Closing the gaP Working to alleviate health inequities - Wave Magazine
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WINNIPEG’S HEALTH AND WELLNESS MAGAZINE jan/feb 2016 CH Re
M po
AN rt
IT
OB
A
Heart
attack
One man’s tale
of survival
Closing
the gap
Working to alleviate
health inequities
Plus
New breast milk donation site opens
Health mobility: moving to inclusion
Understanding bedwetting
Optimistic people have happier, healthier lives
New system for booking endoscopies
aims to shorten wait times
Freezing food is a great way to reduce waste
and save moneyTHINKING ABOUT A CAREER IN HEALTH CARE? Why not think about home care? For current job opportunities, visit wrha.mb.ca/careers
We promote healthy sexuality and harm reduction
to reduce sexually transmitted and blood-borne
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Population and Public Health Santé de la Population et du PublicThis issue of
is brought to you by the following major sponsors:
Partners in building Canada’s
Partners in building Canada’s
healthiest community
healthiest community14
IN THIS ISSUE
FEATURES
CLOSING THE GAP
Working to alleviate
health inequities 14
34
HEART ATTACK
One man’s tale of survival 34
DEPARTMENTS & COLUMNS
A LETTER FROM THE
WINNIPEG HEALTH REGION
Timely care 7
HEALTH BEAT
8 25
Reducing wait times for endoscopies
REGION NEWS
New breast milk donation program 10
RESEARCH NEWS
Skin-to-skin care for premature newborns 12
RESEARCH MANITOBA
Partners in progress 25
IN MOTION 42
Health mobility 42
BALANCE
The power of optimism 44
ASK A NURSE
Understanding bedwetting 46
HEALTHY EATING
How to freeze food safely 48
46
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6 WAVEA letter from the
Winnipeg Health Region
Milton Sussman,
Timely care
President & CEO
O ne of the main goals of any health-care system is to Our flexible approach to providing
home-care services to residents at the Bell
provide timely care. Hotel is a case in point.
As our story on page 14 points out,
The Winnipeg Health Region is no for patients. This kind of continuous the Bell is a residence for the chronically
different. In fact, our commitment to improvement is critical to our goal of homeless, including some who are not used
delivering “the right health care, in the providing our patients and clients with the to keeping regular schedules. That means
right place, and at the right time” is best care possible. home-care staff will sometimes visit the
emphasized in the Region’s mission, There are other ways we at the Region Bell only to find their client is not available.
vision, and values statement. are working to provide timely care. This poses a bit of a dilemma for home-
The importance of being able to do so Take the new Central Intake system for care staff. How can you provide services to
is obvious: it could mean the difference endoscopies. As outlined on page 8 of someone if they are not home?
between life and death. this issue, appointments for endoscopies Fortunately, the people working in
The cover story in this issue of Wave had previously been booked by individual home care were able to come up with
illustrates the point. It tells the story of physicians on behalf of their patients a solution to the problem. On-site staff
Dave Emberley, a Winnipeg man who without being able to compare the wait started building relationships with the
suffered a heart attack about a month times of various specialists. The end result residents to learn more about their needs
before Christmas. was that a patient could wait for a long and schedules. Meanwhile, the program
As the article on page 34 explains, time to see a particular specialist, even if created a block-scheduling system for
Emberley survived his heart attack, thanks other specialists were available sooner. residents. This meant one worker could
in large part to the timely care he received. The Central Intake booking system visit several residents in succession. If one
That care started with a call to 911, is designed to give physicians – and wasn’t available, the home-care worker
which set in motion a rapid treatment and their patients – a chance to review all could move on to the next appointment.
transportation protocol known as Code the available options before making an The end result is a system that allows
STEMI. Under this protocol, paramedics appointment, thereby reducing wait times. home-care staff to deliver care to people
can begin treating a patient for a heart As our story explains, there are 30,000 who need it.
attack as soon as they arrive on the scene, endoscopies carried out within the Region None of this is to suggest that we have
communicating with a cardiologist by by specialists every year, so the idea of perfected the formula for delivering care
cellphone. If the patient is deemed to be trying to make this system as efficient as to all patients or clients at all times and
suffering a heart attack, he or she is rushed possible only makes sense. places. Indeed, there are a number of areas
to hospital, where treatment is quickly Dr. Dana Moffatt, Medical Director of where we could do a much better job of
administered. Endoscopy Services for the Region, sums providing timely care.
