HTHSCI 2RR3 UNIT 11 - 2023 FINAL_Student copy .pptx

CALL TO ACTION HTH SCI 1RR3 LAND ACKNOWLEDGEMENT McMaster University recognizes and acknowledges that it is located on the traditional territories of the Mississauga and Haudenosaunee nations, and within the lands protected by the “Dish with One Spoon” wampum agreement. That wampum uses the symbol...

CALL TO ACTION HTH SCI 1RR3 LAND ACKNOWLEDGEMENT McMaster University recognizes and acknowledges that it is located on the traditional territories of the Mississauga and Haudenosaunee nations, and within the lands protected by the “Dish with One Spoon” wampum agreement. That wampum uses the symbolism of a dish to represent the territory, and one spoon to represent that the people are to share the resources of the land and only take what they need. We acknowledge that Conestoga College is situated on the traditional territory of the Haudenosaunee, Anishnawbe, and Neutral Peoples. I acknowledge the land with sincerity in reconciliation and to honour and express appreciation for the Indigenous Peoples of this Land. AGENDA 1. Public policy in Canada 2. Individualism in health 3. SDoH and public policy 4. Nurses as allies 5. Advocacy resources 6. Final exam 1: PUBLIC POLICY IN CANADA SOURCE REMINDER: WHY ARE WE STUDYING THE SDoH? To better understand: 1) SOCIETAL FACTORS o (e.g., income and employment) that shape health and help explain health inequities 2) SOCIETAL FORCES o (e.g., social and political) that shape the quality and distribution of these factors Image by AD_Images from Pixabay POLICY AND SDoH Bottom line: Policies impact health equity and well-being DEFINING PUBLIC POLICY o “Who gets what, where, when, and how” o Agent: government o Involves a deliberate decision to pursue a specific course of action Image by Capri23auto from Pixabay (doing nothing is still a choice!!) PUBLIC POLICY: THREE MAIN ACTIONS (Source: Raphael, 2020) 1. Share concepts included in the course text 2. Support political parties supportive/committed to act on SDoH 3. Strengthen sectors that have influence on SDoH e.g Unions 4. Join or support organizations active in strengthening the SDoH Image by Capri23auto from Pixabay Q: What is the most critical component? PUBLIC POLICY: DEFINING THE PROBLEM o Causality?? o Scientific paradigms (e.g., QT vs. QL) o Multiple stakeholders (housing/healthcare/education) o What type of knowledge/voices matter? Bottom line: How we define a problem determines our actions. Image by Gino Crescoli from Pixabay SOCIAL POLICY IN CANADA: EVOLVING Middle Period IDEOLOGY (1945 – 1970s) Support for state being more involved Initially dominated by federal footprint – over time, provinces shared cost Early Period Neo-Liberal Period (1867 – 1930s) (1975 – present) Limited “state” involvement – mostly charities and religious organizations Reduced state involvement (and provinces/municipalities expected to foot more of the bill) Move toward individualism 2: INDIVIDUALISM … GOOD OR BAD? SOURCE INDIVIDUALISM IN HEALTH o Structural barriers downplayed – lifestyle approach to health promotion/prevention o Presumes choice – limits space for social activism o Significant implications for responding to and (re)producing health inequities Image by Gerd Altmann from Pixabay POSITIVISM IN HEALTH SCIENCES o Reliance on quantitative approaches o Fixated on individual risk factors o Commitment to “objectivity” o Depoliticizing health issues How you understand health will determine how you treat patients/clients DIFFERING SDOH DISCOURSES (Source: Raphael & Curry-Stevens, 2016, p. 568) Discourse Implications 1. Identify those in need Assumption that service provision will improve health 2. Identify modifiable risk factors Assumption that behavior change will improve health 3. Living conditions shape health Identify SDoH pathways – strengthens evidence base 4. Material circumstances differ among groups Strengthens evidence base – forms basis for anti-discrimination efforts 5. Health determined by public policy Attention directed at public policy 6. SDoH distribution determined by government/societal ideology Structures needing modification are identified 7. SDoH distribution determined by who has power in society Focus on wealth redistribution 3: THE SDOH AND PUBLIC POLICY SOURCE PLURALISM VS. POLITICAL ECONOMY PLURALISM – governments adopt good policy ideas o Why have we made such little movement on low income (e.g., basic income), social exclusion (e.g., free tuition), and social infrastructure (e.g., national pharmacare)? POLITICAL ECONOMY – policies serve the “economic elites” o Little movement (on above) because we do not want to increase taxes on wealthy corporations and individuals. “The foundations of public policy are, at their essence, value judgements and ideologies.” (Course text book Raphael et al 2020) 84-87 Disengaged Citizenry “The privileged person looks at the lived reality of the less privileged and assumes that the world works for others the way it works for themselves.” Image by Quinn Kampschroer from Pixabay (Raphael & Curry-Stevens, 2016, p. 576) “When it comes to someone’s wellbeing, poverty, lack of housing and social supports can have a major impact on a person’s overall health.” https://unityhealth.to/2020/06/how-phone-calls-from-unity-health-are-improving-health-during-covid-19/ HOUSING AND PUBLIC POLICY https://globalnews.ca/news/6206469/affordable-housing-canada-study/ More than 85,000 applicants are on the social housing