As the era of the United Nations (UN) Millennium Development Goals concludes, representatives of national governments have set the next development agenda, under the umbrella of the Sustainable Development Goals (SDGs).(1) The UN’s Sustainable Development Summit for the adoption of Agenda 2030 and the SDGs was held during three historic days in New York, September 25-27, 2015.(2) The UN SDGs include the following targets:
3.3 – By 2030, end the epidemics of AIDS, tuberculosis, malaria and other neglected tropical diseases, and combat hepatitis, water-borne and other communicable diseases
3.5 – Strengthen the prevention & treatment of substance abuse, including narcotic drug abuse
3.8 – Achieve universal health coverage, including, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines
Within New Brunswick, chronic hepatitis C has been identified as a major public health issue with high incidence and prevalence with associated morbidity and mortality. This epidemic is being driven predominantly by addiction and substance abuse. By focusing on the social determinants of health and provision of primary health care with specialist collaboration, it is maintained that these SDG targets can be achieved within our province.
Social accountability has been defined by the World Health Organization (WHO) as “the obligation to direct education, research and service activities towards addressing the priority health concerns of the community, region and/or nation that [one has] a mandate to serve”.(3) Education involves educating individuals as well as raising awareness and understanding within the general community. Education of healthcare professionals is also essential and this “education must go beyond care for the individual to instill the importance of community advocacy and the ethic of practicing in areas of greatest need.”(4)
In allocating care, the justice principle holds that patients in similar situations should have access to the same care.(5) This allows for health equity.(6) These values, ethical principles and approaches to health are consistent with the mandates of global health.
Global health is defined as an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide.(7) In 2010, The expert Panel on Canada’s Strategic Role in Global Health was formed and in 2011 the Panel agreed on this definition of Global Health.(8-10) Reducing health inequalities is an ethical imperative (11) and may be achieved through focus on the social determinants of health. The social determinants of health are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.(12,13)
In 1978, the Declaration of Alma-Ata, the first international declaration underlining the importance of primary health care was put forth. Subsequently this declaration has been adopted and accepted by member countries of the WHO as the key to achieving the goal of "Health For All".(14)
R.E.C.A.P. is a not-for-profit organization founded in the Spring of 2014 with a vision of establishing a place for delivering efficient and effective care to individuals positive and at-risk for hepatitis C, notably those with opiate abuse issues who are so often left under-serviced by our over-burdened Canadian healthcare system. This population is disproportionately affected by hepatitis C (HCV), a curable yet neglected chronic viral infection which is reaching epidemic proportions. HCV poses significant concerns for the resources it will demand of the healthcare system if left unchecked and the disastrous consequences to the quality and quantity of life on those who have it.
Our pilot clinic in Saint John, NB is the foundation, serving as an example to other small and medium sized municipalities that despite fewer resources than large metropolitan areas like Toronto and Vancouver, we too can effectively combat the significant issue of opiate abuse and its' associated consequences on patients, families and communities, it just takes some creativity, determination and innovation. R.E.C.A.P. connects patients to existing community and healthcare services to meet their needs and whose staff and volunteers aim to fill in the gaps that may not currently be met.
1. http://www.un.org/sustainabledevelopment/. Accessed April 12, 2016.
2. CJL Murray. NEJM. September 15, 2015.
3. Boelen & Heck. WHO. 1995.
4. LS Wen et al. Lancet. 2011.
5. http://www.med.uottawa.ca/sim/data/Ethics_e.htm. Accessed October 12, 2015.
6. http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/. Accessed November 1, 2015.
7. Koplan et al. Lancet. 2009.
8. Canadian Academy of Health Science. 2011.
9. Orbinski. The Expert Panel. 2011.
10. Campbell et al. J Global Health 2012.
11. Commission on Social Determinants of Health, Geneva 2008. 12. http://www.who.int/social_determinants/en/. Accessed October 25, 2015.
13. Mikkonen & Raphael. 2010. 14. http://www.who.int/publications/almaata_declaration_en.pdf. Accessed April 12, 2016.