The Code STEMI protocol started saving it up this way: “The perception within For example, wait times in our hospital
lives almost immediately after it was the health-care system is that wait lists for emergency departments are still often
implemented more than a decade ago, a endoscopy services are incredibly long, but longer than they should be. As has been
point that has been made in this magazine that’s not entirely accurate. What we’ve reported in this magazine previously,
and elsewhere before. But the thing that found is that wait lists for a particular we still are some ways from meeting the
many people may not realize is that the specialist may be long, but overall we benchmarks for delivering care that we
effectiveness of this protocol continues to have the capacity to shorten wait times by have set for ourselves.
improve with each passing year. more effectively allocating our available Nonetheless, there are small signs of
As Dr. Davinder Jassal points out in our resources. In other words, it’s mainly an progress. As my predecessor noted in
story, the odds of dying from a STEMI heart administrative challenge, and not just a this space last spring, the Grace Hospital
attack after calling 911 in 2006 were one lack of resources.” has taken steps to reduce wait times in
in 10. By 2015, the odds had fallen to one The new system was pulled together by its emergency department, and efforts
in 30. The steady rate of decline is neatly people working for the Region, Manitoba are underway to make improvements in
illustrated by our graphic on page 39. Health, CancerCare Manitoba, and the other hospital emergency departments
Emberley’s tale of survival underscores Departments of Medicine and Surgery at throughout the city.
the importance of being able to recognize the University of Manitoba. In that sense, As we move forward into this new year,
the warning signs of a heart attack and the creation of the new booking system I am confident that we can continue to
knowing what to do when you experience is also a good example of how different build on this progress as part of our overall
the symptoms. But it also illustrates how groups often work together to improve the effort to provide timely care to our patients
innovative ideas like Code STEMI can delivery of care for Manitobans. and clients. After all, that is one of the
continue to be refined long after they have Sometimes, the pathway to providing main goals of any health-care system. And
been adopted to provide better outcomes timely care is not always clear cut. it certainly is one of ours.
January/February 2016 7health beat
Access
to care
New system for booking
endoscopies aims to
shorten wait times
By Mike Daly
W innipeggers can expect to benefit from a new central booking system designed to cut
wait times for endoscopies.
qualified endoscopist available. Through
By the end of February, physicians will The central intake model, which
be able to book endoscopies for their can be described as a shared, centrally no fault of the physicians, that’s led to
patients through a unified scheduling administered process for the handling of huge imbalances in wait times. One
system known as Central Intake. medical consultations and referrals, offers patient might be scheduled in a week, and
An endoscopy is a non-surgical, an effective means to reduce wait times another might have to wait a year. And
diagnostic procedure that uses a flexible and improve efficiency. that’s a problem if you’re a patient.”
tube with a light and camera attached to it “The perception within the health-care By centralizing the referrals, triage,
to examine portions of a person’s digestive system is that wait lists for endoscopy and booking functions in a single office
tract. Gastroscopies, colonoscopies services are incredibly long, but that’s not – and by standardizing the information
and sigmoidoscopies are all considered entirely accurate,” says gastroenterologist given to patients to help them prepare
endoscopies and are carried out by Dr. Dana Moffatt, Medical Director of for their endoscopy appointments –
specialists. Endoscopy Services for the Region. significant gains can be achieved, says
The new system, spearheaded by the “What we’ve found is that wait lists for Carrie Loewen, Manager of Central Intake,
Winnipeg Health Region, Manitoba a particular specialist may be long, but Regional Endoscopy Services.
Health, CancerCare Manitoba, and the overall, we have the capacity to shorten “Imagine if you were asked to choose
Departments of Medicine and Surgery at wait times by more effectively allocating the fastest teller at a bank. From your
the University of Manitoba, flowed from our available resources. In other words, it’s vantage point, you really can’t see if the
an ambitious re-evaluation and redesign of mainly an administrative challenge, and teller you’ve chosen will be tied up for an
endoscopy services within the Region. In not just a lack of resources.” hour with a customer who has 16 different
addition to shortening wait times, the new Prior to the creation of the Central interactions. But if the bank has a system
booking system is expected to: Intake office for endoscopies, the standard where everyone in line can be routed to
• Ensure patients are getting the right test procedure was for physicians to refer the next available teller, you’ll get faster
for the right indication. their patients to an endoscopist without service. Essentially, that’s what a central
• Improve communication, record keeping central oversight or assistance. But with intake office is all about. By handling all of
and continuity with patients and dozens of endoscopists offering services in the administrative functions out of a single
referring physicians. multiple sites across Winnipeg, it was all office, we get a better overall view on
• Ensure adequate and fair distribution of but impossible for those physicians to see how we can make the most efficient use
endoscopic resources within the Region. where scheduling bottlenecks might occur. of our available resources. Wait times are
There are approximately 30,000 As Moffatt explains, “Your family doctor reduced. And if a patient wants to wait for
endoscopies conducted annually within the thinks they are doing you a favour by a specific endoscopist, that’s fine, too.”
Region. Most are performed at one of the sending you to a well-known endoscopist, HSC, St. Boniface, Grace, and Seven
city’s six hospitals: Health Sciences Centre or one with whom they have a long- Oaks are already using the services
Winnipeg, St. Boniface Hospital, Grace standing relationship. Meanwhile, you of Central Intake, with Concordia and
Hospital, Seven Oaks General Hospital, might have been seen much sooner had Victoria hospitals expected to move to the
Concordia Hospital and Victoria Hospital. your doctor been aware there was another new system by mid-February.
8 WAVEHealthy Reading
These titles have been recommended by McNally
Robinson staff from thousands of health books. For more
reading recommendations, visit the online community
at www.mcnallyrobinson.com, or visit the McNally
Robinson bookstore at the Grant Park Shopping Centre.
