British Columbia People Living with Disabilities with Disability without Poverty in English

‘Accessibilityis theWord’

AconversationaboutPrimaryCarewith BritishColumbianresidentswholivewith disabilities

December2023

AbouttheCommunity Roundtable

OurCareisapan-Canadian conversationwithmembersofthe publicaboutthefutureofprimary care.TheprojectisledbyDr.Tara Kiran,afamilyphysicianand researchscientistbasedatSt. Michael’sHospital,UnityHealth Toronto,andtheUniversityof Toronto.Therearethreephasesto theproject:anationalsurvey, provincialprioritiespanels,and communityroundtables(seeAbout OurCareonpage23formore details).

Inordertodesignaprimarycare systemthatmeetstheneedsofall Canadians, thechallengesand barriersofmarginalizedcommunities mustbecentredintheconversation. TheaimoftheOurCarecommunity roundtablesistolearnfrom communitiesthathavebeen historicallyexcludedorconsistently underservedbytheprimarycare system.

OurCarepartneredwithDisability WithoutPovertyBC(DWPBC)to engageresidentsofBritishColumbia wholivewithdisabilitiesina conversationaboutprimarycare, seekingtounderstandtheunique barrierstheyfaceinaccessing primarycareandelicitingtheirideas

forchange.DisabilityWithoutPoverty (DWP)isanationalorganization whosevisionistoseepeopleliving withdisabilitiesbeprosperous,realize theirpower,pursuetheirpassions, andparticipateineveryaspectof society.WithchaptersinOntario, AlbertaandBritishColumbia,DWP’s missionistobuildamovementthat liftspeoplewithdisabilitiesoutof povertybymobilizinggrassroots power,workingwithgovernments andsecuringpublicsupportfor endingdisabilitypoverty.Akey mandateforDWPistoensurepeople withdisabilitiesareincludedinall policy-makingprocessesthatimpact them.OurCareaimedtofulfillthis objectivebyfacilitatingacommunity roundtableonprimarycare.

TheOurCare-DWPBCCommunity Roundtablewasconvenedintwo sessions,onNovember21and November25,2023,foratotaloffour andahalfhours.Theroundtable’s objectivesweretoprovide participantstheopportunitytolearn abouttheprimarycaresystem,share theirperspectivesabouttheir interactionswiththatsystem,and generateideasforchangesto addresstheirconcerns.

Inordertoensuretheroundtablewas accessible,participantswereoffered stipendsandequity-basedfinancial supportaimedat,forinstance, alleviatingchildcareandeldercare responsibilities.Theroundtablewas organizedintotwosessions(oftwo andtwo-and-a-halfhours)inorder tobemoreaccessiblefor participantswithcognitive disabilities.

Duringthefirstsession,heldvirtually viaZoom,participantshearda presentationfromDr.GoldisMitra,a familydoctorintheLowerMainland andClinicalAssistantProfessorinthe DepartmentofFamilyPracticeatthe UniversityofBritishColumbia.Dr. Mitraspokeaboutthecurrentstateof primarycareinBritishColumbia, presentedanoverviewofthe features,models,andchallengesof primarycare,andanswered questionsfromparticipants.The participantsthenbrokeintosmall facilitatedgroupstosharewhat primarycaremeanstothem,whatis workingwellforthemwithregardsto primarycare,andwhatchallenges they,theirfamilies,andcommunities encounterwhentheyaccessprimary care.

Duringthesecondsession,alsoheld virtuallyviaZoom,participantsspent thebulkoftheirtimeinsmall facilitatedgroups,reflectingonthe challengestheyandtheir communitieshavefacedin accessingprimarycare,exploring potentialsolutionsforaddressing theseconcerns,andclarifying prioritiesforpolicymakersto consider.

Thisreportreflectsthethemesand ideasidentifiedbytheroundtable participants,whichtheysharedwith eachotherandwiththe OurCare-DWPBCteam.

