Scott A. Wolfe, Executive Director of the Canadian Association of Community Health Centers

Scott A. Wolfe

Mark Masselli: This is Conversations on Health Care I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Well Margaret we're well into the month of August the noted dog days of
summer but it's an important time in the world of c ommunity health centers.

Margaret Flinter: This year's theme is celebrating America's health centers innovators
and community health. I think we'd agree innovation is one of the essential hallmarks of
our mission as well.

Mark Masselli: And the National Association of Community Health Centers The Robert
Wood Johnson Foundation and so many other organizations have given us the kind of
support required to improve our care models, it's helped us to develop best practices
that we can share with our colleague s around the country and around the globe as well.

Margaret Flinter: And speaking of community health centers in other countries Canada
now has a growing community health center movement which our guest today is very
familiar with. Scott Wolfe is the Dir ector of the Canadian Association of Community
Health Centers which is also focused on ensuring the needs of that nation's
underserved population and ensuring everyone has access to great primary care. And
Lori Robertson will be checking in the Managing E ditor of FactCheck.org she's looking
at misstatements made about health policy in the public domain.

Mark Masselli: And always if you have comments please email us at CHC
[email protected] or find us on Facebook or Twitter , we love hearing from you. And
we'll go to our interview with Scott Wolfe in just a moment.

Margaret Flinter: But first here is our producer Marianne O'Hare with this week's
headline news.

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Marianne O'Hare: I'm Marianne O'Hare with these health care headlines. The Centers
for Disease Control has expanded a warning area to be avoided by pregnant women
because of the Zika virus outbreak first limited to a small section of Miami - Dade County
in Florida more than a dozen Zika cases has been reported in that region as a direct
result from mosquito bites. The greatest threat is to pregnant women's unborn fetuses
that can suffer severe birth defects if exposed.

Florida Governor Rick Scott has weight in urging congress and the president to take
action im mediately. The president had asked for 1.9 billion dollars in funds for research
and emergency funding for eradication. Congress left for a seven week recess before
acting on that request. Meanwhile, Virginia senator and vice presidential candidate

Scott A. Wolfe

Time Kaine is joining a growing course of law makers urging congress to return from
recess for a special session to address the Zika crisis. Meanwhile the National Institute
of Allergy and Infectious Diseases is already testing a potential Zika vaccine which a
number of companies are also working on this particular clinical trial centers on a so
called DNA vaccine being given to about 80 volunteers. Phase one will test its safety
which those strength might work best as well as what kind of immune response can be
provoked. Dr. Anthony Fauci head of the NIAID warns if congress doesn’t act quickly
on funding they may not be able to make it to phase two of the clinical trial.

There may be a solution to the growing number of American children suffering from
asthma . Currently more than 10% of the overall school aged population, and the
answer just might be found in an Amish barnyard. Researchers have been working on
a so called hygiene hypothesis for some time the notion that too many children are
being born and r aised in environments that are too sterile denying them a chance to
develop a healthy immune response. Scientist studied school aged Amish children who
have extremely low asthma rates live without electricity and live adjacent to barns where
they play alo ngside cows and horses frequently compare to Hutterite children similar
lifestyle but farm animals are housed in industrial barns far from the living space. The
Hutterite children had a far higher rate of asthma, researchers are zeroing in on what
compoun ds in Amish farmyard dust or triggering the growth of neutrophils in the blood
which stimulates an immune response to allergens often a trigger for asthma and when
they apply the compounds to lab mice, the same response occurred in a mice expose to
Amish d ust. Asthma experts see this discovery as a potential breakthrough for staving
off the development of asthma in the first place.

And to floss or not to floss that may no longer be a question. Study at the National
Institutes of Health the Institute o f De ntal a nd Craniofacial Research found little
evidence that regular flossing has any real protective effect against cavities and gum
disease other studied had shown a modest impact on the development of gingivitis from
both brushing and flossing together ver sus brushing alone but the effect was negligible.
Recent Department of Health and Human Services guidelines are focusing more on the
destructive impact of sugars on the teeth rather than flossing effect to reverse that. I'm
Marianne O'Hare with these hea lthcare headlines.

[Music]

Mark Masselli: We're speaking today with Scott Wolfe Executive Director of the
Canadian Association of Community Health Centers. Mr. Wolfe also serves as Acting
Coordinator of the International Federation of Community Health Ce nters. He served as
Director of Global Health Policy for the International Association of Providers in AIDS
care. Mr. Wolfe serves as a Senior Policy Advisor for the Association of Ontario Health

Scott A. Wolfe

Centers, he earned his master's in political science from the University of Toronto.
Scott welcome to Conversations on Health Care.

