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Taking Medicine To The People: Four Innovators In Community Health

Preventing and treating illness at home or in small local clinics makes financial sense. It also makes patients a whole lot happier.

By David South

Canadian Living (Canada), January 1993

Your health is your wealth, my grandmother used to say. It certainly is our most valuable resource – and when its caretaker, universal health care, is under attack, people take notice.

Provincial health ministries across Canada are scrambling to find new cost-efficient ways to deliver health care, and community health care is an increasingly talked-about option.

“Every royal commission has suggested we need to shift resources to community care and stop focusing on institutions,” says Carol Kushner, co-author, with Dr. Michael Rachlis, of Second Opinion (HarperCollins, 1990), a blockbuster book that challenges the way we approach health care in Canada. According to Rachlis, health care nationally cost more than $60 billion in 1992 and is primarily delivered through hospitals and doctors’ private practices. Yet 20 per cent of all patients in acute care hospitals don’t belong there, and about five per cent of hospital admissions for people over age 65 are the result of improper use of prescription drugs.

One study of the Toronto Health Unit found that as many as 50 per cent of seniors residing in nursing homes who were admitted to hospitals with pneumonia had contracted it through mouth infections. If they had received regular dental check-ups in the community or at institutions, these unnecessary and costly admissions could have been avoided.

Increasing numbers of people see community health care as the way of the future. In this model, health care providers – doctors, nurses and support staff – work as a team, and users of health care are involved in making important decisions. Community-based care supplements a medical approach to illness, with emphasis on social and environmental factors like work-related stress. Its advocates say community care can wean us off our addication to expensive hospitals (where one bed costs at least $100,000 a year), drugs and surgery – and make us all healthier.

“Fee for service” encourages doctors to see as many people as possible, emphasizing quantity over quality. In community health centres, doctors are put on a salary and encouraged to give as much attention as necessary to each patient. By simply spending more time with each patient, and by taking into account factors such as illiteracy and cultural differences, community clinics can cut down on misuse of medication.

Jane Underwood, director of public health nursing for the regional municipality of Hamilton-Wentworth in Ontario, says we have reached the limit of what hospitals can do to improve health. “Other factors are now more important than a strictly medical approach, which was the foundation of the old health care system. In 1974, a Health and Welfare paper urged a behavioral approach – stop smoking, get more exercise. Now we are moving to a socio-environmental approach, looking at poverty, social isolation, and unemployment, and their effects on health.”

“Community health care is inevitable because we can now do many procedures on an outpatient basis. With the new technology, all kinds of things can be done outside institutions,” says University of Toronto professor Raisa Deber, co-editor of the recently released book Restructuring Canada’s Health Services System (University of Toronto Press, 1992).

“Just as people can work out of their homes because of computers and faxes, technology can take medical care to the home.” This trend can already be seen in the treatment of cancer. Many patients now receive their chemotherapy at home, with the help of computerized IV pumps.”

If the debate over community health care often seems confusing, it may be because of the haphazard patchwork of programs across Canada. Quebec is the only province that took community health care seriously enough to set up clinics across the province in the 1970s and make those clinics an integral part of the provincial system. Elsewhere in Canada, programs sprang up in the ’60s and ’70s at the initiative of community activists but were met with indifference or hostility from government.

The challenge for community care advocates is to educate both the public and governments. Jane Underwood admits it will be a tough struggle. “Governments are beginning to understand, but the public still has reservations. They panic when there are fewer surgeries and feel that lots of high tech will provide a safety net for health. In fact, it is more scientific to probe for the true causes of illness and not think that just taking a pill will make us better.”

Four Innovators in Community Health

South Riverdale Community Health Centre, Toronto

This fully functioning health centre opened in 1976 in Riverdale, a multicultural and economically diverse neighborhood. The staff consists of doctors, nurses, chiropodists, social workers, health promoters and a nutritionist. Innovative in taking on economic concerns of the community, the centre has set up a community food market to provide cheap and healthful food and recently started workshops with business and community members to come up with strategies to recover jobs lost during the recession. “We consider ourselves part of a movement,” says executive director Liz Feltes. And this is played out in projects with local groups and citizens on a variety of issues – from wife assault, drug abuse and sexually transmitted diseases, to medication literacy for seniors. 

Victoria Health Project, Victoria

Originally started in 1988 to tackle the problem of poor communication between hospitals and community health providers, the project first targeted Victoria’s large senior citizen population. Twelve programs were launched, including Wellness Centres, palliative support teams for patients dying at home and elderly outreach service focused on mental health. The project has been successful at getting local services to cooperate and eliminate duplication. “There are 500 different agencies for seniors in Victoria, so we linked up with them and increased cooperation,” says Susan Lles, excutive coordinator of the project.

