healthonthemind

Canada’s Healthcare System and Our Ageing Population

What does it mean to be vulnerable? The word vulnerability describes an individual or a group of individuals at risk for poor physical, psychological, and social health as a result of barriers experienced by social, economical, political, and environmental resources (Bruskas, 2008). Vulnerable populations include; ethnic minorities, gender, social support, education level, income, genetic predisposition, and age such as children and seniors. As our communities grow, all vulnerable populations should be a priority for our healthcare system. Nonetheless, there is one population that is growing rapidly and requires immediate attention, our elderly population. Over the past 40 years, the proportion of senior population has grown from 8% to 14% in Canada. According to demographic projections, the proportion of seniors is expected to increase rapidly to between 23-25% of the total population by 2036 (Statistics Canada, 2018). What does this mean for the future of our healthcare system?

Currently Canadians over age 65 consume roughly 44% of provincial and territorial health care budgets, and the governments are concerned about the health care system’s capacity to provide quality of services in the future (The Canadian Medical Association, 2013). Although age does not automatically mean ill health or disability, the risk of both does increase with age. Age-related risk factors that influence one’s health include; decreased mobility, increased chronic disease, increased nutritional needs, financial decline related to retirement, and social isolation (Potter & Perry, 2001). Statistics Canada confirms that nearly three-quarters of Canadians over 65 years have at least one chronic health condition (The Canadian Medical Association, 2013). Statistics Canada also indicates that the Canadian healthcare system lacks resources to help older adults cope with these age-related risks. While these risk factors can have major affects on one’s quality of life, many of them can be managed and prevented. The key to providing optimal care for older adults begins with recognizing the risk factors then tailoring healthcare and educational programs towards this population (The Canadian Medical Association, 2013). I believe that in order to provide optimal care and support for Canada’s aging population, while trying to minimize pressure on the health-care system, governments at all levels should invest in programs to promote healthy ageing. As well, a comprehensive continuum of health services to provide optimal care and support.

Figure 1. Canada’s National Expenditures on Health in 2012 for each of the age groups. Retrieved from https://www.cma.ca/Assets/assets-library/document/en/advocacy/policy-research/CMA_Policy_Health_and_Health_Care_for_an_Aging-Population_PD14-03-e.pdf

The Public Health Agency of Canada defines healthy ageing as a process of optimizing opportunities for physical, social, and mental health to enable seniors to take an active part in society and enjoy their lives (EuroHealthNet, 2018). It is understood that initiatives to promote healthy ageing will help lower the healthcare costs by reducing the number of hospital and physician visits due to disability and chronic disease (EuroHealthNet, 2018). Programs focused on physical activity, nutrition, and mental health will have a profound effect on individual quality of life, social support, physical health, and mental well-being. Despite the inevitable declines associated with age, research suggests the way in which older adults spent their final years, either in a nursing home, or living independently, may be greatly influenced by their physical activity habits throughout their life (Krucoff, Carson, Peterson, Shipp, & Krucoff, 2010). Participation in a regular physical activity is an effective way to reduce/prevent a number of functional declines associated with ageing. A minimum of 150 minutes a week at a moderate intensity physical activity such as brisk walking will result in numerous health benefits (Krucoff et al., 2010). These benefits include prevention of heart disease and colon cancer, mitigate the effects of chronic disease, improve coordination and flexibility to avoid falls, and alleviate depression (Goetzel et al., 2007). Adults who practice even simple physical activity can improve their health status and use few health and social services (Goetzel et al., 2007). Our healthcare system should be investing in programs to keeping our older adult population healthy and active in their lives.

The Canadian Medical Association agrees that older adults should have access to high-quality well-funded programs to help them achieve and maintain physical fitness, optimal nutrition, promotion of mental health, and reduction in social isolation (The Canadian Medical Association, 2015). In the province of British Columbia, there are many seniors based programs to keeping individuals active and healthy as they age. A project called Raising the Profile Project (RPP) is a senior project that provides support programs in health and wellness areas such as management of health conditions, affordable housing, nutritional supports – meal services, nutrition education, access to fresh fruits and vegetables, community gardens etc. (Raising the Profile Project, 2018). Information, referral, and advocacy services, which offer support on income benefit and support programs, housing services, health services, and community programs, are also provided. RPP provides education, recreation, and creative arts programs to provide an outlet for creativity, enhancing meaning in life and a sense of purpose (Raising the Profile Project, 2018). Seniors with a strong sense of purpose often live longer (Irving, Davis, & Collier, 2017). Raising the Profile project also offers a broad range of programming to support and promote physical activity, which is partially funded by the help of the Government of British Columbia’s Ministry of Health. Additional funding for RPP is provided by the United Way of the Lower Mainland, Vancity, Union of British Columbia Municipalities, and the City of Surrey (Raising the Profile Project, 2018). In Kamloops, where I live, there is a program called OnTrack. This program is offered through a partnership between the City of Kamloops and Interior Health, to support middle age and older individuals diagnosed with chronic illness to increase their participation in physical activity and receive support from others to better manage their condition (Raising the Profile Project, 2018).

One major problem with these senior programs is funding. British Columbia’s federal government provides some financial support to projects, yet they still require outside funding from other organizations. A study by Aldana (2001) reviewed 32 health promotion programs and found 28 that reported medical cost savings. Of the seven studies that calculated cost-benefit ratios, financial returns averaged $3.48 for every dollar expended. In a study by Fries and McShane (1998), the authors demonstrated that health promotion programs offered to seniors, can save between $101 to $648 per person a year on healthcare costs, depending upon who participates and how many programs they use. I believe the Canadian government should start budgeting for these types of programs and education in each province. These programs will help decrease healthcare expenditures and increase the quality of life of our growing older adult population.

In addition to providing high quality services for healthy ageing, accessibility to these services is crucial. For seniors who have multiple chronic diseases, care is complex. Our Canadian healthcare system should be flexible and responsive when caring for our older adult population. The future of Canadian healthcare should be delivered on a continuum for community based health care, for example: primary health care, chronic disease management programs, home care workers, long-term care and palliative care (HealthLink BC, 2018). This continuum should be managed so that the patient may remain at home, out of the hospital and long-term care as long as possible. It is crucial these individuals have easy access to the level of care they require in order to age healthily (The Canadian Medical Association, 2015). The healthcare continuum should also be offered for individuals in all cities across our provinces. Older adults should not have to drive to major centers to receive the care they require (Fries & McShane, 1998). In addition to the cost of driving to major centers, many of these healthcare services are not covered under the Canada Health Act, requiring out of pocket pay. Many seniors are on a limited income and cannot afford many extra expenses (Fries & McShane, 1998). I feel our government should develop an interdisciplinary health service to ensure older Canadians have access to physicians and multiple levels of care without costing them out of pocket. This type of investment will help decrease the healthcare expenditures related to hospital and physician visits, while increasing the overall quality of life in our population.

In British Columbia, the government website contains a seniors section that provides information in all areas such as healthy aging, health and safety, financial and legal matters, transportation, housing, home and community care. Many of the services stated on the website are covered by the federal government, such as senior’s services agency: island health – provides community-based outreach on the island to older adults with age-related mental health problems such as dementia and psychosis, depression, and addiction problems (HealthLink BC, 2018). There are senior contact programs in Kelowna, that offer brief daily phone calls to ensure the well-being and safety of seniors living alone. The federal government funds this service. Unfortunately, when looking for any type of senior program a majority of these services are around the Vancouver area with a few in Kelowna (HealthLink BC, 2018). This means that anyone living outside these areas do not have access to many senior programs.