Scott A. Wolfe: It's my pleasure to join you.

Mark Masselli: Yeah, you know, you really keep a keen eye on what -- what's
happening both here in the United States and obviously in Canada and but I think
Americans may not have as good of a lens on what's been happening with Canada's
health systems which has a universal access to care for all citizens. I'm wondering if
you could help our listeners understand how the Canadian health system has evolved
overtime and what are some of its key features today?

Scott A. Wolfe: I'd start by saying that we see our Canadian health care system has an
evolving entity. The first attempt at a universalize a single payer system in Canada was
achie ved in -- in the province of Saskatchewan in the early 1960s immediately followed
by a doctor strike there was resistance to the implementation of a single payers system.
From that point 1962 through to 1984 at the federal level of a Canadian government
i mplemented the Canada Health Fact which outlines the core principles and
requirements of the universalized public health care system across all of the provinces
and territories in Canada. They covered a basic number of services in fact 70% of total
spendi ng on health care in Canada is achieved through our public health care system
and what we refer to generally as Medicare here so not to confuse that with Medicare of
the United States. What's covered is basic physician and hospital services as well as a
v ariety of -- of other services what's not included within our -- our universalize system
eye care, dental care, physiotherapy is a common one. And so there's a major gap in
access to -- to all of those.

There are essentially two stages to Medicare the fir st stage of Medicare is to bring
everyone and everything within coverage a single payer system. You're still working
towards pharma care and publicly funded dental care for -- for example, those are two
priority issues for many groups across the country. The second stage and I know we
might tough on this a little bit further is really to focus not exclusively on -- on insuring
coverage but what the best models for service delivery are so that we can do a better
job at actually preventing need for health c are services.

Margaret Flinter: Well Scott I -- you know, what you hear in the United States is
Canada universal access to primary care almost, you know, lot of pocket cost for things
like prenatal and child birth or basic surgeries but the common reframe we also hear
long delays for some services and then the growing out of pocket expense. How is that
trend impacting overall care delivery in Canada and are you seeing the kinds of delays
or avoidance of even necessary care because people feel so constrain ed by those out
of pocket expenses?

Scott A. Wolfe

Scott A. Wolfe: There are many individuals who despite having a access to a single
payer system here don’t have access to a routine primary health care provider. So
there are definitely challenges, governments in Canad a are not required to actually
move beyond, you know, those limited services. Many of the challenges we face are
owing to inappropriate delivery of services, access to physician services alone is -- is
inadequate primary care response. What people need i s access to team based care
where not only are we attending immediate medical and biological concerns but also
people lived realities, the determinants of health because as we know 80% or more of
what effects an impact have life outside of the health care system. And so what we're
faced with is a problem of orientation we are not alone in advocating reforms to the way
that services are delivered throughout the country. To touch on the way that this relates
to the privatization of services, yes there is an increasing trend towards privatizing fund
services, the introduction of user fees by some provinces, the emergence of boutique
health care services, the demand for some privatize services such as MRIs, paid for
plasma etc.

There's a legitimate demand for these services because there are challenges within our
public service it's just that we've got to do a better job at delivering services in the right
places at the right times and through the right models. And so when segments of our
population demand acc ess to private services and say well, you know, I as a relatively
well to do individual or family can afford to pay for my private MRI why don’t you allow
me to do that, take my demand out of the public system and create increase space
within the public sy stem, that's actually an incorrect assertion. The ability to access
services out of pocket it does not mean that you added new health infrastructure etc,
what in fact you're doing is you're exacerbating the pressures on -- on the public
system.

Mark Masse lli: Scott speaking of the public health system I thought we focus little on
community health centers. Many of our listeners know that they've been providing
quality primary care to underserved and uninsured populations in the US real focusing
on economi cally vulnerable immigrant populations but really also there are voice and
vehicle for social change in terms of how they are organized. Majority of the board of
directors are the patients themselves as you mentioned earlier a real focusing on team
base c are. Could you illuminate for our listeners what's happening with the community
health centers in Canada the role that they play in serving the underserved population
across the provinces in the country?

