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Canadian Journal of Public Health

, Volume 107, Issue 6, pp e590–e592 | Cite as

Vancouver Coastal Health’s Second Generation Health Strategy: A need for a reboot?

  • Jeffrey R. Masuda
  • Sophy Chan
Commentary

Abstract

In this commentary, we consider the motivations and implications of Vancouver Coastal Health’s place-based population health strategy called the Downtown Eastside Second Generation Health Strategy (2GHS) in light of a broader historical view of shifting values in population and public health and structural health reforms in Canada over the past three decades. We argue that the tone and content of the 2GHS signals a shift towards a neoliberal clientelist model of health that treats people as patients and the DTES as a site of clinical encounter rather than as a community in its own right. In its clinical emphasis, the 2GHS fails to recognize the political dimension of health and well-being in the DTES, a community that faces compounding health risks associated with colonialism, gentrification, human displacement, the criminalization of poverty, sex work, and the street economy. Furthermore, we suggest that in its emphasis on allocating funding based on a rationalist model of health system access, the 2GHS undermines well-established insights and best practices from community-driven health initiatives. Our aim is to provide a provocation that will encourage public health policy-makers to embrace community-based leadership as well as the broader structural health determinants that are at the root of the current circumstances of people in the DTES and other marginalized communities in Canada.

Key Words

Health care reform social determinants of health mental health 

Résumé

Dans ce commentaire, nous examinons les motivations et les conséquences d’une stratégie de santé des populations fondée sur le lieu adoptée par Vancouver Coastal Health (VHC), appelée Downtown Eastside Second Generation Health Strategy (2GHS), selon une perspective historique élargie de l’évolution des valeurs en santé publique et des populations et des réformes structurelles de la santé au Canada au cours des 30 dernières années. Nous soutenons que le ton et le contenu de la stratégie 2GHS sont signes d’un changement en faveur d’un modèle clientéliste néolibéral de la santé qui traite les gens comme des patients et le Downtown Eastside comme un lieu d’intervention clinique et non comme un quartier à part entière. Axée sur l’aspect clinique, la stratégie 2GHS ne reconnaît pas la dimension politique de la santé et du bien-être dans le quartier Downtown Eastside, une communauté aux prises avec des risques pour la santé amplifiés par le colonialisme, la gentrification, les déplacements de population, la criminalisation de la pauvreté, le travail du sexe et l’économie de rue. De plus, nous faisons valoir qu’en insistant pour allouer les fonds selon un modèle rationaliste d’accès au système de santé, la stratégie 2GHS discrédite des idées et des pratiques exemplaires bien établies, découlant d’initiatives de santé d’inspiration communautaire. Notre but est de provoquer pour influencer à la fois les dirigeants de la santé publique de VCH et la communauté qu’ils servent afin qu’ils tiennent compte de la longue tradition de leadership communautaire en santé et des grands déterminants structurels de la santé qui sont à l’origine de la situation des personnes qui vivent dans le quartier Downtown à l’heure actuelle.

Mots Clés

réforme des soins de santé déterminants sociaux de la santé santé mentale 

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Copyright information

© The Canadian Public Health Association 2016

Authors and Affiliations

  1. 1.School of Kinesiology and Health SciencesQueen’s UniversityKingstonCanada

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