Invisible Walls: Addressing Barriers in Health Access

 martha-dominguez-de-gouveia-k-NnVZ-z26w-unsplash

By Daniel Ojeda, BA’25 - Global Health Studies
Huron University College at Western University

In our present time, we work hard in the health sector to ensure that healthcare services are as accessible as possible. Be it larger chairs for bariatric patients, wheelchair ramps at hospital entrances, or even interpreters for those whose primary language is something other than English. That being said, there are still many healthcare accessibility issues that have grievous impact on health access, and therefore health outcomes.

Often, the barriers that have the most severe outcomes are those that are most overlooked. We understand that prevention of communicable diseases is an important public health intervention. With that, we have implemented things such as needle exchange programs, free sexual prophylaxis (condoms), and vaccination to name a few. On the other hand, issues that are less prevalent such as some of the ones we will examine are not even a though until one is in the situation where they are part of that group who have encountered said barrier.

The first out of several prevalent issues regards physical accessibility. Many family doctors, or even hospital outpatient clinics utilize medical office space from companies that lease out clinics in purpose built medical office buildings. These buildings are often designed to be able to fit many clinics, with large spaces for patient care rooms and administration; but often have small, crammed waiting rooms. The buildings themselves also have small, narrow hallways that are often cold and confusing for people to navigate. Such an example would be when I take my grandmother to appointments with her cardiologist. Entering the building, you are presented with a lobby that has many elevators and signs. Once you manage to get to the floor that your doctor is on, you have to navigate the confusing hallways in order to find which side of the building they are located, and then further locate their office.

This presents issues for those who are elderly, in cognitive decline, or simply just in a hurry. This further causes late or missed appointments, late/no-show fees, and ultimately can cause one to simply not attend appointments all together out of the stress of getting to the doctor.

The Second barrier I see is a policy issue. For years, women who are identified as being part of a breast cancer risk group have been provided free preventative diagnostic tests to screen for breast cancer. These tests (mammograms) are provided through the Ontario Breast Screening Program (OBSP) which is administered through Cancer Care Ontario. According to cancer.org, 13% of women will get breast cancer in their lifetime.

These lifesaving diagnostic measures have saved countless lives and are thankfully covered under provincial healthcare plans such as OHIP. Unfortunately for men however, prostate specific antigen (PSA) testing is not covered. This simple blood test is performed on men to check PSA levels within their blood as the primary cancer marker for prostate cancer.

According to Cancer.org, 1/8 or 12.50% of men will receive a prostate cancer diagnosis in their lifetime, and 3 out of 13 will die from the disease. This yet again ties into the most prevalent social determinant of health which is financial or economic status. While the $50 fee to LifeLabs (a health laboratory service) might not be an issue for some, a “cheap” $12 meal to get through the day may be a lot to others. This unfortunate policy failure has resulted in the deaths of potentially thousands of men across North America.

I understand from a family perspective what the cost of this lack of access to testing looks like. When I was in grade school, my grandfather was given a PSA test as part of his annual physical. He was in his mid 70s and therefor part of the 60+ high risk age group for prostate cancer. While at the lab getting his blood tested for the remainder of the OHIP covered tests, the lab worker asked him if the PSA test was something he was interested in, to which he initially declined. In his own words “if it isn’t covered by OHIP, it can’t be that serious”. After some persuasion from my grandmother, he later agreed to the test. When they returned to the family doctor for the results, he was told that he had an elevated PSA level and that he would need to go for further testing. Upon getting a positive diagnosis, he was able to undergo treatment for the then “aggressive but favorable looking in outcome” cancer, as it was initially put to him.

Finally, one of the most prevalent barriers in today’s day and age is the lack of access to credible and easy to understand health information for lay individuals. The gold standard in credible health guidance and information, is found in peer reviewed journals. These journals are intended to speak to a very specific audience of health and allied health professionals with at least some understanding of basic terms and research methods. Often times, sites and news sources will have lay individuals read through these journal articles, summarize them, and publish their information in typical internet “too long, didn’t read” fashion. This is a dangerous approach as it not only cheapens the information within the studies, but it in many cases can actually give out untrue or misconstrued information.

Such examples would be the case with “red soap” being used as a method of COVID prevention. Earlier articles in news and Facebook posts from Sri Lanka promoted the use of “red soap” as being more germicidal than soaps of other colours. This was later clarified and labelled as “false news” by the Sri Lanka health Promotion Bureau.  It is widely believed that the misinformation came from the idea of Carbolic Soap which is an antiseptic soap that contains carbolic acid and various other decontaminating agents. The bar itself comes in a crimson red colour and is often distributed during disasters to victims by organizations such as the Red Cross for hygienic matters.

Overall, there are many different barriers that can potentially get between a patient and their healthcare. It is up to us however as the next generation of clinicians, researchers, scientists, and allied health professionals to ensure that our practices are as barrier free as possible, and to do our best to ensure that social barriers are torn down for those in our communities and across the world. Ultimately, in order to achieve health equity, globally and locally, we must understand that it requires us to be able to make alternative evaluations of the situations our patients are in. While we may not be able to see the world through the lens of every patient with their unique circumstances, it is where we must be able to take the lived experiences of others and learn from them.

 

 

 

References

LifeLabs, ed. “Early Detection of Prostate Cancer Prostate-Specific Antigen (PSA) Test.” LifeLabs. Accessed March 7, 2022. https://www.lifelabs.com/test/prostate-specific-antigen-psa-test/#tab-2.

Ontario Ministry of Health and Long-Term Care. “The PSA Test Help Your Patients Make an Informed Decision.” Accessed March 7, 2022. https://health.gov.on.ca/english/providers/pub/cancer/psa/psa_test/insert.html.

Lanka, AFP Sri. “'Red Soap, White Handkerchiefs': Experts Refute Misleading Coronavirus Prevention 'Tips'.” AFP Fact Check, March 20, 2020. https://web.archive.org/web/20200321124738/https://factcheck.afp.com/red-soap-white-handkerchiefs-experts-refute-misleading-coronavirus-prevention-tips.

Breast cancer testing and prevention. ontario.ca. (n.d.). Retrieved March 12, 2022, from https://www.ontario.ca/page/breast-cancer-testing-and-prevention

 Breast cancer statistics: How common is breast cancer? American Cancer Society. (n.d.). Retrieved March 16, 2022, from https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html

Key statistics for prostate cancer: Prostate cancer facts. American Cancer Society. (n.d.). Retrieved March 16, 2022, from https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html

 

 

Photo by Martha Dominguez de Gouveia on Unsplash