Yesterday in clinic one of my patients phoned to say she wouldn't make her appointment. Buses aren't running in Saskatoon this week because of a lockout of transit workers, and she had no way to get to clinic.
After hearing her story, I looked at my day sheet and noticed that there were more "no-shows" than usual. One of my colleagues reported that the immunization clinic the day before had been pretty sparse as well. This is one of the unforeseen health effects of the interruption of transit services. Others include people being unable to attend school or losing income as a result of missing work. Even the simple act of getting groceries becomes a major burden for families that live in neighbourhoods without food stores. Carrying bags and bags of groceries home on the bus is difficult enough, walking a couple miles with the same load is near impossible.
Transit functions as an enabler for accessing important determinants of health ... [how can it be] more effective in connecting people to what they need for healthy lives?
This challenge highlights how transit functions as an enabler for accessing important determinants of health, and how quality, accessible transit systems can be a driver for greater health equity. This poses questions beyond the lockout situation, and should prompt discussion on how bus service can be improved when up and running to make it more effective in connecting people to what they need for healthy lives.
This issue also shines a light on an aspect of Upstream that helps us in our work. We are a national organization, with a goal of changing the political conversation to focus on health and wellbeing, recognizing that the social determinants of health – income, education, employment, housing, nutrition, etc. – are the most important elements in achieving the best health outcomes for Canadians. With that national focus we are building partnerships across the country. In our first year we've had events or speaking engagements in New Brunswick, Ontario, BC, Saskatchewan and Manitoba. I've written commentary on viewing the Ontario provincial election through a social determinants lens and on the cancellation of the Health Council of Canada. In the last month I've been in Prince Edward Island meeting with youth from all over Canada on how to build a healthier future, and in the Yukon meeting with frontline workers and advocates for social change. Having a national presence and perspective is essential. The political frames that perpetuate ill health are present across Canada, and any approach to changing the conversation needs to reach across the country.
The frontline and first person perspective of being embedded locally, rather than limiting our national impact, keeps us grounded in the stories that illustrate the impact of the social determinants of health
Underpinning that national focus is the fact that Upstream is grounded in a local reality. Our headquarters are in the Riversdale neighbourhood of Saskatoon. This is also where I live, and a few blocks away is the clinic where I practice family medicine. It's an area that is receiving increasing attention with a recent article in the Walrus Magazine examining the changes in the neighbourhood and posing some provocative questions. This article was a welcome conversation-starter for people to question how the city can be improved in a way that makes everyone's lives better rather than seeing low income people displaced when property values rise. It was great to see Upstream profiled in this national magazine, but it also reminded us of our place in this community and connection with our neighbours.
The frontline and first person perspective of being embedded locally, rather than limiting our national impact, keeps us grounded in the stories that illustrate the impact of the social determinants of health. Local stories, like those featured in the Poverty Costs campaign, bring the personal to the political, connecting our emotions and our intellect in the service of solving society's problems. They also provide the impetus to explore similar situations across Canada, learning from the success of others and sharing the best ideas. Hopefully, Upstream's sense of place in Riversdale will bolster our sense of national purpose, helping bring about a watershed moment in how a whole country approaches health and politics.
Ryan is the Founding Director of Upstream. He is a family doctor at Westside Community Clinic and an assistant professor at the College of Medicine at the University of saskatchewan. You can reach him at firstname.lastname@example.org.
To support Upstream's work to bring the social determinants of health the forefront of our public conversation, consider becoming an Upstream sustainer by making a one-time or monthly donation.