It was such a great success that the minister of health created the Capital Health Council to expand the program to the rest of the community. Now, for example, in hospital emergency rooms, quick response teams of nurses assess whether a patient would be better served by other services in the community or by being admitted to hospital. 

Centres locaux de services communautaires (CLSC), across Quebec

Started in 1972 as part of province-wide health reforms, these comprehensive health centres now number 158, with more than 500 satellite offices all over Quebec. Every citizen is guaranteed access to a CLSC, even in remote areas. With five per cent of the provincial health budget, they are able to serve 41 pr cent of the population. They also involve the community through elected boards. “We think it is a unique model in that it integrates health and social services in the same place – both prevention and cure,” says Maurice Payette, president of the federation of CLSCs. Because CLSCs are close to the community, governments, schools, community groups and other organizations have turned to them for advice during the last five years. In rural areas, CLSCs have been crucial in reducing the number of farm accidents. 

Canadian Healthy Communities Project (CHCP), across Canada

Started in 1989, the program is aimed at municipalities and gets them to pledge that they will review all their actions with community health (including impact on the environment and economy) in mind. CHCP is part of an international movement linked with the World Health Organization’s Healthy Cities movement. With more than 150 participating programs, it is an innovative attempt at getting the powers that be to plan for overall health. “We bring together community leaders to make a list of top 10 health problems and then decide what can be done with the existing budgets and staffing,” says David Sherwood, project director. The city of Sherbrooke, Que., is a classic example. Facing reduced funds for road and sidewalk repairs, the city concentrated on repairs in neighborhoods with hig numbers of the disabled and elderly, thereby reducing the number of accidents. Unfortunately, funding was recently reduced dramatically by Health and Welfare Canada, but programs in Ontario, British Columbia and Quebec continue with the help of their own provincial government. 

Read more about Canadian innovation in healthcare and medical education here: Take Two Big Doses Of Humanity And Call Me In The Morning

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CASE STUDY 1: Investigative Journalism | 1991 – 1997

Case Study 1 badge 2.0.png

Expertise: Investigative journalism, editing, start-ups, content and magazine design, digital content, digital strategy.

Locations: Toronto and Guelph, Ontario, Canada and London, UK 1991 to 1997

Investigative Journalist, Editor, Reporter, Writer: David South

Click here to view images for this case study: CASE STUDY 1: Journalism | 1991 – 1997 Images

Abstract

I worked as a journalist for magazines and newspapers from 1991 to 1997 in Canada and the United Kingdom and as a radio host for a weekly spoken word interview programme, Word of Mouth (CKLN-FM). This included working as an investigative journalist for Now Magazine, “Toronto’s alternative news and entertainment source”, as a Medical and Health Correspondent for Today’s Seniors, and as an investigative journalist and reporter for two Financial Times newsletters, New Media Markets and Screen Finance.  

Samples of published stories can be found here (below) and on the Muck Rack platform here: https://muckrack.com/david-south

About

Could it be possible to do high-quality investigative journalism in the context of a shrinking economy undergoing austerity, and where the media sector is contracting and consolidating around a small number of media companies? Is it possible to launch new media products in the face of a contracting economy and reach new audiences and create new markets?

In Canada, the early to mid 1990s were the years of government austerity and economic crisis. After the crash of 1989/1990*, institutions came under great stress. Health care, for example, was pitched into a period of turmoil and change. Drawing on my experience working in the health sector (Princess Margaret Hospital/Ontario Cancer Institute), I covered this crisis in many stories for various publications, in particular Today’s Seniors.

The Canadian economy severely contracted and unemployment was at 11.4 per cent by 1993 (Statistics Canada), and as Statistics Canada says, “Because employment recovered at a snail’s pace after the recession of the early 1990s, the decline in the unemployment rate was delayed until 1994”. 

The media in general could not avoid the wider economic crisis. According to the book The Missing News: Filters and Blind Spots in Canada’s Press (Robert A. Hackett and Richard S. Garneau, Canadian Centre for Policy Alternatives, University of Toronto Press 2000), Canada’s media was also in a crisis throughout the 1990s, as declining resources, staff layoffs and media closures reduced the breadth and depth of news coverage. Canadian media as a whole also has a “great dependence on advertising, which accounts for more than 70% of daily newspaper revenues, about 64% of magazine revenues,” which means there is enormous pressure to only publish stories that do not upset advertisers. And monopolies exert great control over news content in Canada: “In the United States, ten companies control 43.7% of total daily newspaper circulation. By contrast, in Canada since 1996, one single company controls a comparable share of the media pie.”