WhoWeEngaged andWhy

TheOurCare-DWPBCCommunity Roundtableengagedatotalof12 participantsfromacrosstheprovince whowererecruitedwiththesupport ofDWPBC’snetworkpartners, includingBCComplexKidsSociety, PLAN(PlannedLifetimeAdvocacy Network),thePlanInstituteforCaring Citizenship,andtheVictoriaBrain InjurySociety.

Representedamongthetwelve participantsintheOurCare-DWPBC CommunityRoundtablewerethe followingtypesofdisability,andmost participantsreportedmorethanone type:

● Visualimpairment/blindness

● Autism/ADHD/neurodivergent spectrum

● CerebralPalsy

● Wheelchairusers

● Peoplelivingwithchronicpain

● Peoplelivingwithtraumatic braininjury

● Parentsofchildrenwith physicalordevelopmental disabilities

Thiscommunityroundtablewas convenedtoaddressinequitiesin healthcarethatstemfromsystemic barriersfacedbypeoplewith disabilitieswhoseperspectivesare inadequatelyrepresentedinthe publicdiscourseonprimarycare.

NewfindingsfromStatisticsCanada showthat27percentofCanadians, or8millionpeople,nowlivewitha disability,asharpincreaseinthepast fiveyearsduetothecountry’slarge agingpopulationaswellasthe increaseinmentalhealthdisabilities amongyouthandworking-age adults.1Currentlythereareatleast1.7 milliondisabledpeoplelivingin povertyinCanada,anumberthat comprises41percentofall Canadianswholiveinpoverty.

InBritishColumbia,approximately 400,000peoplewithdisabilitieslivein poverty.Thesupportforlifting disabledpeopleoutofpovertyis strong,with89percentofCanadians indicatingtheyfeelitistherightthing todo.2

1 Statistics Canada, December 2023. “Survey on Canadian Disability, 2017-2022.”

2 Disability Without Poverty, 2023. “Disability Poverty in Canada: A 2023 Report Card.”

AccordingtoDWP’s2023Disability PovertyReportCard,peoplewith disabilitiesaretwiceaslikelytolivein povertyasthosewholivewithout disability.Povertyratesareonthe rise.Womenwithdisabilitiesand peoplewithdisabilitieswholivealone representthehighestrecordedrates ofpoverty.

Incomesecurityisconsideredakey SocialDeterminantofHealth.3There areclearnegativehealthoutcomes forbothadultsandchildrenlivingin ornearpovertythatinclude,butare notlimitedto,increasedratesof cancer,diabetes,cardiovascular disease,mentalhealthdisordersand prematuredeath.4Canadians experiencingpovertyarefarmore likelythanallotherCanadiansto reportthattheyhavenotreceived adequateprimaryorspecialtycarein thepastyear,andaretwiceaslikely asCanadiansinhigherincome bracketstorelyonemergency departmentsfortheirhealthcare needs.5

Peoplewithdisabilitieshavelargely goneunrecognizedasapopulation forpublichealthattention,though thisisgraduallychanginginhealth research.6Studieshaveshownthat peoplewithdisabilitiesaremore likelythanpeoplewithoutdisabilities toreportpooreroverallhealthandto havelessaccesstoadequatehealth care.7

Researchindicatesanoverlapping relationshipbetweenpovertyand disabilitywithrespecttohealthcare accessandhealthoutcomes.People wholivewithdisability,likethosewho liveinorareclosetopoverty,are frequentlymoresociallyisolated, experiencemorestress,havepoorer mentalandphysicalhealth,and havefeweropportunitiestopursue educationoremploymenttoimprove theirsituation.

3 Canadian Public Health Association, 2023, “What are the social determinants of health?”

4 Shelley Phipps, 2003. “The Impact of Poverty on Health: A scan of research literature,” Canadian Institute for Health Information.

5 Deanna L. Williamson et. al. 2006. “Low-income Canadians’ experiences with health-related services: Implications for health care reform,” Health Policy 76 (2006) 106–121.

6 Gloria L. Kahn et. al. 2015. “Persons With Disabilities as an Unrecognized Health Disparity Population,” American Journal of Public Health, v.105(Suppl 2).

