What’s in a Model?
Alphabet soup. That’s how many policy makers and clinicians refer to the range of complex models that we have in Ontario for delivering primary healthcare. Although each model has its nuances, the defining features of Community Health Centres (CHCs), like Access Alliance, are its focus on the underlying determinants of health (i.e. housing, literacy, etc.) and vulnerable populations, as well its community governance model.
As we’re celebrating our 25th anniversary, it’s clear, the CHC – it’s not a new concept!
CHCs began to gain momentum in Canada in the 1970’s, when policy makers were concerned with double digit growth in healthcare spending, recognised the need to shift care from acute settings, and were just learning about new “people-centred” approaches. The Hastings Report, submitted in 1972, laid much of the groundwork for the Canadian CHC movement as did the subsequent WHO 1978 Declaration of Alma Ata that called on governments to provide comprehensive interdisciplinary care to all citizens as close as possible to where people live and work.
As part of a wave of research-informed models of care, CHCs, such as Access Alliance, sprouted up around Canada. Committed to being comprehensive, accessible, client/community-focused, interdisciplinary, integrated, community-governed, inclusive of the social determinants of health, and grounded in a community-development approach, CHCs are the only model of care in Canada that operate by the principles outlined in the Declaration of Alma Ata.
Now More Than Ever
25 years later, it’s clear to me that we’re still just at the beginning of the journey. In a city of over 3 million, tackling the challenges faced by newcomer populations, who make up 49% of Toronto’s population, remains a daunting task. Newcomers often have issues with access to housing and the labour market – which often exacerbates health conditions and chronic disease. Access Alliance, with its responsive programs and services, continues to provide a model of care that takes the time to address underlying issues of high needs populations that are often the most frequent users of our healthcare system.
And it’s important to note that the evidence backs this up. An ICES study comparing primary care models found that CHCs “served populations that were from lower income neighbourhoods, had higher proportions of newcomers and those on social assistance, had more severe mental illness and chronic health conditions, and higher morbidity and co-morbidity.” The study also found that, despite serving high needs populations, CHC clients had considerably fewer Emergency Room visits than expected.
Getting back to the alphabet soup, I’m not sure that we’ll ever simplify healthcare or agree on a one-size fits all model for primary healthcare. I think the beauty of CHC’s is their diversity and responsiveness to the communities they serve. Having visited numerous CHCs throughout Ontario, each one has unique programs and services that are deeply rooted in the model of care and a commitment to health equity.