The impact of this crisis was summed up by Jeffrey Simpson in the book The Missing News, where he said newspapers are “shrinking in size, personnel, ambition and, as a consequence, in their curiosity,” …. “I believe the result has been a diminution in quality.” (p64)

This is the context in which, ironically, it was possible to flourish as a much-sought-after investigative journalist who could get the story and get the quotes and as an editor. And it was also a time for opportunity, in particular as new media rose in importance, from cable and satellite television, to the rise of the Internet.

I broke original stories for Now Magazine as a member of their investigative reporting team, for Today’s Seniors as its Medical and Health Correspondent, and as a reporter for two Financial Times newsletters in London, UK. I also broke original stories as a freelancer for many other magazines and newspapers, including Hospital News, The Toronto Star, This Magazine, The Annex Gleaner, Flare, The Financial Post Magazine, Canadian Living, and others. I drew on strong contacts in health care, media, politics, international relations and the military. 

I was an editor for magazines, newspapers and newsletters as well, gaining invaluable experience and contacts. This included as Editor-in-Chief for start-up youth publication, Watch Magazine (see Case Study 2), and as Features Editor for Id Magazine (see Case Study 3). 

Themes covered included the uses – and abuses – of data, the impact of military engagements to uphold international law, how to re-structure health care when budgets are tight, with populations ageing, and technology and scientific advances quickly expanding options, the emerging new media world of cable and satellite television and the Internet, the sexual revolution 2.0, urbanization and how it re-shapes politics and community, international development, and youth culture. 

Story highlights include covering data concerns over Canada’s border screening measures, questions about the air quality of aircraft cabins, the debate over airstrikes in Bosnia, scandals involving peacekeepers in Somalia and reporting on the UN peacekeeping mission in Haiti, reforms to medical education in Canada, innovators in health care, the tug of war over health care spending during austerity measures, London, UK designers, the growing role of Nordic countries in cable and satellite television, the film financing scene in Europe and the UK, the new sexual revolution and its impact on cable and satellite television and the rising Internet, changes to Canada’s media industry, and Toronto’s embracing of the megacity concept and the political battles it sparked. 

I edited newsletters and newspapers aimed at specific communities, from Canada’s medical history community to part-time students. And had the privilege of helming a start-up youth magazine as its Editor-in-Chief to its commercial success (see Case Study 2). 

It was an exciting time of great change, best reflected by the fact in 1997 Id Magazine (Features Editor: see Case Study 3) was one of the first Canadian publications to regularly publish an online version (https://web-beta.archive.org/web/19970207103121/www.idmagazine.com).  

* “The last two recessions in Canada occurred in 1982 and 1990. … The most recent Canadian recession began in the second quarter of 1990 and over the next 12 months GDP fell by 3.2%. … The recovery from this recession was unusually slow; there was almost no growth between mid-1991 and mid-1992. This slow recovery was export driven.” (The Canadian Encyclopedia)

 “In early 1994, Canada’s economic situation was not that favourable—our economy was facing some rather serious problems.

 “… the recession here was more severe than in the United States.

“Working their way out of these difficulties was disruptive and painful for Canadian businesses. Defaults, restructurings, and downsizings became the order of the day. With all this, unemployment took a long time to recover from the 1990–91 recession and, in many instances, wages and salaries were frozen or reduced (Bank of Canada: Canada’s Economic Future: What Have We Learned from the 1990s?)

A small sample of published stories with links is below:  

Investigative Journalism 

An Abuse of Privilege?

Aid Organization Gives Overseas Hungry Diet Food

Artists Fear Indifference From Megacity

Casino Calamity: One Gambling Guru Thinks The Province Is Going Too Far

Counter Accusations Split Bathurst Quay Complex: Issues of Sexual Assault, Racism at Centre of Local Dispute

False Data Makes Border Screening Corruptible

New Student Group Seeks 30 Percent Tuition Hike

Peaceniks Questioning Air-raid Strategy in Bosnia

Safety at Stake

Somali Killings Reveal Ugly Side of Elite Regiment

Study Says Jetliner Air Quality Poses Health Risks: CUPE Takes on Airline Industry with Findings on Survey

Top Reporters Offer Military Media Handling Tips

Will the Megacity Mean Mega-privatization?