7 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 2020. “Disability and Health Related Conditions.”

Disabilityorchronicconditions, especiallythosethatlimitaperson’s abilitytomaintainviablestable employment,cancontributetoa downwardslideintopoverty.8

Forthesereasonsandmore,people withdisabilitiesarebothatgreater riskofpovertyandarealsoata disadvantagewhenitcomesto achievingpositivehealthoutcomes andaccessingappropriatehealth careservices.

8 Carolyn Shimin, 2015. “Five things to know about the relationship between poverty and health in Canada,” Policy Options.

WhatWeLearned

DuringtheOurCare-DWPBC CommunityRoundtable,participants spenttimeinsmallgroup discussions,sharingtheirexperiences andidentifyingspecifichealthcare needsthatthey,theirfamiliesand communitieshave.Participantswere providedwiththefollowingprompts toframetheirconversations:

● Whatdoesprimarycaremean tous,ourfamilies,andour communities?

● Whatisgoodorworkingwell aboutprimarycareforus/our community?

● Whatbarriersorchallenges affectaccesstoprimarycare forus/ourcommunity?

● Whatstepsoractionscanbe takentoovercomethebarriers andchallengesidentifiedand improvehealthoutcomesfor us/ourcommunity?

● Whatismosturgent?What shoulddecision-makers prioritizeinordertoimprove primarycareforus/our communityandwhy?

Thecontentsoftheseconversations havebeenorganizedintoThemes thathighlighttheexperiencesand challengesthatwereidentified,and IdeasforChangethatdetailpotential

solutionssharedbytheparticipants duringtheroundtablediscussions.

Themes

A.Someareasofprimarycareare workingwellforpeoplewith disabilities:

Participantsreportedthatcare providerscanbeveryattentiveand empathetictowardspeoplewith disabilities,especiallywhenthose disabilitiesare“visible.”Theynoted thatpeoplewithdisabilitiesare frequentlycompelledtobecome expertsintheirowndisabilitiesand careneeds(seebelow)andthatthis sometimeshelpsfacilitatebetter dialoguewithcareprovidersand encouragesthemtolisten. Participantsexpressedgratitudethat theprovinceisgraduallymoving awayfromfee-for-servicepayment modelsforprimarycaredoctors, whichpreviouslycontributedtothe feelingthatcarewasrushedandless compassionate.Theyalso appreciatedthattheprovince’s referralsystemforspecializedcareis beingreformedandthat,inrecent years,clinicsandothercaresettings havegraduallybecomemore physicallyaccessible.Participants reportedusingphoneorinternet

virtualcareregularlyandthatthese optionshavehelpedovercome barrierstoaccess.Participantswho areattachedtoaprimarycare doctororteamreportedthathaving stronglongitudinalrelationshipswith providerscontributedtoasafeand positivecareenvironmentforpeople withdisabilities.

B. Peoplewithdisabilitiesneed moretimeandspace(anddoctors) tobeabletoaccessqualityprimary care:

Peoplewithdisabilitiesandtheir caregiverscommonlyneedmore timetodothingsintheirdailylives andaccessinghealthcareisno exception.Participantsreportedthat theyspendasmuchas30percent longerthantheirabledpeers preparingforandaccessinghealth careservices,includingthetimeand effortrequiredtotraveltoandfrom careappointments,forinquiring aheadoftimewhetherandhowa healthcaresettingisphysically accessible(e.g.forwheelchairusers, visuallyimpaired),andforinquiring whetheracaresettingorstaffare abletomeetmore“complexcare needs”(e.g.multipledisabilities, chronichealthconditionsorpain, and/orcognitive/developmental disabilities).Participantsreported

concernssuchaslongerwaittimes forcare,limited first-come/first-servedclinical services,careservicesthatare dispersedovergreatergeographical areas,limitedvirtualorin-homecare options,andcaresettingsthatare inadequatelyarrangedtomeetthe complexphysicaland/orcognitive needsthatareassociatedwith disability.Theynotedthatthese conditionsaffectthequalityofcare forpeoplewithdisabilitiesand increasethelikelihoodofmissedcare appointmentsandanover-reliance onemergencycareservices.