Figure 2. Depiction of where the majority of senior programs can be found throughout the province of British Columbia. – Vancouver, Vancouver Island, & Kelowna. Retrieved from https://www.healthlinkbc.ca/services-and-resources/find-services

I think in order for our healthcare system to advance, the government should prioritize both care and primary prevention for our older adult population. In 2017, the government provided funding to a number of national-level organizations to help improve care for seniors; including the Canadian Orthopaedic Foundation in collaboration with Bone and Joint Canada, and the Association of Canadian Community Colleges to develop national standards for personal support workers, and to a variety of research projects related to treating chronic diseases. Little funding was provided for support programs that involve primary prevention such as physical activity programs, or nutrition programs. In short, I think a focus on prevention and health promotion programs offers a promising approach to the urgent challenges that our healthcare is facing today and into the future.

What do you think about our Canadian healthcare system?

~Happy Blogging!~

Rachel

References

Aldana, S. (2001). Financial impact of health promotion programs: A comprehensive review of literature. American Journal of Health Promotion, 15(5), 296-320. doi: 10.4278/0890-1171-15.5.296

Bruskas, D. (2008). Children in foster care: A vulnerable population at risk. Journal of Child and Adolescent Psychiatric Nursing, 21(2), 70-77. doi: 10.111/j1744-6171.2008.00134.x

CSEP. (2018). Canadian Physical Activity Guidelines. Retrieved from http://www.csep.ca/CMFiles/Guidelines/CSEP_PAGuidelines_older-adults_en.pdf

EuroHealthNet. (2018) Healthy ageing. Retrieved from http://www.healthyageing.eu/

Fries, J., & McShane, D. (1998). Reducing need and demand for medical services in high-risk persons. A health education approach. The Western Journal of Medicine, 169(4), 201-207. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305287/

Goetzel, R., Shechter, D., Ozminkowski, R., Stapleton, D., Lapin, P., McGinnis, J., Gordon, C., & Breslow, L. (2007). Can health promotion programs save Medicare money? Clinical Interventions in Aging, 2(1), 117-122. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684089/

Government of Canada. (2017). Action for senior’s report. Retrieved from https://www.canada.ca/en/employment-social-development/programs/seniors-action-report.html#tc6a

HealthLink BC. (2018). Services and resources. Retrieved from https://www.healthlinkbc.ca/services-and-resources/find-services

Irving, J., Davis, S., & Collier, A. (2017). Aging with purpose: A systematic search and review of literature pertaining to older adults and purpose. The International Journal of Aging and Human Development, 85(4), 403-437. doi: 10.1177/0091415017702908

Krucoff, C., Carson, K., Peterson, M., Shipp, K., & Krucoff, M. (2010). Teaching Yoga to seniors: Essential considerations to enhance safety and reduce risk in a uniquely vulnerable age group. Journal of Alternative & Complementary Medicine, 16(8), 899-905. doi: 10.1089/acm.2009.0501

McPhee, J., French, D., Jackson, D., Nazroo, J., Pendleton, N., Degens, H. (2016). Physical activity in older age: Perspectives for healthy ageing and frailty. Biogerontology,17, 567-580. doi: 10.1007/s10522-016-9641-0

Potter, P. & Perry, A. (2001). Fundamentals of nursing (5th ed.). St. Louis: Mosby, Inc.

Raising the Profile Project. (2018). Raising the profile. Retrieved from http://www.seniorsraisingtheprofile.ca/about/

Seniors First BC. (2018). Vulnerability. Retrieved from http://seniorsfirstbc.ca/for-professionals/vulnerability/

Statistics Canada. (2018). Seniors. Retrieved from https://www.statcan.gc.ca/pub/11-402x/2011000/chap/seniors-aines/seniors-aines-eng.htm

The Canadian Medical Association. (2015). A policy framework to guide a national seniors strategy for Canada. Retrieved from https://www.cma.ca/Assets/assets-library/document/en/about-us/gc2015/policy-framework-to-guide-seniors_en.pdf

The Canadian Medical Association. (2013). Health and health care for an aging population. Retrieved from https://www.cma.ca/Assets/assets-library/document/en/advocacy/policy-research/CMA_Policy_Health_and_Health_Care_for_an_Aging-Population_PD14-03-e.pdf

Canada’s Healthcare System and Our Ageing Population

Rachel Parkinson

MHST 601

Athabasca University

Canada’s Healthcare System and Our Aging Population

References

Aldana, S. (2001). Financial impact of health promotion programs: A comprehensive review of literature. American Journal of Health Promotion, 15(5), 296-320. doi: 10.4278/0890-1171-15.5.296

Bruskas, D. (2008). Children in foster care: a vulnerable population at risk. Journal of Child and Adolescent Psychiatric Nursing, 21(2), 70-77. doi: 10.111/j1744-6171.2008.00134.x

CSEP. (2018). Canadian Physical Activity Guidelines. Retrieved from http://www.csep.ca/CMFiles/Guidelines/CSEP_PAGuidelines_older-adults_en.pdf

EuroHealthNet. (2018) Healthy Ageing. Retrieved from http://www.healthyageing.eu/

Government of Canada. (2017). Action for Senior’s Report. Retrieved from https://www.canada.ca/en/employment-social-development/programs/seniors-action-report.html#tc6a

HealthLink BC. (2018). Services & Resources. Retrieved from https://www.healthlinkbc.ca/services-and-resources/find-services

Irving, J., Davis, S., & Collier, A. (2017). Aging with purpose: a systematic search and review of literature pertaining to older adults and purpose. The International Journal of Aging and Human Development, 85(4), 403-437. doi: 10.1177/0091415017702908

Krucoff, C., Carson, K., Peterson, M., Shipp, K., & Krucoff, M. (2010). Teaching Yoga to seniors: essential considerations to enhance safety and reduce risk in a uniquely vulnerable age group. Journal of Alternative & Complementary Medicine, 16(8), 899-905. doi: 10.1089/acm.2009.0501

McPhee, J., French, D., Jackson, D., Nazroo, J., Pendleton, N., Degens, H. (2016). Physical activity in older age: perspectives for healthy ageing and frailty. Biogerontology,17, 567-580. doi: 10.1007/s10522-016-9641-0

Potter, P. & Perry, A. (2001). Fundamentals of nursing (5th ed.). St. Louis: Mosby, Inc.

Raising the Profile Project. (2018). Retrieved from http://www.seniorsraisingtheprofile.ca/about/

Seniors First BC. (2018). Vulnerability. Retrieved from http://seniorsfirstbc.ca/for-professionals/vulnerability/

Statistics Canada. (2018). Seniors. Retrieved from https://www.statcan.gc.ca/pub/11-402-

x/2011000/chap/seniors-aines/seniors-aines-eng.htm

The Canadian Medical Association. (2015). A Policy Framework to Guide a National Seniors Strategy for Canada. Retrieved from https://www.cma.ca/Assets/assets-library/document/en/about-us/gc2015/policy-framework-to-guide-seniors_en.pdf

The Canadian Medical Association. (2013). Health and Health Care for an Aging Population. Retrieved from https://www.cma.ca/Assets/assets-library/document/en/advocacy/policy-research/CMA_Policy_Health_and_Health_Care_for_an_Aging-Population_PD14-03-e.pdf

Canada’s Healthcare System and Our Ageing Population

Rachel Parkinson

MHST 601

Athabasca University

Canada’s Healthcare System and Our Aging Population

References

Aldana, S. (2001). Financial impact of health promotion programs: A comprehensive review of literature. American Journal of Health Promotion, 15(5), 296-320. doi: 10.4278/0890-1171-15.5.296

Bruskas, D. (2008). Children in foster care: a vulnerable population at risk. Journal of Child and Adolescent Psychiatric Nursing, 21(2), 70-77. doi: 10.111/j1744-6171.2008.00134.x

CSEP. (2018). Canadian Physical Activity Guidelines. Retrieved from http://www.csep.ca/CMFiles/Guidelines/CSEP_PAGuidelines_older-adults_en.pdf

EuroHealthNet. (2018) Healthy Ageing. Retrieved from http://www.healthyageing.eu/

Government of Canada. (2017). Action for Senior’s Report. Retrieved from https://www.canada.ca/en/employment-social-development/programs/seniors-action-report.html#tc6a

HealthLink BC. (2018). Services & Resources. Retrieved from https://www.healthlinkbc.ca/services-and-resources/find-services

Potter, P. & Perry, A. (2001). Fundamentals of nursing (5th ed.). St. Louis: Mosby, Inc.

