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Commentary - John McGarry, President and CEO

Shifting demographics: Changing the face of health care

Horizon Health Network kicked off 2015 with the launch of a five-year plan aimed at creating a healthier future for New Brunswick. In it, we highlighted the importance of working with our community partners and clinicians to ensure we can achieve that goal. We know that with financial and human resources in the right place, community-based primary health care can be improved. We can, with others, employ the right equipment, technology, treatment and services available to meet the unique needs of citizens.

The face of health care in New Brunswick is changing. We have seen a shift in demography coming for some time - an aging population, southern migration within the province, and the shift from rural to urban living. There are negative health impacts associated with our climbing poverty rate; the incidence of chronic diseases in our province is at an all-time high. Clearly, we need better preventive, primary, long-term and palliative care.

All evidence indicates that the traditional growth in health care spending has done little to improve the health of New Brunswickers. Our province has the unwanted distinction of exceeding the Canadian average in smoking rates, adult obesity rates, diabetes, heart and respiratory disease and unhealthy alcohol use.

Driven by these realities, we see the need to move away from the concept that all care must occur in hospitals. Today, our hospitals are congested with patients/residents who could be better served by another provider. As well, we need to manage health issues like COPD and diabetes differently - these chronic diseases can very often be treated outside of a hospital setting. It means looking beyond our hospital buildings and allocating programs and resources to address primary health care needs by providing access to the right health professional at the right time in the community.

This will take a new way of thinking. Horizon Health is not the traditional provider of primary care. But we recognize the solution means shifting people and money from our institutions into the community and giving health care providers a better opportunity to influence health promotion, prevention and management. Within five years we hope to reallocate $134 million, 12% of Horizon's budget to community-based care, up from 10%.

Making informed decisions about such changes involves finding a community's strengths and needs. Health care is a complex issue and measuring the health of a community goes far beyond looking at rates of disease and the availability of health care services.

We recognize that by working with a community we can truly understand their health care needs. This is where the Community Health Needs Assessments come in. Together with our health and community partners, we and other agencies use the assessment results to guide our priorities and develop action plans to improve the overall health of everyone in the community.

This process aims to improve the health of the entire population and to reduce existing gaps or inequities. It allows stakeholders to examine and act upon factors and conditions known to have a strong influence on our health - health determinants.

The New Brunswick Health Council's model for population health informs the work being done within Horizon communities. Their model identifies and rates four health determinant categories that influence health status: health behaviours (40%), social and economic factors (40%), health services (10%), and physical environment (10%).

Each community we visit is unique and through the eleven Community Health Needs Assessments completed to date, many local issues have emerged. What has become evident, however, is that there are common themes.

We hear about the growing rate of mental health issues, specifically in the child and youth populations, and the subsequent need for improved access to mental health care services. Communities have voiced the need to address obesity, ensure there is sufficient access to nutritious food and more recreational programming to promote healthy living. There is a need for improved access to affordable transportation to get to work, appointments or even the next community. There is a need for improved access to affordable home care services to help keep seniors in their homes longer, which should come as no surprise.    

Addressing these issues will be a collaborative effort among many government and non-government partners operating at a community level. Horizon Health Network is committed to taking these steps to change the face of health care, but we cannot do it alone. We need these partnerships to make it happen.

Our median age is continuing to creep ever upwards and our population records the highest rates of chronic health issues in the country. We have no choice but to act now to put the right resources in the right place, so we can adapt to these new care needs. 

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