Born to Walk, Dan Rubinstein
The humble act of putting one foot
in front of the other transcends age,
FYI geography, culture and class, and
is one of the most economical and
environmentally responsible modes of
Le a r n m o r e transit. Author Dan Rubinstein makes
about the case for the transformative
t h e n e w sy st power of walking as he explores
em for
b o o k in g e n d how far this ancient habit can
o sc o p ie s take us, how much repair is within range, and
a t w w w .w r h guarantees that you’ll never again take walking for
a .m b .c a /
granted.
e n d o sc o p y
10 Habits of Truly Optimistic People,
David Mezzapelle
Take charge by using the most
powerful tool you have – your attitude
– and let optimism be your guiding
Moffatt credits Dr. Dan Roberts and surgery program directors force. In this guide to positive thinking,
Mary Anne Lynch and Lanette Siragusa for seeing the need for Mezzapelle, author of the award-
improvement, and for suggesting the Central Intake model as the winning bestseller Contagious
most effective path forward. In his capacity as Medical Director Optimism, describes methods for
of the Region’s Medicine Program, Roberts has led a number of overcoming obstacles, looking forward
efforts to enhance the delivery of care, including the creation
instead of backwards, and learning from missteps
of the first Critical Care Database in Canada and a city-wide,
without being thrown off course.
integrated adult intensive care service. More recently, he led an
initiative to ensure patients do not stay in hospital longer than Boost Your Brain, Majid Fotuhi
medically necessary. All these efforts helped enhance access to This book brings together the latest
care and improve efficiencies in the system.
brain science discoveries about
Moffatt says most health-care organizing bodies, including
neuroplasticity to show that the size
the Canadian Medical Association and the Royal College of
Physicians and Surgeons of Canada, are recommending that of the brain can be increased within
centralized booking systems be adopted to reduce wait times for a matter of weeks, resulting in better
specialists. Central Intake offices are being used in the Region focus, memory and creativity.
for hip and knee replacement, diagnostic imaging services and Boost Your Brain uses advances in
with the Region’s Home Care program, among others. neuroscience to present a clear
The main difference in setting up Central Intake for endoscopy explanation and a prescriptive plan
services was the complexity of the project, says Linda Hathout, for how to access the benefits of enhanced brain
Senior Process Engineer with the University of Manitoba’s performance at any age.
Department of Internal Medicine.
“To get 51 physicians and surgeons on board – each with The Nursing Mother’s Companion,
specific variations on how they conducted their business or Kathleen Huggins
communicated with patients – took a great deal of discussion. In this fully updated and revised edition
There were some strong feelings on how best to proceed, so of The Nursing Mother’s Companion,
it took a great deal of evidence-based documentation and author Kathleen Huggins provides
consensus-building. Throughout it all, we were guided by a
breastfeeding mothers with all the
single, overriding principle: to try to increase patient access
information they need to overcome
to the right tests with the right consultants in the best possible
timeframe. We feel we’re now in a position to achieve that potential difficulties and nurse their
goal.” babies successfully, from the first
week through the toddler years, or
Mike Daly is a communications specialist with the somewhere in between.
Winnipeg Health Region.
January/February 2016 9region news
Pump
it up
New breast milk
donation program
aims to help
premature babies
B y S u sie S trachan
W innipeg women are being encouraged to donate
breast milk in an effort to ensure premature
babies get the nourishment they need to help Lesley Jackson with twin daughters
Nicole (left) and Nova.
survive the first weeks of life.
A new drop site to receive donations improved neurodevelopment.” ounces) at birth, was discharged in mid-
has been established at the Birth Centre, Unfortunately, many mothers of November, but her twin, Nicole, born
located at 603 St. Mary’s Road. The premature babies are often not ready to weighing 460 grams (16.2 ounces),
local donations are replacing breast milk produce milk. As a result, donated breast remained in the intermediate care unit
imported from the United States. milk is used to provide the nourishment at Women’s. “I’m hopeful she can come
Dr. Michael Narvey, Head of premature babies need. home with me in January,” says her
Neonatology for the Winnipeg Health “Ideally, we’d prefer moms to feed mother. “Nicole is doing things at her own
Region, says the decision to establish a their own infants, but there are many pace. She’ll soon catch up with her sister.”
centre to collect donated breast milk is an reasons why a mother cannot. She might As a registered dietitian, Julie Gislason
important one. have recently gone through surgery, learned long ago about the health
As he explains, premature babies enter or be on medications that cannot be benefits of breast milk. But that lesson
the world facing all sorts of health issues, passed on to her infant through her milk. was brought home in 2014 with the birth
but studies show those who receive breast Other mothers, despite heroic efforts, of her son, Brody, who was born at 27
milk have fewer long-term health needs. are not able to produce enough to feed weeks, 2 days gestation, and weighed
For example, Narvey says premature their own infants and may need some 1,225 grams (2.7 pounds). He spent the
babies run a higher risk of developing supplementation from donated milk.” first six weeks of his life in the neonatal
necrotizing entercolitis, a condition that Lesley Jackson’s story illustrates the intensive care unit at HSC.
damages an infant’s intestines. But studies point. When her twin girls were born at 24 The premature birth meant Gislason
show breast milk can help prevent the weeks gestation last July, they were so tiny wasn’t ready to provide her own breast
condition. that each could fit in the palm of her hand. milk to Brody. Instead, Brody was given
“Breast milk is tolerated by infants Jackson had been flown in to Women’s donated breast milk until Gislason could
much more than formula,” he says. “It Hospital at Health Sciences Centre provide her own. She says there is no
goes through their intestinal tract much Winnipeg from The Pas, just in time to question the breast milk helped make
more smoothly and it prevents the infant give birth to babies Nicole and Nova. Brody the healthy 16-month-old-child he
from developing necrotizing entercolitis.” Unable to produce breast milk for her is today.
