Systems to Optimize Health


Health is determined by the interplay of a wide variety of factors. While genetic inheritance remains relatively immutable, some, like personal life-style, are almost entirely under the control of individuals. Others, the availability and quality of health-related services for example, are subject to a combination of changeable market and societal forces. It is this latter group, healthcare and those social services known to be among the determinants of health, that will be of prime concern to the new Ontario Health Teams (OHT) being established. The overall goal, held in common by every person, family, government, and society as a whole, is to optimize good health and reduce to a minimum the need for and use of healthcare services, the “repair-shop” functions that come into play when good health is compromised, as inevitably some will be, by disease, injury, disability, or other misadventure.

Ever since Medicare began in Canada, governments have focused primarily on facilitating access to healthcare services, in particular those provided by physicians and hospitals. That focus persists, although it has been broadened somewhat recently to include public support of people’s access to other such services, pharmaceutical, mental health, and homecare, for example. Yet incontrovertible evidence shows that 75 to 80 per cent of the health of individuals and of the populations from which they are drawn is attributable to health’s social determinants. The continuing relative inattention to the coordination and association with healthcare services of factors such as secure, safe housing, good and adequate nutrition, education (especially in early childhood), income and personal security, and other social services characteristic of supportive communities is inimical to everybody’s common goal, especially OHTs whose best interests lie in minimizing their workloads through maintaining the good health of every member of the population in the community, district, or region each is to serve.

How, in the new OHT world unfolding in Ontario, can the social determinants of health be effectively ‘bundled’ with hospital, physicians’ and other healthcare services? A good start can be made at the top by consolidating the missions and plans of the Ministries of Community and Social Services (MCSS) and Health and Long-Term Care (MOHTLC) and their giving to OHTs the responsibility of ensuring that the publicly-supported agencies of both Ministries be deployed so as to reinforce the mission in common of optimizing health in their served populations. This could also be augmented substantially by establishing a mutual reporting relationship between OHTs and the relevant Municipal governments much as has long been the case for Public Health Units. As all publicly-supported health-related services are coordinated and brought into genuine systems, extending the reach of those systems to incorporate additional market-financed and/or charitably-supported services, whether healthcare or social, would be greatly facilitated.

None of this would occur overnight but with appropriate leadership from governments and people-centered OHTs, genuine health-supporting, effective, efficient, and sustainable systems could be created relatively quickly, systems that utilize a complete range of services, healthcare and social, to optimize the health of Ontario’s population in all its diversity.


Duncan Sinclair
Don Drummond
Chris Simpson
David Walker
**Members of the Queen’s Health Policy Council

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