Part 2 - Vulnerable Populations: Comparing Alberta and Nova Scotia

This week, my colleague Geraldine Young and I met online to discuss health care for vulnerable populations, within the context of our provinces – Nova Scotia and Alberta. The following are my reflections on our conversation.

As many of the provincial systems and strategies are responses to local context, it is important to first have a basic understanding of each province to properly compare areas of convergence and divergence. Provincial statistics for Alberta and Nova Scotia are provided in the table below:

Alberta is a large province compared to Nova Scotia – both with respect to land mass, population size, and proportion of aboriginals and visible minorities. Alberta’s size contributes to the remoteness and isolation of many rural communities. Accessibility of the health care system, especially in the northern areas of Alberta, can be challenging for vulnerable populations.

When considering the inclusion and exclusion factors (as outlined in Part 1, link here), the higher percentage of aboriginal and visible minority populations in Alberta may act as an ‘inclusion’ factor for certain populations. When more individuals who share the same culture and religion reside within close proximity to one another, it increases the sense of belonging and inclusion. To be of a visible minority living in a rural community in Nova Scotia, this sense of belonging could be difficult to have, as you may be the only individual or family of that minority group in your community.

Poverty has been found to be higher in vulnerable populations and is also linked to greater negative health outcomes. As can be noted in the graph below, Nova Scotia has the highest rates of child poverty, while Alberta has the lowest rates in all of Canada. Aboriginal populations in Nova Scotia are disproportionately affected by poverty. A recent report (Nova Scotia, 2017) notes that although, on average, 21.6% of Nova Scotia children live within poverty, this rate is 72.7% in Eskasoni, an aboriginal community located in Cape Breton.

Table 1: Childhood poverty rates. Stats Canada, 2017.

As per my conversation with Geraldine, in Alberta, diversity and inclusion have become important aspects of providing care. Alberta Health has recently mandated extensive education for all health care workers that addresses patient centered care through the perspective of diversity and cultural sensitivity. One component of this education includes a self-reflection tool on the individual health care provider’s diversity awareness (Young, 2018).

According to the Alberta Health website, other strategies being implemented include accessible indigenous resources which are readily available for health care providers, a framework for chronic disease prevention and management, a ‘diverse population strategy’, and a cultural safety framework (Alberta Health, 2018). These strategies contribute to the ‘inclusion’ factors (as outlined by the Social and Economic Inclusion and Exclusion (SEI) Framework) and may reduce the health inequities felt by vulnerable populations.

The Nova Scotia Health Authority has a Diversity and Inclusion department that provides guidance and education to front line clinicians (Nova Scotia Health Authority (NSHA), 2018). Language services (i.e. translation services) are also offered through this department. The Nova Scotia Health Authority utilizes the Language Line which is available 24 hours per day, does not need to be booked in advance, and offers options for translation into English for more than 170 languages (NSHA, 2018a).

At first glance, it appears that Alberta is focusing more heavily on aboriginal health, as it was difficult to find evidence of a similar focus on the Nova Scotia Health Authority website. However, upon further investigation, one can find health care services (i.e. diabetes care, dietitian, home and community care and mental health services) provided by The Union of Nova Scotia Indians (UNSI, 2018). The Confederacy of Mainland Mi’kmaq also provides support and guidance for members. This support comes in many forms including health care/alternative health care options for members as well as liaison/navigators to help better access health care through the provincial system (CMMNS, 2018).

Other vulnerable populations have different support services in place through the provincial health authority, often times in collaboration with not-for-profit organizations. Examples include collaborations with: 1) PrideHealth to provide sensitive care for our LGBTQ population, 2) Nova Scotia Brotherhood Initiative to provide health care and support services to men of African descent, 3) Immigrant Service Association of Nova Scotia to provide accessible health for immigrants and refugees, and 4) Primary health to provide community based programing, including group sessions on managing chronic disease, and individual sessions to assist with navigating the health care system. (Nova Scotia Health Authority, 2018b).

One can see, as outlined above, that the social determinants of health are factors in the vulnerability of populations in both Nova Scotia and Alberta. Many of these determinants, especially poverty and social inclusion/exclusion, require specific strategic direction from other sectors beyond health. Nova Scotia and Alberta’s provincial health care systems are focused on and responding to their different population health care needs in accordance with the context in which they operate.

References

Alberta (2018). Alberta Statistics. Retrieved on November 12, 2018 from: https://en.wikipedia.org/wiki/Alberta

Alberta Health (2018). Retrieved on November 14, 2018 from: https://www.albertahealthservices.ca/info/Page8431.aspx

Confederacy of Mainland Mi’kmaq (2018). Retrieved November 16, 2018 from:

http://cmmns.com/program/health/

Nova Scotia (2017). Nova Scotia Poverty Rates. Retrieved November 12, 2018 from: https://www.policyalternatives.ca/publications/reports/2017-report-card-child-and-family-poverty-nova-scotia

Nova Scotia (2018). Nova Scotia Statistics. Retrieved on November 12, 2018 from: https://en.wikipedia.org/wiki/Nova_Scotia

Nova Scotia Health Authority (2018a). Diversity and Inclusion website. Retrieved on November 14, 2018 from: https://www.cdha.nshealth.ca/diversity-inclusion/resources

Nova Scotia Health Authority (2018b). Retrieved on November 14, 2018 from: http://www.nshealth.ca/services?field_service_directory_type_value=Primary%20Health%20Care)

Stats Canada (2017). Retrieved on November 13, 2018 from: https://campaign2000.ca/wp-content/uploads/2017/11/AB-Child-Poverty-Report-2017-FINAL-for-releaseNov24.pdf

Stats Canada (2018a). Retrieved on November 12, 2018 from:

https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/abo-aut/Table.cfm?Lang=Eng&S=99&O=A&RPP=25

Stats Canada (2018b). Retrieved November 12, 2018 from: (https://novascotia.ca/finance/statistics/news.asp?id=13268)

Union of Nova Scotia Indians (2018). Retrieved on November 14, 2018 from: http://www.unsi.ns.ca/departments/health/

Young, G. (2018). Personal communication on November 12, 2018.