The Facts and Opportunities in Waterloo Wellington 2015-16 Health Equity.

The Facts and Opportunities in Waterloo Wellington

2015-16

Health Equity

Objectives

• Build a shared understanding of population health and health equity

• Review updates and expectations

• French Language Service report

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What is Population Health and Health Equity?

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Inequality

• A focus on the mere presence of a difference between two or more people/groups on a measure of health

• May be expected and deemed fair, e.g., because of genetic differences

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Inequity

• An unfair or unjust difference in health

• It is systemic, socially produced

• Avoidable or changeable by policy

• Includes Determinants of Health

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“[It breaks my heart to hear about] people that slip through the cracks, people who can't access service because they are excluded or not seen in it, people not receiving care because of financial disparity, people who are stigmatized in health care [and] people who overall face oppression when trying to be healthy individuals.”—Support staff in Guelph

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Sameness vs. Fairness

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“The language piece is huge. In our experience that is one of the biggest barriers across the board in terms of accessing health care. The government tells us that we’re not supposed to provide interpretation, but the workers are caught between a rock and hard place. Our translation budget is cut because they are expected to have that service elsewhere. Health care is one of the greatest needs on arrival. The biggest thing is just getting that care in the first place.”—Service provider in KW4

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Population Health

• Health outcomes of a group of individuals

• Aims to improve the health of the entire population

• Goal of reducing health inequities

• Uses a broad range of factors and conditions

Source: Public Health Agency of Canada

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LHINS and Health Service Providers Have Existing Obligations to Address Population Health and Health Equity

• 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 • Patients First Action Plan• Health Quality Ontario: definition of quality

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Source: Canadian Medical Association

What Makes Canadians Sick?

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Higher income is associated with better self-reported health

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What contributes to Health Inequity?

1. Income and Income Distribution

2. Education

3. Unemployment and Job Security

4. Employment and Working Conditions

5. Early Childhood Development

6. Food Insecurity

7. Housing

8. Social Exclusion

9. Social Safety Network

10. Health Services

11. Aboriginal Status

12. Gender

13. Race

14. Disability

Source: Mikkonen, J., and Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. 14

“[It breaks my heart] that the marginalized in our community continue to receive less care than others in our system. The…homeless, Aboriginal and pediatric population are under served and under funded. For example, end-of-life and hospice care, and mental health access continues to be a challenge…this is a travesty.”—Nurse in Rural Wellington

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“[We need to] focus on the social determinants of health. We point to the individual but don’t look at their environment. Lesbians have a high risk of breast cancer. It’s not because of something they are doing. It is because they are avoiding the doctor because they have experienced stigma. Sexual orientation and identity should be recognized as a social determinant of health.”—Service provider in KW4

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Aboriginal Residents in Ontario

• Aboriginal women and men are more likely to have 2 or more chronic conditions compared to white women and men (POWER Study, 2005)

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Francophone Residents in Ontario• Francophone residents have higher rates of select chronic diseases

compared to non-Francophone residents

18Source: Canadian Community Health Survey (2005 & 2007)

Poverty

• Food insecurity is a risk factor for 12.6% of households in Canada

• Health care costs are 76% higher in households with severe food insecurity

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Impact of Food Insecurity on Health Care Costs

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We can’t ignore the numbers

• 5% of the population accounts for 66% of the spending

• 46% of patients in 95th percentile in one year are still in the top 10% the following two years

• Social determinants of health are associated with high cost health care use

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Right Now - People with low income compared to those with high income

• Over ¼ report their health to be poor or only fair (3X that of high income)

• 2-3 times higher rate of chronic conditions such as diabetes or heart problems

• ¼ of low income people reported their daily activities were prevented by pain (2X that of high income)

• Lower life expectancy - 7.4 years for men and 4.5 for women; Lower health adjusted life expectancy - 11.4 years for men and 9.7 for women

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If all Ontarians had the same health as high income people:

• 318,000 fewer residents reporting fair or poor health

• 231,000 fewer residents living with a disability

• 3,373 fewer residents dying each year

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Who lives in WWLHIN?

• Population of Waterloo Wellington is 778,676

• 14.3% are seniors

• Over 12,000 residents include French as their mother tongue

• Over 10,000 self-identify as Aboriginal

• 13.7% are visible minorities

• 20.5% are Immigrants

• WW has a high percentage of refugees, especially in Waterloo Region

• 22.6% of permanent residents were refugees (Citizenship and Immigration Canada)

• This number is expected to grow with the influx of refugees

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Planning and Implementing System/Service Improvements to Address Population Health

• Integrated Program Council dashboards including health equity measurements

• Access to move information (e.g. GIS mapping, IDS)

• Collaboration with partners outside of health care to address social determinants of health

• Integrated Health Service Plan 2016-2019

• Building knowledge re: health equity—health equity webinar, website

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Role of Health Service Providers

• Funding letters-all funding letters now include clear expectations that funds are used to improve population health and health equity

• Updates to the French Language Services Report-includes questions on improvements made to health equity

• All sections must be filled out completely

• FLS report submission- due one month after the end of the fiscal year, April 2016 (reports@lhins.on.ca)

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“The intake process needs to change. Docs are often afraid of being intrusive so questions aren’t asked…Why are we afraid to ask questions? The data is unavailable because questions aren’t asked. Issues can’t be addressed if you don’t ask questions about income, education, housing and sexual orientation. Asking questions shows you care… We need a detailed assessment for health and social determinants of health.”—Resident in KW4

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But What Can We Do?...It Doesn’t Have to Be Complicated!

• Review available data

• Where do your clients/patients live vs. where your services are delivered?

• What are the cultural linguistic needs of your clients/patients?

• Who are you serving vs. who research says needs your service most?

• Using technology to increase access to services/programs

• Providing direct outreach services-https://www.youtube.com/watch?v=EMiH0GlWOMA

• Collecting data to measure impact of services/programs on vulnerable populations

• Development of culturally and linguistically appropriate services

• Implementation of cultural competency training

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Examples of Health Equity Initiatives—Learning From Others

• TCLHIN and Mount Sinai: measuring Health Equity through demographic data collection

• Language Services Toronto: Provides a single contract for over-the-phone interpretation services 24/7 in over180 languages—cost is less than $1.50 per minute

• Parkwood Mennonite Home: conducts an intake assessment that ask about a residents’ cultural beliefs around death and dying

• CMHA: staff placed in the Sanctuary Refugee Health Centre

• ACCKWA: provides LGBT+ competency training for HSPs

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Next Steps

• Building online resources

• What do you need?

• What can you share? (Please send to Jenny Flagler George)

• A health equity Q&A based on your questions today (posted on our website http://www.wwlhin.on.ca/forhsps/equity)

• Measuring equity as part of all integrated program council dashboards—under development

• Including equity into the planning for our next Annual Business Plan and IHSP

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For more information, please contact Jenny Flagler George, Senior Planner, at

Jenny.FlaglerGeorge@lhins.on.ca

519-650-4472 Extension 221

http://www.wwlhin.on.ca/forhsps/equity.aspx

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