Raising the Profile Project. (2018). Retrieved from http://www.seniorsraisingtheprofile.ca/about/

Seniors First BC. (2018). Vulnerability. Retrieved from http://seniorsfirstbc.ca/for-professionals/vulnerability/

Statistics Canada. (2018). Seniors. Retrieved from https://www.statcan.gc.ca/pub/11-402-

x/2011000/chap/seniors-aines/seniors-aines-eng.htm

Children in Foster Care: The Forgotten Vulnerable Population

What are vulnerable populations? This topic has been at the forefront of discussion in my Master’s of Health Studies class for a few weeks now. Last week we focused on what it means to be a vulnerable population such that vulnerable populations are groups and communities at a higher risk for poor health as a result of the barriers experienced by social, economical, political, and environmental resources (Bruskas, 2008). Vulnerable populations include; ethnic minorities, seniors, children, pregnant women, those with chronic health conditions, and First Nations. This week, our focus was vulnerable populations within Canada and how we think they could be better served. The population I chose to concentrate on is a group of individuals that tend to be forgotten by the system, children in foster care.

Children in foster care tend to endure a number of disadvantages, both from maltreatment and other risk factors, including; poverty, parental drug and alcohol abuse, neighbourhood disadvantage, and epigenetics (Bruskas, 2008). Children in foster care experience more depression, anxiety, behavioural, and conduct problems that children living with biological parents or never married single parents. These issues permeate through a child’s young life and create larger problems in their adulthood. A study by Turney and Wildeman (2016) documented the differences in mental and physical health outcomes between children placed in foster care and the general population. The results supported three outcomes, children in foster care showed more mental and physical health conditions than children not in foster care. For example, children in foster care were twice as likely to have ADD (attention-deficit disorder) or ADHD (attention-deficit hyperactivity disorder), asthma, or speech problems. Children were three times as likely to have hearing or visual problems, five times more to have anxiety, six times more to have behavioural problems, and seven times more to have depression (Turney & Wildeman, 2016). The authors discovered some of these mental and physical health differences were characteristics of households and family situations. For example children in informal kinship arrangements – informal care by a family member, had less behavioural problems than those in group home placement, or non-kinship based family care (Turney & Wildeman, 2016).

Along with behavioural and mental health issues, children placed in foster care have poorer educational outcomes. Many children experience educational obstacles due to transitions from home to home, and face multiple challenges of new schools. These transitions then affect their comfort level that impact their school experience and long-term performances (Bruskas, 2008). A report by Anne Tweedle in 2005 found 50% of youth from foster care did not graduate high school, 50% were unemployed, 60% were pregnant or an unwed parent, and 30% were on public assistance. This compared to 15% of the general population who did not graduate high school, 13.8% who were unemployed, 6.4% who were pregnant or unwed parents, and 5.5% on public assistance (Tweddle, 2005). These statistics prove that in order for children in foster care to succeed in school and in life, their experiences in foster care need to be addressed.

Under the Canadian foster care system, a child who is placed in foster care is under protection of a legal guardian and is responsibility of the government. A majority of foster care children are 14 years old and under (Gretchen, Daly, & Kotler, 2012). The children remain under care of the government until they “age out of care.” This age is different between provinces. For example, in British Columbia and the Yukon the maximum age of guardianship is 19, for Alberta, Manitoba, and Quebec it is 18, and for everywhere else the age is 16 years old (Gretchen, Daly, & Kotler, 2012). Each individual case are filed through individual provinces social services departments. The removal of children from their biological parents requires a substantiation of maltreatment (sexual, physical, or neglect) (Deutsch & Fortin, 2015). This maltreatment and removal from parents are traumatic events that affect immediate and future development and mental health of a child. Once a child is in the system, they are placed in one of five arrangements: informal kinship – an informal arrangement with a family member, kinship foster care – a formal arrangement with a family member, foster care (non-kinship) – a family designated by the foster care system, group home placement – group living with 24h staff on duty, or residential/secure treatment – commonly referred to as lock up, for children who require extra therapeutic treatment. The children then stay in the foster care system until they are adopted, or they reach the age where they are no longer responsibility of the government. At this point they are sent out on their own with little financial, medical, or social support (Deutsch & Fortin, 2015). Many children struggle with their transition from foster care to young adulthood.

I think there are two improvements that could impact child development in the foster care system. One is foster care accountability. Historically, foster care has not been accountable for the performance related outcomes for children (Beyerlein & Bloch, 2014). Performance related outcomes were based on a child’s foster care agency’s compliance to federal and provincial requirements (Beyerlein & Bloch, 2014). I think further research is required to develop an understanding of what children in foster care perceive and experience in their environment. We need to take their perceptions into consideration to help create a smoother transition from their home into the foster care system. I think it is also important to have comprehensive developmental and mental health assessments for each child as they enter the system. This would help determine a baseline for child performance. We could use these assessments as comparisons between different periods throughout a child’s time in the system. This way we would develop an understanding of how each child is handling their time in the system. To improve developmental, mental health, and educational outcomes, improvement plans must address social environments created by foster care that may impact a child’s well being.

A great idea I read from Beyerlein & Bloch (2014) to help smooth the transition into foster care was foster care orientation. This strategy would help answer any potential questions children might have, legitimize their traumatic experiences, and create an opportunity for foster care to affirm the importance and value of children. It would also help children understand what to expect while they are in foster care. Bronfebrenner (1979) defines development as an evolution of change that involves how one interprets their environment. He says, development is characterized by how the environment is perceived rather than its objective reality. Therefore having an orientation for when children enter foster care will help them adjust to their new environment and decrease feelings of confusion, anxiety, stress, fear and sadness. Beyerlein and Bloch (2014) discuss using child-level terminology to help further the understanding. These orientations should also have a rating scale for children to use after an orientation session to determine whether the child fully understood the session. A provision and description of normal feelings associated with entering foster care should also be communicated to help children comprehend what they are feeling. Beyerlein and Bloch (2014) emphasize the importance of these orientations taking place in a community setting to provide meeting grounds for other children. This will create a shared sense of experience and belonging and decrease feelings of isolation.

I think by changing the focus of foster care from provincial requirements towards a child performance focus, and creating children orientations, we can help smooth the transition into foster care and improve their developmental outcomes.

What do you think about children in foster care?

~Happy Blogging!~

Rachel

References

Beyerlein, B., & Bloch, E. (2014). Need for trauma-informed care within the foster care system: a policy issue. Child Welfare, 93(3), 7-21. Retrieved from http://0-eds.b.ebscohost.com.aupac.lib.athabascau.ca/eds/pdfviewer/pdfviewer?vid=3&sid=peb9693d-1f9f-46d8-8134-a33f65c8b446%40sessionmgr104

Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.

