spring 2013

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Canada’s doctors release blueprint for health equity


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In March, the Canadian Medical Association released the paper Physicians and Health Equity: Opportunities in Practice, which outlines ways front-line physicians can help level the playing field and ensure that more of their patients can achieve good health.

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In March, the Canadian Medical Association (CMA) released the paper Physicians and Health Equity: Opportunities in Practice, which outlines ways front-line physicians can help level the playing field and ensure that more of their patients can achieve good health. It was written as part of the CMA’s ongoing efforts to drive transformation in Canadian health care.

Health equity is created when individuals have the opportunity to achieve their full health potential. It is undermined when social and economic conditions, the social determinants of health, prevent or constrain people from taking actions or making decisions that would promote health. Most major diseases including heart disease and mental illness follow a social gradient with those in lowest socio-economic groups having the greatest burden of illness.

“As physicians, we’re not the experts in housing, early childhood development, income equality or any of the other social determinants of health, but we see every day the impact of these factors on the health of our patients,” said CMA President Dr. Anna Reid.

“If we want our patients to truly be well, we sometimes need to look beyond their symptoms and consider the broader context of their lives.”

Based on interviews with physician leaders in health equity from across Canada, the paper lists practical ways doctors can tear down the barriers to health equity. They range from offering flexible office hours and a convenient office location to helping link patients with supportive community programs and services.

“We know that health is linked to income and that the poorer you are, the more likely you are to suffer heart disease, mental illness and other major diseases,” Dr. Reid said. “Physicians, other health care providers, all of us, need to do what we can to can help turn the tide toward health equity program by program, policy by policy, patient by patient.”

Physicians were asked to identify common areas of intervention for addressing health equity within practice. The paper outlines the most common seven steps physicians can take to help their patients counter social or economic factors that are barriers to good health, which include:

  1. linking patients with supportive community programs and services;

  2. asking questions about a patient’s social and economic circumstances;

  3. integrating considerations of social and economic conditions into treatment planning (i.e. cost of medications);

  4. advocating for changes to support improvements in the social and economic circumstances of the community
    (i .e ., advocating for reductions in child poverty);

  5. undertaking advocacy on behalf of individual patients
    (i .e ., letters about the need for safer housing);

  6. adopting equitable practice design (i .e ., flexible office hours, convenient practice location); and,

  7. providing practical support to patients to access the federal and provincial/territorial programs for which they qualify.

Interviewees also highlighted facilitators to this work such as clinical training about how to do this type of work (i .e ., service learning programs in medical school and residency); interdisciplinary team-based practice settings; a relationship with community services and programs; clinically relevant resources about the programs and services that were available for patients; supportive compensation models (i .e ., salary, billing codes for complex patients); continued research that demonstrates efficacy in the clinical environment; and, finding a like-minded community of practice.

Physicians and Health Equity: Opportunities in Practice is available online.

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Nexus is published quarterly for Newfoundland and Labrador's physicians. It is a forum for the exchange of views, ideas and information for members.