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Researchers urge action to improve health of all Ontarians


Researchers at St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences (ICES) released findings of a six-year long women’s health report they say provides government and health system players with the evidence and tools they need to drive reform to improve the health of women and men across Ontario.

The POWER Study (Project for an Ontario Women's Health Evidence-Based Report), examined access, quality, and outcomes of care across the province using a comprehensive set of evidence-based indicators for the leading causes of disease and disability in the province and how they varied by sex, income, ethnicity and where one lives. Researchers are also providing the government with indicators and a 10–point road map (see attached) to reduce health inequities among men and women.

Evidence-based reform is a key component of the Ministry of Health and Long-Term Care’s (MOHLTC) new Action Plan for Healthcare and a core aim of the provincial government’s Excellent Care for All act.

“The healthcare needs of men and women are different, and among women, health needs vary enormously depending on income, ethnicity and other social factors,” says Dr. Arlene Bierman, an ICES scientist and principal investigator of the study. “We have more than enough evidence to make health equity a priority and move forward. We need to reduce health inequities in our system to improve the quality of care we provide. Our study provides a 10-point health equity road map that will help move Ontario in the right direction,” adds Dr. Bierman, also a physician at St. Michael’s Hospital.

The POWER Study consistently found large and modifiable health inequities on multiple measures. These inequities place a large burden on individuals, their families and the health system. Investigators estimated that if all Ontarians had the same health as Ontarians with higher incomes:

  • 318,000 fewer people would be in fair or poor health
  • 231,000 fewer people would be disabled
  • 3,373 fewer deaths would occur each year among Ontarians living in metropolitan areas

Further, if people from all income groups had the same hospital admissions rates as those from the highest-income group for four conditions alone (heart failure, diabetes, COPD, and asthma) there would have been 15,709 (30%) fewer hospitalizations for these conditions contributing to health system sustainability.

“This research provides critical information on inequities which will support achievement of goals around reducing the burden of chronic diseases,” says Dr. Bierman. “We now have a Road Map to help ensure that the needs of diverse communities are considered explicitly as providers, policymakers, and citizens work together to implement needed change.”

"I want to thank Echo, St. Michael's hospital and ICES for the substantive work accomplished through the Power Study and for bringing to light ways in which health system stakeholders can address the unique health needs of Ontario women. Our government is committed to reducing health inequities," says Deb Matthews, Minister of Health and Long-Term Care. "This landmark study confirms the importance of considering the unique health implications for women in all the health research we undertake."

The POWER Study was funded by Echo: Improving Women’s Health in Ontario, an agency of the MOHLTC. The POWER Study has garnered international attention by developing a model for routinely incorporating health equity into health systems performance measurement. The POWER Study website has had visitors from 132 countries/territories, 49 of the 50 US states, and 675 cities across Canada.

“To ensure excellent care for all, it is important to recognize women’s perspectives and address differences when implementing plans to increase the quality and value of Ontario’s health and social support systems,” says Pat Campbell, CEO, Echo: Improving Women’s Health in Ontario. “The POWER Study provides the evidence, identifying healthcare disparities and establishes a baseline for measuring improvement.”

For more information on the POWER Study and its partners, visit the POWER Study website.

POWER Health Equity Road Map:

  • Equity, a major attribute of high performing health systems and important dimension of healthcare quality, is key to health system sustainability.
  • Health equity cannot be achieved without moving upstream and addressing the root causes of disease in the social determinants of health. A multifaceted approach is required to tackle the many complex problems which contribute to greater chronic disease prevalence and poorer health outcomes in some groups.
  • Prioritize chronic disease prevention and management to improve overall population health and reduce health inequities. Because chronic diseases and their risk factors contribute greatly to health inequities, the implementation of a comprehensive and coordinated chronic disease prevention and management strategy—one that addresses the need of at-risk populations—is the key to improving population health and achieving health equity.
  • Focus on patient-centeredness to improve access and satisfaction with care for all.
  • Province-wide, integrated, organized models of care delivery can improve health outcomes and reduce inequities in care. We found few inequities in the delivery of acute cancer and stroke care, areas where organized, integrated, and coordinated strategies for guideline implementation, quality improvement using performance measurement and feedback with validated quality indicators have been implemented.
  • Coordinate population health, community and clinical responses. There are many important ongoing activities aimed at improving health in the province including: targeting population-based health promotion, enhancing the quality and capacity of community-based services, and improving the quality of care delivered in clinical settings. Efforts to integrate and coordinate these efforts could produce synergies to accelerate progress in improving health and reducing health inequities among Ontarians.
  • Link community and health services. Both health services and community services are vital for maintaining health. Improving linkages between these sectors can help assure that people can readily access needed care and services to promote, maintain, and improve health.
  • Routinely include gender and equity analysis in health indicator monitoring.
  • Develop strategies for effective implementation by creating learning networks and designing innovations for scale up and spread.
  • Create a culture of innovation and learning while building the evidence base for accelerated improvement through rigorous evaluation and research.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.