Unit 3 Regional Differences Between Provinces on Determinants of Health

By: Shandel Grimm and Lorraine Brownlee

Differences in Focus on Determinants of Health: BC and Alberta Governments

British Columbia and Alberta have various initiatives and policies in place to deal with the inequalities of health care for various populations and age groups. In this blog we have just scratched the surface on what is a very complex and cumbersome task. We have identified our sources of information regarding the priorities laid out by each province for the determinants of health, as well as the similarities and differences of the provincial health care priorities.

Canada Without Poverty (2016) reports that in early 2016, Alberta had a higher unemployment rate (8.5%) than that of the national average (7.0%), and the unemployment rate for youth was up to 12.8%. In September 2018, Alberta's unemployment rate was 7.0% compared to the national rate of 5.9%, and British Columbia's unemployment rate was 4.2%, significantly lower than the national average (Government of Alberta, 2018). The Government of Alberta demonstrates that in comparison to least year, unemployment rates in Alberta have reduced slightly for both males (8% to 7.7%) and females (7.5%-6.3%), but has increased for youth (12.2% to 13%). It is further reported that in 2014, 11.1% of First Nation peoples with a university degree or higher education were employed, as opposed to 26.4% of non-Indigenous people (Canada Without Poverty, 2016). Reports also show that there is a significant gap between men and women in terms of income in Alberta. On average, women earn only 68 cents per dollar that men earn (Canada Without Poverty, 2016).

Acknowledging Determinants of Health within Government Policies

To address these determinants of health, we look to our provincial governments for guidance. Mikkonoen and Raphael (2010) suggest that public policies should focus on the source of the problems rather than react to symptoms; by improving living conditions that populations experience, a reduction in stress and an improvement in health will inevitably result. Both provinces have several public service ministries that make up the government, each to deliver programs and services that are mandated by law. Each ministry is responsible for a certain sector, each of which are connected to social determinants of health. These ministries are responsible for implementing policies that will create improvements within their sectors. See BC Ministries and Alberta Ministries for a full list.

While taking social determinants of health into consideration, the Alberta Government (2013) released Alberta's Social Policy Framework, which is a vision for social policy that will reflect the needs of Alberta's population and provide opportunities to reach individual and communal potentials. This framework also acknowledges that social, economic, and environmental policies interact and complement each other. This new framework outlines a shift in policy focus, from dealing with aftermaths of crisis situations and addressing deficiencies, to balancing prevention with intervention by providing resources and competencies for success in health potentials. Furthermore, Alberta's Social Policy Framework outlines roles for individuals and families, non-profit organizations, business communities, and different levels of governments, which aim to reach health potentials for both individuals and populations. Similarly, several priorities of BC's new government include preventative health care for seniors, promotion and protection of the public health services, mental health and addictions, youth mental health, and homelessness (Longhurst, A, 2017). British Columbia has also recently proposed to build and implement a province-wide poverty reduction plan with targets and timelines. The government asked for community input regarding poverty, and reports that poverty reduction legislation will be brought forward in the fall of 2018. Within both governments, there are audits completed on existing policies and programs to ensure they are successful in achieving what they are set out to do. These audits are completed by Auditor Generals in both British Columbia and Alberta, with reports available to the public.

Addressing the Roots of the Problems

Reducing poverty. Some of the initiatives that Alberta and British Columbia are taking to reduce poverty and increase population health is by addressing determinants of health. Alberta appears to be focusing on improving unemployment rates and increasing financial aid for low and middle income Albertans. Alberta plans to make life more affordable by providing financial assistance to those who need it, some program initiatives include: the Alberta Child Benefit, the Alberta Family Employment Tax Credit, Alberta Seniors Benefit, and carbon levy rebates for lower and middle income Albertans when filing their taxes. The Government of British Columbia has already raised income assistance rates by $100 per month. BC Poverty Reduction Coalition also iterates that there should be an increase in earning exemptions to reduce poverty levels. In a similar manner, Alberta plans to increase the minimum wage to $15 per hour, while the British Columbia Poverty Reduction Coalition also recommends increasing minimum wage to $15 an hour, and encourages employers to pay a "living wage", which means adequate pay based on actual living costs for families in particular communities. A more complete list of Alberta's initiatives to reduce poverty can be found here.