Other conditions that can be prevented daughters, the twins were fed donated “I give a lot of credit to that breast milk
by feeding breast milk to premature breast milk for the first months of their in helping him thrive and grow,” she says.
infants include various infections, chronic lives in the hospital neonatal intensive Approximately 200 newborns at HSC
lung disease, intraventricular hemorrhage care unit. “That’s what kept them going,” and St. Boniface Hospital require donated
and retinopathy of prematurity, an eye says Jackson, who is grateful this was breast milk every year, says Narvey.
disease that can cause blindness in available for her girls. “A lot of people Each preterm infant weighing less
premature infants. were holding their breath, hoping they than one kilogram (2.2 pounds) receives
“Mortality is greatly lessened,” says would survive.” around 150 mL (5.2 ounces) of donated
Narvey. “And the infants also have Nova, who weighed 490 grams (17.2 breast milk per day, with the amount
10 WAVEHow to donate
The Birth Centre is accepting breast milk from donors
approved by NorthernStar Mother’s Milk Bank in
Calgary.
In order to donate, mothers must be: 1313 Portage Avenue
• In general good health Winnipeg, Manitoba
• Able to pump their own milk
Telephone: 204-774-0511
• Willing to have a blood test to rule out certain
diseases www.adoptionoptions.mb.ca
They must not be using certain drugs or herbal
products and they can’t use tobacco products.
NorthernStar will conduct a verbal screening, have the
mom fill out a questionnaire regarding their lifestyle
and medical history, and refer them to their family
physician for the blood test.
Once qualified, the mother will pump milk into the
supplied container and take it to the Birth Centre in
Winnipeg, where it will be frozen.
To donate, contact the milk bank at 1-403-475-6455 or
go online to www.northernstarmilkbank.ca.
scaled up for larger infants.
The Winnipeg drop site for breast milk donations is a
partnership between the Winnipeg Health Region, the
Women’s Health Clinic and the Calgary-based NorthernStar
Mother’s Milk Bank. The drop site collects and freezes the Mastectomy
Comfort Pillows
milk before forwarding it on to the NorthernStar Mother’s
Milk Bank for processing. The freezer for the milk drop
was purchased by the Region with funds provided by the
Winnipeg-based Siobhan Richardson Foundation.
Once processed, the pasteurized milk is then shipped for
use in neonatal intensive care units across Canada, including
HSC and St. Boniface Hospital, says Narvey.
On the first day the program was announced, 40 mothers
applied to be donors, says Narvey, adding that donations are
used by preterm infants in the hospital only.
HSC and St. Boniface have been purchasing donor breast
milk from a milk bank in Ohio. However, they have found
that with the low currency exchange rate, the cost of the
Better Night Sleeps
milk shot up to around $17 Canadian per ounce. Also, each Less Pain & Discomfort
shipment is soon to be hit with a $250 tariff at the border.
J.S.A.W. Mastectomy
“We compared that to the cost of working with
NorthernStar, which charges $4.25 per ounce. That Designs Brand
includes the cost of processing, pasteurization, shipping,” Have you got yours?
says Narvey. “And the best part is that we are guaranteed
to receive the same amount of breast milk back that was
donated by mothers in Manitoba.” J.S.A.W Mastectomy Designs
The Region will continue to use Ohio as a backup, but
Narvey hopes that with continued interest from Manitoba 1-866-594-7435
mothers, the Calgary milk bank will be able to supply all
the breast milk needed for use in the two hospitals that have
Pillows are available and can
neonatal intensive care and intermediate care units.
Designing & Sewing Custom be viewed at:
Susie Strachan is a communications specialist with the Made Mastectomy Clothes www.mastectomydesigns.com
Winnipeg Health Region.
January/February 2016 11RESEARCH NEWS
The following stories have been produced by the staff
of HealthDay. For more research stories, visit:
www.wrha.mb.ca and click on Health Headlines.
Skin-to-Skin Contact May Lower Preemies’ Risk of Death: Review
Tiny newborns who get prolonged skin-to- and promotes breast-feeding.
skin contact with mom while they’re in the The new review, reported online in
hospital may have better survival odds, a the journal Pediatrics, confirmed that for
new review finds. preterm newborns, kangaroo care can
Experts said the analysis, of 124 studies also lower the risk of sepsis – a serious blood
from around the world, confirms the value of infection – and boost infants’ survival odds.
