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March 1, 2019

Addressing the causes of the causes of poor health

By Rob MacIsaac, President & CEO

Exceptional health care, like the kind we have in Hamilton, is a huge benefit to the lives of many people. Everyday, the skilled teams working at Hamilton Health Sciences fix broken bones, halt cancer and help reduce the impact of infectious and chronic disease. Our work increases the opportunity for good health for many people of all ages across the city. However, all the work we do doesn’t create healthy populations of people. If it did, our neighbours living in Hamilton’s urban core would be among the healthiest and longest-living people in Ontario. Sadly, the facts tell a different story.

The core of Hamilton is home to among the most advanced hospital care in the province. But its residents use hospitals on a per capita basis more than any other city in Ontario. Residents in the core of our city live shorter, less healthy lives than those residing in every other part of Hamilton. Why does this health gap exist? And, more importantly, what are we doing about it?

The things that bring people to hospital are not the source of the problem.

The answer to the first question is well-established and supported by research examining similar health disparities around the world. The things that bring people to hospital – chronic disease, injury, a lack of well-being – are not the source of the problem. Rather, it is the causes of these causes that are to blame for health disparities as large as those experienced in Hamilton. These are the social determinants of health. The most influential of these determinants are income, education, opportunity, housing and food security. These factors far outweigh the impact that access to medical care has on a person’s health. In fact, they influence someone’s ability to live a healthy life more than medical care and genetics combined.

One of the world’s leading thinkers on this topic, Dr. Michael Marmot, explains in his 2015 book The Health Gap that the conditions in which people are born, grow, live, work and age have a profound impact on their life-long health and wellbeing. Shortcomings and inequities across our city have an enduring impact on the relative health of our citizens. These shortcomings exist in early childhood development, access to affordable housing, attainment of education, opportunity for high-quality employment, social inclusion and support for healthy aging. The damage to health caused over time is far greater than we can ever hope to repair with medical care, drugs, surgical interventions, counselling and therapy. So, what should we do?

Well, as the adage goes, an ounce of prevention is worth a pound of cure. For our part at Hamilton Health Sciences, we’ve made population health a strategic direction for our organization. To us, this means creating a healthier community in collaboration with health and social service providers, to support people who are most at risk of disease or preventable hospital stays. It also means leveraging our status as an anchor institution in Hamilton to provide uplift and better living circumstances for those we serve. I’ll give you a few examples.

As the adage goes, an ounce of prevention is worth a pound of cure.

Four years ago, our hospital formed a team of staff designed to help people who frequently need the support of our emergency departments. Now called the “Hospital 2 Home Team”, this innovative, community-based group of health professionals partner with patients, caregivers, primary care, and other community service providers to address individuals’ health disparities and facilitate easier access to health services. The team works together with our patients to ensure they can fill their prescriptions, attend medical appointments, and access food and adequate housing. The team focuses on what is most important to the person in our care and what is most concerning to them about their health. Since 2014, the team has helped over 1000 people in Hamilton to improve their quality of life and in doing so reduced their cumulative emergency department visits by 40 per cent.

As the largest employer in our region, Hamilton Health Sciences is also leading by example and using our significant hiring power to create high-quality, local job opportunities, particularly for youth in the urban core.

We’ve partnered with Mohawk College’s City School and the City of Hamilton’s Neighborhood Action Strategy to make jobs in our workforce more accessible to youth, by giving local high-school students a firsthand look at a career in health care. Students enrolled in this 4-week program shadow health care professionals, including dietitians, clerks, therapeutic recreationists and technicians who reprocess medical equipment between uses. They experience simulation training in a variety of workplace scenarios and get a complete picture of what their pathway to a fulfilling career might look like.

Our hospital sees the numbers in the Code Red series. We also see the impact on people’s lives, perhaps more than most.

We’ve also recently signed-on to Civic Action’s Hire Next initiative, committing to look at our own human resource practices to see how we can better hire and retain young people, especially in parts of our community where youth face multiple barriers to employment. By reaching young talent that has traditionally been marginalized, we can increase diversity within our organization, construct a workforce that reflects the community we serve, and help out the neighborhoods surrounding our hospital, especially in areas of the city experiencing poor health outcomes. It’s a win-win-win.

Our hospital sees the numbers in the Code Red series. We also see the impact on people’s lives, perhaps more than most. From that vantage point, we cannot overlook the role we can play in addressing the root causes of poor health in our community. We have to make good health more attainable in the places where inequities make it elusive.

We are leaning-in on this work in a big way, and we’re not alone. It will take more than ten years to turn back the tide of health disparities discussed in this series, but we’ve started the work and we’re not turning back.