CNUR240 Week 4: Health Policy, Political Action, and Advocacy PDF

Week 4 Module Introduction This class delves into policies, political action, and advocacy in health promotion, focusing on the ethical issues related to these activities. We will examine how public policies can both contribute to and address poverty, homelessness, and economic...

Week 4 Module Introduction This class delves into policies, political action, and advocacy in health promotion, focusing on the ethical issues related to these activities. We will examine how public policies can both contribute to and address poverty, homelessness, and economic vulnerability, and explore the role of community nurses in policy development and advocacy. Policy, political action, and advocacy in community health are interconnected components that play critical roles in shaping public health at the community level. These elements involve developing, implementing, and promoting health policies, engaging in political processes to influence health decisions, and advocating for changes to improve health outcomes and reduce disparities. Health policy in community health refers to the decisions, plans, and actions undertaken to achieve specific healthcare goals within a community. These policies can address a range of issues such as public health, environmental health, and access to healthcare services. The primary goals of community health policies are to improve the general health of the population, address health disparities, and promote sustainability in healthcare. Effective policy development typically involves: Assessment: Identifying community health needs and resources. Planning: Setting objectives and deciding on strategies to address identified need. Implementation: Putting strategies into action. Evaluation: Monitoring and assessing the effectiveness of implemented policies. Political action involves engaging with and influencing the political system to support public health goals. This can include lobbying, participating in elections, engaging with lawmakers, and influencing public opinion to support health initiatives. Political action is crucial because political decisions directly affect health services, funding allocations, and legislative priorities. Key activities include: Lobbying: Advocating for specific health issues to influence legislation and funding. Campaigning: Supporting political candidates or movements that align with health improvement agendas. Building Alliances: Collaborating with other organizations and stakeholders to bolster influence over policy decisions. Advocacy in community health is the active support of policies and actions that promote health equity and access to healthcare within communities. Advocates work to bring about change by influencing those in positions of power, raising public awareness, and empowering communities. Effective advocacy often involves: Education: Increasing knowledge and awareness of health issues within the community and among policymakers. Empowerment: Helping community members gain the skills and resources needed to influence health decisions. Action: Organizing and mobilizing community members to participate in health-related initiatives. Public policies play a pivotal role in shaping the economic and social landscapes of communities and nations. These policies can both contribute to and address issues such as poverty, homelessness, and economic vulnerability. For instance: Regressive Tax Policies: These can disproportionately affect lower-income groups (e.g., flat taxes on essential goods), reducing the disposable income of the poor and exacerbating poverty and economic vulnerability. Insufficient Welfare Programs: Without adequate support during economic downturns or personal crises, individuals may be pushed toward poverty or homelessness. Lack of Affordable Housing Policies: This can lead to increased housing costs, pricing out low-income individuals and families, and contributing to homelessness. Employment Policies: Deregulation of labour markets without protective measures for workers can lead to job insecurity and poor working conditions, making it difficult for workers to maintain stable, adequate income. By understanding and engaging with these aspects of policy, political action, and advocacy, community health professionals can significantly impact public health outcomes and work towards a more equitable health system. Topics Health policy Political action Advocacy Poverty and homelessness Learning Objectives By successfully completing this module, you should be able to: Discuss levels of preventive measures Describe the differences and similarities among primary healthcare, primary care, health promotion and population health. Examine critically the community development as a strategy to empower people to gain control over the factors influencing their health. Investigate community-based participatory research as a strategy for working with communities to reduce health inequities and disparities while promoting health. Required 1. Etowa, J., Ashley, L. & Moghadam, E. (2020). Policy, politics and power in health care. Chapter 2 in L. L. Stamler, L. Yiu, A. Dosani, J. Etowa and C. Van Daalen-Smith (Eds.) Community health nursing: A Canadian perspective (5th ed.). Toronto: Pearson Prentice Hall. 2. Hardill, K. (2020). Poverty, homelessness and food security. Chapter 29 in L. L. Stamler, L. Yiu, A. Dosani, J. Etowa and C. Van Daalen-Smith (Eds.) Community health nursing: A Canadian perspective (5th ed.). Toronto: Pearson Prentice Hall. Videos 1. Introducing the Political Determinants of Health (3.50). PAEA online. 2. The Political Determinants of Health – Jessica's Story (5:18). Satcher Health Leadership Institute. 3. Advocating for Health-Promoting Policies. (3:06) Healthy School Campaigns. 4. What is Advocacy? (2:22). Advocacy Training for CHWs. Stanford Center for Health Education. 