A recent report by the Canadian Medical Association (CMA), Physicians and Health Equity: Opportunities in Practice, argues that physicians can and have been finding innovative ways to address the needs of vulnerable populations. They interviewed 32 physicians across the country practicing family medicine, emergency medicine, pediatrics, psychiatry, and public health, and the report outlines common interventions, barriers, and facilitators for physicians to address health equity within their practice.
Health inequities are one of the most important problems facing Canadian society as a whole. Although root causes lie in the social determinants of health outside of the health sector, we must also remember that equity needs to be addressed in the health care sector as well. Wellesley Institute’s Health Equity Road Map provides a seven point roadmap for building equity into the health care system.
The report highlights key areas that physicians can act upon:
- Providers need to know the barriers to access that their patients face; for example, accessibility can be improved for those with rigid work hours or family responsibilities by more flexible practice hours and ensuring convenient locations;
- There is increasing emphasis on person-centred care, meaning that inequitable social and living conditions that some face are taken into account when designing treatment plans. Promising practices noted include asking questions about patients’ social circumstances, integrating patients’ constraints into their care plan (e.g. cost of medications), and advocating for patients (e.g. for better housing);
- Helping patients apply for support programs for which they may be eligible;
- Linking patients into wider social and community supportive programs and networks.
Front-line providers also noted challenges to incorporating equity into their practices:
- Funding and other incentives are a significant barrier (fee-for-service or simple capitation payment schemes do not recognize the complex conditions that many disadvantaged patients bring) – a challenge that provincial Ministries need to address;
- The time and administrative burdens of ensuring patients are linked into the programs and support they need – currently illustrated by the cuts to the Interim Federal Health Benefits for refugees, which have resulted in providers developing clinics and other work-around measures to ensure refugees can access care, and, spending an inordinate amount of time negotiating with insurers on their patient’s behalf;
- The fragmented and uncoordinated nature of healthcare and other social service systems – a key challenge for governments and regional health authorities.
The CMA argues further that physicians play an important role in addressing health inequities in the country’s health care system, as they hold respected and influential positions in society and their opinions can add strength to advocacy work in these issues. Interestingly, a major British report released this week also argued that health professionals can play a key role in addressing social determinants of health and building equity into their practice.