Can Community Health Centres take on social conditions that impact health?

Collins, PA, Resendes SJ, Dunn JR. The Untold Story: Examining Ontario’s Community Health Centres’ Initiatives to Address Upstream Determinants of Health. Health Care Policy. 2014; 10(1): 14-29.

Issue: Evidence demonstrates that often interrelated factors like racism, low income, precarious work and lack of quality, affordable housing contribute greatly to the prevalence of chronic diseases like diabetes, coronary heart disease and depression. Community Health Centres (CHCs) have, as part of their mandates, the responsibility to address the underlying factors that negatively impact health.

What we did: ‘Community Initiatives’ (CIs) are a type of CHC program intended to help build healthier communities by addressing the issues that make people sick in the first place. CIs include a range of activities involving community members like community gardens, advocacy work and leadership building programs. We interviewed community workers and health promoters involved in 11 CIs in Ontario that addressed the upstream causes of illness.

What we found

– The CIs we explored have the potential to make improvements in the lives of individuals and small groups through addressing issues like social isolation, employment prospects and community leadership.

– CIs also have the potential to improve engagement between CHCs and the broader community (i.e., community-based organizations, municipal governments and residents), and to cement CHCs in their role as something more than primary care centres.

– CHCs are often required to run CIs due to a lack of capacity or mandate on the part of other organizations. However, funding for CIs is generally insufficient and short-term, making it difficult for CHCs to sustain them for long periods.

– The sustainability challenges facing CIs are likely exacerbated by the broader, neoliberal environment which emphasizes competition for short-term and limited funding; short-term, quantifiable outcomes; the application of private sector metrics and management practices to health and social services; and, market-based solutions to social problems.

Implications for research, policy and practice:

– CIs in Ontario require both long-term commitments from parent CHCs, and recognition from the Local Health Integration Networks for their role in improving the health of individuals and groups.

– Future research should consider the impacts of funder metrics and reporting requirements on the continuation, resources and success of CIs.

– In Ontario, CHCs are the only community-level health provider with an explicit mandate to address the social determinants of health. As a result, the work of CHCs to address the root causes of illness through CIs and other initiatives should be examined and strengthened.

Full text of this article is available here.