Musings on MHS601: Just Like The Beatles, (Let's Put it) All Together Now
- sflevac
- Apr 4, 2021
- 8 min read
Introduction
My first Masters of Health Studies course started by looking at my role within the Canadian health system. As my ePortfolio describes, I am the Clinical Manager for Infection Prevention and Control (IPAC) in a Northern Ontario Hospital. I am also a registered nurse, and am a member of the College of Nurses of Ontario, a regulated profession. As such I am required to follow professional guidelines. I believe in certain values that align with the Registered Nurses of Ontario Association, an advocacy group that I also belong to.
Social identity and online presence are important to recognize. Appropriate social media indicates how I represent myself. When I did searches of my name, no real surprises came up as I had previously done a review to ensure professionalism. Throughout this the course, we examined determinants of health, levels of influence on health, chronic diseases, Indigenous health, vulnerable populations, and finished by looking at the future of health. I considered many of these topics in relation to infection control.
Defining Health & The Determinants of Health
According to the government of Canada website, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.“
The Ottawa Charter for Health Promotion affirms social, economic and environmental aspects of ‘health’. This important Canadian document states that, in order to be healthy, “an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment”. In this way, health is seen as a resource or an asset that helps us lead our everyday lives. Health is seen as a positive concept that emphasizes social and personal resources, as well as physical capacities.
Public Health Ontario defines Health Equity: “Health equity is created when individuals have the fair opportunity to reach their fullest health potential. Achieving health equity requires reducing unnecessary and avoidable differences that are unfair and unjust. Many causes of health inequities relate to social and environmental factors including: income, social status, race, gender, education and physical environment.”
All of this refutes the very simplistic definition of health described by the WHO over seven decades ago. How should one define health? Is it only the absence of disease, or is it much more complicated yet easily defined?
Ereshefsky (2009) suggests that there are three main views: Naturalists who refute giving values, normativisits believe health and disease are or reflect values and judgments, and hybrid theorists look to combine both the naturalists’ and the normativists’ points of view.
Public Health Ontario has developed an interactive site with the following qualifiers which are tracked and may be understood as to the importance by Ontario Government what Social Determinants of Health are priorities:
● Material Deprivation
● Ethnic Concentration
● Dependency
● Residential Instability
● Low Income
● Government Transfers
● Employment
● Receiving EI
Levels of Influences on Health
We next looked at levels of influence on health. The different levels of influence of health are closely related to the determinants of health and allow us to learn about what impacts health. For this part of the course I looked at the social ecological model and how it affects People Who Inject Drugs (PWID).
The social ecological model states that behaviour is shaped by numerous factors at multiple levels, including individual, interpersonal, organizational, community, and public policy (Kim et al., 2009).
Mental health and addictions is a term used to cover a wide range of issues. The Ontario Ministry of Health reports:
Directly, or indirectly, mental illness and addictions affects one in five Ontarians. It can affect our personal lives, extended families and workplaces. It also affects Ontario's health care system and the provincial economy…
One hospital in Calgary decided to provide safe injections within its facility. Studies show that PWID use unsterile supplies and are infecting themselves, and allowing safe injections in an acute care setting will help decrease infections (Wituik, 2019, Sharma et al, 2017). As the manager for Infection Prevention and Control (IPAC), my team of Infection Control Nurses (ICNs) is responsible to send out notifications of exposures of staff who were not wearing the appropriate personal protective equipment (PPE) to the Occupational Health and Safety Services (OHSS) department. Increasingly, these notifications are for infectious Group A Streptococcus (iGAS). From speaking with the ICNs many of the patients are repeatedly admitted for this and other infections which include, but are not limited to bacterial endocarditis, Methicillin-resistant Staphylococcus aureus (MRSA), Methicillin-sensitive Staphylococcus aureus (MSSA), Hepatitis C, and HIV. Research has shown that patients that inject IV drugs prior to admission continue to use IV drugs while in hospital.Abstinence-based approaches such as the one at many acute care facilities are known to be ineffective at prohibiting drug consumption.
From A review of Frameworks on the Determinants of Health, (2015), the socioeconomic model is most commonly used. Utilizing this, one tries to understand and subsequently support an initiative such as the one in the Calgary hospital.
Chronic Disease
Managing chronic diseases is everyone’s responsibility. It is done by primary care (physician/NP/family health teams), tertiary care - hospitals (admission of patients, out-pt. clinics), Ministry of Health/Ontario Health, Home and Community Care (under the Local Health integrated Networks), pharmacies (pharmacists), Public Health Units, but most importantly those who live with chronic diseases: the patients and their caregivers. Holman and Lorig (2004) note:
· There is no cure for chronic disease; instead, management over time is essential.
