The Problem of Access (In Healthcare)

Many folks are talking about the problem of access in healthcare.

Many people in my network are speaking about access through the lens of the patient and treatment. This call for improved access in healthcare has become even more pronounced post pandemic. The pandemic made it crystal clear that a lot of folks die needlessly because they can’t access healthcare and that access in Canada, despite what we may aspire to, is not universal.

One can unequivocally say that this is all true when we look at this problem through the lens of the patient and a more conventional understandings of healthcare. Early detection of illness and timely, democratized access to treatment helps to ease pain. Most would agree. Many of the people I love dearly are still around because of access to life prolonging treatment.

The difficulty is that as we look at access from a meta, trans contextual perspective, we realize that the problem of access runs 10,000 leagues deeper. What we encounter in that abyss is an octopus with countless tentacles. So, while access includes access to screening and treatment, it also transcends it.

Let’s open to a new way of understanding access (in healthcare). I put health care in parentheses because we’re going to notice that this question of access reaches far beyond the walls that hold the conventional healthcare narrative. This has always been true. Healthcare has just been stubborn and slow to catch on.

One of the etymological roots of the word access is from the Latin accedere which means “to approach”. I would like us to reflect on ways we could approach access if we considered it through a more relational and integral prism.

Here is a quick and abridged sampling to get us reflecting differently. Notice how every one of these faces of access are woven into the experience of health and that they reflect a range of internal and external realities:

Psychological

The challenge of accessing my thoughts, feelings, sensations, and perceptions.

Cultural

The challenge of accessing someone who understands my cultural values. ?

Socio-Economic

The challenge of accessing a place to live and food to eat.

Education

The challenge of accessing education about myself and the world.

Environmental

The challenge of access to clean air and water.

Gender

The challenge of access to equaled care regardless of identity or orientation.

Lifestyle

The challenge of accessing health promoting resources.

Labour

The challenge of accessing employment.

Spiritual

The challenge of accessing the meaning of life.

These are some. The list goes on. All of these are interdependent which is what makes the question of access so incredibly complex.

The lesson of the pandemic wasn’t a lesson about accessing treatment or diagnostics alone. It was a lesson about how we make sense of what is healthy people and healthy planet, and how systems and societies are or are not organized to hold the depth of those interdependent realities.

Healthcare creates silos because it is a silo. We become how think about ourselves. When we reduce the conversation around access to one of diagnostics and treatments, we silo our way of seeing the broader landscape that sustains and supports health. We also narrowly hold what we mean by “health”. ?And it is that way of seeing that is ultimately holding healthcare captive in a pattern of worsening outcomes, unhappy patients and practitioners, monocular and band-aid policies, unsustainable costs, and fragmented models of practice and governance. These are some of the side effects of being seduced by the trap of narrow goals and compartmentalized intelligence.

Because one way of seeing is right, doesn’t mean it is all right. That kind of narrowness is pushing health care to a cliff where it may be forced to look more deeply into the abyss of the many tentacled reality it has been refusing to notice. My sincerest hope is that healthcare dives head on and courageously into the complex waters below so that it can understand that the problem of access is, at least partly, a prison of its own sensemaking.

If you’re inspired to explore the next evolution in health care, we invite you to contemplate #HumanCare.

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