Meet Janet.
Janet is 68 years old and suffers from multiple issues. She is diabetic, has heart disease a common complication of diabetes and also suffers from depression. Because of these chronic illnesses, she lost her job and now relies on social assistance. She also lives in an at-risk community in Toronto where her living conditions affect her health and well-being. Janet has become overwhelmed by her situation and rarely leaves her house. As a result, she rarely gets exercise, and her diabetes is worsening.
Believe it or not Janet’s case is not unusual. Many Ontarians have had or are currently dealing with multiple health issues just like Janet. In fact, just 5 per cent of Ontarians consume 68 per cent of health-care spending. What’s even more distressing is that research shows a third of these patients are still high-cost health-care users two years later, which means that medical interventions alone are not enough to improve health among our most vulnerable populations.
In many cases, our health is not determined by what medical treatment we receive or the lifestyle choices we make, but rather by the living conditions that they experience. These conditions are known as social determinants of health, and most Canadians are only beginning to hear about them in the news and elsewhere. But the health-care and research communities have been studying these factors for decades to better understand how they influence our health over the course of our lives.
What they’ve learned is that our health is largely shaped by social factors such as how income and wealth is distributed across our communities, whether or not we are employed and what our working conditions are like, which health and social services we receive and how able we are to obtain quality education, food and housing, as well as less mutable factors like race, gender and disability, among others.
Contrary to popular belief, most Canadians have no control over the social factors that play such a huge role in our health. In most cases, these factors are imposed upon us by the quality of the communities in which we live and the quality of the health, social and educational institutions we have access to.
Because of this, and the direct impact these factors have on our health-care system, the need to care for people’s physical, mental and social well-being is critical. Sinai Health System hopes to address some of these issues by looking at people’s broader health needs and making sure that people get back to a healthier and happier life by providing more integrated, coordinated care.
“Treating patients who have multiple health conditions or who may be dealing with issues in their lives like housing and food insecurity that can negatively affect their health requires a very different approach than the one we’ve traditionally taken, and we’re working to find ways to deliver better care to them,” says Dr. Ross Upshur, Assistant Director of Lunenfeld-Tanenbaum Research Institute (LTRI) and Director of the Collaboratory for Research and Innovation, now part of the LTRI.
Dr. Upshur, who leads the LTRI’s new health system services research pillar, has first-hand knowledge of the strengths and weaknesses of our current health-care system and is excited at the prospect of accelerating breakthroughs and advances through collaborating with teams and researchers at the various campuses.
Dr. Upshur and his team are exploring some of the fundamental issues of complex care to build a more comprehensive understanding. Their research, which involves studying real patients with real problems, is focused on trying to figure out what the best model of care is, how to measure its effectiveness and what tools health-care professionals need to deliver this type of care.
“By working so closely with real patients and their families, and with teams of colleagues in our emergency, family medicine, general internal medicine and human rights and health equity departments, we can accomplish a great deal of research and often see the results pretty quickly,” says Dr. Upshur.
That’s good news for Janet and the thousands of Ontarians like her whose health needs are not yet being met.