall community. Public authorities often proclaim health priorities (diabetes, mental health, obesity, and so on), but we know that a ‘one-size-fits-all’ initiative often fails to reach parts of the population that often bear the heaviest health burden. Community health centres are uniquely positioned to know their communities, to effectively target initiatives and – crucially – to move beyond vulnerable individuals to the neighbourhoods and communities in which they live.
Thank you for the opportunity to make these brief comments in support of a new community health centre for Markham and Richmond Hill. As our printed material shows, we have a large number of resources on community health centres and health equity, and we would be pleased to answer questions or comments that you might have.