I recently had the privilege of joining Community Health Centre colleagues from across the United States for the 2018 Policy and Issues conference of our partner association, the US National Association of Community Health Centers (NACHC).

Imagine over 2500 CHC healthcare providers, executive leads, program staff and board members from all 50 states and US territories  converging on Washington DC for a week long series of innovation workshops, advocacy sessions, and organized lobbying visits on Capitol Hill with Members of Congress.

Not only was I energized by the size and scope of this gathering, I was inspired by the unified national movement that Community Health Centres and their federal and state associations have created and continue to nurture.

From humble beginnings in the 1960s, when two founding CHCs were established in Dorchester, MA and Mound Bayou, MS, a national CHC movement has evolved which now includes over 9000 federally-funded CHC sites serving more than 28 million Americans in all U.S. states and territories.

It is a real example of what might be possible in Canada through growing commitment by CHCs to work together across provinces and to advocate with federal and provincial governments for progressive policy and funding.

We face a number of challenges and questions that we need to contend with as CHCs in Canada if we want to move the yardstick:

1. The nature of our federal political system and the division of responsibilities for « healthcare » mean that discourse about healthcare policy and funding gets pushed down to 13 provincial and territorial healthcare system silos. Health service agencies, including CHCs, largely mirror the organizing logic  and gravitational pull of our province-dominated systems. How do we as CHCs and associations focus due attention on provincial discussions while also building and investing in a shared federal vision and agenda? 
2. The limited focus of our Canada Health Act tethers us to the dictatorship of medical services and stalls our shift toward team-based and preventive services. How do we uphold the spirit of the Canada Health Act while stewarding conversations about the need to develop policy and funding that move beyond the strict letter of the Act? How do we engage health professional associations, most notably medical associations, in this process?
3. Healthcare is largely dislocated from programs and services that address the day-to-day factors that affect health. CHCs, of course, are a glowing exception. How do we make the case for multi-sector policy and for deliberate investments by provincial and federal governments in integrated healthcare, social, and community services?

These are no small challenges, even though I believe we, as a national CHC movement in Canada, have at least begun to break the ice. And, while this is the sort of mission that will require not years but generations of work, the experience of our U.S. Community Health Centre  cousins should inspire us to have a grand vision. 

What have the key factors for success been in the U.S.? There are several. 

Success in embedding CHCs in federal legislation. The U.S. Public Health Service Act (section 330) embeds CHCs in federal legislation and provides core guidance for what CHCs are. At first blush, this might seem unimaginable in Canada given the nature of our federal system. Still, it behooves us to consider if there are reasonable grounds to argue for federal legislation and/or policy covering CHCs.  Not only are CHCs multi-sector organizations that deliver more than just healthcare, most are already funded by multiple sources and they help fulfill many federal government mandates including in such areas as newcomer settlement, housing, disaster relief and other areas. 

An unfliching commitment to advocacy. CHCs in the U.S. were born in the 1960s out of the national « war on poverty » and they continue to be the country’s go-to agencies for the medically-uninsured. The sheer magnitude of these social inequities demanded from the very outset that CHCs develop a fighting spirit and a strong advocacy agenda. That work has only increased over time. See www.hcadvocacy.org, for example. We have ample evidence in Canada to suggest that inequities in our health and social service systems and the barriers faced by those we serve demand that CHCs adopt advocacy as an essential pillar of work (many, of course, already do).

A commitment to working through association. Community Health Centres have invested in their national and state associations as the vehicles for collective impact. Moreover, all associations have been sufficiently resourced by their members to do for them as a collective what no CHC or small cluster of CHCs would ever be able to do for themselves. We have made some inroads in Canada, the most notable being Ontario’s CHC association — the Association of Ontario Health Centres — and more recently, CACHC. But we must continue to treat our associations as investments in the future.

I want all of my Canadian CHC colleagues to have regular opportunities to connect and collaborate with our US CHC counterparts. There is much to learn and much to share, in both directions. That’s why I am particularly excited about the work we’re currently undertaking to foster Canadian-American CHC collaboration on a region by region basis. 

More updates will be coming on this from CACHC over the months ahead. In the meantime, I encourage any CHC colleagues who are inspired by the prospect of collaboration with U.S. CHCs to make plans to join us at the 2018 CACHC Annual General Meeting Summit this September in Victoria, BC, where this will be a core area of focus.

Scott Wolfe is Executive Director of the Canadian Association of Community Health Centres (CACHC) and Coordinator of the International Federation of Community Health Centres (IFCHC).