5. How advocacy makes a difference (3:30). The Advocacy Project. Historical Milestones in Health Promotion and Community Health Nursing in Canada Comparable Levels of Public Service In the Canadian Constitution Act, 1982, the federal government and the provinces commit to ensuring that all Canadians receive comparable levels of public services at comparable levels of taxation. Equalization Payments The federal government provides equalization payments to less wealthy provinces. This program is designed to help ensure that all provinces can offer reasonably similar levels of public services without having to levy disproportionately high taxes. Key Events 1947: Saskatchewan becomes the first province to establish a publicly funded healthcare system 1957: The federal government introduces the Hospital Insurance and Diagnostic Services Act, which provides funding to provinces that offer hospital services without direct charges to patients 1984: The Canada Health Act is passed, reinforcing five key principles for the Canadian healthcare system: o Public Administration: The system must be publicly administered o Comprehensiveness: All medically necessary hospital and physician services must be covered o Universality: All residents must be entitled to healthcare coverage. o Portability: Coverage must be maintained when moving between provinces or territories o Accessibility: Healthcare services must be accessible without financial or other barriers Paradigm Shift in Community Health Nursing Health Promotion and Disease Prevention 1974: The Lalonde Report, “A New Perspective on the Health of Canadians,” highlighted the importance of health promotion and preventive measures, influencing community health nursing practice and policy. 1986: The Epp Framework laid the groundwork for the Ottawa Charter. It highlighted the need to address the underlying causes of health issues, not just the symptoms, and emphasized strategies like health promotion, prevention, and community participation. 1986: The Ottawa Charter for Health Promotion was introduced at the First International Conference on Health Promotion. This charter outlined key strategies for health promotion, including the development of healthy public policies and supportive environments, which shaped the approach to community health nursing. Primary Health Care Goal The central aim is to provide comprehensive, accessible, community-based care that is essential for improving the health status of individuals and communities. It emphasizes the need for equitable access to healthcare services and addresses the broader determinants of health. The Epp Framework and the Ottawa Charter for Health Promotion have been pivotal in shaping modern health promotion strategies. Factors Influencing Community Health Nursing Emerging Diseases and Health Emergencies: Community health nursing must be adaptable to address new and evolving health threats. This includes managing outbreaks and responding to health crises. Public Health Agency of Canada (PHAC): PHAC plays a crucial role in: Protecting Health and Safety: Ensuring the health and safety of all Canadians. Preventing Chronic Diseases and Injuries: Focusing on prevention strategies to reduce chronic disease and injury rates. Responding to Emergencies: Coordinating responses to public health emergencies and infectious disease outbreaks. Strengthening Public Health Practice: Enhancing public health practices and promoting effective health strategies across the country. Indigenous-Specific Policies and Frameworks Limited Policies and Frameworks: There is a lack of comprehensive Indigenous-specific policies and frameworks in many regions.  Provincial Variations: Some provinces, like Ontario, have developed specific strategies and policies, such as Ontario’s Indigenous Health and Wellness Strategy (1990) and the Aboriginal Health Policy (1994). However, many provinces do not have specific legislative frameworks for Indigenous healthcare. Community Health Services Regional Health Authority Structures: Most provinces and territories have adopted regional health authority structures, aiming to integrate a broad range of health services, including community health nursing (CHN) services. Core Components of Health Services Primary Health Care: Focuses on comprehensive, accessible, community-based care. Primary Care: The first point of contact for clinical services. Public Health: Aims to enhance community health status and promote health equity. Cultural Competence: Essential for reducing health inequities and improving outcomes by ensuring that services are sensitive to cultural differences. Home Care: Provides safe, respectful, and dignified care to individuals in their homes. These elements collectively shape the delivery and organization of community health nursing in Canada, emphasizing the need for an integrated, culturally competent approach to meet diverse community needs. Policy, Politics, and Power Community health nursing (CHN) operates within a complex sociopolitical environment, where policy and politics play significant roles. Sociopolitical Context Policy Guidance: Policies shape and direct the work of community health nursing, impacting various aspects such as practice standards, funding, and resource allocation. Political Influence: Policy making occurs within a political context, meaning that decisions are influenced by political agendas, priorities, and power dynamics. Impact on Patient Care CHNs need to be aware of how policies and political decisions affect the quality, safety, and accessibility of patient care. This includes understanding regulations, funding mechanisms, and healthcare reforms. Impact on Working Conditions Policies also impact CHNs’ working conditions, including job security, professional development opportunities, and workplace safety. Health Equity and Social Conditions Undermining Health Equity: Health equity can be compromised when social conditions prevent individuals from making decisions or taking actions that would promote their health. These conditions can include socioeconomic status, education, access to resources, and systemic discrimination. Social Justice and Fairness Fairness in treatment and decision-making is central to social justice. This means ensuring that everyone has equal opportunities and resources to achieve good health, regardless of their background or circumstances. Addressing Systemic Disadvantage To promote good health for all, it is essential to identify systemic disadvantages and work towards removing them. This involves addressing structural inequities and ensuring that policies and practices do not perpetuate inequality. Navigating the Policy Environment Micro Level: CHNs must understand how individual and community-level factors, such as personal health choices and local resources, impact health equity. Macro Level: At a broader level, CHNs need to be aware of how policies, laws, and political decisions shape health outcomes and access to care. Strategic Engagement Advocacy: CHNs often need to engage in advocacy to influence policy changes that benefit patient care and improve working conditions. Education and Training: Enhancing knowledge and skills related to social determinants of health, equity, and justice. Collaboration: Building strong relationships with team members and understanding their roles facilitates effective collaboration and enhances the ability to navigate the political landscape. Challenges in Community Health Nursing  Community Health Nurses (CHNs) face several challenges that can impact their effectiveness and visibility. Some challenges they encounter include: 1 – Health System Challenges Need for Advocacy and Collective Action: CHNs often need to advocate for changes within the health system to address gaps and improve care delivery. Collective action and collaboration with other healthcare professionals and organizations are crucial for influencing system-wide changes. 