Decreasing marginalization. In both provinces, there is focus on reducing marginalized populations, such as Indigenous people, people with disabilities, single mothers, the LGBTQ community, and immigrants. British Columbia has already implemented an additional $100 a month for people with disabilities. The BC Poverty Reduction Coalition suggests to restructure the federal and provincial fundings to adequately address the needs of Aboriginals. To this end, British Columbia has allocated $6.4 million to First Nations and Métis-serving agencies to help keep Indigenous families together and improve outcomes for children and youth. There is currently a framework in BC called the Aboriginal Policy and Practice Framework that is intended to improve outcomes for Indigenous peoples through restorative policies and practices that take culture into consideration. As an example, many of Kamloops Aboriginal People live in poverty, over-crowded homes and suffer from various addictions. The First Nations Health Council (2018) has developed a discussion guide that shows direct links to specific issues and health outcomes of First Nations People, such as the wellbeing of children and families, the significance of early childhood experiences and poverty. Similarly, Alberta has set forth an Aboriginal Policy Framework with goals to improve relationships with Aboriginal communities while outlining opportunities to improve wellbeing and self-reliance as well as he roles and responsibilities of governments. In addition to Aboriginal efforts, the BC Poverty Reduction Coalition also suggests to increase disability rates and take inflation into consideration, guarantee access to income assistance, regardless of citizenship status, as well as provide free transit for children and reduced rates for low income adults. Alberta actually recently introduced a low income transit pass at a significantly reduced cost in Calgary, in order to help people gain access to jobs, services, and resources they need. Alberta also provides support for unemployed individuals to find jobs, through Alberta Supports and Alberta Works Centres.

Increasing access to education. School Nutrition Programs were also implemented in select schools last year in Alberta, where students receive one nutritional meal a day during the school year, accompanied by education surrounding dietary nutrition. To reduce barriers to access to education in BC, the BC Poverty Reduction Coalition suggests that tuition fees be reduced by 50%, increase availability of post-secondary grants for low income adults, allow welfare recipients to attend post-secondary education, and adequately fund elementary up to high school education to mitigate inequalities in education institutions.

Improving healthcare. While addressing the healthcare section of determinants of health, Alberta Health Services (AHS) has stated that they are focusing their action plans on increasing care in communities, achieving better health outcomes, and continuing to work on sustainability. This is similar to efforts in British Columbia that address increasing essential health services to the public, such as eye and dental care, as well as mental health services. British Columbia also has a goal to expand residential care services, especially for seniors. Keeping seniors healthier at home and out of hospital through "home support, professional home care including rehab and nursing, assisted living and residential care" are also goals of the government (Longhurst, A.,2017). BC has already opened Primary Health Care Centres throughout the province, which focus on a comprehensive and interdisciplinary approach to health care, meaning services provided in a single location may include a family physician, physiotherapist, a pharmacist, and/or a public health nurse. These services reflect diversity in the needs of communities. To these goals, AHS has also released a Health Plan and Business Plan that outlines a 3 year plan (2017-2020) to achieve these goals, see: A healthier future. Together. AHS also outlines several action plans for increasing population health, including the Oral Health Action Plan, the AHS Chronic Disease Prevention Action Plan 2015-2018, and Healthy Children and Families Strategic Action Plan. Public health programs in both British Columbia and Alberta all attempt to increase population health with a focus on promoting prevention services.

Although there are differences in focus between the two provinces, it is important to note that they are both attempting to achieve the same overall goal, population health. By addressing social determinants of health, and implementing strategic action plans, the health of Albertans and British Columbians will be improved.