“kangaroo care” for premature newborns. Across the studies, newborns given
The concept goes back to the 1970s, kangaroo care, along with standard
when a doctor in Colombia started medical care, had a 36 per cent lower
advocating the practice as an alternative death rate than those under standard care
to incubators, which are not readily only. They also had about half the risk of
available in some parts of the world. developing sepsis, a 78 per cent lower risk of
Instead, mothers hold their newborns hypothermia, and an 88 per cent lower risk
against the chest, skin-to-skin, with a blanket of dangerously low blood sugar.
over the baby. Neonatal intensive care units (NICUs)
Research since then has shown that at many hospitals, including St. Boniface
kangaroo care not only regulates newborns’ Hospital and Health Sciences Centre
body temperature, but also improves other Winnipeg, use kangaroo care for preterm
vital signs – like heart rate and breathing – infants.
To read the complete story, visit www.wrha.mb.ca/healthday and search: skin-to-skin or visit
www/wrha.mb.ca/wave/2015/05/meet-mac.php
Too Much TV Linked to Leading Causes of Death
A new study links watching too much TV with some of diseases at the start of the nearly 15-year study. All were
the leading causes of death in the United States. followed until death or until December 2011.
Ninety-two per cent of Americans have a TV in their The more TV the older adults watched, the more likely
home, according to background information in the study. they were to die from conditions such as heart disease,
And 80 per cent of American adults watch an cancer, diabetes, flu/pneumonia, Parkinson’s
average of three-and-a-half hours of TV a day, disease and liver disease, the investigators
which is more than half of their leisure time. found.
“We know that television viewing is the Compared with those who watched less
most prevalent leisure-time sedentary than one hour of TV per day, the risk of
behaviour and our working hypothesis is death during the study period was 15 per
that it is an indicator of overall physical cent higher among those who watched
inactivity,” explained study author Sarah three to four hours of TV a day, and 47
Keadle, a cancer prevention fellow at the per cent higher for those who watched
U.S. National Cancer Institute. seven or more hours a day, the findings
“In this context, our results fit within a showed.
growing body of research indicating that too The increased risk of death associated with
much sitting can have many different adverse watching a lot of TV was seen in both active and
health effects,” Keadle said. inactive people in the study, according to the report
In the study, the researchers followed more than 221,000 published online in the American Journal of Preventive
people, aged 50 to 71, who did not have any chronic Medicine.
To read the complete story, visit www.wrha.mb.ca/healthday and search: TV linked
12 WAVEDo you have an Aging Parent or Friend?
Encourage them to explore new activities (physical or mental),
support them to stay engaged and find ways to stay stimulated.
Let’s guide them to live vibrant, active and fulfilling lifestyles!
Did you know that Manitoba
has over 50 Centres?
!
ere
ins h
Active living beg For more information visit
www.manitobaseniorcentres.com
Phone: 204-792-5838
Manitoba Association of Senior Centres info@manitobaseniorcentres.com
DID YOU KNOW?
Access this issue
and previous issues at
is available online www.wrha.mb.ca/wave
Optimistic Outlook May Boost Recovery After Heart Attack
Having an optimistic attitude after a heart attack may gratitude two weeks after the heart attack and again six
be good for your health, Harvard researchers report. months later.
Two weeks after a heart attack, patients who had These findings suggest that all positive emotional
a positive attitude were less likely to be readmitted to experiences may not be alike when it comes to their
the hospital. After six months, these patients were more potential effects on heart health, he said.
physically active than less optimistic patients, the study “It may be that optimism, as a forward-looking
found. expectation, may help people to feel that they can make
“In contrast, gratitude, assessed right after the heart healthy changes and thrive,” Huffman said.
attack, actually had no effect on readmissions or Gratitude, however, often focuses on immediate or past
increasing physical activity,” said lead events, and while it may have benefits, these may be
researcher Dr. Jeff Huffman, an assistant less connected to taking active steps in managing one’s
professor of psychiatry at health, he said.
Harvard, in Boston. This connection between optimism and positive health
For the study, Huffman outcomes was independent of patients’ age, sex, health
and colleagues studied or level of activity before the heart attack, Huffman said.
164 patients. The Huffman said these findings may make it worthwhile to
researchers find ways to make patients more optimistic after a heart
assessed a attack as a way of improving their recovery.
patient’s The report was published online Dec. 8 in the journal
optimism and Circulation.
To read the complete story, visit www.wrha.mb.ca/healthday and search: optimismClo
ga
th
Region works with community gro
By BOB Armstrong
14 WAVEsi ng
ap
he
ups to alleviate health inequities
photography by marianne helm
January/February 2016 15S haron Kuropatwa tells a small story that helps
illustrate a much larger one.
In 2011, she was working on a The concept was first endorsed by the
project to convert the Bell Hotel into a Region’s board in a position statement
residence for individuals with a history approved in Dec. 2012. Last year, the
of homelessness. At the time, a number board took another step to emphasize
of the residents living in the newly the importance of health equity by
renovated facility signed up for home embedding it in the Region’s strategic
care. plan for 2016-2021.
