System overhaul
A recently announced task force has hit the ground running with the mission of reimagining health and health care in Newfoundland and Labrador.
On Nov. 5, Premier Andrew Furey and John Haggie, minister, Health and Community Services, announced that Dr. Pat Parfrey, professor in the Discipline of Family Medicine and clinical epidemiologist, Faculty of Medicine, and Sister Elizabeth Davis, congregational leader of the Sisters of Mercy of Newfoundland and Labrador, will co-chair a task force on health, known as Health Accord N.L.
Their vision is two-fold: To create awareness of, and interventions in, the social factors that influence health; and to achieve better balance and higher quality in community-based care (primary health care, elder care, social care) and acute hospital services.
To do this, Health Accord N.L. is focusing on the social and economic factors that influence people’s health.
Perception vs. reality
In 2017, 20 per cent of the Newfoundland and Labrador population was 65 years old and older.
That’s projected to reach 34 per cent by 2038. The province also has the highest rate of several chronic diseases such as cancer, cardiac disease and stroke.
According to statistics, Newfoundland and Labrador also has the highest rate of chronic disease in seniors and the lowest life expectancy of any province in Canada.
“We are asking citizens to reimagine a modern health system that is more community-based.” — Dr. Pat Parfrey
Despite the data, Sister Elizabeth says there are disparities between how Newfoundlanders and Labradorians view their health, versus the reality.
“This denial may be related to their happiness in the place they live and their relationships with family and friends that outweigh the health issues,” she said.
Since 1981, social spending has increased by six per cent, while health spending in the province has increased by 232 per cent even though social factors, rather than the health-care system, are likely to have a higher impact on health outcomes.
“The current health system is over 50 years old, is institution-based and is targeted at a different demography than today’s population,” Dr. Parfrey explained.
“We are asking citizens to reimagine a modern health system that is more community-based and targeted at the current population of more seniors, fewer children and fewer people in rural communities.”
Cultural change
According to Dr. Parfrey and Sister Elizabeth, culture change means changing behaviours and choices, but it also means looking at other populations for examples of what Newfoundlanders and Labradorians can do differently.
“An understanding of our own population is as important as taking lessons from other communities,” said Sister Elizabeth.
“In our research, we have used Australia as a marker for what change is necessary and possible in our health system and Norway as a country that has integrated social changes into their polity.”
“It is a myth that every locality can have a doctor and every region a full-service hospital in order to have good health care,” added Dr. Parfrey, who is also the clinical lead for Quality of Care N.L. and Choosing Wisely N.L.
“The more reasonable and realistic objective is that every citizen has a link to continuing care and to good quality acute hospital care. This would be facilitated by digital technology and by hub-and-spoke connections to both community care and hospital care.”
Ten-year plan
Health Accord N.L. is planning to deliver a 10-Year Health Accord with short-, medium- and long-term goals developed in consultation with communities, Indigenous leaders and health-care professionals.
There are six committees established for Health Accord N.L.: Aging Population; Digital Technology; Hospital Services; Primary Health Care; Quality Health Care; and Social Determinants of Health.
Once committees are struck, the first step is letting the residents of the province know about the existing evidence on the status of our health and health system, as well as to challenge communities to help them reimagine new ways to improve both health and health care.
There are virtual town halls planned in multiple areas this month to move from visioning better health and social systems to finding ways to make the new vision happen. There’s also a website to explore.
Memorial involvement
Quality of Care N.L., a Memorial based program, is helping produce the evidence on health-system performance and quality of care and will provide the secretariat for the task force.
The Faculty of Medicine has faculty, staff and learners on committees and will bring its experience on promoting health, delivering care and educating providers, as well as its role in strengthening the province’s health and health system.
Other faculties such as the faculties of Nursing and Business, the schools of Social Work and Human Kinetics and Recreation as well as the Genesis Centre are involved as influencers in social factors impacting health.