In discussion with Jessica Byrne who lives and works in Newfoundland and Labrador (NL) I was quite surprised at the difference between the province of Ontario (ON) in response to intimate partner violence (IPV) and chronic disease. I assumed that since we were in the same country our approaches would be similar. In Ontario we have a strong population health approach that addresses many factors that define health and, therefore, affects the health of the entire community or population.
In 2015 Ontario's Patients First Act, was implemented. This act requires public health units to work with the local health planning agencies, the Local Health Integration Networks (LHINs) The utilization of a population health approach in order to meet the unique health needs of every community throughout Ontario was implemented. With this act the LHINs have taken on a more robust role in order to ensure that individuals in all provinces receive care that is individually geared to their particular needs and that of the community in which they reside.
When speaking with Jessica and completing multiple searches, I found NL has a primary care approach. This is not that far from some of our approaches here in Ontario. Where there is an emphasis on population health and public health with a component of primary care in some of our cities and built-up areas in our more remote areas such as Northern Ontario primary care remains the model of choice. Primary health care refers to an approach to health and a spectrum of services beyond the traditional health care system. It includes all services that play a part in health, such as income, housing, education, and environment. For many primary care remains the first point of contact in the healthcare spectrum.
According to the health accord document NL has the worst life expectancy, highest death rates for cancer, cardiac disease and stroke, and highest rate of chronic disease in Canada. This along with the fact that NL spends more on health care per person than any other province speaks to the situation in that there is more emphasis on treatment than prevention.
NL has a higher than national average of chronic disease and therefore there is quite a burden on the health care system. This is also impacted by the inability to retain primary health care providers particularly in rural and remote areas. This is also the case in more northern points in Ontario. To add further to this situation is the fact that provincial health care system is further tested by high hospital admission rates. (2019)
The Government of NL in 2015 released a provincial framework, “Healthy People, Healthy Families, and Healthy Communities: A Primary Health Care Framework for
The framework identifies the following goals:
1. Engaged individuals, families, and communities sharing responsibility for health promotion, illness and injury prevention, early intervention, and self-management.
2. Individuals and families attached to a collaborative primary health care team.
3. Timely access to comprehensive, person focused primary health care services and supports.
4. Connected and coordinated services and supports across the health and social sectors.
In short NFLD has a predominantly primary care model whereas Ontario has both primary care and population health model. There is a place for all these models to work hand in hand. However, as clinical interventions are preferred over more complex policy interventions and as NL finds itself with an aging population and having the highest chronic illness rates in Canada, the emphasis on a primary care model approach is understandable in the short term.
The need to combine this with a more forward-thinking population health model not only in NL but also in areas throughout Ontario ais necessary but this will take time and financial investment from the provincial governments.
cbpp-pcpe.phac-aspc.gc.ca
Health Accord Newfoundland and Labrador. (2020). Health accord for Newfoundland and Labrador: A 10-year health transformation. St. John’s, NL.
A primary health care framework for Newfoundland and Labrador. https://www.gov.nl.ca/hcs/files/publications-phc-framework-update-nov26.pdf.
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