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

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 La traduction du résumé se trouve à la fin de l'article.

Informal Recyclers’ Health Inequities in Vancouver, BC

“…The barriers and experiences conveyed by informal recyclers in accessing services and the constraints and challenges expressed by key informants in providing services speak to well-documented tensions associated with the neoliberalization of healthcare and other social services, including the depoliticization of health issues in the neighborhood, decreased public funding and increased reliance on volunteer labor, and the individualization of responsibility for health. [45][46][47][48][49][50] The social determinants lens thus points to the structural inequities that informal recyclers experience in accessing various kinds of resources and services in the DTES in the context of the neoliberalizaiton of public services and emphasizes the need for empowering community-based knowledge and leadership in redressing the environmental health inequities experienced by marginalized urban dwellers.…”

Vancouver’s Alcohol Knowledge Exchange: lessons learned from creating a peer-involved alcohol harm reduction strategy in Vancouver’s Downtown Eastside

“…Alcohol has remained largely an afterthought within a harm reduction sphere that has been, understandably, focused largely on opioids and stimulant drugs for decades. Despite a commitment to scale up evidence-based Managed Alcohol Programs (MAPs) in VCH’s Second Generation Strategy, the demand for MAP services continues to outpace the capacity of the Drinkers Lounge, which is the only MAP accepting clients identified in the DTES [ 33 , 34 ]. Over the last 12 years of the group’s operation, EIDGE members (MH, GS) and program staff (AB, BG) have informally documented a number of repeat systemic concerns shared by the illicit drinking community.…”