How can primary care promote and improve health equity? Insights from the Second Toronto International Conference on Quality in Primary Care
Across Canada and around the world, people are becoming more aware of the vast and increasing gaps in health and healthcare caused or exacerbated by the social determinants of health and systemic barriers in our society. These deep-rooted inequities lead again and again to worse health for marginalized people, particularly those who are Black, Indigenous, and people of colour – something we have seen happen during the COVID-19 pandemic. There has never been a more urgent time to act towards a more equitable healthcare system and society, and primary care is ideally placed to lead the way. But how can we, in primary care, best address the social determinants of health and promote health equity?
Last year, on November 16, 2019, the second Toronto International Conference on Quality in Primary Care hosted by the University of Toronto Department of Family and Community Medicine (DFCM) brought together clinicians, patients, health administrators, educators, and researchers from ten different countries to try to answer this question from a primary care perspective. This week, a paper summarizing insights from the day and a course for moving forward was published in Annals of Family Medicine, a leading international journal.
“Every day in clinic I see the effects of marginalization, of racism, of poverty on my patients’ health,” says Dr. Braden O’Neill, an Assistant Professor at DFCM, a family physician at North York General Hospital, and lead author on this paper. “More and more we know that there are effective ways to do something about these issues, to design systems and provide support through primary care. By doing things differently we can help people live healthier lives within a more just society.”
Primary care providers are well positioned to advocate for their patients and work to address the root causes of health inequities, says Dr. Tara Kiran, the Vice-Chair of Quality and Innovation and Associate Professor at DFCM.
“We get to know the whole of a patient and the context they live in over years – not just one disease at one point in time. So we’re able to share their story because we can really see the impact of how someone’s social circumstances impacts their health,” says Dr. Kiran. “And when a number of people in our practice are affected similarly, we can see the patterns and share their collective story based on the experience in our practice.”
Conference participants identified key themes about how primary care can advance health equity including the importance of team-based approaches that meaningfully include leadership and perspectives from community members, and the importance of involving people with lived experience of discrimination in generating solutions. Practices also need to have resources proportional to need and strengthen relationships between the health and social sectors.
“Addressing health equity can seem like a daunting task so it was nice to see that participants came up with some really practical actions they could take in their own setting. These can be as simple as flagging patients who need more time at an appointment, proactively following up on people who are not coming into clinic and looking for ways to deliver care outside the walls of the clinic," says Dr. Kiran.
But one of the most important themes that came from the conference was that primary care providers must confront structural determinants of health such as racism, capitalism, and colonialism in order to truly address health inequities.
“The root of health inequity is societal distribution of power and resource, and that's not easily changed and it's certainly not changed by academic papers,” says Dr. Graham Watt, a professor at the University of Glasgow, and the keynote speaker at the conference. “The challenge is to do something about it, and for family doctors, the challenge is to build on the opportunities within family medicine for improving population health.”