Peoplewithdisabilitieswhohave “complexcareneeds”alsospend moretimeandeffortinstudyingand followingcareinstructions, self-educating,andself-coordinating theircare.Longitudinalcareis thereforeevenmoreimportantfor peoplewithdisabilitiesbecauseit caneasethecomplex-careburdens onpeoplewithdisabilitiesandoffer moreflexibility.Participantsreported acommonfearoflosingtheir primarycareclinicians(i.e.becoming “unattached”)duetotheretirement ofprimarycarecliniciansorhavingto move,whichplacesanextraordinary burdenonpeoplewithdisabilitiesnot onlybecauseoftheir

complexcareneedsbutalsothetime andeffortneedtore-establishcare relationshipswithnewclinicians. Accessingsocialworkersand broaderteam-basedcareisalsoof highpriorityamongpeoplewith disabilitiesandmostparticipants havenotbeenabletoaccess team-basedprimarycarewhere theylive.Theperceivedshortageof primarycaredoctorsandassociated servicesintheprovincewasof paramountconcerntoparticipants, especiallyasmoredoctorshave takenearlyretirementsincethe pandemic.

Asoneparticipantsummarized, “Accessibilityistheword”whenwe thinkaboutwhatprimarycareneeds tobeforpeoplewithdisabilities acrossallcaresettings.

C.Livingwithadisabilitymeans havingtobecomeanexpertinone’s owncare–andateacher: Complexity,confusion,andlackof awarenessincaresettingswere commonlyreportedbyparticipants. Asnotedabove,livingwithdisability oftenmeanshavingtospendextra timeandefforteducatingoneself aboutindividualhealthcareneeds, understandingcomplexcare instructions(e.g.multiple

medications,physicalor occupationaltherapy,specialized care),and/orlearningaboutmental healthsymptomsordiagnoses. Gainingexpertiseinone’sowncareis especiallyimportantforpeoplewith disabilitieswhen,asseveral participantsreported,theyhaveto takeonmoreoftheburdenof coordinatingtheirowncarebetween primarycareandspecialtycare,and communicatingtheircareneedsand historytoproviders.Thisisespecially challengingforpeoplewith cognitive/developmentaldisabilities andoverlappingmentalhealth challenges.Mostparticipants reportedexamplesof“havingto educatemyowndoctors”abouttheir complexcareneedsandmedical history.Manyalsoreportedfacing barriersinprovidingthiseducation becauseoftheextratimeandeffort involved,andbecauseofobstacles presentedbythediscriminatory behavioursofsomeproviders(see ThemeEbelow).

D.Primarycareclinicians(andthe healthcareandsocialservices systemsatlarge)needmore knowledgeandbettertrainingon howtotreatpeoplewithdisabilities:

Participantsreportedthatpeople withdisabilities,whetherbecauseof thecomplexorongoingnatureof theirdisabilitiesandcareneeds,or becauseofstigmaandbiases,often findthemselvesnotbeingheard, trusted,believed,acknowledged, empathizedwith,and/orempowered bythehealthcaresystem(despite reportsofpositiveencountersnoted inAabove).Theparticipants recognizedthatfamilydoctorscan’t alwaysdevotethetimetobecome well-informedaboutcomplexcare needs,thattheydon’talwaysknow thedetailsofthedrugstheymay prescribe,andthatcommunication betweenfamilydoctorsand pharmacistsandspecialistsis imperfect.Primarycareneedsto providemoresupportinthisregard.

Participantsalsoreportedthat certainbiases,includingmaking wrongassumptionsabouttrauma, chronicpain,braininjuries,anddrug history,areprevalentinthehealth caresystemandemblematicofthe “invisiblebarriers”facedbypeople wholivewithdisabilities.