Bruskas, D. (2008). Children in foster care: A vulnerable population at risk. Journal of Child and Adolescent Psychiatric Nursing, 21(2), 70-77. doi: 10.1111/j1744-6171.2008.00134.x

Deutsch, S., & Fortin, K. (2015). Physical health problems and barriers to optimal health care among children in foster care. Current Problems in Pediatric and Adolescent Health Care, 45(10), 286-291. doi: 10.1016/j.cppeds.2015.08.002

Gretchen, P., Daly, M., & Kotler, J. (2012). Permanent stability in kinship and non-foster care: a Canadian study. Children and Youth Services Review, 34(2), 460-465. doi: 10.1016/j.childyouth.2011.12.001

Turney, K., & Wildeman, C. (2016). Mental and physical health in children in foster care. Pediatrics, 138(5), 1-11. doi: 10.1542/peds.2016-1118

Tweddle, A. (2005). Youth leaving care report. Retrieved from http://voices.mb.ca/wp-content/uploads/2016/03/Final_Youth_leaving_care_report_copy.pdf

Chronic Disease

Chronic diseases are becoming increasingly common and are a priority for action in the healthcare system. Did you know that about 1/3 of British Columbians are living with one or more chronic diseases? A further 2% are living with four to six chronic diseases (WHO, 2018). It is estimated that about 17% of the total population of British Columbia may be living with at least one undiagnosed chronic condition. Lifestyle factors such as physical inactivity and inadequate nutrition are heavily correlated with the development of chronic disease (WHO, 2018). In British Columbia, the percentage of individuals over the age of 12 who consume fruits and vegetables at least 5 times per day, is 43.5%. The percentage of individuals over the age of 12 who are physically active in their leisure time, is 59.3%. Students in grades 3,4,7,10, and 12 who report that at school they learn how to stay healthy, is 51%. These statistics are terrifying as the amount of energy consumed in relation to physical activity and quality of food are key determinants of nutrition related to chronic disease (WHO, 2018).

Thinking from a program director’s point of view, who is focused on health promotion through physical activity and lifestyle management, I chose to concentrate on obesity, diabetes, and hypertension for this week’s assignment.

Obesity is due to the imbalance between declining energy expenditures due to physical inactivity and high energy in the diet (excess calories whether from sugar, starches, or fat) (WHO, 2018). The Canadian Medical Association (2015) says health care providers need to recognize obesity as a disease so preventative measures can be put in place. Being overweight and obese can lead to serious health consequences including diabetes and cardiovascular disease.

In British Columbia in 2007/2008, men were more likely than women to report unhealthy weights, 52.8% compared to 36.3%. In comparison with the rest of Canada, British Columbia was found to have the lowest unhealthy weight for adults, with 44.5% of adults being classified as obese.

Figure 1. British Columbia gender based statistics of overweight or obese residents throughout the years of 2007/2008.

By simple adjustments to lifestyle habits, such as increasing physical activity and reducing intake of foods high in fat and drinks high in sugar, we can manage and prevent unhealthy weight gain and the development of other chronic diseases (Durstine, Gordon, Wang, & Luo, 2013).

Unfortunately, physical inactivity and poor nutrition can result in many other chronic diseases, for example diabetes. Diabetes is classified as a nutritional and metabolic disease. There are two types of diabetes, type I which is caused by the immune system destroying the cells in the pancreas that make insulin. There are no specified causes for this type (Diabetes, 2018). Type II diabetes is classified as a metabolic disorder, which results in high glucose levels in the body. Type II diabetes is caused by a multifactorial of triggers, but there are a variety of risk factors that increase the chance of developing this condition. Triggers include obesity, living a sedentary lifestyle, and a bad diet (Diabetes, 2018). Without management of individual lifestyle habits, such as physical activity and nutrition, diabetes can lead to increased risk of heart disease, kidney disease, stroke, and infections. An increase in physical activity and maintaining a healthy weight plays a critical role in treatment and prevention of diabetes (Diabetes, 2018).

In 2007/2008, 6.46% of the total population of British Columbia had diabetes, with 6.92% being males, and 6.01% being females.

Figure 2. British Columbia gender based statistics of individuals with diabetes through 2007 and 2008.

Analogously, other chronic diseases are also affected by poor lifestyle habits. Cardiovascular disease, with the inclusion of hypertension, is largely affected by an unbalanced diet and physical inactivity. Eating less saturated and trans fats, and sufficient amounts of polyunsaturated fats, fruits, and vegetables, and by participating in regular physical activity, will reduce risk of this chronic disease (Government of British Columbia, 2018).

According to British Columbia statistics, in 2007/2008 men were less likely to have hypertension than women, with 16.2% compared to 18.3% of women. A total of 17.2% of the total population of the province had hypertension.

Figure 3. British Columbia gender based statistics of individuals with hypertension throughout the years of 2007/2008.

In British Columbia, there are many chronic disease management (CDM) programs available to individuals with chronic health conditions. These programs provide ongoing care and support through medical care, knowledge, skills, and resources to manage individual lifestyles (Interior Health, 2018). Interior health services, the public health services in Kamloops and Interior of BC, offer services and support for chronic diseases such as: asthma, COPD, lung health, brain injury, chronic pain, diabetes, heart health, renal, stroke and TIA, mental health and substance abuse and more. Interior health suggests good chronic disease management includes proactive, team-based approaches that are well integrated with primary care. This management should be well coordinated across healthcare providers, is easily accessible, has a focus on health promotion and wellbeing, and encourages involvement of the individual and family in their care (Interior Health, 2018).

Within the city of Kamloops, there are many chronic disease programs. The Strategic Health Alliance (SHA) is a partnership between the city of Kamloops and Interior Health, to support rehabilitation exercise programing. Programs include the vascular improvement program, which is a one-year multidisciplinary program risk factor reduction clinic for cardio vascular conditions (City of Kamloops, 2018). The On Track Program, which is a physical activity program focusing on primary prevention of cardiovascular disease, hypertension, diabetes, depression, anxiety, and metabolic syndrome. It is a 10-12 week fitness program involving exercise, nutrition counselling, and goal setting for a healthy life style (RPP, 2018). There is a Pulmonary Rehabilitation Program, for COPD, emphysema, chronic bronchitis, chronic asthma, pulmonary fibrosis, and other lung conditions. This program provides education and rehabilitation for chronic respiratory conditions, utilizing group or individual counselling focused on self-management skills. There are two programs designed for individuals recently diagnosed with cancer; sensational survivors for women, and true nth for men. The SHA also offers a program called Keep On Moving, designed to help community members identify safer exercise options closer to home (City of Kamloops, 2018). I think it is important for every individual to develop healthy lifestyle habits. By staying physically active, and being conscious of the nutritional value in our food, we can begin to manage and prevent further advancement in chronic diseases.

Researching the various programs that Kamloops and Interior health have to offer, has further added to my excitement for the program director career I wish to have! I cannot wait to be apart of these programs, supporting individuals in their healthy lifestyles!

What are you passionate about?

~Happy Blogging!~

Rachel

References

City of Kamloops. (2018). Chronic disease programming. Retrieved from https://www.kamloops.ca/parks-recreation/programs-lessons-activities/fitness/chronic-disease-programming

Diabetes (2018). Cause of diabetes. Retrieved from https://www.diabetes.co.uk/diabetes-causes.html

Durstine, L., Gordon, B., Wang, Z., & Luo, X. (2013). Chronic disease and the link to physical activity. Journal of Sport and Health Science, 2(1), 3-11. doi: 10.1016/j.jshs.2012.07.009

Government of British Columbia. (2018). BC health reports. Retrieved from http://www.phsa.ca/population-public-health-site/Documents/BCHealth_Indicators_Report.pdf

Government of British Columbia. (2017). Guiding framework for public health. Retrieved from http://www.health.gov.bc.ca/library/publications/year/2017/BC-guiding-framework-for-public-health-2017-update.pdf

Government of British Columbia. (2018). Hypertension. Retrieved from https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/hypertension

Interior Health. (2018). Chronic disease management. Retrieved from https://www.interiorhealth.ca/YourCare/ChronicConditionDisease/Pages/default.aspx

Raising Profile Project. (2018). OnTrack. Retrieved from http://www.seniorsraisingtheprofile.ca/wp-content/uploads/2017/06/ProgramProfile_On_Track.pdf

WHO. (2018). Diet, nutrition, and the prevention of chronic disease: Report of the joint WHO/FAO expert consultation. Retrieved from http://www.who.int/dietphysicalactivity/publications/trs916/summary/en/

Promotion of Physical Activity through the Social Ecological Model

What is health? How is health explained and promoted? These questions have been at the forefront of discussion for the last couple weeks of my Master’s of Health Studies class. Health is determined by several interior and exterior factors of individuals and communities. The WHO states there are three main determinants of health; the social and economic environment, the physical environment, and a person’s individual characteristics and behaviours (WHO, 2018). These determinants include income and social status, education levels, social support networks, genetics, and more. Therefore to explain and promote health, various factors must be taken into consideration. Over the last 50 years, along side the development of the healthcare system, many health models have been established. These health models include; the Health Belief Model, the Relapse Prevention Model, Stages of Change Model, Social Cognitive Theory, and the Social Ecological Model. With my background in psychology, and career focus on health promotion, I like to think of health with a behaviour focus. Therefore I’m going to focus on the Social Ecological Model.

