Other Notables

Leading Health Care Initiatives in China:
David Zakus from the Centre for International Health

David Zakus is an Assistant Professor in HPME, and Director of the Centre for International Health, Faculty of Medicine. His research focuses on Canada's role in global health research; the effects of globalization on health professions and service delivery; community participation in primary health care; and urban community health reform in China. In this issue he describes his work in China.

In mid February, 2002 I made my fifth working visit to China. The first was in late 1999 when I, along with five other executives from Mount Sinai Hospital, collaborated with Chinese colleagues in presenting a hospital management seminar for 135 Chinese hospital managers. Following on its success, the Chinese Ministry of Health (MOH) then visited Canada and invited the University of Toronto's participation in working with them on urban community health reform, a current national priority. This initiative also involves Beijing University's Department of Health Policy and Management. A second visit then led to subsequent collaborations, many of which have taken even deeper roots.

The February visit included stops in Beijing and then Shanghai. In Beijing I, along with colleagues in the Faculty of Social Work and Department of Economics, are working with the Chinese Academy of Social Sciences on a community development research proposal with strong emphases on health services, community networks and labour markets. Other Beijing-based activities involve: the Capital University of Medical Sciences and our Department of Family and Community Medicine on the development of family medicine in China; with Beijing University, the development of a Masters program in Health Services Management (a senior official from BU will visit our Department on April 22); a data analysis project involving the State Family Planning Commission and our Department of Sociology at the Scarborough Campus; and a long standing congenial relationship with Beijing People's Hospital, one of the top tertiary level hospitals in China.

After a few days in Beijing (already fully satiated with the most amazing Chinese food you can imagine…maybe beyond imagination) I flew to Shanghai where I was met by my main colleague in the Shanghai Municipal Health Bureau. We are working with them on several major initiatives:

1. the establishment of a traditional Chinese medicine clinic at Sunnybrook and Women's College Health Sciences Centre, where there is great enthusiasm for the project;
2. an evaluation of urban community health services for the elderly, in which an HPME PhD student is involved;
3. two collaborations with the Shanghai Second Medical University, one in the area of hospital management training and the other will establish a family medicine program; and
4. youth health promotion and statistical analysis with the Shanghai Centre for Disease Control, which signed an agreement last September with the U of T Department of Public Health Sciences for collaboration in HIV/AIDS research.

While this may seem quite daunting, let me assure you that it is. But above all, it is very exciting and challenging. It is such an incredible experience to go to China and work with the Chinese people. Even though most of the above-mentioned projects are still in the proposal development stage, we expect some of them to move along quite rapidly. Working with some of the best minds in China is both rewarding and an honour. That this country, which has the whole world courting them for cooperation and collaboration, has specifically chosen the University of Toronto with which to partner is extremely gratifying.

After the first trip there some two and a half years ago, subsequent trips have only confirmed my initial impressions - that everything is big, and done on a large scale; that they are some of the nicest and most committed people I have ever worked with; at the working level, the cultural divide is not so deep; and that they strive for excellence by selecting only the best and most credible partners.

If anyone reading this would like to learn more about these initiatives (and others not mentioned) and perhaps get involved, please feel free to contact me at (416) 978-1458 or davidzakus@compuserve.com.

Closing the Gap between Best Information and Practice

The Guideline Advisory Committee (GAC) - a joint body of the OMA and the Ontario Ministry of Health and Long-Term Care - is working to close the gap between best available clinical information and practice.

The GAC attempts to provide Ontario physicians and other practitioners with a recommended set of brief and usable clinical policy statements on a variety of topic areas for quick reference.

Primary care physician and chair of the GAC, Dr. Dave Davis explains that physicians are inundated with information. Hundreds of clinical practice guidelines find their way to physician offices, many of which are complex, overly long and outdated. To help this problem, the GAC endorses only those guidelines assessed a minimum of three times by community-based physicians using the Cluzeau Appraisal Instrument for Clinical Guidelines (Cluzeau et al., 1997). These guidelines are then synopsized by a medical editor, providing clinicians with the best available evidence in convenient and useable forms - to be used when practitioners are unclear about appropriate best practice and when scientific evidence can provide an answer.

Recognizing the challenges of implementing clinical practice guidelines into practice, the GAC has also brought together a variety of organizations and associations to develop a coordinated, comprehensive guideline implementation strategy based on GAC endorsed guidelines. Implementation partners in this collaborative, known as the Ontario Guideline Collaborative (OGC), include the Ontario Medical Association (OMA), Ontario Ministry of Health Long-Term Care (MOHLTC), College of Physicians and Surgeons of Ontario (CPSO), the Ontario College of Family Physicians (OCFP), Continuing Medical Education (CME) Programs at the provincial medical schools, Ontario Hospital Association (OHA), Institute For Clinical Evaluative Studies (ICES), and Ontario Program for Optimal Therapeutics (OPOT).

+ + IN THE NEWS + +

Here, there and everywhere
Canada Health Act not in step with contemporary health care delivery

< - - summarized from UofT Bulletin - - >
The Canadian Institutes of Health Reseach recognized that innovative transdisciplinary scholarship is needed to grapple with many 21st-century health care issues. The principles of the 1984 Canada Health Act support universal, comprehensive, accessible and portable services delivered inside hospitals by an array of providers and by physicians only in other settings. However, most contemporary health care is neither hospital based nor delivered primarily by physicians.

To an unprecedented extent, health care activities are sought, delivered and received in ambulatory, home-based and e-health settings. In other words most health care interactions occur in places where Canadians live, work, shop and attend school and involve a wide range of professional, alternative, lay, paid and unpaid providers. Increasingly, providers, care recipients, devices and equipment do not need to be proximal in space and/or time. Technological connections blur boundaries between bodies and machines, life and death, people and settings and join geographical regions that until recently were economically and jurisdictionally separate. In other words, unprecedented relationships exist among and between health care technologies, providers, recipients and settings.

These health services, however, are outside the scope of the act. Canadians are entitled to publicly funded necessary health care regardless of the setting within in which it is received, therefore metaphors such as landscapes, settings, boundaries, pathways, networks, sites and nodes should be used to view the Canadian health care terrain. In universities, truly transdisciplinary scholarship is needed to address the clinical, ethical, economic, existential, sociocultural and political implications of the new health care order. This could be accomplished through collaborative programs designed to bridge knowledge and communication gaps between clinical and health services researchers and social scientists and humanists who are interested in the body, place and/or technology.

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