Further,participantsreporteda disconnectbetweenprovidinghealth careforchildrenwithdisabilitiesand theprovincialMinistryofChildrenand FamilyDevelopment(MCFD).The

MCFDischargedwithguaranteeing thewell-beingofchildrenwholive withdisabilitybutemployschild protectiveofficersinsteadofcertified socialworkers,whoarenottrainedto recognizesignsofdisabilityandmay makefalseassumptionsthathave enormousconsequences. Participantsfeltthatthecurrent supportstructuresforchildrenwith disabilitiesincentivizesremoving childrenfromtheirfamiliestocare facilitiesandthisneedstochange.

E.Peoplewithdisabilitiesface discriminationandstereotypingin healthcarelikemanyother Canadians—butalsounlikeothers: Whilemostparticipantsreported examplesofpositiveorempowering careinprimarycaresettingspastor present,theyalsoreportedfacing discrimination,bias,orstereotyping fromcareprovidersbecauseof gender,sexuality,age,race, indigeneity,medicalordruguse history,andbodysizeortype.While theseformsofbiasareoften reportedinhealthcarebyCanadians withoutdisabilities,therewasa perceptionamongparticipantsthat thesebarriersareespecially pronouncedforpeoplewith disabilitiesbecauseofthose disabilities,betheyphysicalor “visible”disabilitiesbutespecially

whentheyare“invisible”(e.g.chronic pain,somebraininjuries,mental health-related,autism spectrum/neurodivergence).

Participantsreportedexperiencing “gaslighting”or“infantilization”in healthcaresettingsandofnotbeing believed,listenedtoor acknowledged.Severalnoted instancesofbeingtraumatizedin caresettingsasaresultofbias,orof re-traumatizationwhenfacingbias regularly,aswellasbeing misdiagnosedorbeinglesslikelyto followcareinstructionsortreatments fromdoctorswhodidn’tengagewith themcompassionately.The intersectionofmultiplebiases(e.g. beingIndigenouswithamental healthdisorderorautism;havinga physicaldisabilityandbeinga womanand/orelderly)wasreported byseveralparticipants.

Ideasforchange

Toovercomethechallengesand barriersidentifiedintheThemes above,theparticipantsinthe OurCare-DWPBCCommunity RoundtableonPrimaryCare developedthefollowingideasfor improvingprimarycarefortheir communitiesandallCanadians:

1.Createafederaldisabilitybenefit specificallytosupportthehealthcare needsofpeoplewithdisabilitiesand thepeoplewhocareforthem,with provisionsincludingbutnotlimited to:

● Financialsupportforpeople withdisabilitiesthatrecognizes thetime,effort,andmonetary costsofaccessinghealthcare;

● Financialsupportforspouses, partners,parents,children, long-termroommatesandall othercaregiversforpeoplewith disabilitiesthatrecognizesthe time,effort,andmonetarycosts ofcaringforpeoplewith disabilitiesalongsidethehealth caresystem;

● Financialsupportthatensures thecostsofsupplementaryor extendedhealthcareservices, suchason-demandASL interpretation,CSIL(Choice SupportsforIndependent Living),andpersonalsupport workers,arecoveredforpeople withdisabilitieswholack accessordon’tmeetexisting eligibilitycriteria;

● Financialsupportthatensures thecostsofpharmaceutical care,dentalcare,opticalcare, anddermatologicalcareare fullycoveredforpeoplewith disabilities

2.Enactpoliciesthatsupportthe developmentofmultidisciplinary, team-basedprimarycaretorelieve burdensonfamilyphysicians, incentivizeholisticcare,andincrease opportunitiesforcareprovidersto focusonthespecificandcomplex needsofpeoplewithdisabilities, includingbutnotlimitedto trauma-informedcare,mentalhealth care,pharmaceuticalcare,and ensuringaccessibilityforallkindsof disability.

3.Createandfundanetworkof specializedhubsfordisabilitycare withtheexpertiseandresourcesto careforpeoplewithdisabilities, especiallycomplexneedspatients andpediatricpatientswith disabilities.

