D1 - Engaging the community and addressing the social determinants of health at St. Michael’s Hospital Academic FHT

Theme 1. Population-based primary health care: planning and integration for the community

(I) Going Upstream: Building the Infrastructure to Address Social Determinants at the St. Michael's Hospital Academic Family Health Team

Learning Objectives

At the end of the presentation, participants will have: 1. Gained knowledge of initiatives being implemented to intervene on the social determinants of health at St. Michael's Hospital Academic Family Health Team, including work on income security, access to legal services, access to decent work and child literacy. 2. Gained skills in developing an administrative structure and partnerships required to administer these new programs, including the creation of a Social Determinants of Health Committee. 3. Gained knowledge of the role of evaluation in helping build and sustain new programs that address social determinants.

Summary

Social determinants of health (SDOH) are “the conditions in which people are born, grow, live, work and age.” The concept of the SDOH is not new, and indeed, can be found in the observations of Hippocrates. However, modern healthcare organizations have typically not considered addressing SDOH as part of their core business, with few exceptions (e.g. community health centres). The landmark 2008 Final Report of the Commission on Social Determinants of Health triggered renewed interest in this area, followed closely by calls by the British Medical Association, the Canadian Medical Association and the College of Family Physicians of Canada for greater action by health professionals on SDOH. Family Health Teams are well-placed to address SDOH as they aim to provide quality primary care to Ontarians. Over the past two years, we have identified a number of new and innovative approaches to address SDOH in a practical manner. These include:

  • the routine collection of detailed socio-demographic data on all patients in order to assess health equity;
  • the implementation of an innovative Income Security Health Promotion service;
  • the implementation of a medical-legal partnership;
  • the implementation of a Reach Out And Read early childhood literacy program; and
  • the development of a combined advocacy and service program to address employment conditions and access to decent work.

Our experiences implementing and evaluating novel interventions will be described and used as a springboard for supporting participants to effect changes to the SDOH in their own communities. 

Presenters

  • St. Michael's Hospital Academic FHT
    • Andrew D. Pinto, MD CCFP FRCPC MSc, Staff Physician & Scientist
    • Gary Bloch, MD CCFP, Staff Physician & Chair, Social Determinants of Health Committee

(II) Community Engagement Can Support Population-Based Primary Health Care: Lessons learned at St. Michael’s Hospital Academic Family Health Team

Learning Objectives

At the end of the presentation, participants will have:

  1. Gained knowledge of what community engagement is and how it relates to patient engagement.
  2. Gained knowledge of the role of community engagement in Family Health Teams, particularly in supporting population-based primary health care.
  3. Gained skills around applying for funding to support community engagement specialists and reporting on performance measures, based on lessons learned within the St. Michael’s Hospital Academic Family Health Team.

Summary

Community engagement is defined as the process of working collaboratively with groups of people – connected by geographic proximity, interest, identities or similar situations – to address issues affecting their health and wellbeing. St. Michael’s Hospital Academic Family Health Team was recently successful in obtaining funding for a full-time Community Engagement Specialist as part of opening a clinic site in a new community. The need to ensure that services was responsive to community needs was evident, alongside the growing focus within the Family Health Team on addressing social determinants of health and improving access to care for the most vulnerable populations. The key actions of community engagement are

  1. intelligence gathering,
  2. relationship building, and
  3. conceptualizing innovative services.

The focus to date has been on relationship-building with residents, health care providers, other community members and organizations through formal and informal activities. The Community Engagement Specialist acts as a liaison: mobilizing information, connections and resources between the Family Health Team and various groups to support action that improves primary health initiatives through intersectoral collaborations and partnerships. This role provides value to primary health providers and to communities through better informed decision-making, an increased sense of involvement and responsibility, an increased range of ideas and options for improvements in primary care, better access and outcomes, and increased credibility, transparency and accountability. It is an approach that aims to engage beyond our patient population, reaching unattached patients, community members and residents in communities to reduce health inequities.

Presenters

  • St. Michael’s Hospital Academic FHT:
    • Cian Knights, MBACED HonBA, Community Engagement Specialist
    • Andrew D. Pinto, MD CCFP FRCPC MSc, Staff Physician & Scientist
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