The Dalhousie Global Health Office, in collaboration with the Healthy Populations Institute, The National Collaborating Centre for Determinants of Health and Upstream, hosted the “Health Care Teams Addressing Poverty and Determinants of Health” event on March 3rd. This event featured three speakers, who shared stories of addressing the social determinants of health in their work, and participated in a panel discussion.
Dr. Ryan Meili, the Executive Director of Upstream and a family doctor in Saskatoon, shared his experience as both a doctor treating patients in inner city Saskatoon affected by poverty, and as an advocate for health equity. Dr. Cindy Forbes talked about her experiences in advocating for health equity as the President of the Canadian Medical Association. Dr. Barb Hamilton-Hinch provided local context to this global issue, by discussing the barriers to healthcare faced by the African Nova Scotian population. All three speakers had common themes in their work: the need for policy change, the importance of story sharing to drive impact, and of course, the priority of addressing the social determinants of health in healthcare.
Dr. Meili shared the story of one of his HIV-positive Aboriginal patients who was facing several barriers to proper healthcare access. “She’s not sick with HIV,” Dr. Meili said after introducing us to her story, which was initially puzzling. However, if you take a moment to ponder this statement, it makes a lot of sense. By listening to her story, we learned that his patient has been sick with poverty, historic marginalization, poor living conditions, low education and addictions throughout her life. These factors have contributed to her HIV infection, and subsequent difficulty accessing care. This way of thinking is the fundamental to addressing the social determinants of health, and to the upstream approach. For a refresher on the social determinants of health in Canada, see our blog post from January. To learn about the upstream approach, check out this video created by Upstream, where Dr. Meili acts as the Executive Director. Upstream thinking requires us to reframe the public discourse around addressing the social determinants of health. We should be focusing more resources on the things that have the greatest influence on our health, including income, education, housing and nutrition, rather than pouring our resources into the healthcare system down the line.
Building a body of evidence, and sharing these findings are both important pieces to guiding policy change. But as Dr. Forbes noted “evidence doesn’t make people feel empathy.” Upstream also aims to share stories through a variety of media in order to creatively engage citizens, showing them they have a personal stake in the social determinants of health. Citizen engagement can lead to a political push for evidence-based, forward-looking policy innovations to address these determinants so people can live longer, fuller and healthier lives.
Dr. Hamilton-Hinch highlighted the importance of not only addressing policy change, but ensuring that power dynamics shift to reflect the diverse makeup of our Canadian population. Dr. Hamilton-Hinch is involved with PLANS (Promoting Leadership in Health for African Nova Scotians) at Dalhousie. PLANS seeks to improve health outcomes within the African Nova Scotian community (about 2.3% of the NS population), while creating mentoring and outreach opportunities. In order to facilitate access to healthcare for African Nova Scotians, Dr. Hamilton-Hinch discussed the need for change in our healthcare system. Change to the way healthcare professionals are educated by challenging curriculum, change to the way healthcare professionals practice in order to reflect cultural proficiency, and most importantly, change in the disparity between the small numbers of African Nova Scotian healthcare professionals and the much larger population they serve.
The Global Health Office would like to thank Dr. Meili, Dr. Forbes and Dr. Hamilton-Hinch for sharing their stories with over 80 attendees. The stories you have shared will go on to impact the way that we approach our learning, practice and advocacy.