By Ramandeep Kaur (ON) & Lindsay MacDonald (NS)
("Source: Media from Wix").
In evaluating the determinants of health affecting Canadians, we took a closer look at the two provinces in which each of us reside- Ontario & Nova Scotia. Our goal was to identify the priority, or most influential determinants on population health for each respective province and analyse how they compare to one another. In our research, we also looked at ways in which Ontario and Nova Scotia are working to address population health issues within their province and regional communities.
Health Determinants
Ontario:
Out of the multiple social determinants of health discussed in a report by the Health Quality of Ontario in 2016, population is known to be one of them. Ontario is the largest and the most diverse province of Canada along with simultaneously being the most populated. A densely populated province accounts for delivering healthcare services to a larger volume of people which unfortunately leads to long wait times and poor health care delivery. Besides wait times being an issue, the variation in the quality of healthcare due to differences in income in Ontario is a major issue. Unfortunately, the poor in Ontario get a low quality of healthcare. As per the statistics mentioned by Health Quality Ontario, Ontarian's in poor neighborhoods account for nearly 49.9% of people who are due for colorectal cancer screening as opposed to 34.9 % in the richest neighborhoods. An additional observation made through statistical analysis by Health Quality Ontario was that the poorest people in Ontario are twice as likely to have multiple chronic conditions such as anxiety, arthritis, asthma etc. which can poorly impact an individual’s health. Thus, overpopulation, variation in quality of healthcare due to income and the associated link of low income with multiple chronic conditions are some of the few prioritized determinants of health for Ontarians (Let’s make our health system healthier, 2016).
Nova Scotia:
In Nova Scotia, one of the most pressing determinants affecting the health of the population is access to health services. A recent 2019 public poll conducted by the Pharmacy Association of Nova Scotia found that 86% of respondents expressed concern about having adequate health care access in Nova Scotia; a reality that emphasizes that issues surrounding this fundamental health requirements are being recognized not just by government and professional bodies but by the everyday population (Peddle, 2019). The province is currently experiencing a severe shortage of family physicians, a crisis which is adding to the population’s concerns. According to Doctors Nova Scotia, as of 2018 there were 100,000 N.S residents without a family doctor and close to 60,000 of those were on the provincial waitlist for a primary care provider. These statistics however are based on residents self-reports of their inability to access medical care, leading to the assumption that the number of residents without a family doctor is likely much higher (Doctors of Nova Scotia, 2018).
Also affecting the health of Nova Scotians is healthy behaviours, statistics on smoking in Canada published in 2013 found 21.8% of the N.S population aged 12 and older were smokers; comparatively, only 19.8% of Ontarians were found to be smokers- given the significant population difference between provinces this is a considerable determinant contributing to poor health outcomes for Nova Scotians (The Chronicle Herald, 2019). Nova Scotians also represent some of the highest levels of obesity in the country with 1 in every 3 Nova Scotians falling into the ‘overweight’ or ‘obese’ category. Once in this category, individuals are at a much higher risk for the development of chronic disease including Type II diabetes and hypertension amongst others. Issues around food security and the rising cost of healthy and nutritious food options are cited as contributing factors to the obesity crisis (Doctors Nova Scotia, 2015).
Interprovincial Differences & Similarities (Nova Scotia vs. Ontario)
Differences:
In order to address health determinants of importance at the community level, Nova Scotia relies on the work of local Community Health Boards, an initiative that is run by volunteer members to improve the health of the community in partnership with the Nova Scotia Health Authority. The ‘811’ hotline is also a prominent service utilized by Nova Scotians which allows them to speak directly with a Registered Nurse who will offer support services and direct residents to the appropriate health services in their area (Government of Nova Scotia, 2019).
In Ontario, this work is done through Community Health Centres which are strictly run by the government. Considering Ontario is one of Canada’s largest provinces, besides community organizations there are also multiple public health agencies and health units that guide the social determinants of health in the province. Ontario also has 14 LHINs (Local Health Integration Network) distributed all over the province who collaborate with physicians, hospitals and healthcare providers to improvise the access of long-term care (Ontario Ministry of Health, 2016).