Typically, clients are required to keep As the position statement notes,
track of their home-care appointments. “Health equity asserts that all people
When a client is not at home for their have the opportunity to reach their
scheduled appointment, the Home Care full health potential and should not be
program still covers the cost of sending disadvantaged from attaining it because
staff and uses staff time without actually of social and economic status, social
making a connection for service. If this class, racism, ethnicity, religion, age,
happens repeatedly, the client’s service disability, gender, gender identity,
may be at risk. sexual orientation or other socially
But there was just one problem, says determined circumstance.”
Kuropatwa, who serves as the Winnipeg In practical terms, this commitment
Health Region’s Director of Housing, means the Region will continue to work
Supports and Service Integration towards ensuring all the services it
and Community Area Director for provides – either on its own or through
Downtown-Point Douglas. partnerships with community-based
As she explains, many of the formerly groups – will be in line with the values
homeless residents of the Bell hadn’t and goals of health equity.
lived the kind of life in which set The Region’s evolving role in
schedules and appointments were a housing is a case in point. In the past,
regular feature. As a result, clients were the Region’s emphasis in housing
often not home for their scheduled was on connecting seniors with the
visits, meaning that they did not get appropriate kind of assisted living or
their needed service and home-care personal care homes. More recently,
workers were not making the best use of however, the Region has started working
their time. with government and community
After reviewing the problem, the organizations to develop housing options
Home Care program came up with a for the city’s homeless population, many
solution. The on-site support workers of whom suffer from a variety of chronic
were able to build relationships with mental or physical illnesses.
the tenants, get to know them and their In the case of the Bell, for example,
schedules, and build up a system of the hotel was converted into an
reminders. In addition, staff visits for apartment building for the homeless
the building were scheduled in block based on the “housing first” model.
appointments, so that if the home-care Under this approach, individuals with
worker arrived and one client wasn’t a history of addictions, mental illness
available, another client could be seen and chronic homelessness are provided
instead. housing without having to undergo
The result, says Kuropatwa, was treatment or receive other services
that the program was able to provide as a pre-condition. The project was
better health care to the residents of the undertaken through a partnership that
building by adapting to their needs. included the Region, Centre Venture,
In its own way, the story about the Bell Main Street Project, and the three levels
and its residents is symbolic of a much of government. The building is currently will prove useful in helping to address a
larger shift in thinking taking place within managed by Main Street Project, with wide range of health issues, particularly the
the Region, one that is being driven by the Region providing health services, large gap in health status between people
a desire not just to make health care such as home care. living in the inner city and those living in
available, but to make sure it is received As Kuropatwa explains, the the suburbs.
by those who need it most. reasoning behind this approach is fairly This gap was outlined last year in the
This approach is embodied in a straightforward: “In order for people Region’s Community Health Assessment.
concept known as “health equity,” a to have stabilized health, they need to The 500-page report, released every five
term used to describe efforts to ensure have stabilized housing.” years, compares health outcomes across
everyone in the community has the Of course, the application of health Winnipeg’s income quintiles and in 12
chance to reach their full potential for equity is not limited to housing. Indeed, community areas, which are also broken
health. the Region believes that this approach down into 25 smaller neighbourhood
16 WAVEFrom left to right: Stephane Gray, Program Manager, Bell Hotel, Lisa Goss, Executive Director, Main Street Project, and Sharon
Kuropatwa, Director – Housing, Supports and Service Integration and Community Area Director for Downtown-Point Douglas.
.
clusters. A quick look at the report Self-perceived health follows the same Simply put, lower-income
reveals that on most indicators of health, pattern: 59.5 per cent of people within neighbourhoods, which are concentrated
Winnipeg is on average a little healthier Winnipeg consider themselves in very in the inner city, particularly in the North
than the province as a whole and a little good or excellent health, compared to End, tend to have higher rates of child
less healthy than the Canadian average. 57.6 per cent for Manitoba and 59.9 per mortality, premature death and suicide.
For example, the average life cent for Canada. People living in these neighbourhoods are
expectancy in Winnipeg is 80.1 years, But a closer look at the numbers also more likely to have diabetes, heart
which compares to 79.5 years for reveals much sharper differences in the issues, cancer, dementia and hypertension.
Manitoba and 81.1 years for Canada. health status of people living within the Region public health officials say the
For premature mortality, the rate within city itself, particularly between those gap in health status is caused in large
the city is 2.9 per 1,000, compared to living in higher-income and lower- measure by factors known as the social
3.1 for Manitoba and 2.6 for Canada. income neighbourhoods. determinants of health – issues such
January/February 2016 17Region partners with Peg to
produce health equity report
TRAUMA Information about the health and well-being of
HEALING &
people living in Winnipeg can now be found on
n i t y
Peg, a local website dedicated to tracking the
Commu
city’s vital signs.
Our City: a Peg Report on Health Equity was
produced by Peg in partnership with the Winnipeg
Health Region last year. It can be found at
Conference www.mypeg.ca/node/42.
Among other things, the
report highlights some
of the health inequities
among people living
within the city and points
out that in many cases
they appear to be
Theo Fleury Kim Barthel getting worse.
