As you are, we're certainly concerned about the sustainability of our health care system. We all have to think about how we're going to do things differently to slow the increasing costs of the health care system as well as the rising rates of chronic disease. We are also concerned about the quality of care and the patient experience. Critical to this is keeping people healthy longer but also to recognize that for many people, making the healthy choice is not the easy choice. We really have to consider new ways of reaching those who are most at risk.
In the short time available, we want to focus on a couple of developments that we think are really important. I would like to say we certainly support what you've heard from earlier witnesses today about the importance of cross-collaboration between professionals, and also what we've heard about the use of Rosie in robotics. That is an important point.
Madam Chair, I think you will be quite familiar with this, because the examples are in fact from your constituency, and you may have had the chance to meet the folks involved.
The first is the social primary care model. As we think about vulnerable populations and vulnerable communities, the literature on improving health equity, and the evaluation of existing models, we are proposing a targeted approach based on what is known as the RICHER social pediatrics model, which has been under way since 2008 in the Strathcona community of Vancouver. It's one of the lowest-income communities in Vancouver, as the chair well knows.
Research has shown that in both urban and rural communities with high rates of material and social disadvantage, populations are less likely to have accessible and appropriate health care services. The effects of socio-economic status are more prominent, for example, in some types of hospital admissions, which is where the big cost issues are. There's an example of a CIHI study of 15 census metropolitan areas over a three-year period. They found that when compared to others with high incomes, hospitalization rates for people in low incomes were more than double for chronic conditions treatable in the community, diabetes, and chronic obstructive pulmonary disease. A hospital is not the place where people need to go. The children from low-income families also had hospitalization rates for asthma 56% higher than children from high-income families.
So the social primary health care model, or RICHER, example in Vancouver delivers health care to hard-to-reach, disadvantaged communities by building relationships and responding to the social determinants of health. Those are just a few highlights from it, and there's lot of literature that we can refer you to. It uses nurse practitioners in community settings where people go. This way, the person doesn't have to go to the doctor; the nurse practitioners go to them. They are out in the daycare centres, in the schools, in the community centres. They develop relationships in the community, and they act as a point of contact for tertiary and specialist services. They partner with social service agencies and NGOs to work together on social determinants. They have a formal memoranda of understanding, and they address in a very practical and immediate way the conditions that impact housing. If the family, the mother and the children, have not just health care but housing or other issues, they can address that collaboratively. They have a community table that meets weekly to talk about the issues involved in the clientele.
Dr. Judith Lynam at UBC, the lead researcher on this model, has found even in these early days that it has fostered access for families with multiple disadvantages. It's also catching mostly kids who were not getting their health needs, both developmental and mental health, addressed before. It's improving outcomes by empowering parents, particularly of vulnerable children, to become more active participants in care, which is usually associated with the use of nursing services, and reduces the use of emergency departments for primary care.
Overall, Dr. Lynam believes it's having an impact on health care costs by reducing acute, costly exacerbation of chronic illnesses. As we know, there are similar approaches under way in Quebec, for example.
The Fondation du Dr Julien—
who was one of the early models for this.
We really think that this is a model that needs to be addressed, and that the federal government could provide support to provinces and territories, with funding for further research, and expand this model in appropriate communities through the provision of research and practice grants.
I want to highlight another example. This comes from another hat that I wear as vice-chair of the Vancouver Police Board, again looking at people who have been working in isolation.
People in the downtown eastside have, as the chair knows, high mental health and physical health problems. They were being dealt with by the police, by health services—uncoordinated. We now have in Vancouver, as in Victoria, what we call “assertive community treatment” groups, which bring together all of the services and go out to these highly vulnerable folks.
In the first year, we've already seen some dramatic changes in terms of admissions to emergency departments as well as in police interactions with those folks. In one case, someone who had been involved in 300 incidents with the police and health issues has gone to zero.
This is so logical and so sensible: people working together in collaborative, community-based teams. We really urge and we would be delighted to have members of the committee come out to Vancouver—I'm sure with your chair—to visit some of these on-the-ground examples of how people are working differently.
Just quickly, our other point is about primary health care.