Equity In Primary Health Care Services: An Overview Of Access And Key Determinants In Canada

Therefore, inclusion of Person-centred care and evidence-based solutions that Nurses contribute in their roles as Primary Health Care providers, in the prevention of illness and promotion of health is sought.

Related Course Objectives:

1. Identify, evaluate and apply the philosophy and principles of primary health care outlined by the World Health Organisation as a fundamental approach to holistic nursing care.
2. Demonstrate an understanding of equity, social justice and the epidemiology of health and disease across different population groups in a global context.
3. Critically analyse the significance to nursing practice of (i) to social determinants of health; (ii) availability, accessibility, acceptability, affordability and cultural appropriateness of health service provision.
4. Construct innovative, person-centred solutions to global health issues through the application of evidence-based theories, reflection critique and academic literacy skills.

Access of Primary Health Care in Canada

Primary health care has been the driving force in healthcare systems across the globe. The values set by the WHO, principles, and approaches have informed the basis for improved access to care and health fairness among the population. Primary health care model embeds on the holistic view of health and disease in general. It focuses itself on the role of various root causes of morbidity. Primary health care is oriented on individual, family, and community care. Further its basis hinges on the preventive approach of care which is oriented to humankind and environment. Primary health care approach follows a spectrum of services which lay a crucial part in the healthcare system which include health promotion activities.

The focus of this paper is health care service equity in Canada. Canada’s health care services have a broad spectrum of activities and services which address the health care. The primary health services in Canada majorly focuses on providing first direct contact services through avenues such as primary health care professionals in the service. The healthcare service is coordinated as to ensure continuity and mobility across the various systems in place. Thus the impact of health equity access for the Canadians, the key determinants underlying it, environmental factors linked and contribution of health care provider’s nurses has been deeply discussed.

The aim of primary health care service in Canada serves a crucial dual function in the health care system. They offer the provision of direct first care services through the usage of the various healthcare service providers in its disposal. Secondly, it offers coordination of health care function so as to ensure that there is continuity of health care service. This means that care for the Canadians remains open and serve the general population. The aim of the health access equity in Canada is to provide responsive care of the needs of the population. In order to facilitate this, it has offered a range of healthcare services which vary according to the community needs. These primary health care services which ensure equity include prevention and treatment, basic emergency services, health promotions, palliative care, healthy child development among other health care services, (Aggarwal & Hutchison, 2012).

Previously, the health care system in Canada faced numerous challenges. The services were delivered mainly through the physician and the general practitioners whom their key focus was the treatment of illness and injury assessment. Various concerns were raised with this regard which includes the lack of emphasis on health promotion and prevention of disease, problems regarding access especially in the rural and far remote areas and providers relating to working conditions, (Osborn et al, 2015).

With the raised concerns, primary health care reform took center stage. This brought about to a shift towards a team of providers responsible for providing comprehensive care of service to the citizens. This was initiated by the consensus that  having better working conditions among the health care team including the nurses, physician and other healthcare professional team yielded better health outcomes leading to improved access to services, prudent usage of health care resources in an equitable manner and offering the satisfaction of health care services among providers and the patients. The shift in the team of providers ensured that health promotion and improvement of chronic disease management, (Sweetman & Buckley, 2014).

Key determinants of health care in Canada

Various territories and provinces in Canada are putting forward plans which enhances primary health care reforms in partnerships with the Transition fund in primary health care, body initiated to oversee reforms in primary health. Various initiatives have emerged which enhances health care equity access for all the service providers. These include creation of primary health care teams which promote comprehensive care service for their clients, enhancing telephone line services, improving on management of chronic services, putting emphasis on health promotion and prevention, voluntary participation among health providers and enhancing capacity building through evaluations to enhance quality of care, (Hutchitson & Glazier, 2013).

Through international health standards lenses, Canada is experiencing low  ratios of physician to the  population , however, the rate of general practitioners is high and above average compared to member states of  OECD (Organization for Economic Cooperation and development). Family physicians account for an estimate of about 51% of the total workforce of physicians,(Canadian Institute of Health Information, 2010). An estimate of 91% of Canadians, taste to normal care service delivery through a family physician, however, many residents still argue difficulty to obtain primary care and referral services, (Canadian Institute of Health Information, 2009) An estimate of 13% argue that there is difficulty in accessing health care services and ongoing care and 33% reported that they had to experience a long waiting time to access care services. Canadian citizens are however entitled to a free family physician, making the physician services free at the health facilities.

It is interesting to note that Canada’s primary health care has entered into critical phase of transformation. Various initiatives have been put forward for interprofessional healthcare teams, patient enrollment, group engagements, and patient intake with health care provider and enhanced governance to support the changes for ensuring health access and equity for all.

Preventive measures aiming at healthy food practices of healthy living have been rolled out as a crucial aspect in Canada health care systems in challenging the rise of chronic diseases. The rise in chronic disease and the epidemic proportions have raised the epidemic levels and pose serious health issues towards health care sustainability in general through avenues of health promotion.

Important underlying issues to this mentioned health characteristic in Canada lies in the social and economic factors underlying health inequalities. Many factors have an impact on influencing health. Health determinants are broad and often range from social, economic, environmental and personal factors which are key determinants of population and individuals. Major determinants underlying health are income, social status of the populations, working conditions status, education levels, physical environment, health behavioral patterns, health service access, gender, and cultural influences, (Mikkonen & Raphael, 2010).