Hannah Moffatt,
Population Health Equity
Initiatives Leader for the
Dr. Reg Crowshoe Region, says it is hoped
that the report, which draws
heavily from the Region’s 2014 Community Health
Assessment, will stimulate discussion about what
can be done to address these inequities.
Dr.Earl Dr. Joseph
“People sometimes think of health outcomes as a
Henslin Spinazzola
matter of an individual’s choice, yet we find that
PRO life circumstances profoundly affect opportunities
FE
Earn SSIONA
All aree to
for health,” says Moffatt. “The circumstances
aC LS
Beverly for a ertificate
t
that impact health, like education, employment,
t
equiv ending
Welcomend
Keeshig-Soonias hour alent to 1
housing and income, are unequally distributed
LLB, M.Sc s
Educ Continuin
3 across our city.”
AttBand Members
ation
Cred g
its. The report on health equity adds to a growing
collection of indicators on the Peg website.
Chiefs
First Nations
Advocates Early Bird Tickets Launched in 2010 by the United Way and the
Parents & Foster
ParentsCaregivers
Child & Youth Care
Only $379 per person* International Institute of Sustainable Development,
Peg tracks a wide range of social and economic
Counsellors (available until Feb. 28, 2016 only) indicators grouped into eight theme areas – basic
Physicians & Nurses
needs, health, education and learning, social
Family Therapists
Social Workers
Group Pricing Available vitality, governance, built environment, economy,
Addictions, Clinical &
School Counsellors when 5 or more register. and natural environment.
Teachers & Aides * Price includes all meals. Hotels extra.
Employee Assistance & The website bills itself as a place where
HR Professionals “Winnipeggers can learn how their life, their
Corrections Workers
Mental Health Workers RBC Convention Centre neighbourhood and their city is changing – for
& Psychiatric Nurses
Rehab & Vocational Winnipeg, MB the good and the bad. Peg is a starting place
for Winnipeg citizens, business owners and policy
Counsellors
Occupational Therapy MARCH 17 & 18, 2016 makers to learn the facts so you can lead change
Coaches & Volunteers
to create a better city for your children and their
Purchase Tickets Online Now
children.”
In addition to posting documents such as the
http://bpt.me/1863406 healthy equity report, the website can also
produce various charts and graphs based on
www.relationshipinspired.com/conferences information collected in a database.
403-986-2122 kim@relationshipinspired.comas education, housing and
employment. Indeed, a 2008
on health care for everybody,
according to Hannah Moffatt, Gaps in health
report to the Canadian Senate Population Health Equity
stated that as much as 50 per Initiatives Leader for the Region. The 2014 Community Health Assessment is a
cent of health outcomes could “If people are sicker and 500-page compendium of health statistics
be attributed to these factors. come to the hospital more broken down by income. It compares
A report produced by the often, then you have more health in Winnipeg’s 12 community
Region entitled Health For people in hospital and longer areas, which are also broken down into
All: Building Winnipeg’s waits for everybody,” says 25 smaller neighbourhood clusters. The
Health Equity Action Plan Moffatt. assessment, produced every five years, is
sums it up this way: “Income, Of course, tackling these
published by the evaluation platform of
education, where you live, health issues is much more
the Centre for Healthcare Innovation, an
the opportunities you had or complicated than it might seem.
did not have in childhood, For example, health issues office of the Winnipeg Health Region and
especially early childhood, such as diabetes or cancer the University of Manitoba that performs
are among the key factors that are often linked to various evaluation research on the effectiveness
shape your chances of good risk factors. And, as one and efficiency of health-care delivery. Like
health throughout life.” might expect, lower-income previous CHAs, the 2014 version reveals
The gap in health status neighbourhoods also have substantial differences in health status
across the income gradient has higher risk factors than higher- between higher-income and lower-income
the most impact on people in income communities. For communities.
lower-income neighbourhoods. example, the smoking rate
But it also has an effect on among people 12 years of age Here are a few examples from the report:
the health-care system as a and older in Point Douglas is
whole, as revealed by a number 39 per cent, compared to the Life expectancy
of measures in the health city-wide average of 19 per
Female life expectancy is 16.6 years shorter
assessment. cent (as low as 10 per cent
in the lowest-income community than
One startling statistic is that in Assiniboine South). The
the rate of hospitalization obesity rate is higher and the the highest-income. For males, the gap is
for ambulatory-care sensitive immunization rate is lower 15.6 years. Comparing the lowest-income
conditions (people hospitalized in Point Douglas. Fruit and quintile (20 per cent of the population)
for conditions that can be vegetable consumption is also with the highest-income quintile, the gap
treated in the community) is lower in Point Douglas, as is smaller but still substantial: 8.1 years for
9.1 times higher in the lowest- is travel and leisure-related women and 10.2 years for men.
income community than in physical activity.
the highest. These conditions Conventional wisdom would
include asthma, angina, suggest that if you can address
child mortality
In the lowest-income quintile, the rate of
gastroenteritis and congestive these risk factors, you can
heart failure, which, with good improve health outcomes. But child mortality is 4.3 times higher than in
primary care, can be treated while there is obviously some the highest-income quintile. Comparing
and managed without the truth in that, it’s not the whole communities, Point Douglas has a child
patient being admitted to a story. mortality rate of 55.5 deaths per 100,000
hospital. As Harlos points out, the children, compared to rates of 9.3 to 20.6
“Health inequities have difference in the rates of activity per 100,000 across suburban Winnipeg
significant financial costs – they level, fruit and vegetable communities.
aren’t just unfair and unjust, consumption and other lifestyle
which by itself should drive us factors is much smaller than the
to action,” says Horst Backé, difference in overall health.
