Opinion

The importance of health-system navigators

It’s not always easy to see how societal factors affect our health. In fact, when we experience illness, we sometimes blame ourselves or attribute our condition to bad luck. However, how we navigate social determinants of health (SDOH), such as education and housing, can ultimately influence how we prevent and manage disease.

Health Canada describes SDOH as the “broad range of personal, social, economic and environmental factors that determine individual and population health.” For example, for people living in northern regions of Canada, the high cost of fresh, nutritious food can make a healthy diet financially inaccessible.

For others, the impact of SDOH may be less visible, but remains important. For example, studies have shown that disadvantaged housing may lead to significant mental health concerns. Consider individuals living in a city who work full-time but still struggle financially due to high living costs. The stress of financial insecurity, coupled with work demands, can contribute to mental health issues like anxiety or depression. They may reside in a neighbourhood with limited access to affordable, healthy food options, leading to a reliance on processed or fast foods.

Furthermore, they might live in substandard housing conditions due to unaffordable rent prices that can expose them to environmental hazards such as mold or poor air quality.

This underlines the importance of addressing health issues at the root while using a holistic approach to health.

Family doctors are indispensable resources – they serve as great starting points for accessing supports to help address SDOH while overseeing patients’ medical care. However, with the current crisis in family medicine, many doctors are overwhelmed by the demands of the health-care system. They face increasing patient loads and administrative burdens. In this respect, patients can also benefit from other experts who have comprehensive expertise in accessing local community resources.

This is where the support of a system navigator well-versed in the social aspects of health is important. Luckily, these system navigators are already out there supporting patients in their communities, but their mandate is unfortunately not well understood by the public.

While some institutions, such as the Winnipeg Regional Health Authority, have provided comprehensive resources to help patients find a system navigator, not all regions have the same level of visibility. For example, in Ontario, patients will have to examine whether their health institution offers system navigators on an individual basis. Ontario Health Teams, mental health units and family clinics are currently the most likely institutions to offer system navigation services.

Family clinics funded by Ontario under certain models, such as the family health team (FHT) model, are often able to create roles for experts skilled in health system navigation. These roles are titled system navigator, care navigator, community connector and health promotion specialist, among others.

To address SDOH, system navigators who work with family doctors can assist patients in accessing community, education and social services. They help navigate the complexity of our health-care system and act as advocates and guides. Ultimately, through collaboration, this shifts an aspect of care from the hands of overburdened family physicians to system navigators, thus helping improve health and reducing costs in the long term.

It’s not always easy to bring up topics like housing or cost-of-living to your family doctor. One way to approach this could be by saying: “Lately, I’ve been dealing with a lot of stress from things like my housing situation and finances. I worry it’s affecting my health. Is there someone who can help me sort through these issues?”

Discussing these issues can be uncomfortable, but doing so empowers you to take control of your overall health. By acknowledging these factors and seeking help, you become a champion for your own well-being.

Social factors and our environment influence our health more than we realize. It is critical for individuals to recognize this and reach out for help. In turn, the province must support family doctors and patients in accessing system navigators. Failing to do so risks exacerbating our current health crisis.

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  • John M Maxted says:

    Health system navigators is a concept for which we advocated for years. Navigation of our very complex health system often remains at the level of individual providers, e.g., family doctors, social workers and nurses. Ideally, this role should not stay there because providers and their teams operate within the confines of their known world whereas true system navigators may have access to resources unknown to the provider or team. To quote from Dr. Ian McWhinney, the Father of Family Medicine: “Sometimes good ways are lost for no good reason.” Our desire to create is often a barrier to our ability to learn from the past. Such is the history of health system navigators.

Authors

Avital Pitkis

Contributor

Dr. Avital Pitkis, MD is a resident physician in the Family Medicine program at McMaster University. 

Perrine Tami

Contributor

Dr. Perrine Tami, MD is a resident physician in the Family Medicine and Public Health and Preventive Medicine program at McMaster University.

Peter Zhang

Contributor

Peter Zhang, PharmD, MBA, is a Reach Alliance research alumni and PhD student at the University of Toronto’s Leslie Dan Faculty of Pharmacy.

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