● Thesehubscouldbemodelled onCLSCs(inQuebec)or CommunityHealthCentres(in BC),andshouldbe patient/community-led.

4.Workwithdisabilityorganizations andadvocatestoreformallsystems forbookingcareappointments(e.g. withfamilydoctors,clinics,and specialists)employingadisability lensthatemphasizesflexibility, increasedtimeforcare,and guaranteespriorityforthosewith accessibilityneeds.

● Requirethatallcareproviders offerflexibleappointment optionsforpeoplewith disabilitiesincludinghomecare andvirtualcare.

5.Embedmandatoryspecialized trainingonworkingwithpatientswith disabilitiesintoallareasof medical/healthcareeducation,and requirehealthcareprofessionalsto receiveongoing(e.g.yearly) professionaldevelopmentand knowledge-buildinginpartnership withdisabilityorganizationsand educators.Thistrainingshould include:

● Ensuringthatprimarycare provision(e.g.services)and settings(e.g.clinics,facilities) meetallaccessibilityneeds andrequirementsin accordancewiththe AccessibleBritishColumbia Act;

● Developingeffective communicationskillsfor interactingwithpatientswith disabilitiesrespectfullythat emphasizestheuseofclear andplainlanguage;

● Fosteringcollaborationand knowledgetransferamong healthcareworkers,social services(includingMCFD),and disabilityorganizationswith respecttocaringforchildren whohavedisabilities.

6.Createopportunitiesforpeople withdisabilitiestolearnhowto interactwiththehealthcaresystem. Thisshouldincludeimproving educationandawarenessforpeople withdisabilitiesaroundwhatprimary careisandhowitshouldsupport theminotherareasofthehealth caresystem,aswellastobecome empoweredtohavetheconfidence toadvocateforthemselvesinall healthcaresettings.

7.Createandprioritizefundingfora medical“intranet”forprimarycare doctors,teams,andtheirpatientsto accessinformationaboutproviding appropriatecareforpeoplewith disabilitiesbefore,during,andafter careappointments.

● Thisintranetwouldideallybe housedinthesamesystemas universalelectronicmedical recordssothatbothpatients anddoctorscanaccessitand useittotrackandvalidate care,andallowbothpatients anddoctorstoadd information,notes,and documentsfor disability-specificcare.

8.ImplementtheBritishColumbia PrioritiesPanelonPrimaryCare’s recommendationforapublicly fundedPatientAdvocacy Organizationandensureithas representationbyandforpeoplewith disabilities,includingdifferentkinds ofdisabilities.

● Suchanorganizationshouldbe empoweredtoholdprimary careprovidersaccountablefor ensuringaccessible, compassionate,andunbiased careforpeoplewithdisabilities;

● Thisorganizationshouldalso workwithdisability organizationstoraise awarenessonhowpeoplewith disabilitiescannavigatethe healthcaresystemand advocateforthemselves.

9.CreateaPrimaryCareCharterof Rights,pertherecommendationof theBritishColumbiaPrioritiesPanel onPrimaryCare,thatincludesa disabilityfocusandguaranteesa rightofbarrier-freeaccesstoprimary careforpeoplewithdisabilities.

10.Expandaccesstohomesupport forpeoplewithcognitivedisabilities orneurodivergence.

11.Indigenizeprimarycareby ensuringallfeaturesandservicesof care,includingbutnotlimitedto thoserecommendedabove,align withIndigenousmodelsand practicesofcareandareledby Indigenouscommunitiesthemselves.

● Integrateelementsof Indigenousholisticcare (physicalandmentalhealth), aboriginalpatientliaisonsand healthnavigators,spiritualand communitycarers,traditional ceremony,andmore.

Acknowledgments

TheOurCareprojectteamgratefullyacknowledgestheleadershipofour communitypartner,DisabilityWithoutPoverty,inthedevelopmentand hostingoftheOurCare-UmbrellaCommunityRoundtable.

