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Trevor Hancock: Reverse 45 years of neglect of health centres

In the late 1970s, I was one of two family physicians in a new community health centre in Toronto. We were on salary and worked with a nurse practitioner and a community board.

In the late 1970s, I was one of two family physicians in a new community health centre in Toronto. We were on salary and worked with a nurse practitioner and a community board. These were the early, heady days of CHCs, with several established at the same time across Toronto and elsewhere.

It wasn’t easy. We were met with suspicion, resentment and sometimes outright hostility from the medical profession, to whom we were traitors, undermining physician autonomy and the fee-for-service system while bringing in a nurse practitioner. But we were passionate, idealistic and committed to implementing the model proposed just a few years before in the Hastings Report.

This report, released in 1972, was commissioned by Canada’s ministers of health and led by Dr. John Hastings, a distinguished professor of health administration at the University of Toronto. Its key recommendation was “the development … of a significant number of community health centres … as non-profit corporate bodies in a fully integrated health-services system.”

The authors described a centre as “a facility … enabling individuals and families to obtain initial and continuing health care of high quality … provided in an acceptable manner through a team of health professionals and other personnel working in an accessible and well-managed setting.” What’s not to like about that?

Ideally, a CHC would be responsible for providing care to people living in a defined geographic area, co-ordinating their primary care with home and community care. Facilitated by a community board, the centre would become involved with public health, various community-based organizations and local government in efforts to improve the overall health of the community.

But while a few community health centres were established, the model did not become widely adopted, in large part because of the opposition noted earlier. In fact, CHCs mostly became seen as a way to provide health care to low-income and disadvantaged populations. For example, there are only three CHCs here in Victoria, one for adults over the age of 55 and another for people who are homeless, vulnerable and living on very low incomes; only one, the Victoria Community Health Co-operative, is for the general population.

Thus, ordinary Canadians did not get to reap the benefits of this superior form of health care. This is a shame, because a 2012 report from the Canadian Foundation for Health-care Improvement noted “despite significant progress since 2000, the performance of Canadian primary care trails that of many other high-income countries.”

Today, there is a growing interest in CHCs, including a much more favourable attitude among family physicians. Moreover, there is a growing body of evidence that the belief espoused by the Hastings report — “that some shift from the present emphasis on acute hospital in-patient care to other forms of health care, including types of community health centre, offers a means of slowing the rate of increase in health-services spending” — is correct.

But unfortunately, community health centres in B.C. have received only weak support from the government and generally lack core operational funding.

A newly released position paper from the B.C. Association of Community Health Centres, which speaks for the 29 CHCs in B.C., cites evidence that the centres have been shown to reduce avoidable use of hospital emergency rooms, improve accessibility and comprehensiveness of health and social services in rural areas, and enhance the accessibility and effectiveness of mental-health and addictions programs — all Ministry of Health priorities.

Importantly, last month, the B.C. legislature’s Liberal-dominated select standing committee on health released a report in which it supported many of the elements of CHCs. Specifically, it recommended implementing “a community health centre model of care” and providing “adequate operational and capital funding for new and existing community health centres throughout the province.”

In an online petition to all three major party leaders, the association calls on the next government to “invest in 20 new community-governed community health centres throughout British Columbia” by 2020. It’s way past time the province did so.


Note: I have been writing this column without a break for more than two years, so I am taking a break for vacation and will be back in June.


Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

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