Primary health care leads to better health



Marg Dykeman, PhD, NP, has recently retired from The Faculty of Nursing, University of New Brunswick.

We hear the term primary health care (PHC) frequently, but the concept is poorly understood, in part because of confusion between primary care and primary health care. Simply put, primary care is what you receive when you go to your provider for treatment of an ailment. In contrast, PHC is a health-based model. Its services are based on certain defined principles (essential, accessible, equitable, collaborative and using the appropriate technology) and account for the social determinants of health. Offering care from a PHC perspective means providing more episodic care and becoming involved in the social and environmental issues that affect health.

If Canada were to adopt a PHC model of service delivery, health care would become the responsibility of individual Canadians, their communities and their governments, not just provincial and territorial departments of health. In this country, government services are separated into departments that function like silos. True PHC necessitates daily contact with a variety of government services and hence multiple departments, including social development, public safety, justice and education. Searching across departments is time-consuming and often leads nowhere, because no one is willing to make needed decisions. Although the language of PHC has been used for many years, only now are government departments beginning to function collaboratively, communicate openly and thus facilitate PHC. We need to promote widespread understanding of PHC to ensure that this approach becomes the model of care delivery across Canada.

At the Community Health Clinic (CHC) in Fredericton, managed by the University of New Brunswick's faculty of nursing, staff members fully understand the difference between PHC and primary care. They provide a wide range of health and social services to address each clients' needs. The CHC takes an interdisciplinary approach where the client is a respected member of the care team and programs are based on community input. The clinic serves vulnerable populations, including homeless and addicted people, women without family doctors and newcomers to Canada, and staff frequently deal with complex issues that have arisen because of lack of timely access to services. In many cases, what was originally a simple issue has become a life-threatening illness.

In addition to offering primary care, the CHC provides various services with broader effects on individuals, families, population groups and the community as a whole. For example, students provide CHC outreach services in shelters and a soup kitchen. Clients attending the clinic can visit a clothing bank, take a shower and leave their laundry to be washed. The CHC offers warm drinks on cold days and water for hydration in hot weather. Staff members sit on numerous community and government committees addressing issues that affect community health. They provide education to community groups and work with other allied health organizations to eliminate care gaps. Our model of care delivery, one rooted in the principles of PHC and encompassing the determinants of health, has allowed the CHC to better meet overall community needs.

We often hear that health-care costs are too high. I firmly believe that if Canada as a whole were to adopt a PHC model of service delivery, embedded in the community and based on the needs of the individuals seeking care, our health-care dollars would be used more effectively and Canadians would be healthier.