2 – Lack of Role Clarity Greater Role Clarity Needed: The roles and responsibilities of CHNs can vary significantly across different regions and settings. This lack of consistency can lead to confusion and inefficiencies. Developing clear, standardized role definitions and expectations can help enhance the effectiveness and recognition of CHNs. 3 – Need for Strong Leadership Invisibility of CHNs: A lack of strong leadership can contribute to the invisibility of CHNs in the broader healthcare landscape. Effective leadership is essential for advocating for the role of CHNs, securing resources, and ensuring their contributions are recognized and valued. Nurse leaders must create and articulate a clear purpose and vision with a broad perspective incorporating multiple aspects of communities, the political environment, and the larger health and social systems. Attributes that support community and public health nursing practice include: management practice; organizational culture; and government policy. The Registered Nurses Association of Ontario created “Best Practice Guideline: Developing and Sustaining Nursing Leadership” to discuss the positive impact of leadership in the workplace and community. 4 - Issues in Interprofessional Relationships Need for Strong Organizational Supports: Positive interprofessional relationships are critical for effective collaboration and coordination of care. Strong organizational support, including clear communication channels and mutual respect among team members, is needed to foster these relationships and improve teamwork. Poverty in Canada According to Statistics Canada, the poverty rate in Canada was 8.1% in 2020. Racialized populations are more likely than non-racialized populations to be poor. Systemic barriers, discrimination, and socio-economic disadvantages contribute to these higher poverty rates. First Nation, Inuit, and Métis peoples face persistent inequities in accessing social determinants of health, including employment, housing, food security, and education. These disparities are rooted in historical and systemic factors, including colonization and systemic racism. Approximately 1.3 million children in Canada live in poverty, which translates to about one in five children. This high rate of child poverty has significant implications for their overall well-being and future prospects. 1 in 7 people living in homeless shelters are children. Impact of Homelessness Influence of neoliberalism can be seen in federal government decisions to cut funding for housing and social spending. Homelessness emerged due to dramatically reduced federal investment in affordable housing, structural economic shifts, and reduced spending on social safety nets. The Canadian federal Homelessness Partnering Secretariat estimates that about 150,000 Canadians use shelters every year across Canada. Indigenous people are vastly overrepresented among shelter users at between 27.7% and 33.5% (while comprising less than 5% of the general population). Indigenous people were overrepresented in all 13 Canadian cities and were at least 5x more prevalent in the homeless population than in the general population. Morbidity and mortality are higher in homeless populations. Homeless people’s higher morbidity is their inequitable access to healthcare. Fears related to dying alone, not being treated respectfully, and having their wishes disregarded. Who Is Homeless in Canada Rural homeless people tend to be much less visible. Homeless youth typically become homeless as they seek to escape difficult and traumatic environments, including problematic child welfare placements.  Women are more likely to head families experiencing homelessness, who typically stay in shelters twice as long as single adults. Food Insecurity Food insecurity in Canada is worsening 12% of households experienced some level of food insecurity Food insecurity predicts poorer overall physical and mental health and can lead to nutrient deficiencies and chronic diseases A growing number of poor spend up to 70% of their incomes on rent, leaving very little for food Residents in Nunavut spend twice as much on food as the rest of the country on average ($14,800 v. $7,300 annually) Upstream interventions to improve food security include advocating for increased minimum wage, increased social assistance, and affordable housing and childcare Community Health Nurse Role CHNs act to provide community empowerment through their public health functions, with outcomes such as protection, promotion, prevention, and access CHNs take roles such as advocacy through political action (i.e., lobbying) as well as enabling clients to empower themselves The CHN is the healthcare provider who may have first access to poor or homeless persons through community outreach activities An important example of nursing political advocacy is found in the Canadian nurse-led organization Street Health The work of Street Health provides a useful blueprint for CHNs seeking to work upstream on structural issues that create health inequities Module Summary In summary, policy, political action, and advocacy serve as essential instruments in community health, working in harmony to enhance public health outcomes. They address the structural and systemic factors influencing health, ensuring that health initiatives are not only effective and sustainable but also inclusive. Governments have the capacity to develop integrative policy approaches that tackle multiple facets of poverty and homelessness simultaneously. For instance, combining affordable housing initiatives with support services such as mental health counselling and job placement can significantly aid individuals in transitioning out of homelessness. By comprehending the root causes of these issues and recognizing the interconnectedness of economic and social policies, governments can formulate comprehensive strategies that not only alleviate the impacts of poverty and homelessness but also prevent their recurrence. Public policy, when wielded thoughtfully, emerges as a powerful tool capable of transforming the socioeconomic conditions contributing to poverty and economic vulnerability.