By Worldchanging Canada writer Peter ter Weeme

As Canadians, we cherish national universal health care. It’s part of our Canadian identity and one of the ways we like to differentiate ourselves with Americans. In fact, health care is a national obsession in Canada. And we like to share endless views in the media about how to “fix” it or make it better.

Case in point: The January 14th edition of Maclean’s magazine landed on my doorstep last week with a front cover about “The Doctor Crisis” and “why it’s about to get a whole lot worse”. The same week, the CBC ran a segment on The Current called “Desperately Seeking Doctors”.

If you thought that we just need to put more money into the system to make it work better, then read the article for a broader perspective. (Incidentally, 45% of government program spending at the federal and provincial/territorial levels is already directed at health care). The reason why you or someone you know doesn’t have a family doctor is because the aging population is putting more demands on the existing pool of doctors. Meanwhile, we aren’t graduating enough new doctors. And those who do enter the field want more work-life balance; they simply won’t work 80 hours a week. As well, many medical students opt for a more lucrative specialization, rather than family medicine.

But, even if we manage to deal with the family doctor crisis, health care in Canada faces a number of other challenges. It is still largely viewed as a way to address ill health, not to foster wellness. Funding is considered inadequate. The range and abundance of services varies from place to place. So does quality. And so on.

In the public dialogue I’ve seen on the topic, two strong voices emerge: one in favour of more publicly-funded delivery, the other more privately-funded. But as we all know, this is not a case of black or white. There are many shades of grey.

For me, this points to the need to think more creatively about solutions to what ails our health care system (pun intended). Enter: co-ops.

In my last posting, I talked about their role as we try to balance the forces of globalization with our need as humans for community. In this one, I’d like you to consider how co-ops can play a similar role in health care.

Back in 2001, when the Liberal government was elected in BC, they began their mandate by cutting the amount of personal income tax collected by the Province. At the same time, they launched a variety of initiatives to cut costs. Across the province, a range of services was cut, including health care. In Nelson, a picturesque city of 10,000 souls on the shores of Kootenay Lake, the result of these cuts was the closure of the local hospital. Residents were expected to travel to Trail, about an hour away by car, for those services.

This expectation was simply not good enough for the residents of Nelson, an area currently home to more than 100 successful co-ops. They took matters into their own hands. In 2002, a group of citizens, health care professionals, business and community leaders formed the Community First Health Co-op (CFHC) to enhance and support health care services. Various levels of membership in the co-op are available but start at just $10 for a basic share. Additional shares can be purchased for $10 each.

The CFHC guiding principle is “to focus on the preventative and integrated benefits of health and wellness.” All of this is delivered with an approach that is community-oriented, locally controlled and responsive, and proactive. As a co-op, it’s also structured to reinvest its surplus back into services and health promotion.

Community response has been phenomenal, in large part because the co-op is designed by and responsive to the need of local residents. Indeed, one in five Nelson residents own shares in the co-op. In her recent annual report, Deb Zeeben, Chair of Community First Health Co-op, stated stated, “We continue to have inquiries from many practitioners near and far, interested in joining this community’s vision for achieving wellness. When the community owns the vision, it is achievable!”

In the case of Nelson, the co-op operates on a consumer/user model (a co-op that provides services for its members’ personal use). This contrasts with a worker co-op model. There, members are both owners and employees who control all of the co-op’s operations. This model has the advantage of allowing workers to improve their managerial abilities and to create a more democratic business environment that meets the needs of its members (i.e., the employees). At the same time, worker co-ops are generally more responsive to the needs of their customers because all of the employees have a stake in the co-op’s success.

In Québec, a significant niche has emerged for worker-owned ambulance co-ops. In fact, they provide one-third of ambulance services in the province. However, perhaps most significant of all is the recent boom in the home care co-operative sector in Québec and Ontario. As the name implies, a home care co-operative delivers a variety of support services to people where they live. This can range from medical aid, to assistance with the activities of daily life for the elderly, or for those with physical challenges.

These home care co-operatives often employ a third, multi-stakeholder, model. This approach brings together users, providers, workers and others with a stake in the co-op’s success to realize their health care vision. Home care co-ops provide a range of important benefits to the public. For example, they improve the quality of work of many people, mostly women, by providing them with steady, better-paying jobs, and allowing them to contribute to the government pension fund. Most importantly, they enable seniors to stay at home while delivering quality care and support services to them. This reduces the frequency of their hospital stays, and the need for nursing home care.

It’s fair to say that more co-ops are not the only solution to the challenges facing health care in Canada. However, co-ops deserve more attention for their cost-effective, community-driven and integrated approach. It will take the right legislative and financial framework, more emphasis on health promotion, and preventative health care, and more education with users and providers, to get there. And that’s no bitter pill to swallow.