A blend of public health and primary health care approaches that aims to improve the health of individuals and populations
Residents, nurses, physicians and community group members at the
Annual Community Orientation 2012 in Cote des Neiges
What is COPC?
Community oriented primary care (COPC) has been defined as “a continuous process by which primary care is provided to a defined community on the basis of its assessed health needs through the planned integration of public health practice with the delivery of primary care services.”1 Thus, beyond treating health problems that present to the clinic, COPC involves better understanding the health needs of the local population as a basis for planned interventions and outreach programs. This may be easier to do in rural areas where the population is relatively small and well-circumscribed. However, it is just as important, if not more so, in large urban areas where primary health care workers are not as deeply embedded in the communities they serve.
Why do we need a COPC approach at McGill?
The 3 urban teaching sites of the McGill family medicine residency program are located in the neighbourhood called Cote des Neiges. This area of Montreal is well known as one of the most culturally and linguistically diverse communities in Canada with representatives from over 75 different ethnic groups. Almost two-thirds of the inhabitants of Cote des Neiges are immigrants, with a growing rate of new arrivals each year. Perhaps contrary to popular belief, there is a healthy immigrant effect whereby most new immigrants to Canada are in fact healthier than the average population.2 However, over time, and depending on integration and adaptation to their new surroundings, these health advantages can rapidly deteriorate. People in the community struggle with a range of issues from unemployment and food insecurity (i.e. not having enough to eat) to social isolation and poor housing conditions. Frontline health workers therefore need to identify and address the social causes of poor health and to partner with local community groups to improve the health of their patients and of the entire community.4
Training Frontline Health Workers to Address the Social Causes of Poor Health
Health inequities are ubiquitous around the world. Even across the island of Montreal there exists a gradient of life expectancy according to socio-economic status whereby people living in the wealthier parts of Montreal live up to 10 years longer than people living in more socially deprived parts of Montreal.5 Addressing health inequities requires healthy public policies, intersectoral action and whole of government approaches,6 however, primary health care professionals can do more than just “put on bandaids.” Indeed, local care models can make a difference in reducing health inequities, particularly when they attempt to address the root causes of morbidity and mortality, in addition to treating illness.7 As well, there are numerous opportunities for increased advocacy from primary health care professionals who come into regular contact with the health effects and human suffering caused by these inequities while working on the frontlines. With the launch of the recent World Health Report 2008 on revitalizing primary health care8 as well as recent provincial health system reforms which promote a population health approach, there is a renewed interest in COPC and closer links between primary health care and public health in addressing population needs and reducing health inequities.9
1. Mullan F, Epstein L. Community-Oriented Primary Care: New Relevance in a Changing World. American Journal of Public Health 2002;92(11):1748-1755.
2. McDonald JT, Kennedy S. Insights into the “healthy immigrant effect”: health status and health service use of immigrants to Canada. Social Science & Medicine 2004; 59(8): 1613-1627.
3. Commission on the Social Determinants of Health. Closing the Gap in a Generation: Health equity through action on the social determinants of health. Geneva: World Health Organization, 2008.
4. Andermann A. Addressing the social causes of poor health is integral to practicing good medicine. CMAJ 2011; 183(18): 2196.
5. Social inequalities in health: 1998 Annual report on the health of the population. Direction de la santé publique de Montréal-Centre. June 1998, 84 pages.
6. Le Blanc MF, Raynault MF, Lessard R. Social Inequalities in Health in Montreal: 2011 Report of the Director of Public Health. Montreal: Direction de santé publique, Agence de la santé et des services sociaux de Montréal, 2011.
7. Geiger HJ. Community-oriented primary care: a path to community development. Am J Public Health. 2002;92:1713–1716.
8. Van Lerberghe W, Evans T, Rasanathan K, Mechbal A, Andermann A, Evans D et al. World Health Report 2008. Primary Health Care: Now More than Ever. Geneva: World Health Organization, 2008.
9. Harvey B. The Issue of Public Health. Canadian Family Physician 2009; 55:1057.
10. Gofin J. On “A Practice of Social Medicine” by Sidney and Emily Kark.Social Medicine 2006; 1(2): 107-115.
susan.ferreira [at] ssss.gouv.qc.ca (Ms. Susan Ferreira), St Mary’s FMC Teaching Office
anne.andermann [at] mail.mcgill.ca (Dr. Anne Andermann), Chair / Director, COPC Committee