Other differences affecting the health of residents of Ontario versus Nova Scotia is in the substantially different minimum wage rates. The residents of Ontario make a minimum wage of $ 14 per hour whereas Nova Scotia residents only earn $ 11.55 per hour. Discrepancy in economic status is also a key determinant of health. In comparing minimum wage rates with provincial taxes and cost of living, Ontarians fare much better than their Maritime counterparts. Economic discrepancy represents a major setback when it comes to individual and population health, giving rise to considerable health inequities.
Similarities:
Despite variances in the determinants of health viewed as most concerning for the population of each province, many similarities can be drawn from our analysis. One of the most poignant similarities is that both provinces are experiencing long wait-times for health care services leading to insufficient treatment for both acute and chronic diseases contributing to poor health outcomes.
While Ontario battles dense population issues and an ongoing opioid crisis resulting in overcrowding and lengthy wait times in emergency departments, Nova Scotians are seeking a hospital setting for non-emergency issues out of desperation from their inability to access a primary care provider. This similarity highlights the many ways in which determinants of health can arrive at the same issues of health inequality despite regional differences.
In regards to addressing population health issues, it was encouraging to note that both provinces have ‘Health Quality Systems’ in place; branches of government which are crucial to enhancing the quality of the determinants of health. The concept of health quality is interconnected to refining an individual’s health and well-being. Determinants of health of a population is interrelated to the quality of health. The HQO (Health Quality Ontario) and the Nova Scotia Health Quality System branch both serve to identify areas for health system improvement in their respective provinces.
The determinants of health affecting the residents of Ontario and Nova Scotia is multifactorial and can vary dramatically even within their own provincial boundaries. Our comparative analysis of the two has highlighted the differences in health care issues affecting residents leading to widespread health inequity. Additionally however, analysis of these provinces has allowed a closer look into how each province is structuring successful programs at both government and community levels in order to address health inequalities affecting residents. It is our opinion that in order to better the health outcomes for the population of our respective provinces, the application of new health care models developed through a melding of interprovincial ideas and initiatives should be considered.
REFERENCES
CBC News (2013). Which Part of Canada Has the Most Smokers? Retrieved from https://www.cbc.ca/news/health/which-part-of-canada-has-the-most-smokers-1.138583
Doctors Nova Scotia. (2018) 6 Reasons Why Family Doctors Matter More Than Ever. Retrieved from https://www.yourdoctors.ca/blog/health-care/6-reasons-why-family-doctors-matter-more-than-ever
Doctors Nova Scotia. (2015) The Obesity Crisis: Nova Scotia’s Growing Waistline. Retrieved from https://www.yourdoctors.ca/blog/health-tips/the-obesity-crisis-nova-scotias-growing-waistline
Government of Nova Scotia. (2019) About 811. Retrieved from https://811.novascotia.ca/
Government of Nova Scotia. (2019) Health System Quality. Retrieved from https://novascotia.ca/dhw/hsq/
Health Quality Ontario (2016). Let's make our health system healthier. (n.d.). System Performance. Retrieved from https://www.hqontario.ca/System-Performance/Specialized-Reports/Health-Equity-Report
Health Quality Ontario. (2018) Hospital Overcrowding. Retrieved from https://www.hqontario.ca/System-Performance/Yearly-Reports/Measuring-Up-2018/hospital-overcrowding
Ontario Ministry of Health and Long Term Care. (2019) Health Services in Your Community. Retrieved from http://www.health.gov.on.ca/en/common/system/services/default.aspx
Peddle, S. (2019). Nova Scotians increasingly worried about health care access: poll. The Chronicle Herald. Retrieved from https://www.thechronicleherald.ca/news/local/nova-scotians-increasingly-worried-about-health-care-access-poll-293154/
Retail Council of Canada.(2019) Minimum Wage by Province. Retrieved from https://www.retailcouncil.org/resources/quick-facts/minimum-wage-by-province/
The Chronicle Herald. (2019) Nova Scotians increasingly worried about health care access: poll. Retrieved from https://www.thechronicleherald.ca/news/local/nova-scotians-increasingly-worried-about-health-care-access-poll-293154/
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