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Introduction
Over the past several months, I have had the opportunity to learn more about myself as a professional. A deeper understanding of Canada’s health care system, both federally, and in my home province of Manitoba, has given me a better perspective on where I fit within the system. It has allowed me to reflect on my professional identity and has expanded my vision of what I can bring to my profession along with increased awareness and knowledge from my learning experiences.
In this course, I have explored the many factors that have influence on people’s health in Canada. My journey has included defining health, understanding the social determinants of health, using a multilevel model of health approach, examining chronic disease and prevention, identifying vulnerable populations, researching future directions in health care and, finally, applying these principles to my professional practice.
What is Health?
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In 1948, the World Health Organization (WHO) defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO, 1948). Many scholars are asking if this definition is still relevant today. The word “complete” in the WHO definition appears to imply that an individual must be totally well in every aspect of their life in order to meet the criteria of being in a healthy state. Oleribe, Ukwedeh, Burstow, Gomaa, Sonderup, Cook, Waked, Spearman & Taylor-Robinson (2018) question whether it is even possible for an individual to be without any physical, mental or social challenges. Prior to researching the definition of health, I had not considered what it’s definition might mean. I think it is imperative for professionals who work with clients in the health care field to have a solid perception of what health means to them and how they distinguish between good health and poor health. In this way, they are able to allow this personal definition to guide them in their professional practice. While a new definition has yet to be created, it is clear that the health care needs of the world’s populations change over time and our concept, as well as our definition of health, will need to change with it.
Social Determinants of Health
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The World Health Organization defines the social determinants of health as the non-medical factors that influence health outcomes (World Health Organization, n.d.). The Government of Canada (2020) describes the determinants of health as a broad range of personal, social, economic and environmental factors that determine individual and population health: These factors include:
· Income and social status
· Employment
· Education and Literacy
· Physical environments
· Social supports
· Healthy behaviours
· Access to health services
· Gender
· Culture
· Race (Government of Canada, 2022).
Health inequity refers to the differences in the health status of individuals and groups that are unfair or unjust and modifiable (Government of Canada, 2022). With the concepts of health inequity and the social determinants in mind, I have focused my research on the health of Indigenous populations in Canada. Most of the Indigenous clients I work with experience the negative impacts of the social determinants of health resulting in poorer health outcomes. From my research on this topic, I have become aware of the reciprocal nature of these factors and how they affect my clients. I now have a much deeper understanding of the multiple challenges they face. With this in mind, my goal is to tailor my recommendations to each individual’s circumstances in an effort to ensure the best outcome for them.
Multilevel Model of Health
Socio-ecological model: framework for prevention, centres for disease control. Available from the Centres for Disease Control and Prevention (CDC). http://www.cdc.gov/vioenceprevention/overview/social-ecologicalmodel.html. 4
When examining health inequities and the social determinants of health on populations, it is beneficial to view these concepts within a multilevel model of health perspective. The Social Ecological Model (SEM) is a framework used to understand the multiple levels of influence within our society and how individuals and the environment interact within this social system. The levels include the Individual level, the Interpersonal level, the Organizational level, the Community level and the Public Policy level. The reciprocal nature of the model demonstrates the interaction between the levels. When working with clients, this interconnection can be viewed as an opportunity for intervention to influence health behaviour change. From studying this model, I have learned that changing one aspect of influence in a client’s life, could result in a positive change in another area of that client’s life.
Fig. 1. Ecological model for understanding obesity in children, which illustrates the reciprocity among levels that influence active living, the consumption of healthy foods, and weight status, and which recognizes that historical factors encompass and influence all ecological levels. (Willows, Hanley & Delormier, 2012).
I applied the SEM to garner a better understanding of obesity among Indigenous women in Canada. The socioecological model offers a framework to represent the reciprocal interaction between individual behaviours and the environment in the development of obesity (Willows, Hanley & Delormier, 2012). This model illustrates the interconnectedness between levels of influence and their impact on individual health. For example, it demonstrates that the food choices people make are influenced by factors within their environment and interactions between these factors. As a health practitioner, I can use this model as a tool when working with Indigenous clients who struggle with obesity. I can explain to clients how they are impacted by their environment and help them to pursue opportunities for change.
Chronic Disease Prevention and Management
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Chronic disease prevention and management are important factors to consider as our health care system faces current and future strain. In my work with Indigenous populations, the most common chronic diseases I encounter are diabetes, heart disease and obesity. Chronic health conditions tend to be interrelated and exacerbate each other. Therefore, most of my clients have more than one chronic disease condition impacting their health. Using data from the Canadian Community Health Survey, Kuwornu, Lix & Shooshtri (2014) found that overall, 38.9% of Aboriginal respondents in the study had two or more chronic diseases compared to 30.7% of non-Aboriginal respondents.