Ecological theories and frameworks present health as an interaction between the person and their ecosystem, which consists of their family, community, culture, and physical environment (Glanz & Rimer, 2005). The interaction between behaviour and environment contributes to both health and illness. The Social Ecological Model (SEM) consists of person-focused and environment-focused interventions to promote health. According to the SEM, human behaviour is shaped by reoccurring patterns of activity in different environments. In each of these environments, social roles, personal behaviours, and situational conditions influence a person and their well-being. There have been many versions of the social ecological model developed. The most common model used is the Ecological Systems theory by Urie Bronfenbrenner (1979). Bronfenbrenner’s work was influenced by Kurt Lewin’s proposition that both the person and the environment influence behaviour (Bronfenbrenner, 1979). In the Ecological Systems Theory, the primary influences are intercultural, community-level, organizational level, and interpersonal/individual. Bronfenbrenner describes these influences like Russian dolls.

Figure 1. Russian Dolls depicting the metaphor of how every level of influence affects one another. Retrieved fromhttp://www.ebay.co.uk/itm/5pcs-set-Russian-Nesting-Dolls-Matryoshka-Red-Babushka-Wooden-Stacking-Toys-Gift-/292340973865

The individual, the organization, the community, and the culture are all nested three different spheres. Actions in one sphere influence what happens in another sphere. The three spheres are called the microsystem, the mesosystem, and the exosystem (Bronfenbrenner, 1979). One interpersonal microsystem consists of the roles a person plays with in their social context, such as mother, father, sister, brother, friend etc. These microsystem roles can be learned, but also ingrained based on gender, ethnicity, and culture. Mesosystems are organizational factors that shape one’s environment, such as government policies, and norms of behaviour. Schools, companies, communities are examples of mesosystems. Exosystems are community-level influences that include norms, standards, social networks, media etc. One does not have to be an active member in the exosystem for it to influence them (Gregson, 2001).

Figure 1. Bronfenbrenner’s Social Ecological Model (1979).

An article by Boulton, Horne, and Todd (2017) used the Social Ecological Model for promoting physical activity amongst older adults. In my future career as a program director, my ambition is to promote healthy living through exhibiting the benefits of physical activity. During my undergraduate degree, I spent a majority of my time researching the effects of physical activity on cognitive development throughout the life spans. I also studied the effects of physical activity on cognitive decline in older adults. Physical activity is known to improve mental health, well-being, and cognitive functioning (Boulton, Horne, & Todd, 2017). The article by Boulton, Horne, and Todd (2017) held focus groups and semi-structured interviews with 60 adults between the ages of 50-87 years, to determine what they thought motivated them to be active and what might encourage them to change. Using the Social Ecological Nodel as a framework, researchers found five themes that influence physical activity; individual/interpersonal, relationships/interpersonal, perceived environment, community/organizational, and policy levels.

Figure 2. The Social Ecological Model explaining each level. Retrieved from https://www.slideshare.net/drswaroopsoumya/public-health-model

Figure 3. The Social Ecological Model for promoting physical activity amongst older adults from the Boulton, Horne, and Todd (2017) article.

Through discussion with participants, many areas were identified to affect the way older adults perceive their ability to remain physically active. At the individual level, factors such as maintaining health, and preventing physical decline, was an essential part of one’s identity. Knowledge of the physical and psychological health benefits of being active were identified to act as an incentive to be physically active. At the interpersonal level, the social element of engaging in physical activities was found to be a major motivator to be physically active. Relationships with others were established and maintained through attending activities with others. Other factors such as affordability, accessibility, enjoyment, weather, seasons, and time also influenced individual levels of physical activity (Boulton, Horne, & Todd, 2017).

There are many theoretical perspectives the researchers could have taken when looking at interventions to increase physical activity in older adults. However, the inclusion of multidirectional influences between people, their physical, social, and political environments in the SEM, is what makes this approach successful. I think when focusing on public health interventions to promote physical activity, a multilevel approach is necessary. Health and decisions about health are not made singularly. They are influenced by both interior and exterior factors in an individuals social, physical, and psychological environment. By taking all these factors into consideration, we can create successful intervention programs for individuals to make healthier choices.

For example in British Columbia, seniors make up 16.4% of the population in 2013, and will be between 24 to 27% by 2038 (Raising the Profile Project, 2018). Community-based seniors services play a critical role in supporting seniors to age in place by offering a broad range of services that support seniors to remain physically active, socially engaged, and as healthy and independent as possible. Raise the Profile Project (RPP) is a senior project in BC that focuses on helping seniors maintain positive health outcomes. RPP provides support programs in health and wellness areas such as management of health conditions, affordable housing, nutritional supports- meal services, nutrition education, access to fresh fruits and vegetables, community gardens etc., and accessible transportation. Services such as information, referral, and advocacy, which offer support on income benefit and support programs, housing services, health services, and community programs, are also provided. RPP provides education, recreation, and creative arts programs to provide an outlet for creativity, enhancing meaning in life and a sense of purpose (Raising the Profile Project, 2018). Seniors with a strong sense of purpose often live longer (Irving, Davis, & Collier, 2017). This project also offers a broad range of programming to support and promote physical activity! Specifically in Kamloops, where I live, there is a program called On Track. This program is offered through a partnership between the City of Kamloops and Interior Health, to support middle age and older individuals diagnosed with a chronic illness to increase their participation in physical activity and receive support from others to better manage their condition (Raising the Profile Project, 2018).

Interior Community Services in Kamloops also offers a program called FoodFit, where participants are immersed in the areas of cooking, nutrition knowledge, and physical activity. It is a 12-week long program offered to anyone in the community (Interior Community Services, 2018).

I think the best aspect of these programs, is that once you are in the program; a program director will help tailor the program to your specific needs. They will look at individual’s current health conditions, accessibility to resources such as transportation and food, physical activity levels, and cater the program to help you improve your own health. These programs take the social ecological model, and apply the different levels of influence to create personalized programs to meet each individual needs.

I think these programs are a great step to improving awareness of one’s health, nutrition, and promoting physical activity!

How do you keep motivated to be physically active?

~Happy Blogging!~

Rachel

References

Boulton, E., Horne, M., & Todd, C. (2017). Multiple influences on participating in physical activity in older age: developing a social ecological approach. Health Expectations, 21, 239-248. doi: 10.1111/hex.12608

Bronfenbrenner, Urie (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press

Glanz, K. & Rimer, B. (2005). Theory at a glance: A guide for health promotion (2nd ed). Bethesda, MD: U.S. Department of Health and Human Services, National Institute of Health. Retrieved from http://www.verpleegkunde.net/assets/health-promotion-theories.pdf

Gregson, J. (2001). System, environmental and policy changes: Using the social-ecological model as a framework for evaluating nutrition, education and social marketing programs with low-income audiences. Journal of Nutrition Education, 33(1), 4-15. doi: 10.1016/S1499-4046(06)60065-1

Interior Community Services. (2018). Interior community service programs. Retrieved from http://www.interiorcommunityservices.bc.ca/programs/location/kamloops-programs

Irving, J., Davis, S., Collier, A. (2017). Aging with purpose: Systematic search and review of literature pertaining to older adults and purpose. The International Journal of Aging and Human Development, 85(4), 403-437. doi: 10.1177/0091415017702908

Raising the Profile Project. (2018). Raising the profile. Retrieved from http://www.seniorsraisingtheprofile.ca/about/

Gender Differences in Health

This week in my Master’s (week 6) we were asked to study the determinants of health. During my research, I discovered a Canadian paper by Denton, Prus, and Walters (2004) that discussed gender differences in health. They studied the psychosocial, structural, and behavioural determinants between men and women to determine where gender differences can be attributed.