Social determinants, on the other hand, entail certain aspect of social and economic factors which have broader health significance. These have been shown to have an effect on the societal position of an individual’s, education status, and employment and income opportunities. Further discrimination of individual and trauma experiences has been shown to have an effect as a health determinant of health, (Public Health Agency of Canada, 2011).

 In Canada, economic and wealth disparities are evident. Some of the Canadians citizens have more wealthy possessions and have a more healthy life compared to other citizens. Those pertaining health status have been contributing factor to health inequalities. The differences have been observed due to the choices made. This means that social factors can be a factor as a determinant of health. Health inequity and equity have been observed in the Canadian society.

Various approaches have been put forward to combat and reduce health inequalities. This ensures that everyone gets the same opportunities for health, in wherever places they are in. various avenues have been put forward by the Canadian government to reduce this social determinant of health. Strengthening of evidence-based practice to inform decision making has been practiced. This has been undertaken using health inequalities data tool which entails a data set on health inequalities, created by the Canada public health agency. Another key tool being used is the identification of key health inequalities illustrating the challenges existing, developed through various stakeholder agencies. Data informatics on children about health and developmental issues in the early years and effective childhood development programs and interventions has been outlined. Engaging other none health sectors has been established across the Canadian health system. This looks into beyond board in working with other sectors towards improving and eliminating the social determinants affecting health and scaling equity of health care, (GoC, 2018)

Research undertaken has shown a link between health and the environment. WHO states environmental factors account for an estimate of 24% of the world burden of morbidity and 23% all death causes. This tremendous costs it puts on human beings are higher in highly developed countries, Canada included. Data suggests that the greatest impacts are borne to the lowest income category of people especially the aboriginal and marginalized groups. This phenomenon is true with regard to the global context, where the developing countries are bearing the harmful consequences of changing the climate, (RNAO online, 2018).

Protection of environment has not been only the matter of health, but also linked to social equity and justice. Access to clean water and air, needs to be recognized as a human right due to the seriousness of the threats it causes. Canada advocates for precautionary approaches towards protecting the health of human beings and the environment in general.

The health costs related to the failure to act on environmental factors of health are a record high. With illustrations of four commonly related environmental factors such as diabetes, neural development, and Parkinson disease effects, their total health costs is estimated to be up to US 10billion in Canada. This costs are high hence need for adequate actions by the various health and none health actors to act, (RNAO online, 2018).

There are various factors which play a crucial role in the health care delivery have been attributed to various organizational gaps which include health care fragmentation, low management  levels and inability for successful follow-ups of to the vulnerable groups, limited priority of health promotion practices, equality issues and patient information sharing. With respect to these challenges, new models and innovations have been rolled out to meet these challenges. Collaborative interdisciplinary approaches and quality improvement strategies have been put forward, (Wong et al, 2010).

Primary health care symposium held in 2016 in McGill discussed collectively on the challenges health care system was facing. This forum put into shape the role nurses played in healthcare practice. In the current arena, the role of the nurses has always been undermined contrary to many successful models where nurses have played a crucial role. Nurses play a crucial role in health promotion, illness prevention, caring for the ill, dying and the disable persons. Further, advocacy roles, safe environmental area, engaging in research, and the shaping of health policy forms key areas of focus for nurses, (Bartz, 2010).

The Canadian Nurses associations have put forward key roles of the nurse as impacting positivism in the patient, being a provider and achievement of organizational outcomes. The nurses play a crucial role in shaping current and future professional nursing decorum, (Canada Nurses Association online, 2018).

The Canadian healthcare continues to evolve; the prevalence of chronic disease continues to rise. This has brought into focus health professionals. The concept of patient-centered care has been advanced in various surveys done, (Montaque et al, 2017). Patient-centered care has been structured around healthcare user and enhancing empowerment. Various platforms have been initiated such as personal electronic health records packaged with effective interoperability functionality has been put in place. A person-centered approach has initiated positive working relations among health care workers, promoting wellness and involving all parties with the overall agenda of promoting equal health access for all, (Canadian Association of Person Centred health, online, 2018).

Towards the promotion of evidence-based solutions in nursing practice, nurses play a key role in nursing research. This addresses key focus areas of knowledge and personal enhancement desires. The critical tasks in coming up with evidence-based recommendations entail performing laboratory experiments and utilizing analytical skills. Nurse’s role is diverse and calls for assertiveness, high clinical practice and commitment. This portrays the critical phase the nurses are in Canada in promoting primary health care and ensuring evidence-based care practices, (Gibbs & Lowton, 2012).

Conclusion 

Canadian primary health care is undergoing a tremendous transformation, through the implementation of key initiatives which promote interprofessional health approaches, healthcare networking, patient, and financial incentives all geared towards ensuring that there is an easy access to health care for all. Canada's changes have shown that primary health care can be made equal and accessible to all. Acting on the various factors affecting health care and the critical role of nurses plays a fundamental aspect in healthcare delivery.

References 

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Osborn, R., Moulds, D., Schneider, E. C., Doty, M. M., Squires, D., & Sarnak, D. O. (2015). Primary care physicians in ten countries report challenges caring for patients with complex health needs. Health Affairs, 34(12), 2104-2112.

Public Health Agency of Canada. Canada Signs UN Declaration on Preventing and Controlling Chronic Diseases. https://www.phac-aspc.gc.ca/media/nr-rp/2011/2011_0919-eng.php. Accessed on 09/09/2018.

Registered Nurses Association of Ontario, Environemntal Determinats of Health. Accessed at https://rnao.ca/policy/projects/environmental-determinants-health. viewed on 09/09/2018.

Social determinants of health and health inequalitie, 2018. Accessed at https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html. viewed on 0909/2018.

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