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Health equity: the work we’re doing in cooperation, and the collective efforts that remain

Posted by Dr. Joshua Tepper on July 26, 2016

Health equity is one of the six dimensions of quality, as defined by the Institute of Medicine and adopted by Health Quality Ontario. Health Quality Ontario’s recent efforts have shed light on the relationship between income and health; our recent consultations with partners and people with lived experience have helped us to understand the opportunities and challenges facing Ontario. We believe that equity cannot just be implicit in our work – equity needs to be explicitly reflected in our quality efforts. Here’s why.

What information is available suggests Ontario has a problem with equity in healthcare and health outcomes. How is it that we can have large societal inequities that are widely known… yet nothing seems to change?

We’ve known that suicide rates among our Aboriginal people were unacceptably higher, long before a state of emergency was recently declared in Attawapiskat. We’ve similarly known that dozens of Aboriginal communities in Ontario have been living with boil-water advisories for more than a decade.

Inequity presents itself in many ways when it comes to health care. Our recent report on the subject shows that the poorer people are, the more likely they are to have shorter lifespans and to suffer from multiple chronic conditions. Inequity presents itself in smoking rates that vary dramatically from the North to the South, from the poor to the rich. Francophone populations have demonstrable inequities in their access to care; new Canadians and refugees, as well. And as we know, health outcomes vary radically by Aboriginal and non-Aboriginal status.

Health equity can be understood as all people being able to reach their full health potential – meaning some will need more help than others. It’s not the equal dividing of resources so that everyone gets the same piece of pie; rather, it’s an approach whereby factors like income, race, language, geographic location, and disability don’t impede health.

Issues leading to inequity here, and around the world, can be considered in light of these factors. And though we can talk about inequity in such organized fashion, the way in which it manifests is anything but.

We see that certain groups of people face societal stigmatization, disenfranchisement and disempowerment - all of which affects their health outcomes. But how do we begin to break this down in a comprehensive way? Though many factors can work in isolation, often, they tend to compound: For example, mental health, addiction, poor education and homelessness. The challenge of tackling equity begins here. This means for those of us working to bring equity to the forefront of our health care system, it begins by recognizing the difficulty in untangling the labyrinth.

Health Quality Ontario has recently stated the dimension of equity as a principal focus in our strategic plan. We are alive to the fact many issues contributing to health inequity fall far beyond the purview of the health care system. Despite some social determinants – housing, income, education – greatly influencing people’s overall health, the health care system can mitigate some inequities, and can partner appropriately with those beyond the system to address them.

In acknowledging such complexities and challenges beyond our control, we’ve developed a plan for Health Quality Ontario on how to embed equity into our own work, and to encourage health care providers, system leaders and planners to make it prominent in their thinking, discussions, and actions. We will work with our partners to develop targets, and to advance health equity throughout our public reporting; we will apply a health equity lens as we develop new standards of quality to support our health system. We will support, and, where appropriate, lead a provincial data strategy in order to address health inequities in policy, planning and practice. We will engage people with lived experience who face inequities as we work together to improve health care planning and evaluation.

A successful publicly-funded health care system is one that works for everyone. Yes, equity is complex. Applying an equity lens to health quality allows us to start to piece apart the challenges we face.

Our strategies at Health Quality Ontario may not be perfect. But the absence of perfect strategies cannot paralyze our collective efforts.


Blog Archive

Health Quality Ontario’s 2014 analysis put a spotlight on end-of-life care. Today, we continue to help transform palliative care in Ontario as part of the newly-formed Ontario Palliative Care Network.

Posted by Dr. Joshua Tepper on July 4, 2016

HQO’s latest report looks at palliative care. We look at the care and services people received during their last month of life to understand how the health care system is serving people as they near the end of their lives.

Conversation around end-of-life has been at the forefront of public discussion recently, in part due to the Federal Parliament’s focus on medically assisted death. However, this conversation should not overshadow the important evolution of our healthcare system to focus on palliative care. Our healthcare system takes responsibility for ‘cradle to grave’ care but far more attention has been placed on the beginning of life and the events during life than at the end.

Perhaps because of this traditional focus our report on palliative care found room for improvement.

Of the 95,000 people who died in Ontario in 2014-15, only just over half received some form of palliative care. And of those 54,000 people, half did not begin receiving this care until their last month of life.

This statistic alone is revealing. Modern medicine has extended our lives in ways that once would have been unimaginable. With the changing nature of disease, and chronic illness at the root of most deaths, we often now have the ability to better anticipate end-of-life. This means tremendous opportunity for palliative care to begin much sooner, and for people to understand its benefits - care that not only helps patients with their pain and symptoms, but also helps patients and their families through a difficult time of loss and grief.

We also report that nearly two-thirds of those who’d received palliative care had unplanned emergency department visits in the last month of life. While it is unlikely the number should be zero, the current rate is almost certainly higher than a high performing health system would anticipate. Another area for improvement is our finding that nearly two-thirds died in hospital although we know most people’s preference is to die at home.

Getting care when it’s needed, where it’s needed, and by well-trained people are hallmarks of quality health care. We need to build a health system that provides quality care at the end of people’s lives.

Let’s make our health system healthier

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Claude Lurette and Kowsiya Vijayartnam, Health Quality Ontario Patient, Family and Caregiver Advisors Council Co-Chairs

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