AmandaLockitch,CommunityOrganizer,DisabilityWithoutPovertyBC

AmandaLockitchisamultitaskingmomwithabackgroundintheatre, filmandeventmanagement.Apassionateadvocatefordisabilityjustice, youcanfindherfightingfortheimplementationoftheCanadaDisability BenefitthroughherroleasBCCommunityOrganizerforDisabilityWithout Poverty.

DisabilityWithoutPovertyBCisamovementledbypeoplewith disabilitiessupportedbyfamilies,friends,serviceproviders,allies,and organizations.Findoutmoreatdisabilitywithoutpoverty.ca.

RecruitmentPartners

TheOurCare-DWPBCCommunityRoundtableisgratefultothefollowing organizationsfortheirsupportwithrecruitment:

● BCComplexKidsSociety

● PLAN–PlannedLifetimeAdvocacyNetwork

● PlanInstituteforCaringCitizenship

● VictoriaBrainInjurySociety

PrimaryCarePresenter

Dr.GoldisMitra

FamilyPhysician,LowerMainland;ClinicalAssistantProfessor, DepartmentofFamilyPractice,UniversityofBritishColumbia

Dr.GoldisMitraisafamilyphysicianbasedinNorthVancouver,British Columbia,andpracticesasaHospitalistatSurreyMemorialHospital.Her interestsincludebothpractice-andsystem-levelinnovationinprimary care.SheworkswithBCFamilyDoctorsandDoctorsofBCnegotiating provincialprimarycarecompensationandprimarycarereform.Sheisa ClinicalAssistantProfessorintheDepartmentofFamilyPracticeatthe UniversityofBritishColumbia,andteachesbothmedicalstudentsand residents.

RoundtableTeam

TheOurCare-DWPBCCommunityRoundtablewasdevelopedand managedbyMASSLBP.MASSisCanada'srecognizedleaderinthedesign ofdeliberativeprocessesthatbridgethedistancebetweencitizens, stakeholders,andgovernment.Formorethanadecade,MASShasbeen designingandexecutinginnovativedeliberativeprocessesthathelp governmentsdevelopmoreeffectivepoliciesbyworkingtogetherwith theirpartnersandcommunities.Findoutmoreatmasslbp.com.

OurCarePrincipalInvestigator

Dr.TaraKiran

FamilyPhysician,St.Michael'sHospitalAcademicFamilyHealthTeam; Scientist,MAPCentreforUrbanHealthSolutions,St.Michael'sHospital, UnityHealthToronto;FidaniChairofImprovementandInnovation, UniversityofToronto

NationalProjectDirector

JasminKay

Director,MASSLBP

RoundtableModerator&ReportEditor

RichardJohnson

SeniorAssociate,MASSLBP

Facilitators

LissCairns

AddyeSusnick

TylerTootle

CopyEditing

JasonWhiting

Illustration

MarijaMladenović

Translation

AccentTraduction

Additionalthanksto

BurnabyAssociationforCommunityInclusion

CommunityLivingSociety

DeltaCommunityLivingSociety

DisabilityAllianceBC

InclusionBC

InclusionLangleySociety

InclusionPowellRiver

Kinsight

PosAbilities

SpectrumSocietyforCommunityLiving

UNITIInclusiveLiving

VancouverFoundation

AboutOurCare

OurCareisapan-Canadianconversationwitheverydaypeopleaboutthefuture ofprimarycare.TheprojectisledbyDr.TaraKiran,afamilydoctorand renownedprimarycareresearcherbasedinToronto.OurCarehasthreestages:

1. NationalResearchSurvey

ThesurveywasonlinefromSeptember20toOctober25,2022.Morethan 9,200Canadianscompletedthesurvey,sharingtheirperspectivesand experiences.VoxPopLabsco-designedandexecutedthesurvey.

2. PrioritiesPanels

PrioritiesPanelswereheldinfiveprovinces:NovaScotia,Quebec,Ontario, BritishColumbia,andManitoba.MASSLBPco-designedandexecutedthe panelswithOurCareadvisorsandlocaldeliverypartners.