After my Master’s, I would like to become a program director that will design programs to promote health within the community. I thought researching the effects of psychosocial, structural, and behavioural determinants between genders would benefit later when I am working and encouraging healthy behaviours.

What makes someone healthy or unhealthy? At every stage of life, health is determined by a complex interaction between interior and exterior factors called determinants of health. The determinants of health include the social and economic environment, the physical environment, and the person’s individual characteristics and behaviours. The World Health Organization says to a large extent factors such as income and social status, educational level, our environment – access to clean water and air, safe houses, safe workplaces, our social support systems, genetics, and gender affect our health (WHO, 2018).

Gender-based inequalities are at the forefront of the news right now. These inequalities reflect the different social experiences and conditions of women and men’s lives. The results of these different social experiences are differences in mental and physical health. A study by Denton, Prus, and Walters (2004) proposed two hypotheses to account for gender inequalities in health. The differential exposure hypothesis suggests that women report higher levels of health problems because of their reduced access to material and social condition in life that foster health. Women also react greater to stress associated with their gender and marital roles. The differential vulnerability hypothesis suggests that women report higher levels of health problems because they react differently than men to material, behavioural, and psychosocial conditions that foster health.

According to the differential exposure hypothesis, women occupy different socio-economic locations than men. Women are less likely to be employed, more likely to have lower income, and do domestic labour (Denton, Prus, & Walters, 2004). There are also gender differences in exposure to various lifestyle behaviours such as smoking, drinking alcohol, and being active. Women tend to smoke and drink less than men, but are more likely to be inactive. Evidence shows that women report higher level of health problems because they are exposed to higher social demand and obligations in their social lives. Women also experience more stressful life events (Denton, Prus, & Walter, 2004). Based on the differential exposure hypothesis, differences in health between men and women are due to the inequality in socio-economic status. This difference needs to be eradicated. All women should be equally as employable, are provided equal wage, and have the same voice in the workplace as men. Having equality in socio-economic status between the genders would produce a healthier society.

The differential vulnerability hypothesis suggests that women are more susceptible to health problems because they react differently to social determinants. For example, women are more likely to report and react to stressors experienced by others, especially their spouse, while men are more likely to react to economic stress (Kessler & McLeod 1984). Social support is known to be a good predictor of health for women, in comparison to men. Smoking and alcohol consumption are more likely to be determinants of health for men, than women. Moreover, men and women experience the effects of stress and coping differently. Research proposes women react more to ongoing stressors than men do, due to the stress associated with their societal roles and role in their marriage. Based on the differential vulnerability hypothesis, these gender inequalities may persist due to the differences in societal roles, different life stressors, and events that will affect their physical and mental health.

While it is important to decrease the socio-economic differences between men and women, diminishing inequalities between the genders may not significantly result in a healthier community. Not only do men and women occupy different spaces and roles in life, they are affected by health determinants differently. These differences need to be taken into account when designing programs to promote healthy behaviours for both genders.

What do you think about the differences in socio-economic status for men and women?

~Happy Blogging!~

Rachel

References

Denton, M., Prus, S., & Walters, V. (2004). Gender differences in health: A Canadian study of the psychosocial, structural, and behavioural determinants of health. Social Sciences & Medicine, 58, 2585-2600. doi: 0.1016/j.socscimed.2003.09.008
Kessler,R. C.,& McLeod,J. D. (1984). Sex differences in vulnerability to life events. American Sociological Review, 49(5), 620–631. doi: 10.2307/2095420
WHO. (2018). Determinants of health. Retrieved from http://www.who.int/hia/evidence/doh/en/

Provincial Healthcare System Comparison: British Columbia versus Alberta

In week 6 of my Master’s of Health Studies 601 class, we were asked to pair up with a classmate from a different province and search for the divergence between provinces in terms of prioritizing health determinants. For this week, Catherine, a student from Alberta, and myself from British Columbia decided to pair up and compare the healthcare systems and priorities between our provinces, and against Canada as a whole. This blog contains; the chart we formulated to show the differences and similarities more easily, Catherine’s view point of Alberta Health, and my own view point from British Columbia.

Figure 1. A comparison chart of determinants of health for Alberta, British Columbia, and Canada as a whole.

Determinants of Health Alberta compared to BC.

The attached chart demonstrates the Regional differences between Alberta and BC’s approach to the priority setting regarding the determinants of health. For interest sake, the chart also outlines the priorities in relation to Canada’s Priorities that demonstrates the overall lack of correlation between the two.

The chart Rachel and I developed helped to identify the similarities and differences easily. Improving patient centered care and quality of services seems to be what underlines the framework for both provinces. Rachel points out that BC’s Health Agenda outlines four themes, providing effective health promotion, prevention and self–management to improve health; meeting the majority of health needs with high quality primary and community based healthcare and support systems; ensuring high quality hospital care services are available when needed and finally; improving innovation, productivity and efficiency in the delivery of health needs. It was interesting to note how similar the provinces are in their direction of healthcare. I will attempt to align AB, BC and the Glenrose (where I work) as I demonstrate AB’s Health Plan below.
Alberta has a clear Health Plan that provides direction for 2017 – 2020. The chart shows Alberta’s Health Plan and outlines Alberta Health Services vision, goal, purpose and foundational concepts.

The first, Improve Patients’ & Families Experiences. The outcomes include seamless transfer of care, involve patients in their care and decision making and improve access. This change has been developing over the past several years as a result of people having more access to health information and making more demands to be involved. Patient journey and positive patient experience is directly linked to better health outcomes. When people feel valued and heard they are receiving that psychosocial support / social support that is one of the determinants of health.

BC’s overall goal to Improve patient centered care and quality of services aligns well with AB goal to improve patient experience. Although not stated in the same way the outcome matches

At the Glenrose Rehabilitation Hospital this concept has been realized over the past few years in many ways. We have hired two patient and family advisors that sit at tables where decisions are being made. We have formed a Quality Improvement Team with the goal of improving patient outcomes. We have implemented patient stories at meetings to be cognizant of our patients being the center of our care.

The second AB goal is to Improve Patient & Population Health Outcomes. This highlights Alberta’s goal to improve the health of Indigenous population, reduce and prevent harm to patients in our facilities and health promotion and disease and injury prevention with an emphasis on child immunization. This goal encompasses the recent rise of the opioid crisis. This goal is a great example of health issues that have affected us on a national, provincial and community level and demonstrates the need for a collaborative system approach as well as individual community response.

Again, BC’s overarching goal of improving patient centered care supports the ideology above. However, BA’s goal of meeting the majority of health needs with high quality primary and community based healthcare and support systems, demonstrates both provinces commitment of meeting the needs of resident’s and improving patient and population outcomes. They are just going about it in a different way.

At the Glenrose we have responded to this goal by creating ‘Leader Rounds’ where leaders meet with patients and discuss opportunities to improve process. There is continued focus on fall reduction strategies as well as improved process for medication delivery. We have Naloxone available on our units at all times, in response to the fentanyl issue. Our Indigenous patients have opportunity to attend an in-house smoke grass ceremony and all staff are required to take a course on cultural sensitivity. There is a strong emphasis on creating strong community partnerships and increasing patient flow.