Premature mortality
Interim Director of Public As a result, she says, it’s Premature mortality, measured as the rate
Health with the Region. important to look at “the cause of deaths before age 75, is 5.5 times more
Dr. Sande Harlos, a medical of the causes.” In other words, common in the lowest-income community
officer of health with the if people in lower-income than in the wealthiest. The lowest-income
Region, agrees. She says that a areas are more likely to smoke quintile has a premature death rate 3.1
report from the Public Health or less likely to eat fruits and times higher than the highest-income
Agency of Canada estimated vegetables, it’s important to quintile.
in 2004 that 20 per cent of look at the underlying reasons
Canada’s health spending and search for potential
(then $200 billion) could be solutions.
Suicide
attributed to socio-economic This is where health equity The suicide rate in the lowest-income
disparities. comes into play. quintile is 4.2 times higher than in the
As a result, improving “To close the large health highest-income quintile.
outcomes for the least healthy gap shown in the Community
members of the population Health Assessment, there is no
could have a positive effect single answer,” explains Harlos.
January/February 2016 19“No simple health-care fix like a new to care can lead to service improvements inequities alone, says Réal Cloutier, Vice
drug or technology can close decades of for those who need it most. President and Chief Operating Officer
difference in life expectancy,” she says. A recently published assessment of for the Region. As he explains, the
“But the accumulation of many simple a program called Partners in Integrated interconnected nature of health, housing,
solutions, some as simple as kindness, Inner-City Prenatal Care (PIIPC) – which education, employment and other factors,
can. Simple actions across many sectors specifically focuses on mothers-to-be underscores the need for co-operation
and at many levels, like better child with the highest needs – found that the among a broad range of government
care, education, job training, income, program doubled the percentage of departments and community groups.
transportation, health-care services in women starting prenatal care in the first Cloutier points to a concept called
proportion to need, all add up to better trimester. And women participating in the “collective impact” as a way to bring
and equitable health for all.” program had a 10 per cent lower rate of partners together to address complex
In the current thinking on the health preterm birth than women with similar problems like health inequity. It’s been
effects of poverty, it’s now thought the backgrounds who didn’t participate. used by several communities in the
issue is not only the lack of money for Moffatt says programs with a health- United States to address issues as diverse
healthy food, recreation or other health equity focus, like PIIPC, acknowledge as student achievement, river pollution
needs. Part of the problem, says Harlos, that it’s necessary to build relationships to and childhood obesity. The approach
is that growing up in poverty – with remove barriers to health care. “It’s about involves bringing together a variety
uncertain housing and family or other us intensifying our efforts to engage with of organizations that can work with a
stresses – creates “a toxic soup of stress families facing disadvantage.” common agenda, a shared system of
hormones” that have future impacts on Concentrating resources on those who measuring results, mutually reinforcing
health. need them most isn’t always the most activities, continuous communication and
“The health effects of chronic stress popular approach, in part because it flies a support organization that can act as the
should not be underestimated,” she says. in the face of many people’s perception backbone to hold the project together.
Moffatt says that in order to address of equality. But equity isn’t the same as The Winnipeg Poverty Reduction
health inequities, one must first equality. “Sometimes the most inequitable Council, on which the Region has
understand the kinds of barriers that thing you can do is treat people living representation, uses a collective impact
organizations put up to those trying to in unequal circumstances equally,” says approach in its current plan for action
access services. Moffatt. and its 10-year plan to
Fixed appointments (remember the While the Region has made health end homelessness.
lesson learned at the Bell Hotel) can be equity a priority, it also recognizes that So does the
a challenge for people whose lives are it can’t solve the problem of health Block by
stressful or who have multiple barriers,
like child care or transportation costs, that
prevent them from meeting schedules, says
Moffatt. Holding programs at locations that
are hard to reach by transit prevents those
without cars from attending.
Overcoming mistrust can be a
challenge when working with people
whose past experience has led them to
dread encounters with programs and to
avoid accessing services.
“What we see is that with
poverty and health, there is
a system of barriers,” says
Moffatt. “Sometimes I’ve
sat down and asked,
‘Who is accessing this
program and who
isn’t accessing
this program, and
why?’”
To illustrate
her point, Moffatt
points to a pre-
natal care pilot
project as an
example of how a
health equity approach
Members of the Winnipeg Health Region’s Bell Hotel Home Care team, from left:
Mario Agacer, direct service staff member, Hardeep Singh, case co-ordinator,
and Sue Lotocki, Team Manager, Home Care and Nursing, Downtown.
20 WAVEYou can also read
