Abstract
Background: If we know that insufficient income is one of the most powerful factors impacting health and is linked to higher rates of cancer, chronic disease, and healthcare utilization, what role can the health system and community play in improving financial wellness
Approach: To focus on root causes - the determinants of health and health disparities, a groundbreaking collaboration called Reducing the Impact of Financial Strain (RIFS) in Alberta, Canada was initiated between Primary Care Networks and communities. Primary care teams screened for and responded to the financial concerns of their patients, while teams from multiple sectors within communities came together to discuss financial strain, identify community assets, and find ways to build relationships.Health promotion and primary care teams from 4 rural communities invited community members and partners together including Primary Care Networks and clinics, Alberta Health Services (AHS) (public health, nutrition, primary health, mental health, etc), social organizations, municipalities, faith groups, indigenous partners and organizations, police, libraries, businesses, nonprofit groups, community agencies and community members. As they engaged and created connections, they began to discover a shared vision and common understanding of their community. Together, they uncovered related local assets through asset mapping and explored experiences of those with financial strain through coffee chats, digital storytelling, journey mapping, and poverty simulations. Principles from asset-based community development and human centred design help guide a collaborative approach.The multi-sectoral community teams were supported from provincial and regional partners including Alberta Medical Association and AHS and locally, co-create financial wellness goals and enabled action. Primary care teams infused empathy as they established workflows, whole team capacity, connections to community supports and patient trust. They wove financial wellness into health care conversations with patients around one validated question- do you ever have difficulty making ends meet at the end of the month.
Results: Primary care reported a shift in mindsets about their role in social care and patients with financial strain and found patient interactions became more meaningful and effective. Most primary care teams went from feeling medical needs should be their focus to agreeing that screening for financial strain is important, relevant to practice, and easily implemented. Primary care teams established strong relationships with community partners that have been sustained.Collectively, communities took local action inspired by the Building Financial Well-being Toolkit. Community partners stated working together was the way of the future as part of collaborative factors inventory scale conversations. They uncovered services they did not know existed and provided co-designed innovative solutions with diverse stakeholders.Four years after the start of collaborative action, local communities and primary care continue to explore ways to support their local community. Some host collaborative primary care and community conversations, hired community navigators, and strengthen relationships and collective action.
Implications: Collaboration among the health team with community partners and citizens is a key mechanism to support social determinants of health. Stories and discoveries featured at https://financialwellness.healthiertogether.ca/ website offer inspiration for others. Health systems such as primary care, public health, and social care can embrace integrated approaches and resource collaboration to tackle root causes and health inequities with communities and citizens. Plans to Modernizing Alberta Primary Health Care at the government level is calling to leverage this work as they move towards a regional model that serves the entire population within a defined geographic region.