Alberta’s third goal outlines the need to Improve the Experience & Safety of Our People. The plan is to improve workforce engagement, reduce disabling injuries, building leadership capabilities and fostering an inclusive workplace and build a culture where people enjoy what they do. Building a healthier workplace is a win win for patients and staff. Developing a sense of community reflects in work relationships and directly results in best patient care.

BC calls it ‘ensuring high quality hospital care services are available when needed’. AB’s ‘safety of our people’ and BC’s ’high quality hospital care’ are basically saying the same thing, you cannot approach one without the other. Although BC is referring to patients and AB is referring to ‘our people’ (staff), when you make a change with one, there are positive result for both.

AHS initiated a Gallup Survey for all staff that would provide a benchmark that would identify the satisfaction of the employees. Safety, regarding equipment use and the delivery of patient care causes injury. AHS has made a commitment to ensure the proper equipment is used for patient care to protect staff from injury. Also as a result of the Gallup survey they have requested all site leaders/managers to respond with an action plan that would address the mental health concerns of their staff. AHS has sanctioned the use of the ‘Not Myself Today’ program where leaders/managers are to have discussions with staff and use tools that will open dialogue about mental health in the workplace and reduce stigma. At the Glenrose all leaders/managers were required to participate in a two day mental health first aid course.

Finally, the fourth goal of Improving Financial Health & Value for Money demonstrates the need and commitment of reducing costs and improving efficiencies. The costs of health in Alberta is 21.4 billion per year, 2.4 million every hour and 54 million a day and in the present socio – economic climate, this is not sustainable.

BC and AB’s fourth goal are perfectly aligned. BC states improving innovation, productivity and efficiency in the delivery of health needs and AB states improving financial health & value. The cost of health affects all of the provinces so it is no surprise that each have committed to reduce costs, find efficiencies and be innovative in the delivery of health care.
The price of oil highly influences Alberta’s health spending. Over the past three years the leaders/managers have been expected to hold vacant position, reduce spending, and forgo any wage increases. We have had to ask our staff to work smarter not harder as a result of the addition workload added to them. This socio economic issue influencing our inability to provide a Cadillac service on a Honda budget has and continues to be challenging.

Alberta’s Alignment with Canada’s Goals?

Rachel and I thought it interesting to note not only the differences of the priorities between our provinces, but we also wanted to know how the provinces align with Canada’s overall priorities. (see Rachel’s forum post / blog for the discussion on BC)

‘Improving patient and population health outcomes’ and ‘Improving the experience and safety of our people’ dovetail within Canada’s wanting to build safe and healthy communities. However, when you look at Canada’s first four goals, Alberta has totally missed the mark.

It is important when trying to address the determinants of health from a structural perspective we need to look at the socio economic and political context nationally and provincially. It is conflicting when the goals do not align. It is difficult for consensus when we are creating a plan at a national level and ignoring that plan at a provincial level. It is important to create individual provincial plans for many obvious reasons, however it would seem that without the support of the provinces, the national goals would not be met. Perhaps by engaging all provinces to participate in creating an overarching plan for a National Health Plan, the national plan would have opportunity to succeed. This plan could be used by the provinces as a place to start their individual provincial plans. The Prime Minister might look to Alberta as a model for engaging people to participate in a health care plan.

By Catherine

Determinants of Health BC compared to Alberta

Catherine and I thought it would be a great idea to show the differences and similarities between our provinces health care systems through a chart, and then describe individually how our systems operate. What I noticed when discussing with Catherine, and through completion of our chart was the vast amount of similarities between British Columbia and Alberta health. Both provinces have very clear plans for managing their communities’ health. Alberta has a Health and Business plan with four organizational goals; 1) improve patients and family experience, 2) improve patient and population health outcomes, 3) improve the experience and safety of our people, and 4) improve financial health and value for money. Catherine explains Alberta Health Care in significantly more detail.

Health care in British Columbia operates under The Innovation and Change Agenda, which focuses on driving change in areas of prevention, primary care, home and community care, and hospitals. The framework for this agenda has a vision of delivering a patient-centered culture across all health sectors, programs, and services, while improving quality of service outcomes. The Innovation and Change Agenda has four major themes, the first being: providing effective health promotion, prevention, and self-management to improve health and wellness in British Columbia. The second key theme is meeting the majority of health needs with high quality primary and community based healthcare and support systems. Third, ensuring high quality hospital care services are available when needed. Fourth, improving innovation, productivity, and efficiency in the delivery of health needs. The goal is to achieve system-wide improvements, not only from population wellness, patient health, and quality of life perspective, but also from a budget management perspective. With the help of this framework, the provincial government would like to provide effective health interventions to address all major factors across the life cycle related to chronic disease. They would like to reduce hospitalization and the need for residential care by preventing slowing down the onset of frailty through targeted efforts to better manage the patient journey. To create effective community services for patients with moderate to severe mental illness and addictions to reduce hospitalizations, and increase timely access to evidence informed care from specialists, diagnostic imaging, and elective surgery to reduce wait times. They would like to provide consistent quality of care for residential care patients, with a strong focus on quality of care for dementia patients, and provide effective and compassionate end of life care. In support of these improved outcomes, seven priority areas (shown in the chart) have been identified along with seven accompanying strategies to reach these outcomes.

This framework has provided opportunity for many large system strategy organizations to arise. Some strategy organizations include Healthy Families BC – a provincial prevention strategy, establishment of a First Nations Health Authority – to close health gaps for aboriginal people, BC Patient Safety & Quality Council, and Patient Care Quality Review Boards. The Minister of Health and the British Columbia legislation manage the Innovation & Change Agenda along with the many strategies to improve the health of individuals in our communities. Strategies such as a shared plan of action across all sectors of the healthcare system, accountability to providing quality improvements across the health care system, skilled change management, a health human resource strategy that develops an engaged, skilled, well-led, and healthy workforce, and to constantly update information on management, technology, and budget management.

While the framework for Alberta and British Columbia’s healthcare systems are rather comparable, there is one major difference: the execution of their health plans. In Canada, we have a publicly funded healthcare system. Therefore all the residents have reasonable access to medically necessary hospital and physician services without paying out-of-pocket. The federal government provides health care funding to each of the provinces and territories. This primary healthcare does not include all healthcare services, such as vision care, dental care, prescription drugs, ambulance services, and home care. Therefore, each province provides supplemental healthcare coverage to pay for the services not covered. This healthcare comes at a cost. For British Columbia, the public health insurance plan is called the Medical Services Plan (MSP). Residents pay monthly MSP rates based off individual annual net income. Individuals who earn more than $30,000 must pay a flat monthly fee of $72. This means that people who earn $40,000 or $400,000 pay the same amount per month for health insurance.

All other provinces in Canada, including Alberta, have moved away from monthly premium charges and instead use provincial income tax, which is based on the premise that higher income earners would pay more than lower income earners. It is only BC that uses a regressive over progression taxation for healthcare. British Columbia may have an advance health care framework with many approaches to providing quality services, but the execution of their healthcare plan is rudimentary. I think BC should upgrade and join the rest of the provinces in Canada to a progressive system of health care funding.

Catherine and I thought it would be interesting to compare no only the differences in provincial priorities, but against Canada’s overall priorities. Similarly to Catherine’s piece on Alberta, British Columbia focuses on ‘improving patient and population health outcomes’, and ‘improving the experience and safety of our people.’ When comparing to the first four of Canada’s priorities in our chart, BC also misses the mark. I think in addressing health from a provincial and national level, we need to take into consideration not only health at a population level but at an environmental level. Each province has a unique set of environmental resources that make money for the Canadian government. For example: British Columbia has mining and forestry, Alberta has oil and mining, Saskatchewan has potash & uranium mining, oil, along with agriculture. I think it is important to look at the effects of harvesting these resources on our environment. By making the ground of our provinces’ a priority, we would align with Canada’s first four priorities, and the health our country would increase.