References

Alberta Government. (2013). Alberta's social policy framework. Retrieved from: https://www.humanservices.alberta.ca/documents/spf-full-report.pdf

Alberta Health Services. (2016). AHS Chronic Disease Prevention Action Plan 2015-2018. Retrieved from: https://www.albertahealthservices.ca/assets/info/cdp/if-cdp-action-plan-highlights.pdf)

Alberta Health Services. (2016). AHS Oral Health Action Plan. Retrieved from: https://www.albertahealthservices.ca/assets/info/oh/if-oh-action-plan.pdf

Alberta Health Services. (2015). Healthy Children and Families Strategic Action Plan (https://www.albertahealthservices.ca/assets/info/hp/hcf/if-hp-hcf-strategic-action-plan.pdf

Auditor General of Alberta. (n.d.). Retrieved from: https://www.oag.ab.ca

B.C. Government's primary health-care strategy focuses on faster, team-based care. (2018). Retrieved from https://news.gov.bc.ca/releases/2018PREM0034-001010

B.C. Poverty Reduction Coalition. (n.d.). Retrieved from: https://bcpovertyreduction.ca/learn-more/plan-for-bc/#health

Canada Without Poverty. 2016. Alberta poverty progress profile. Retrieved from: https://www.cwp-csp.ca/resources/sites/default/files/resources/Alberta-PPP%202016.pdf

Government of Alberta. (2000). Strengthening Relationships: The Government of Alberta's Aboriginal Policy Framework. Retrieved from: https://indigenous.alberta.ca/documents/final_strengthrelations.pdf?0.17981452129112319

Government of Alberta. (2018). Unemployment Rate. Retrieved from: https://economicdashboard.alberta.ca/Unemployment.

Government of Alberta. (n.d.). Ministries. Retrieved from: https://www.alberta.ca/ministries.aspx

Government of British Columbia. (n.d.). Ministries. Retrieved from: https://www2.gov.bc.ca/gov/content/governments/organizational-structure/ministries-organizations/ministries

First Nations Health Council. (2018). Retrieved from https://fnhc.ca/wp-content/uploads/FNHC-Social-Determinants-of-Health-Discussion-Guide

Interior Health Authority Information Page. (2018). Retrieved from https://www.interiorhealth.ca/FindUs/_layouts/FindUs/info.aspx?type=Location&loc=Kamloops%20Urgent%20Primary%20Care%20Centre&svc=Primary%20Health%20Care&ploc=Royal%20Inland%20Hospital

Longhurst, Andrew. Three Health Care Priorities for a New Government. (2017, July 27). Retrieved from https://www.policynote.ca/three-health-care-priorities-for-a-new-government/

Mikkonoen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management. Retrieved from: https://thecanadianfacts.org/the_canadian_facts.pdf

Ministry of Children and Family Development. (2015). Aboriginal Policy and Practice Framework. Retrieved from: https://www2.gov.bc.ca/assets/gov/family-and-social-supports/child-care/aboriginal/abframework.pdf

New health plan to provide primary care to B.C. residents without a family doctor. (2018, May 24). Retrieved from https://bc.ctvnews.ca/new-health-plan-to-provide-primary-care-to-b-c-residents-without-a-family-doctor-1.3943969

Office of the Auditor General of British Columbia. (n.d.). Retrieved from: https://www.bcauditor.com/pubs/2013/report11/health-benefits-operations-are-expected-benefits-being-a

Poverty Intervention Tool. (2015). https://www.divisionsbc.ca/sites/default/files/CMSMedia/WebPageRevisions/PageRev-10164/BC-Poverty-2015-Final.pdf

Province of British Columbia. (2018). Premier Horgan announces $100 increase to income assistance and disability rates. Retrieved from https://news.gov.bc.ca/releases/2017PREM0065-001330

Province of British Columbia. (n.d.). Retrieved from https://www2.gov.bc.ca/assets/gov/government/ministries-organizations/ministries/health/office-of-indigenous-health/together-in-wellness-2016-17

Social Determinants of Health | Divisions of Family Practice. (2018). Retrieved from https://www.divisionsbc.ca/kootenay-boundary/our-impact/social-determinants-of-health