· For effective treatment of chronic disease, the patient must engage continuously in different health care practices.
· The patient knows the most about the consequences from the chronic disease and its therapies, and must apply that knowledge to guiding the management over time.
· To achieve effectiveness and efficiency in treatment, the patient and health professional must share complementary knowledge and authority in the health care process.
Funding
According to the Ontario Auditor General’s report for the fiscal year 2016/17, the “Ministry of Health and Long-Term Care spent $1.2 billion on public health and health promotion programs. Public health units received $702 million (58%) and PHO $163 million (14%) of provincial public health funding. Overall, Ontario spent about $192 million (16% of total public health spending) on preventing chronic diseases.”
From the PHO website, I was able to find the most recent information on these three chronic diseases and their incidence (age standardized as all adults 20 years and over, rates are per 100 000 population):
· Diabetes 855.7
· COPD 544.6
· Hypertension 1876.3
Primary Determinants
Primary determinants can vary in a large province like Ontario. The highest population in the country is situated within the Greater Toronto Area (GTA). There is a vast immigrant population there, and many live in substandard housing. In contrast, the far north is almost exclusive to the indigenous population, and by their very distance from main towns/cities (and many lacking roads except in winter), food insecurity and housing insecurity are important factors which contribute to chronic diseases.
From the image below, it can be concluded that these are some of the determinants of these three chronic diseases:
· COPD – smoking/education
· Hypertension – diet/poor exercise/education
· Diabetes – genetics/age/poor exercise/diet
(From Preventing and Managing Chronic Disease: Ontario’s Framework 2007)
Vulnerable Populations
Many vulnerable groups that experience poor health in Canada. Some of the groups the class identified were Indigenous peoples, older adults, and children. From a personal perspective, sadly, with working in several northern communities including having to medivac from small communities, I have witnessed much discrimination. From labelling as "frequent flyers", "alcoholics", to discussing how some got to where they are as "what do you expect when then live in the 'third world'", it was very upsetting and frustrating to hear these conversations. What upsets me more is not until about 10 years ago did I ever start to speak up.
Looking Forward & Final Thoughts
Examples of health transformation that has and will continue to evolve include Telemedicine, Ontario Telemedicine Network (OTM), including Patient Care via eConsult - with specialists, eVisit - real-time video visits with patients and other providers via room-based, desktop or mobile available, and eCare - apps and other devices to monitor and coach patients to manage their condition at home, and Professional Development via eLearning with a library of resources, archived learning videos, peer-reviewed literature and other clinical information and ePodium - live learning events via video and webinars on how to use telemedicine services.
Marr (2020) describes five trends in healthcare, such as virtual care/remote care, genomics and gene editing, data and Artificial Intelligence (AI) which drives shift to fairer healthcare insurance and coverage (noting this is an American author and perspective), AI, Internet of Things (IoT) and Smart Cities (improve our ability to detect and respond to future outbreaks). Bublitz et al (2018) also spoke to some of these concepts concluding that while AI, IoT and Blockchain, “have great potential to support initiatives integrating health and environmental data, including potential to be part of a pan-Canadian surveillance system, there are some limitations and challenges related to the use of these technologies in health surveillance that should be addressed”. Blockchain is defined by Chen et al (2019) as a “system for storing and sharing information that is secure because of its transparency. Each block in the chain is both its own independent unit containing its own information, and a dependent link in the collective chain, and this duality creates a network regulated by participants who store and share the information, rather than a third party”.
Smart hospitals (Guran, 2020), pharmaceuticals that are formulated on an individual’s genetics, (Marino, 2019), genomics (Marr, 2020, Schlake et al, 2012), and drone deliveries (Scott and Scott, 2020) are some of the areas being considered for future transformation of healthcare. The COVID-19 pandemic has expedited some of this transformation, as well as highlighting some of the limitations and ethical considerations that are involved with the decision-making processes by those in power, whether by politicians and their political parties, bureaucrats, or businesses.
References
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Erit, P. (2019). Distruptive Technologies for Environment and Health Research: An
Overview of Artificial Intelligence, Blockchain, and Internet of Things.
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Canadian Council on Social Determinants of Health: A Review of Frameworks on the
Determinants of Health, May 20, 2015, retrieved from
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Heathcare: A Patient-Centered Model. Biomedical journal of scientific & technical
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CCO and Ontario Agency for Health Protection and Promotion (Public Health Ontario). The
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