After almost two years of consultations, the Association of Ontario Health Centres has adopted the Charter for Health Equity. With the adoption of the Charter, the sector (which includes ten Aboriginal Health Access Centres, 73 Community Health Centres [of which six are francophone], 15 Community-governed Family Health Teams and four Nurse Practitioner-led Clinics) commits itself to action in identifying and redressing health disparities within its member agencies and the communities they serve.
Community Health Centres (CHC) have been leading the way on health equity since the first CHC opened in Ottawa 43 years ago – yet they remain largely unknown in the province of Ontario. Despite a recent expansion in the number and reach of CHCs, the percentage of Ontarians with access to a model that combines community governance and inter-disciplinary, collaborative primary health care with a focus on illness prevent and health promotion based on the social determinants of health — remains at a mere 4%.
Health and health inequities, as we have known for a long time, are shaped by those social determinants: income distribution, access to education affordable housing and food, early childhood development, the environment and social inclusion/exclusion. Health disparities are defined (by the Wellesley Institute) as ‘those differences in health outcomes that are avoidable, unfair and systematically related to social inequality and disadvantage’.
CHCs will be guided by the Charter in a strengthened leadership in health equity through the creation and design of ‘policies and interventions that address discrimination and oppression with a goal of eradicating social inequality and disadvantage for the purposes of reducing differences in heath outcomes’. The Charter makes particular mention of the distinct histories of the Aboriginal and Francophone communities and their constitutionally-protected rights, as well as the distinct health needs of those living in rural and remote Ontario, impoverished urban neighbourhoods and of those who are uninsured and undocumented.
Health problems, the Charter affirms, are not just medical/biological problems – though our system continues to focus the vast majority of its resources on the medical/biological and perhaps pharmaceutical aspects of sickness – but social, affecting access to resources and to power. ‘In our society, access to resources and power is often constrained by poverty, racism, sexism, homophobia, transphobia, ageism, ableism and other forms of social exclusion’, and the multiple intersections.
In a multitude of workshops and plenary sessions, presenters and participants echoed the essence of the Charter, asking: If health is a fundamental human right, embracing the physical, mental, social and spiritual aspects of well-being, why are we continuing to fund medicalised sickness care while making cuts to education, social assistance, employment insurance, culture and the arts, daycare, the environment, and coupling a downward pressure on wages with the ongoing removal of constraints on capital’s – especially in the area of resource extraction – capacity for profit maximisation? Why do we continue a model of physician placement and compensation that fails to take into account population health needs and incents doctors to cherry-pick the healthy and wealthy and focus on quantity, rather than quality of care. Media reports on these topics raised the profile of the provocative and well-received contributions of clients and providers, including Drs Nicole Nitti (physician at Access Alliance), Richard Glazier (senior scientist at the Institute for Clinical Evaluative Sciences) and Kieran Moore (associate professor, emergency and family medicine at Queen’s University).
The Charter Backgrounder laments the ‘uneven’ official support for health equity, ‘in view of unmet commitments to sustain a poverty reduction agenda and the absence of policy and programme approaches’. However, it applauds the government’s encouragement of the use of the Health Equity Impact Assessment Tool (HEIA), initially produced by the Wellesley Institute for the Toronto Central LHIN, as a ‘decision-support tool to identify how a specific programme, policy or initiative may impact population groups in different ways’. The Backgrounder point to the work of the CHCs in the Greater Toronto Area, which has issued in a three-year health equity plan, ‘Building on Potential – Driving Action’.