Ray Markham, Megan Hunt, Robert Woollard, Nelly Oelke, David Snadden, Roger Strasser, Georgia Betkus, Scott Graham,
Correspondence to Dr David Snadden; firstname.lastname@example.org
Background [Excerpts] There are few examples of the practical application of the concepts of social accountability, as defined by the World Bank and WHO, to health system change. This paper describes a robust approach led by First Nations Health Authority and the Rural Coordination Centre of British Columbia.
This was achieved using partnerships in British Columbia, Canada, where the health system features inequities in service and outcomes for rural and Indigenous populations.
Social accountability is achieved when all stakeholders come together simultaneously as partners and agree on a path forward. This approach has enabled socially accountable healthcare, effecting change in the healthcare system by addressing the needs of the population.
There are persistent health and wellness inequities across multiple domains including rural, remote and Indigenous communities in Canada.
One unique factor in British Columbia (BC) is the establishment of the First Nations Health Authority (FNHA) taking over the remit of First Nations Health from the Federal Government.
The negative variance in population health between rural and urban populations is present throughout our world.
These disparities are more prevalent in remote, resource-based and isolated First Nations communities as seen in BC, Canada.
Their genesis is multifactorial, generally not from malice but from forces like economies of scale, system bias (eg, negative assumptions about rural), structural racism and historical and current day colonial systems of possession and control of Indigenous lands and services as well as critical mass perceptions to maintain service—all of which have created persistent inequities for decades.
These forces can be seen as a gravitational pull to urban centres in health systems, including deliberate centralisation of services. We have demonstrated that it is possible to embed counter forces in community relationships and healthcare systems that mitigate this pull, moving towards a more socially accountable equitable, and just health system.
[Please note that references have been omitted in this excerpt.]