Will Niagara Falls Become the Northern Vegas?

Health and Medical

Changing Health Care Careers a Sign of the Times

Critics Blast Government Long-Term Care Reforms

Cut Services to Elderly, Says Doctors’ Survey … But Leave Our Salaries Alone!

Feds Call for AIDS, Blood System Inquiry: Some Seniors Infected

Government Urged to Limit Free Drugs for Seniors

Health Care on the Cutting Block: Ministry Hopes for Efficiency with Search and Destroy Tactics

Health Care in Danger

Lamas Against AIDS

New Legislation Will Allow Control of Medical Treatment

New Seniors’ Group Boosts ‘Grey Power’: Grey Panthers Chapter Opens with a Canadian Touch

Philippine Conference Tackles Asia’s AIDS Crisis

Private Firms Thrive as NDP ‘Reinvents’ Medicare

Psychiatric Care Lacking for Institutionalised Seniors

Seniors Falling Through the Health Care Cost Cracks

Specialists Want Cancer Treatments Universally Available

Take Two Big Doses of Humanity and Call Me in the Morning

Taking Medicine to the People: Four Innovators In Community Health

US Health Care Businesses Chasing Profits into Canada

Magazines

The Ethics of Soup: Grading Supermarket Shelves – For Profit

Freaky – The 70s Meant Something

Land of the Free, Home of the Bored

Man Out Of Time: The World Once Turned On the Ideas of this Guelph Grad, But Does the Economist John Kenneth Galbraith Know the Way Forward?

Oasis Has Arrogance, A Pile of Attitude and the Best Album of 1994

Porn Again: More Ways to Get Off, But Should We Regulate the Sex Industry?

Redneck Renaissance: A Coterie of Journalists Turn Cracker Culture into a Leisure Lifestyle

Safety at Stake

Swing Shift: Sexual Liberation is Back in Style

Time Machines

Too Black

Media 

The Big Dump: CP’s New Operational Plan Leaves Critics with Questions Aplenty

Channel Regulation: Swedes will Fight Children’s Advertising all the Way

Do TV Porn Channels Degrade and Humiliate?

Is the UK Rushing to Watch TV Porn? 

Playboy ‘is not for sad and lonely single men’

TV’s Moral Guide in Question – Again

UK Laws on Satellite Porn Among Toughest in Europe

Undercurrents: A Cancellation at CBC TV Raises a Host of Issues for the Future

Special Reports

From Special Report: NMM (New Media Markets) Spotlight on the Emergence of Satellite Porn Channels in the UK

From Special Report: Sexual Dealing: Today’s Sex Toys Are Credit Cards & Cash: A Report on the Sex-for-Money Revolution

United Nations

Freedom of Expression: Introducing Investigative Journalism to Local Media in Mongolia

Starting from Scratch: The Challenge of Transition

State of Decay: Haiti Turns to Free-market Economics and the UN to Save Itself

Traffic Signs Bring Safety to the Streets

Magazines

Watch Magazine

Id Magazine

Newsletters

Hannah Institute for the History of Medicine

New Media Markets

Screen Finance

Blue Sky Bulletin

Other Resources

Ger Magazine: Issue 1

Ger Magazine: Issue 2

In Their Own Words: Selected Writings by Journalists on Mongolia, 1997-1999 (ISBN 99929-5-043-9) 

Mongolian Rock and Pop Book (ISBN 99929-5-018-8) 

Wild East: Travels in the New Mongolia (ISBN 1-55022-434-4)

Timeline 

1991: Begin career as investigative journalist and editor.

1992: Work as a Medical and Health Reporter for Today’s Seniors and as an Investigative Journalist for Now Magazine. Work as Editor and Writer for the Hannah Institute for the History of Medicine’s newsletter. 

1993: Published in many publications, including The Toronto Star, Canadian Living and This Magazine.

1994: Work on re-launch of Watch Magazine 2.0 and its expansion (see Case Study 2). 

1995: Work as reporter for two Financial Times newsletters in London, UK.

1996: Work on re-launch of Watch Magazine 3.0 and its expansion. Begin work at Id Magazine as its Features Editor (see Case Study 3).

1997: Begin two-year assignment with the United Nations mission in Mongolia (see Case Study 4). 

Testimonials 

David South … proved himself to be a penetrating, thorough and hard-working journalist. He produced a lot of very good stories …” Neil McCartney, Editor, Screen Finance, Telecom Markets and Mobile Communications, London, UK

© David South Consulting 2017