By Annamarie A. Fuchs, Creator. Partners in Health | Conversations.
March 18, 2021
“There is no limit to the amount of good you can do if you don’t care who gets the credit.”
I’ve had some fascinating conversations over the winter months with a Social Worker who works with the immigrant and refugee community. This is an area of health and social services that I’ve had only modest exposure to in my career. When I hear about the challenges that are faced by Social Workers and others in their efforts to facilitate reasonable access to healthcare services for vulnerably populations, I am amazed at the barriers that exist. In one case, this Social Worker reached out to one of the regulatory colleges for assistance when a provider refused to accept a new client because of the language barrier. Despite the Social Worker offering translation services via face time, zoom, or other applications, the answer remained a resounding ‘no.’ Unless translation is available in person, some providers will hesitate to take on an immigrant or refugee client. And, in many cases, family members are equally challenged to provide in-person translation support due to their own language barriers and work schedules. Social Workers are often unable to accompany clients to their appointments because of the demands of their caseloads. The regulatory college assured my Social Worker friend that simply refusing to offer care is not an option. Ultimately, a solution was reached, and the individual was accepted as a client, but the process was time consuming and cumbersome, leaving the individual and her family frustrated and disempowered.
Years ago, when I was still practicing as a clinical nurse, I became acquainted with a beautiful and frail woman who had come to Canada with two of her children from a war-torn country. She had watched her husband murdered in front of her by a young man who had grown up alongside one of her own sons, only to become a solider for the opposing group. Her story was complex and horrific. When the surviving members of her family finally escaped 9 months later and arrived in Canada, she had been suffering abdominal pain, weight loss, and other symptoms for some time. Given the trauma she had experienced in her home country and language barrier, the immediate assumption was that she suffered from post-traumatic stress and was subsequently hospitalized on a psychiatric unit. When I met her, months had passed, and she was weeks away from dying from end stage pancreatic cancer. I’m not qualified to judge whether she might have survived if she had been diagnosed earlier. I’m not a physician and pancreatic cancer is known to have a poor survival rate. But, because her diagnosis was delayed, the care she needed wasn’t provided. Her quality of life, the needs of her children, and her faith in the system had been eroded and the results were catastrophic. She was suspicious of the health professionals around her and her children were angry. Over time the staff on the palliative care unit worked tirelessly with her to try to restore a measure of trust and I was privileged to be at her bedside along with her children and her Canadian sponsor family when she died.
Most of us assume that everyone in Canada has reasonable access to the same health care services regardless of our address, culture, language, or standard of living. Such is not the case, at least not yet. We regard our healthcare system with pride and defend it as one of the best in the world but it’s far from perfect and far from equitable. The social determinants of health refer to the broad social and environmental circumstances that influence our health and health outcomes. Social determinants acknowledge our rank (and place) in society and our personal choices relative to lifestyle and education. They also recognize for example that our address (where we live and work) can profoundly influence our access to health and the decisions we make. Differences based in any of these categories can result in what Health Canada calls “health inequalities.” For example, I am an educated health professional who lives in a bedroom community within minutes of a large regional referral center. If needed, I have access to advanced diagnostics and therapeutics. A friend of mine however, lives in a remote community in northern Alberta where access to even basic services requires either a considerable wait (one family physician in town), considerable distance travelled, and inconsistent scheduling. My likelihood of being able to remain well is higher than hers, simply because of my address.
Work has been underway across the country to address inequities for some time. In 2011, Canada signed the Rio Political Declaration on the Social Determinants of Health “alongside other WHO member states in a pledge to strengthen capacity, evidence, and action on the social determinants of health and health equity.” Then in 2015 the UN General Assembly 2030 Agenda for Sustainable Development was adopted as a means to reduce inequality in healthcare. But disproportionate access to healthcare in Canada appears to be worsening. The Canadian Medical Association reports that even when access to services is available, those from disadvantaged groups like the individual my social worker friend worked with or the lady I cared for, remain less likely to receive appropriate care when they need it. Barriers like those we talked about along with system barriers such as lack of available services in remote communities, wait times, coordination of care, standards of practice, and the attitudes of healthcare workers also heavily influence equity. In an effort to eliminate those inequities, the CMA report recommends widespread implementation of person-centered primary care, improved health system planning, and more comprehensive coordination of care.
Meanwhile, there’s much we can do, individually and collectively. I believe that there’s no end to the good we can do when we contribute to making a difference in our own communities. The social worker I told you about has been advocating for her new Canadian families for nearly a year. She calls the regulatory colleges, calls clinics, speaks to professionals, offers advice to family members, and continues to fight the good fight. And by the way, she is an immigrant herself. She and her husband have also run local bottle drives to support immigrant families. My own volunteer work in my local community focuses on attracting and retaining family physicians and other health professionals so we can better serve our 10,000 residents. A physician friend who recently retired is volunteering in his community and vaccinating people for COVID-19.
I could go on. There are people helping to reduce food insecurity while others are volunteering in inner cities with high risk populations. If you think about the social determinants of health and other inequities my guess is that you’ll find areas of interest or need that will challenge you to make a positive impact on the lives of those around you. Check your own community’s website for ideas. Many communities offer volunteer opportunities such as snow angels who shovel driveways in the winter and mow grass in the summer for older adults and the disabled. Other communities have their own local food banks. Others offer meals on wheels, transportation services, and other supports to shut ins. Launch bottle drives to support immigrant women and their children. Join one of AHS’s many Health Advisory Councils. Citizen engagement groups such as IMAGINE: Citizens Collaborating for Health or Greg’s Wings and others are always looking for volunteers or donors. Find a need. Fill the need. The system is working hard to improve healthcare for everyone, but we should not simply sit back and be passive recipients of that great work. We need to be part of the solution and we can all do more if we truly believe that we are in this together.
 Key Health Inequalities in Canada, A National Portrait. August 2018 https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/science-research/key-health-inequalities-canada-national-portrait-executive-summary/hir-full-report-eng.pdf
 CMA Position Statement. Ensuring Equitable Access to Care: Strategies for Governments, Health System Planners, and the Medical Profession. 2014. https://www.cma.ca/sites/default/files/2018-11/PD14-04-e.pdf