Health Equity Dr Kwame McKenzie CEO Wellesley Institute Date 2015
Disclaimer Commissioner of Human Rights Ontario Special Advisor for Basic Income; Minister Housing & Minister of Community and Social Services Member of Mental Health and Addictions Leadership Council These comments are my own and do not reflect institutional positions
Things we know
Diversity puts us on the map Charles Correa & Moriyama / Teshima Architects
2016 Census Ontario population 51.1 % are 1 st/ 2 nd generation immigrants Ontario 1 st generation immigrants 45% Asia 33% Europe 16% Americas 5% Africa
Areas in Ontario with over 20% immigrant population Toronto Hamilton Kitchener Windsor Guelph Leamington
Health equity enshrined as way to improve health systems in Ontario The French language Act Local Health System Integration Act Canada Health Act Future of Medicare Act Charter of Rights and Freedoms Ontario Human Rights Code Excellent Care for All Act
Health equity will be measured Anti-Racism Directorate HQO MOHLTC
Health equity = system quality A high quality and efficient health system is based on the matching of population need to the resourcing of effective interventions to meet those needs. A more equitable health system is more efficient. If Ontario is to bend the cost curve for health there is a need to deal with upstream issues that increase risk of illness but also a need to ensure that effective treatments are given to people at highest need.
Health equity helps users to align services with need enabling better health outcomes Source: Health Equity Audit: A Guide for the NHS, UK Department of Health 10
In this simplified example, those with the most need get the lowest level of service: the undesirable inverse care law Source: Health Equity Audit: A Guide for the NHS, UK Department of Health 11
In this simplified example, there is a good alignment between high need and high service provision: a desirable situation Source: Health Equity Audit: A Guide for the NHS, UK Department of Health 12
We know all this but we do not do provide equitable services
Examples of disparities for immigrant refugee and racialised populations Poorer screening rates for cancers Poorer survival from cancer Higher diabetes rates Poorer outcomes from diabetes Poorer access to long term care
Rates of psychosis for immigrants in Ontario (Anderson et al 2015)
MH services costs 2008 Ontario per person means (case for diversity)
Systems are perfectly designed for the outcomes they produce. Health equity requires an analysis of why, as well as what and how inequities exist.
Health inequity Health inequities are avoidable differences in health usually caused by: Social determinants of health Inadequate social response to differences in need Inadequate health response to differences in need
Two forms of health equity horizontal equity equal treatment of those with the same circumstances vertical equity individuals who are unequal should be treated differently according to their level of need
Change requires strategy - knowledge, attitudes, skills and implementation science.
Simple change strategy 1) Create the environment for change pull more effective than push 2) Movement usually incremental works inside budgets but not always 3) Speak their language use existing strategic direction and institutional levers Policy maths 2+3 = 1
3 levels of cultural competence are needed for equity Organizational culturally competent interventions Competent service system; data, links, inclusiveness Structural culturally competent interventions Appropriate therapies or pathways to care Clinical culturally competent staff Training and monitoring
Example: CAMH multi-level approach delivering equity 23
Specific population: mental health of refugees Higher rates of: anxiety and depression post traumatic stress disorder adjustment disorders increased risk of psychosis, substance use problems. 24
Share of immigrants self-reporting as healthy by immigration category 25
Mental health service use Refugees seek help for mental health problems less frequently than the general Canadian population. Use mental health services less than Canadianborn population. Experience barriers in access to services. (MHCC, 2016)
Drivers Equity in CAMH strategic plan Patients first Public perception of Syrian refugees Board became a private sponsor Data collection to identify problems and monitor progress Health equity office Willing clinicians with expertise
CAMH multi-level approach to addressing the mental health needs of refugees 28
Refugee Mental Health Project Evaluation 29
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