A Comparison between Two Provinces
In my MHST601 course we were tasked with completing a comparison between two provinces on differences in how health priorities are determined. Pat and I did a comparison between Ontario and Nova Scotia. We created a chart that is found in the MSHT601 Course Work Section on this site. It focused on the differences between the Health Systems, the Action Plans for Health Care, Monitoring of Quality of care, Challenges of the system, Health Challenges and Programs for Health Promotion. We created the chart as a place to combine our information and allow for easy comparison.
In comparing the two provinces, one of the biggest differences would be the size and population of the provinces. Both have rural areas and highly populated urban cores. Interestingly, Ontario has 14 Local Health Integration Networks. Nova Scotia currently has two District Health Authorities but had nine up until 2015.
One of the main reasons for the change in the Health Care delivery system was based on saving costs associated with administration and streamlining the system to provide consistency. When comparing the population of Ontario to Nova Scotia it would be hard to justify the cost that were associated with having nine Health authorities. The change in Nova Scotia has not been a smooth transition. Many of the system that were previously in place do not work together such as reporting and significant resources have been used in developing shared policies and equipment etc. across the province. The change in the system itself has been the main focus of government for the past couple of years and that has taken away from initiatives that were started to promote Healthy Communities and work between different Departments with a goal of improving health. When researching for information one can find many older documents outlying programs and initiates that had begun in Nova Scotia to address the other determinants of health and their effect on health status. Many of these have been abandoned with the changes in government over the years. In many ways, The Change in structure was a starting point for many departments that had good initiatives underway. It is evident that the Government through the Department of Health and Wellness ultimately sets the priorities for health in Nova Scotia.
The government priorities and action plans for health Care have similar themes. Both provinces are focusing on overall health and not just treating illness and disease. Both provinces have a priority to make health care integrated and systems co-ordinated throughout the province. Nova Scotia is achieving this by focusing on opening Collaborative Care Clinics that would include other social supports services on top of primary health care. Both provinces also speak about transparency and informing the public of how the system works. Engaging the public in Nova Scotia has been ongoing for a couple of years through Town Hall Meetings in communities across the province and an initiative known as, “Talk about Health”. Community Engagement in Nova Scotia is also maintained through Community Health Boards. The governance of the health system is through the DHW and underneath their umbrella are many programs and initiatives that look at integrating other social departments into creating solutions. That being said each Government Department has set out their own priorities and there is not much overlap except in the area of Mental Health.
When looking at system performance Ontario has a provincially funded agency, Health Quality Ontario that reports the government and public. In Nova Scotia, system evaluation really falls back on the health authorities to measure and report outcomes to the Department of Health and Wellness. The DHW then uses highlights from these reports to support their own accountability report. I think that having an agency that is exterior to the actual health authorities offers more opportunity for critical evaluation and for system improvement. They may also identify where other departments could be involved in improving health.
The Challenges for Ontario and Nova Scotia are relatively similar. Both have fiscal challenges and both provinces need to change the system in order to make it sustainable. Both provinces report that there is a widening income gap and that the poorer you has the greatest impact on your overall health. Even with programs in place to address food insecurity, shelter and the ability to afford medications the general health continues to decline. Both provinces have aging populations and a focus on prevention and continuing care needs to be at the forefront.
References - Ontario
https://ontario.cmha.ca/provincial-policy/social-determinants/
Health Care Quality Ontario. Income and health: Opportunities to achieve health equity in Ontario. (2016). Toronto: Queen’s printer for Ontario. Retrieved from http://www.hqontario.ca/Portals/0/documents/system-performance/health-equity-report-en.pdf
Understanding Healthcare system. Healthcare Tomorrow Retrieved from http://healthcaretomorrow.ca/wp-content/uploads/2015/04/Structure.pdf
Public Health Ontario. (2017). Chronic Diseases and Injuries .Ontario Agency for Health Protection and Promotion http://www.publichealthontario.ca/en/BrowseByTopic/ChronicDiseasesAndInjuries/Pages/Chronic-Diseases-and-Injuries.aspx
http://www.publichealthontario.ca/en/DataAndAnalytics/OntarioHealthProfile/Pages/default.aspxhttp://www.health.gov.on.ca/en/public/publications/hpromo/hpromo.aspx
References – Nova Scotia
Business Plan 2017-2018. Department of Health and Wellness. Retrieved from: https://novascotia.ca/government/accountability/2017-2018/2017-2018-DHW-Business-Plan.pdf
Can Nova Scotians Afford to Eat Healthy? (2015). Retrieved from: http://foodarc.ca/wp-content/uploads/2017/03/2016_Food_Costing_Report_LR_SPREADS.pdf
DHJW Accountability Report 2016-2017 Retrieved from: https://novascotia.ca/government/accountability/2016-2017/2016-2017-DHW-Accountability-Report.pdf
Frank, L. (2016) Another Year, No Improvement. Report Card on Child and Family Poverty in Nova Scotia. Retrieved from: https://www.policyalternatives.ca/publications/reports/2016-report-card-child-and-family-poverty-nova-scotia
Glaze, A. (2018) Raise the Bar, A Coherent and Responsive Education Administrative System for Nova Scotia. Retrieved from: https://www.ednet.ns.ca/sites/default/files/docs/raisethebar-en.pdf
Gunn, A. (2017, September 5). INFOGRAPHIC: Census shows Nova Scotia has highest number of low-income children. Herald News. Retrieved from: http://thechronicleherald.ca/novascotia/1502728-infographic-census-shows-nova-scotia-has-highest-number-of-low-income-children
Innovation for Mental Health. Recommendations and Responses. (2017). Retrieved from https://novascotia.ca/dhw/publications/Minister_s_Advisory_Panel_on_Innovation_in_Mental_Health_and_Addictions.pdf
IWH Strategic Plan 2016-2010. Retrieved from: http://www.iwk.nshealth.ca/iwk-strategic-plan
IWK Public Accountability Reports. Retrieved from: http://www.iwk.nshealth.ca/about-us/public-accountability
Nova Scotia Health Profile. (2015). Retrieved from: https://novascotia.ca/dhw/publichealth/documents/Population-Health-Profile-Nova-Scotia.pdf
NSHA Reports, Statistics and Accountability. Retrieved from:http://www.nshealth.ca/reports-statistics-and-accountability
The Nova Scotia Minimum Wage Review Committee Report (2018) Retrieved from: https://novascotia.ca/lae/pubs/docs/nova-scotia-minimum-wage-review-committee-report.pdf
Talk about Health – Final Report. (2016) Retrieved from: http://www.nshealth.ca/sites/nshealth.ca/files/tah_final_report_final_aug_242c2016.pdf
The Health Authorities Act of Nova Scotia (2017). Retrieved from: https://nslegislature.ca/sites/default/files/legc/statutes/health%20authorities.pdf