Most of the clients I work with have type 2 diabetes. The rate of type 2 diabetes was 3.5 times higher among First Nations Manitobans than among all other Manitobans. First Nations people with type 2 diabetes were also more likely to be female (Manitoba Centre for Health Policy, 2020). A study by Riediger, Lix, Lukianchuk & Bruce (2014), reported a significantly higher prevalence of obesity, abdominal obesity, dyslipidemia, and metabolic syndrome among First Nation’s women compared to First Nation’s men. I now have a more complete understanding of how diabetes, obesity and other co-morbidities are interrelated and are influenced by each other as demonstrated in the SEM. In light of this, I feel that taking a holistic approach to addressing my clients’ health concerns would be a more effective strategy.
Vulnerable Populations
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Many of my clients struggle to meet their basic needs such as housing, food and medical care. Through my research, I have come to recognize that this is a result of many interrelated factors. From a public policy perspective, the complex patchwork of policies under which Indigenous people receive health care funding has made it challenging for Indigenous people to access health services (Government of Canada, 2021). Under the Indian Act of 1867, traditional hunting, trapping and agricultural ways of life have been lost without being passed on to future generations, thus increasing their reliance on less healthy store-bought foods. On an individual level, many of my clients live in poverty, have low literacy and education levels, and experience unemployment and food insecurity. They may have limited knowledge of healthy eating and often lack the proper equipment and resources to prepare nutritious meals.
Indigenous peoples face persistent health gaps resulting from historic and contemporary traumatic experiences related to racism and colonization (Manitoba Health, Seniors and Active Living, 2018). They may experience discrimination and bias within the health care system. A story I presented during the course was the tragic case of Mr. Brian Sinclair who died in a Winnipeg hospital emergency room after waiting 34 hours to receive care for a bladder infection. The inquest that followed determined that Mr. Sinclair’s death was, at least in part, a result of bias and discrimination toward an Indigenous person within the health care system (Manitoba Courts, 2014). While there has been much progress in addressing some of the issues facing our most vulnerable populations, it is clear we still have work to do.
Future Directions
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While the outlook for vulnerable populations such as Indigenous peoples in Canada remains uncertain, there are many individuals and organizations working to ensure that future generations will have better access to equitable health care. The Truth and Reconciliation Commission of Canada released a summary report identifying 94 recommendations referred to as “Calls to Action”. This report states that redressing the legacy of residential schools and achieving reconciliation will have a direct impact on improving Indigenous health outcomes (Truth and Reconciliation Commission of Canada, 2015).
In my research of the literature, two recurrent themes that give us much hope and promise for a better future for Indigenous health in Canada include: (1) recruitment, retainment and mentorship of Indigenous staff and health care providers at all levels of the organization and the creation of working and learning environments where they can thrive and where their Indigenous knowledge is valued and (2) promotion, encouragement and support of Indigenous youth to pursue education, training and career opportunities within the health care sector (Richardson & Murphy, 2018). A better future for my clients will encompass the provision of health care by both Indigenous and non-Indigenous health care professionals working together to share their wealth of beliefs, culture, knowledge and expertise to create a more equitable health care system for all.
Future Professional Practice
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This course has been an incredible experience for me. I have had the opportunity to learn new ideas and concepts from my colleagues. I have expanded my depth of knowledge of Canada’s health care system, chronic disease prevention and management, models of health and the social determinants of health. I have taken an introspective look at myself as a professional. I have gained further insight into the issues facing vulnerable people in my care. I have grown in my ability to work on behalf of my clients with greater understanding, respect and compassion. I look forward to applying my newfound knowledge and skills in my practice every day.
References:
Government of Canada. (2021). Indigenous health care in Canada.
Government of Canada (2022). Social determinants of health and health inequities.
Kuwornu, J., Lix, L. & Shooshtari, S. (2014). Multi-morbidity disease clusters in Aboriginal and non-Aboriginal Caucasian populations in Canada – CDIC. Public Health Agency of Canada.
Manitoba Centre for Health Policy. (2022). Type 2 Diabetes in Manitoba.
Manitoba Courts. (2014). Brian Sinclair Inquest.
Manitoba Health, Seniors and Active Living (2018). Chief Provincial Public Health Officer Position Statement on Health Equity.
Oleribe, O. O., Ukwedeh, O., Burstow, N. J., Gomaa, A. I., Sonderup, M. W., Cook, N., Waked, I., Spearman, W., & Taylor-Robinson, S. D. (2018). Health: redefined. The Pan African medical journal, 30, 292.
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July, 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April, 1948.
Richardson, L. & Murphy, T. (2018). Bringing Reconciliation to Healthcare in Canada: Wise Practices for Healthcare Leaders.
Riediger, N., Lix, L., Lukianchuk, V. & Bruce, S. (2014). Trends in diabetes and cardiometabolic conditions in a Canadian First Nation community, 2002-2003 to 2011-2012. Preventing Chronic Disease, 11(E198), 1-8.
Truth and Reconciliation Commission of Canada: Calls to Action (2015).
https://www2.gov.bc.ca/assets/gov/british-columbians-our-governments/indigenous-people/aboriginal-peoples-documents/calls_to_action_english2.pdf
Willows, N., Hanley, A. & Delormier, T. (2012). A socioecological framework to understand weight-issues in Aboriginal Children in Canada. Applied Physiology, Nutrition and Metabolism, 37(1), 1-13.
World Health Organization (n.d.). Social Determinants of Health.
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