Scott A. Wolfe: Unfortunately, we in Canada don’t benefit from the thing federal angle
that you do in the United States, community health centers in the United States benefit
from federal legislation and funding which enables not only a degree of public
awareness about community health centers but a degre e of similarity in mission
approach and so forth across the country. Now, here in Canada health care as it's

Scott A. Wolfe

understood and it's primarily a responsibility of the provinces. It means that the
provinces are left to their own devices to determine how to en sure access to primary
care services. And so there are varying levels of progress across the provinces in
terms of moving from a medicalized model to a team based care approach and
integrating into that attention to determinants of health. There is no si milar model
through which community health centers are funded from province to province. The
way that community health centers have come into being very quite significantly, what I
think it says is that there's something virtuous and organic about the com munity health
center that regardless of how the soil is fertilize the -- the desire to make access
available to services that meet people where they're at and that understand that in order
to improve health outcomes we've got to provide more than just heal th care services but
they don’t have a framework in -- into which to fit. So it's quite a desperate movement
throughout the country but we've achieved a great degree of success and I would say
the future is incredibly bright. And I think public awareness is increasing around what
community health centers are, why they are so vital and why they are necessary.

Margaret Flinter: Well I think you've captured the evolution and -- and I would imagine
that you are finding yourself at one of the pressure points at community health centers
in the whole health care system in the US and I'm betting in Canada are facing as well
and that's the training of the clinical workforce that's prepared to work in a team base
model of primary care, that's a big focus area for p rimary care in the US. And we would
be curious about what the workforce development strategies are that are evolving in the
Canadian health system.

Scott A. Wolfe: It's a little bit of a different story here in that in principle our universal
health care system provides for universal access to primary care, and so it -- it has
already been previewed and built into the system that we need to train and fund health
care workforce that -- that attends to the needs of the entire population. I think the -- the
major challenges here in Canada are the shift from the medicalized model to a -- a
mixture of complimentary models which would include team based clinical services that
might be, you know, serving some of the population and then more robust services like
community health centers that are required to meet the needs of a different segment of
the population. So I think it's really around the shift in how primary care services are
delivered as oppose to training up the number of providers. There's a lack of policy in
many provinces to actually enable allied health staff to work within the primary care
setting. You know, nurse practitioners are licensed in all the provinces, however the
majority of the limited for nurse practitioners tend to filter into acute care settings
because they're just not the funding mechanism for them to practice in primary care.
The other area I would say that is discuss such in frequently is the need to actually shift
training programs providers from different disciplines do a lot more in - training
collaboration with practitioners from other disciplines.

Scott A. Wolfe

Mark Masselli: We're speaking today with Scott Wolfe Executive Director of the
Canadian Association of Community Health Centers. Mr. Wolfe also severs as Acting
Coordinator of the International Federation of Community Health Centers. Scott, you
know, I'd really like to learn more about the work that's going on there and as Margaret
said earlier everybody sort of at a point in time but they all have teachable moments for
each other or about the work they're doing in providing primary care for the underserved
and tell us what are the goals and aspirations of the larger global movement?

Scott A. Wolfe: We establish the International Federation of Community Health Centers
in 2012 and so we're still quite young as a federation. Among our key achievements
over the past few years as two or three formalized global exchanges among community
health centers so really building the -- the knowledge exchange and learning program
for the interna tional federation. We've had the opportunity for community health center
representatives from Australia, throughout Europe, United States and Canada at
different points to participate in global exchanges with each other. It's really developing
a mechanis m for ongoing information exchange and enabling each other to access
examples of success. And so to be able to relate back to our respective funders, policy
makers and -- and other partners that there is a rich community health center movement
to another jurisdiction we for instance are tremendously thankful for the -- the rich
supply of evidence that you have in the United States regarding the community health
center model, why governance is important. The impact of health services on local
economic deve lopments reduction in avoidable hospitalizations and so forth, but our
realities are similar enough that we can extrapolates from your experiences and your
evidence to make the case here and likewise I know that others are looking at what we
do have in Can ada to be able to further support their own local efforts in their countries
and -- and I think this is a tremendous trajectory for -- for international federation of
community health centers and for our global movement.

Margaret Flinter: I'm going to als o ask you just comment area we haven't talk so much
about and that we certainly learned a lot from looking around the world as well as in
United States and the capacity of low cost intervention such as mobile apps for
community health workers armed with a smart phone, being deployed in regions with
little on the way the health care infrastructure and any thoughts about what you've
learned from your global partners and from the work that's going around the country that
you think is a high value or high prior ity for implementation in your system?

