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The hospital as a launching pad for community health care services and health promotion.

A hospital, in the minds of the general public, is a place to go when one is ill, injured or in need of special assistance. To the health professional, however, it is much more than that. The hospital is the centre of expert diagnosis and treatment, where the members of the healing professions exercise their skills and work together as a team to identify disease conditions, overcome their ill effects and restore or improve function. In fact, hospitals have played a larger role in health care. By providing such facilities as prenatal clinics, well-baby clinics, immunization clinics and specialized laboratory services, they have assisted in the prevention of disease and illness. In the last 2 decades in particular, hospital services have expanded widely. Such services as rehabilitation and remedial clinics have added a new dimension. As the members of modern society become more knowledgeable of health matters and more aware of their health needs, they expect and demand more health care services, wider availability of these services and greatly improved protective measures to diminish the incidence of disease and injury. But how such services are to be provided and by whom has not been made clear. No doubt this is why so many commissions, both federal and provincial, have been established over the last 15 years to study the provision of health care services. The consensus appears to be that hospitals should be playing a major role in meeting community health care needs by providing services for the diagnosis, treatment and prevention of illness, and the restoration of function. The initial enthusiasm for a network of independent community health care centres1 has been replaced by a preference for having the community hospital reach further into the community and provide it with a wide variety of services. Perhaps the best known and most often quoted document on the provision of health care services is Marc Lalonde's "A New Perspective on the Health of Canadians".2 The main emphasis of this document is on health care promotion and the need for health care professionals and institutions to devote more effort to the prevention of illness and injury. The American Hospital Association3 expressed a similar philosophy in its policy statement on the provision of health services when it stated: "This system [for the delivery of health services] must be oriented to the maintenance of personal good health and to the prevention of illness rather than being primarily oriented to the treatment of illness after it becomes acute." It further stated that "health education is the key to health protection and hospitals should assume a leadership role in this field." The Canadian Hospital Association,4 in its comments on the Hastings report,1 stated that to establish a network of independent community health care centres to' provide for community needs, including preventive medicine, would be wasteful and too often would create duplication of existing facilities. The association believed that in most cases hospitals could supply all the required services, provided they were given the necessary financial resources. Hospitals do have the potential to meet community needs. The great expansion of outpatient and emergency services, and the initiation of home care programs are eloquent proof of the hospital's capacity to reach into the community. Given an integrated medical record, the hospital is in an ideal position to provide a continuum of health care that is difficult to duplicate anywhere else. Notwithstanding the too often unfounded criticisms of the news media and misguided consumer groups, hospitals retain the greatest credibility of any community agency, which makes them ideally suited to establish such outreach programs as those for crisis intervention, drug misuse, sex education and family planning. The main obstacles to establishing such programs are financial and attitudinal. Government authorities at all levels are increasingly more reluctant to support such services under the pretext that health care costs, particularly hospital costs, are already excessive. The new federal-provincial financial agreement for established programs5 will not improve this situation. Attitudinal problems among professional staff, although serious, are far from insurmountable and have not proven to be a serious barrier. A great deal has already been accomplished, particularly in core urban centres, where these problems are more acute. However, further progress is unlikely unless there is a change in government attitudes, and