wait list for Toronto for far in 2023 ● https://www.toronto.ca/city-government/data-research-maps/research-reports/housing-and-homelessnessresearch-and-reports/social-housing-waiting-list-reports/  Cut chronic homelessness by 50%  Remove 530,000 families from housing need  Renovate and modernize 300,000 homes  Build 125,000 new homes https://www.cmhc-schl.gc.ca/en/nhs/guidepage-strategy Report 2023 https://www.placetocallhome.ca/progress-on-the-national-housing-strategy#pdfreport 2018 - 2028 QUESTION: Impact of Federal and Provincial elections? Impact of ending covid related benefits? CHILDCARE AND PUBLIC POLICY https://Childcarenow.ca Canadian Centre for Policy Alternatives report 2023 - https://monitormag.ca/reports/measuring-matters/#chapter0 EDUCATION AND PUBLIC POLICY July 2023, Over 200,000 teachers in six Canadian provinces remain without an active collective agreement. https://monitormag.ca/articles/ca nadas-silent-crisis/ https://www.macleans.ca/opinion/education-cuts-ontario-doug-ford-inequality/ HEALTHCARE AND PUBLIC POLICY ~ 20% of Canadians (~ 7.5M people) have inadequate drug coverage Letter campaign and report available from https://pharmacare2020.ca https://www.budget.gc.ca/2019/docs/themes/pharmacare-assurance-medicaments-en.html National Pharmacare Table 2: Overall impacts of implementing pharmacare in 2022 & 2027 ($ billions) (net of confidential rebates) Status quo Total Rx spending 37.2 National pharmacare 2022 With pharmacare 36.9 Status quo 51.6 7.6 2027 With pharmacare 46.8 38.5 Other public plans 16.1 12.5 23.0 2.6 Private plans 14.7 11.4 19.8 3.2 Out of pocket 6.4 5.3 8.8 2.4 Net incremental public spending (with ancillary savings) N/A 3.5 N/A 15.3 Source : A prescription for Canada : Achieving Pharmacare for all . Chapter 6 Financing National Pharmacare - saving money while providing universal access to medicines . Available from https://www.canada.ca/en/healthcanada/corporate/about-healthcanada/public-engagement/external-advisory-bodies/implementation-national-pharmacare/final-report.html Examples of housing policy recommendations (Unit 6) ● Raphael et al. (2020) suggest: ○ Increasing funding of social housing programs for low-income Canadians ○ Support non-profit and co-operative housing sectors ● RNAO (2009) recommends: ○ Policy to reduce discrimination in rental housing ○ Policy to address the gap between housing costs and tenant incomes ○ Policy to increase access to supportive community-based housing Upstream: Welfare & Governance  Welfare state-how society views what it owes members by virtue of citizenship or residence  Canada’s electoral system a barrier to welfare state development  Implementation NOT impossible but requires members of society to demand policy changes in health and health equity Raphael, 2020 p. 86- 87 4: NURSES AS ALLIES SOURCE ALLYSHIP AND PATIENT-CENTRED CARE “When nursing duties and loyalties conflict with societal power structures and nurses blindly adhere to policies rooted in structural racism, patients are no longer the center of care.” Weitzel et al., 2020, p. 103 BECOMING A FORMIDABLE ALLY o Recognize and dismantle white supremist ideology o Work to center voices of the marginalized/underserved (not your own) o Recognize that silence is violence o Advocate for social justice – a core CNO competency (be competent  ) o Work to understand (and address) historical trauma o Utilize a theoretically-informed approach to examine the SDoH (e.g., intersectionality) o Engage with movements that confront oppression (e.g., BLM) KNOWLEDGE AS POWER “Knowledge is inextricably linked to power…nurses have the capacity to both exercise and resist power, making nursing care inherently a political activity.” Weitzel et al., 2020, p. 111 5: ADVOCACY RESOURCES SOURCE Becoming an Ally ● Be informed - Reputable sources ● Join others as student, citizen and or Professional ● Educate yourself and others on the issues https://www.youtube.com/watch?v=_dg86g-QlM0 The next 8 slides are examples of sources and opportunities to become informed See also Unit 7 Indigenous Communities & Health, (Slide - Allyship Kit; and Coin Model link) SDoH COMMITTEE AT ST. MICHAEL’S HOSPITAL https://unityhealth.to/social-determinants-of-health/#sdoh-committee-covid-19-working-group-block_60d24bf66b 4da https://www.nccdh.ca/ ONTARIO DRUG BENEFIT FORMULARY https://www.formulary.health.gov.on.ca/formulary/ https://effectivepractice.org/wp-content/uploads/2016/02/Poverty_- https://maphealth.ca http://www.welllivinghouse.com/people-dying-unnecessarily-because-of-racial-bias-in-canadas-health-care-system-researc her-says/ http://nccdh.ca https://www.rawtalkpodcast.com/episode/69 CRITICAL THINKING QUESTIONS 1. There are both domestic and international factors that have helped to shape Canadian health policy. Do you think one is more influential than the other? Why? 2. What are some things that you could do to promote action on the social determinants of health by governments and other Canadian institutions? 3. What do you think of the Canadian plan for ongoing COVID-19 vaccine purchasing and distribution THANK YOU FOR PARTICIPATING!! o Class and tutor evaluations available (A2L) o Final exam Dec 12th (see Mosaic/A2L) o Exam focus : primarily Units 7-11 with up to 10 questions from units 4, 5 & 6 , Scenario questions = 6-10 o All readings, media files are testable (unless otherwise specified) o Max 90 multiple choice questions; 120 mins o Information for the Exam will be posted on