Scott A. Wolfe: I came to the community health center movement in Canada after work
internationally and largely focused on HIV prevention care and support. And -- and
throughout my travels in the Caribbean throughou t Latin America and Southern Africa
for instance what struck me is that wherever there was a successful program that not
only was -- was reducing incidence of HIV but was successfully introducing antiretroviral
therapy and resource poor settings. There wa s something special about those places

Scott A. Wolfe

where it was working well and it was working well because there was a integration of a
clinical component with all of the other wraparound components that we know through
community health centers are essential to -- t o improving outcomes and so -- a local
community garden to ensure that people had access to the nutritious foods that they
require. Local -- microenterprises to ensure that we're not only providing the care and
support for people we're helping them to -- to rise out of poverty and so forth. None of
these examples as I can recall were articulated as community health centers but they
were in essence community health centers. And many of them was being done at lower
no cost, well we want to keep our eyes on the need for funding through our respective
health care systems in those more affluent countries such as ours, we really do need to
take inspiration from locations around the world where innovative providers groups that
are being trained to achieve specif ic goal such as community health workers, local
cultural peer educators and others have been introduced to the health system -- are
adding tremendous benefits to it. I think in witnessing how this is done in resource
limited context that it inspires us to think of how we might achieve something similar in
our own setting.

Mark Masselli: We've been speaking today with Scott A. Wolfe Executive Director of
the Canadian Association of Community Health Centers and the International
Federation of Community Heal th Centers. You can learn more about their work by
going to CACHC.CA or you can follow him on Twitter @ Scott A. Wolfe. Scott thank
you so much for joining us on Conversations on Health Care today.

Scott A. Wolfe: It's been my pleasure.

[Music]

Mark Mas selli: At Conversations on Health Care we want our audience to be truly in the
know when it comes to the facts about health care reform and policy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck.org a nonpartisan,
nonprofi t consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week?

Lori Robertson: Donald Trump has said that enhanced interrogation works but scientist
have shown that the stress and pain in duce by techniques like water boarding can
impair memory and therefore inhibit a person from recalling information. Trump has
made the claim a few times. In a report released in 2014 the Senath Selects Committee
on Intelligent said that the CIA use of en hanced interrogation wasn't effective in
acquiring intelligence. But we took a look at what scientific research on that topic has
shown. Enhanced interrogation can entail technique such as sleep deprivation, cramps
confinement and water boarding which tr iggers the feeling of drowning. A 2009 review
paper in trends and cognitive science found that the idea that suspects would be

Scott A. Wolfe

motivated to end enhanced interrogation by revealing truthful information from their long
term memory isn't supported by the sci entific evidence and in fact that evidence suggest
that the opposite can occur, suspects may give incorrect information. Research has
looked at how increased stress affects brain regions prolonged and extreme stress
having negative effect on brain regions needed for short and long term memory
function. Information presented by the captor can accidentally become part of the
suspect's memory, and that’s my fact check for this week I'm Lori Robertson Managing
Editor of FactCheck.org.

Margaret Flinter: FactC heck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com. We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Health C are.

[Music]

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and to everyday lives. On any given day about 4
million Americans can be found utilizing their local library. An estimated 15% of the
daily patrons at the San Francisco main library held from the city's homeless population
of about 7000 people. Often this population not only lack s access to safe housing but to
much needed social services as well. So they decided to capitalize on the opportunity
to help their homeless patrons by hiring the nation's first library based psychiatrist social
worker.

Leah Esguerra: It's easier to do o utreach on the streets because it's a neutral territory
but here it's a -- it's their safe place, it's their sanctuary. So we try to be very respectful.
My way is hi I don’t know if you know that there is a social worker at the library, okay, to
say, you know, we have these services if you think you might want to know more about
it I'm available, I'm always here.

Mark Masselli: Social worker Leah Esguerra speaks to a reporter from PBS recently,
she understands the challenges of leading the homeless popul ation to behavioral health
interventions and social services that will best meet their need.

Leah Esguerra: I do the full clinical assessment and then I make a presentation to my
colleagues at the San Francisco Homeless Outreach Team, they provide case
ma nagement and also housing.

Mark Masselli: Since they launch the program at the San Francisco library hundreds of
homeless patrons have benefited from behavioral health and addiction services and
many have also found themselves with permanent homes. Some two dozen libraries

Scott A. Wolfe
across the country have initiated similar programs following San Francisco's novel
model, a responsive strategically situated behavioral health clinician being made
available to those most in need using the opportunity to leave the popu lation to the care
and shelter they most need, now that is a bright idea.
[Music]
Margaret Flinter: This is Conversations on Health Care, I'm Margaret Flinter.
Mark Masselli: And I'm Mark Masselli, peace and health.
Conversations on Health Care, broadcas t from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.