Figure 2. British Columbia’s framework for meeting health needs

Figure 3. British Columbia’s key themes for delivering quality health services

Figure 4. British Columbia pairs the expenditures of their healthcare system against other provinces. British Columbia spends the second lowest amount in Canada.

~What do you think about Canada’s Health Care System?~

Rachel

Who or WHO’s Definition of Health?

What does health mean to you? The definition of health seems to vary between individuals, cultures, and countries. Health from a Western perspective is described as the potential that individuals have at their disposal to master the short, medium and long-term demands of their life (Bircher, 2005). From an Eastern perspective, health is thought of in a slightly different but similar manner. Human beings are thought to be made up of energy systems, and to maintain health, the energy systems flowing between the mind, body, and environment must be balanced (Carlson, 2003). Through either perspective, health is a result of complex and dynamic interactions between physical, mental, and social challenges in life.

When looking back over the past 100 years, the definition of health has changed tremendously. Early definitions of health focused on the body’s ability to function (Bircher, 2005). A disruption of normal state caused by disease was viewed as unhealthy. In 1948, the World Health Organization (WHO) modernized the definition of health to include mental and social dimensions. Health was “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity” (Bircher, 2005). Although the WHO’s definition did broaden the view on health over all, it lacked insight into individual health needs, the differences in cultural views on health, and the amount of available resources for diverse age groups.

One major criticism of the WHO’s definition of health is that it no longer defines health in the 21^st century given the rise of chronic diseases. In 1948, illness and chronic disease used to lead to an early death. With the healthcare available now, there is improved nutrition, hygiene, sanitization, and stronger healthcare interventions, which have changed the patterns of disease and mortality rates (Huber, 2011). Ageing with chronic diseases has become common. The WHO definition describes individuals with chronic diseases as unhealthy. Using the WHO definition, individuals who experience headaches, back pain, stomach pain etc. would also be classified as unhealthy (Clouser et al., 1997). Where we know this is not the case. Individuals whether they have a chronic disease or not, have the ability to meet the demands throughout their life. I think a new health definition should be based on one’s capability to cope and self manage their own well being throughout their life span.

I think it is important to include individual’s culture and age in the definition of health. The demands of life vary with the lifecycle. For example young children and older adults tend to require more healthcare than younger adults (Bircher, 2005). Throughout these developmental periods the amount of healthcare expenditures have been found to be at their greatest (Bircher, 2005). This does not mean these individuals are less healthy, they only require additional resources to maintain their health.

A person’s cultural background can also have profound effect on their health. Culture works at all levels; it affects health disparities, individual health outcomes, communication and interactions with doctor-patient relationships, and the illness experience (Rassool, 2015). For instance, among Asian/Pacific Islanders in the U.S., the oldest male in the family is often the decision-maker and harmony within interactions is viewed as important. Therefore many patients may not voice their concerns, or follow treatment recommendations (Cutler & Meara, 1998). From an article by Rassool (2015), individuals from the Muslim culture often have specific privacy, modesty, and dietary requirements, including the need to avoid medication with alcohol. Therefore, before classification of someone’s health status, their personal values, culture, and ability to meet the demands in their life must be taken into consideration.

Overall, modernization of the WHO’s definition of health is necessary. A new definition should conserve the importance of the separate physical, mental, and social well being described by the WHO, but should take into consideration an individual’s culture, values, age, and ability to cope in life regardless of their chronic health issues. In an article by Bircher (2005), the author described a possible health definition that I thought was quite fitting: Health is a dynamic state of wellbeing characterized by a physical, mental, and social potential, which satisfies the demands of life commensurate with age, culture, and personal responsibility for maintaining one’s wellbeing.

Although there are other areas of improvement in the WHO’s 1948 definition of health to make it more inclusive and plastic, I thought these were of greatest importance.

~Happy Blogging~

Rachel

References

Bircher, J. (2005). Towards a dynamic definition of health and disease. Medicine, Health Care and Philosophy, 8, 335-341. doi: 10.1007/s11019-005-0538-y

Carlson, J. (2003). Basic concepts. In J. Carlson (Ed.), Complementary therapies and wellness (pp. 1-8). Upper Saddle River, NJ: Prentice Hall.

Clouser, K, Culver, C, & Gert, B. (1997). Malady. In J.M. Humber & R.F. Almeder (eds.), What is Disease? (pp.173-217). Totowa, NJ: Humana Press.

Cutler, D., & Meara, E. (1998). The medical costs of the young and the old: A forty year perspective. National Bureau of Economic Research, 98, 215-246. Retrieved from http://www.nber.org/chapters/c7301.pdf

Huber, M. (2011). Health: How should we define it? British Medical Journal, 343(7818), 235-237. doi: 10.1136/bmj.d4163

Rassool, GH. (2015). Cultural competence in nursing muslim patients. Nursing Times, 111(14), 12-15. Retrieved from https://www.researchgate.net/publication/274254735_Cultural_competence_in_nursing_Muslim_patients

Stokes, J., Noren, J., & Shindell, S. (1982). Definition of terms and concepts applicable to clinical preventive medicine. Journal of Community Health, 8(1), 33-41. doi:10.1007/bf01324395.

Who Are You on Social Media?

Every week in my Master’s class, we are asked a variety of questions. Last week our focus was on social media and professionalism within those platforms. We were then asked to comment our own social media activity. I found this to be a very interesting topic of conversation because I personally struggle with seeing the advantages of social media over the detrimental effects. Coming from a psychology background, I tend to look at the effects of social media on individuals, and then communities as a whole. I understand that social media is great for networking and communication with others, it is a way to share information, events, and news quickly, but at what expense? What about individual mental health, self-esteem, and the effects on development?

A fascinating TEDtalk by Danya Bashir called Social media: The Double Edge Sword (TED, 2015) discussed how the 1990 generations and on are called the “now” generation. Due to the advancement of the Internet and social media, this generation has constant access to information and people to share it with. Before social media, in order to take a photo people were required to have a camera and film. After taking the photo people had to take their film to the photo centre and wait for it to develop before they could share it. Now, all you need is one device. Within seconds you can take a photo, post it, and share it with the world. Unfortunately, there is one catch. Once this photo, or status update is shared, it is online forever. I find people tend to forget this. It does not matter whether you delete the original post, or delete your account, your post can always be found. Your future employers can see those photos or status updates.

Personally, I do not tend to post a lot on social media platforms. I do have Facebook, which I use to keep in contact with friends and family and to post the odd travel photo. This platform is kept to maximum privacy from the outside world. I do not feel anyone else should be able to see more of my life than I chose to show them.

I do use Instagram as well. This platform is also used to maintain connection with friends and family and to share my travel photos. Instagram has become my main way of networking with individuals from different provinces and countries. For example, I made some friends while travelling in Europe in November 2017 and Instagram is our line of communication. We talk through direct messaging a couple times a week. We find using a telephone difficult as there is a 19+ hour time difference between us! (She lives in Melbourne, Australia). That is the extent of my social media existence.

If I could, my goal would to be as non-existence as possible on social media. After my master’s, my goal is to work as a program co-ordinator designing programs to help keep individuals active and our communities healthier. If my presence must be on social media, I would like it to only reflect my love for fitness, my goals of a healthy community, my objective to lower the rates of young individuals being exposed to risk as they develop, and to teach them healthy behaviours so they become habits in adulthood. I would like the public to see my determination and my hard work in striving for the career and life that I want. I would also like to show the world I have an open-mindset and am open to opportunity. (I love to travel!) This is what I find important and this is what I think social media should be used for.

Who are you on social media?

~Happy Blogging!~

Rachel

References

TED. (2015). Danya Bashir: Social media: the double edge sword. Retrieved from https://www.youtube.com/watch?v=5zW6EnysDcw