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Dr. Joshua Tepper

A Plan to Bring Health Equity to Northern Ontario

A quality health care system is one that provides its citizens with an equitable opportunity to be healthy.

Equity is one of the core dimensions of quality care, along with safety, effectiveness, patient-centeredness, efficiency and timeliness, and it is a dimension to which Health Quality Ontario pays special attention.

Guided by leaders in the North, Health Quality Ontario has recently helped facilitate an in-depth multi-faceted engagement of people living in the North to develop a comprehensive plan to address these inequities. The strategy was developed after meetings with nearly 150 organizations and more than 300 participants living and working in the North.

Northern Ontario has long been a region of this province where health equity is lagging. Last year, Health Quality Ontario released a report to the public on health and health care in the north. It showed that the approximately 800,000 people living in our two northernmost Local Health Integration Networks have a life expectancy more than 2 years lower than the provincial overall. They are also more likely to die (before age 75) from suicide, circulatory disease (like heart attacks and stroke) and respiratory disease.

Some populations in the North face greater health inequities than others. Indigenous people make up a significant proportion of the population in parts of Northern Ontario and face unique challenges as a result of colonization and systemic racism that results in higher rates of poverty, lower levels of education and overall poorer health outcomes than non-Indigenous people. The North’s large Francophone population also faces challenges in receiving culturally appropriate care, including care in the language of their choice.

There are many reasons why the health of those living in the North is not equitable with the rest of the province. Underlying factors, such as an adequate income and housing, access to healthy and affordable foods and a safe water supply– the social determinants of health – are unavailable to many people. Those providing medical care and the patients they treat can also attest to the impact long distances, poor weather conditions and a shortage of medical resources (including health professionals) can have on trying to provide high-quality, timely care.

Obviously a comprehensive strategy to address all of these issues impacting equity needs to involve many players. The new strategy that has been developed to address these inequities has involved representation from health care, health promotion, education and research institutions, social services, enforcement, municipalities, Indigenous communities and organizations, Francophone organizations, LGBTQ2S organizations, early childhood education and care, elder care and more.

The strategy for improving the quality of care outlines four foundations for action that were considered most important by stakeholders in the North:

  • Addressing the social determinants of health
  • Ensuring equitable access to high-quality and appropriate health-care services
  • Addressing indigenous healing, health and well-being
  • Having the evidence for equity-based decision-making

It highlights the need, and a strong desire among Northerners, to take a collaborative approach across different sectors to bring partners and stakeholders together in a network to address the key health quality priorities.

The key enabling step in the strategy is the development of a Northern Network for Health Equity. This will involve public health, LHINs, community health centres and Aboriginal Health Access Centres. The network will also include those not always associated with health, such as municipalities, Indigenous organizations, educational and research institutes, Francophone organizations, provincial and federal ministries, municipalities and community organizations and members.

It is intended that a steering committee for the network will be supported by working groups tied to each of the four foundations for action. Working group members will be individuals with expertise relevant to their group domain, with representation from partnering agencies and sectors, including sectors outside of health.

Barriers to equitable quality care have existed for too long in the North. The issues involved are complex and real solutions will take time to develop.

A Northern Network for Health Equity will involve individuals and organizations across the spectrum willing to tackle and dismantle these persistent inequities. Creation of this network is an ambitious and aspirational undertaking and will be just the first step in developing the capacity to address pressing health equity challenges.

Improving health equity in the North, by the North and for the North.

Previous Article Health Equity in Northern Ontario: Thinking Locally

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