U of T Researchers Compare Primary Care in England and Ontario, Find Investment Strategy Helps Reduce Premature Deaths

January 19, 2018

Photo of stethoscope in foreground in black and whiteIn 2004, England and Ontario had similar rates of premature mortality with just over 110 deaths per 100,000 people or about 15,500 premature deaths in Ontario. 8 years later, a new study by U of T researchers has found that England has reduced its premature mortality rate by more than 10%. Ontario has also improved, but at a slower rate. Premature mortality is a measure of how many people die at an early age from infections or chronic conditions that normally they should be able to live with until they reach an older age (over 75 years).

“While both Ontario and England increased funding in primary care throughout the 2000’s, England targeted their investment to reduce inequity, whereas Ontario supported enhanced primary care in all neighborhoods regardless of socio-economic status” said Walter Wodchis a Professor of health economics at the Institute of Health Policy, Management and Evaluation and Research Chair in Implementation and Evaluation Science at the Institute for Better Health at the Trillium Health Sciences Centre.

In the early 2000’s reducing health inequity was a top priority for England’s National Health Service (NHS), so they implemented a strategy that increased physician services to disadvantaged adults, such as those residing in low income neighbourhoods, in an effort to prevent premature deaths.

“We were already pro-poor in Ontario; we have more doctors in our disadvantaged neighbourhoods,” said Wodchis, “But England is catching up in primary care physician supply and has surpassed us in achieving a reduced mortality rate for their disadvantaged population.”

While the study suggests that an increased supply of physicians to these neighbourhoods may have resulted in a reduction in premature deaths, Wodchis also points to other factors that may have contributed, such as the fact that physicians in England are required to accept patients who live in their local areas, whereas such rules do not apply in Ontario.

While England improved health outcomes, in spite of having fewer physicians by population, the study also notes that more research is needed to determine the impacts of additional supports put in place in England aside from the targeted increase in primary care physician supply including a national priority on inequalities, guidance on secondary prevention of cardiovascular heart, diabetes and related conditions and a program of vascular risk assessments.

Could Ontario do even better? “Certainly,” said Wodchis.

The study has concluded that more research will be needed to determine which areas of primary care would benefit from the most investment in order to effectively reduce premature deaths, such as cardiovascular care or other diseases and risk factors like smoking and hypertension.

The study was funded by the NIHR in the U.K, and the Ministry of Health and Long-Term Care, ICES and HSPRN in Ontario and published in PLOS One.