3. CommunityRoundtables

Communityroundtableswerehostedineachofthefiveprovinces, focusingonhistoricallyexcludedgroupsthatwedidnothearenoughfrom duringstages1and2.MASSLBPco-designedandexecutedthe communityroundtableswithOurCareadvisorsandlocalcommunity organizations.

OurCareProjectPartners

OurCareisfundedby:

HealthCanada

HealthCanadaistheFederaldepartmentresponsibleforhelpingCanadians maintainandimprovetheirhealth,whilerespectingindividualchoicesand circumstances.Productionofthisdocumenthasbeenmadepossiblethrougha financialcontributionfromHealthCanada.Theviewsexpressedhereindonot necessarilyrepresenttheviewsofHealthCanada.

MaxBellFoundation

MaxBellFoundationbeganmakinggrantstoCanadiancharitiesin1972.Today, theFoundationsupportsinnovativeprojectsthataredesignedtoinformpublic policychangeinfourprogramareas:Education;Environment;Health&Wellness; andCivicEngagement&DemocraticInstitutions.TheFoundationalsodelivers thePublicPolicyTrainingInstitute,aprofessionaldevelopmentprogram designedtohelpparticipantsmoreeffectivelyengageinthepublicpolicy process,andPolicyForward,afuture-orientedspeakerseriesthatbringsthought leaderstogethertodiscusstheintersectionsofpolicy,technology,and innovation.

StaplesCanada—EventheOddsCampaign

StaplesandMAPhavecometogethertocreateEventheOdds:aninitiativeto raiseawarenessofinequityinCanadaandtohelpbuildvibrant,healthy communities.Thepartnershipisbasedonthesharedbeliefthateveryone shouldhavetheopportunitytothrive.EventheOddsfundsresearchand solutionstohelpmakethefuturefairforeveryone.Learnmoreat staples.ca/eventheodds.

OurCareSupporters

OurCareisbasedat:

MAPCentreforUrbanHealthSolutions

MAPCentreforUrbanSolutionsisaresearchcentrededicatedtocreatinga healthierfutureforall.Thecentrehasafocusonscientificexcellence,rapid scale-upandlongtermcommunitypartnershipstoimprovehealthandlivesin Canada.MAPisbasedatSt.Michael’sHospitalinToronto.

St.Michael’sHospital,UnityHealthToronto

St.Michael’sHospitalisaCatholicresearchandteachinghospitalindowntown Toronto.ThehospitalispartoftheUnityHealthTorontonetworkofhospitalsthat includesProvidenceHealthcareandSt.Joseph’sHealthCentre.

OurCareissupportedby:

DepartmentofFamily&CommunityMedicine,UniversityofToronto

TheUniversityofToronto’sDepartmentofFamily&CommunityMedicineisthe largestacademicdepartmentintheworldandhometotheWorldHealth OrganizationCollaboratingCentreonFamilyMedicineandPrimaryCare.

St.Michael’sFoundation

Establishedin1992,St.Michael'sFoundationmobilizespeople,businessesand foundationstosupportSt.Michael’sHospital’sworld-leadinghealthteamsin designingthebestcare–when,whereandhowpatientsneedit.Fundssupport state-of-the-artfacilities,equipmentneeds,andresearchandeducation initiatives.BecauseSt.Michael'sFoundationstopsatnothingtodeliverthecare experiencepatientsdeserve.

AdvisoryGroups

OurCareisguidedbyseveralnationalandprovincialadvisorygroups comprisingclinicalleaders,representativesfromprofessionalorganizations, researchers,healthsystemadministrators,andpatients.Theadvisorygroups havehelpedshapeeachphaseoftheinitiative.TheOurCareBritishColumbia ProvincialAdvisoryGroupprovidedinputintopopulationsoffocusforthetwo communityroundtablesinBritishColumbiaandmembershelpedmakerelated connectionstolocalcommunityorganizations.Afulllistofadvisorygroup membersisavailableontheOurCarewebsite.

TolearnmoreaboutOurCare,pleasevisitourcare.ca.

OurCareisfundedby

OurCareisbasedat OurCareissupportedby