Week 2 Slides: Foundational Concepts in Public Health PDF

Foundational Concepts: Primary Health Care, Health Promotion, Health Equity, Social Determinants of Health, Population Health NURS 3003 Week 2 1  By the end of class, you will be able to: Describe primary healt...

Foundational Concepts: Primary Health Care, Health Promotion, Health Equity, Social Determinants of Health, Population Health NURS 3003 Week 2 1  By the end of class, you will be able to: Describe primary health care, health promotion and population health ​ Learning Define population health with objectives consideration to social determinants of health and health equity Identify, describe and discuss how population health is impacted by nursing practice.​ Examine the socio-environmental approach to health promotion 2  Upstream discussion Primary healthcare Outline Charters for Health Promotion Social Determinants of Health and Health Equity Social Marketing Think about upstream vs downstream intervention s  Prevention and promotion strategies: Focused on policy interventions that benefit the whole population Upstream intervention Upstream PHC interventions: focus on people’s well-being vs Addressing and taking action on the root causes of preventable diseases Downstrea and injuries Midstream intervention m (1 of 2) Acute care services: Tertiary prevention measures Focused on individual treatment and cure Downstream interventions  Upstream approaches Upstream extend beyond vs addressing individual behaviours and Downstrea identify programs, m (2 of 2) policies, and environmental changes Health Promotion (Let's Learn Public Health, 2017) Think, Pair, Share Think: Reflect on your own personal definition of health and on what they base their definition on (the WHO, experience, readings, etc.) for three minutes. Pair: Then I will have you share with a partner what they were thinking. Share: Finally ask students to volunteer some of their thoughts with the larger group. Health and Health Promotion Health: A dynamic process with multiple assumptions and understandings that evolve over time and evolve with varying professional perspectives and purpose. Health promotion: The process of enabling people to increase control over, and to improve, their health.  An Indigenous understanding of health includes the family and community and focuses on a balance between the body, mind, emotion, and spirit. Health For many Indigenous people, health and includes nature as an integral component. Health A key component of health promotion is the concept of empowerment Promotion The Truth and Reconciliation Commission of Canada’s Calls to Action: raises awareness of health-promoting changes that calls upon every Canadian’s involvement in the healing process.  Two underlying values of PHC: Social justice Equity Primary Health Care (1 of There are five 3) principles of PHC: 1.Accessibility, 2.Public participation, 3.Health promotion, 4.Appropriate technology, 5.Intersectoral collaboration or co-operation.  The WHO has outlined eight essential components of PHC, used as guiding principles to set Primary direction and measure success Health Class Discussion: Name one of the Care (2 of components you expect to see 3) included. Why?  1. Education about health problems and prevention techniques. 2. Promotion of food supply and proper nutrition. 3. Adequate supply of safe water and Primary basic sanitation. 4. Maternal and child healthcare, Health including family planning. 5. Immunization against major infectious Care (3 of diseases. 3) 6. Prevention and control of locally endemic diseases. 7. Appropriate treatment of common diseases and injuries using the PHC principle of appropriate technology. 8. Provision of essential drugs.  Ottawa Charter The first international conference on health for promotion was held in Ottawa in November 1986 Health It resulted in the production of the Ottawa Charter for Promoti Health Promotion. on  Key Actions of 1. Build healthy public policy. Ottawa 2. Create supportive environments for health. Charter 3. Strengthen community action. for Health 4. Develop personal skills. 5. Reorient health services Promotio toward preventing diseases and promoting health. n Charters for Health Promotion Charters for Health Promotion (3 of 6) Australia 1988: Health was asserted as a human right and a sound social investment; therefore, health is a fundamental social goal Sweden 1991: public concern about global environmental threats had grown, and the need for a focus on sustainable development was highlighted. Charters for Health Promotion (4 of 6) Indonesia 1997: action was declared to have a marked impact on the social determinants of health and improving human rights and reducing inequities Mexico 2000: acknowledged promotion of health and social development as a central duty and responsibility of governments Charters for Health Promotion (5 of 6) Thailand 2005: policies and partnerships to empower communities and improve health and equity at centre of global and national development. Kenya 2009: health promotion the core and most cost-effective strategy to improve health and quality of life and reduce health inequities and poverty worldwide. Charters for Health Promotion (6 of 6) Finland 2013: discuss how political decisions related to health are implemented in the form of practical actions; Helsinki Statement on Health in All Policies China 2016: focused on creating a new vision for health promotion based on the United Nations 2030 Sustainable Development Goals (SDGs).  NCCDH SDOH (National Collaborating Centre for Determinants of Health, 2014) Social Determinants of Health (1 of 2) Poor health & early death are linked to SDOH not just to accessibility to health care. Social Determinants of Health (2 of 2) The Toronto Charter Canadian women recognized that the following groups Canadians of were at significantl colour y higher risk of Newcomers poor health  Jason’s Story Equity vs Equalit y Image credit: Interaction Institute for Social Change | Artist: Angus Maguire Equality vs Equity Video: Robert Wood Johnson Foundation, 2018 EXAMPLE Fair? If not, what could be done to make it more just (equitable)? 1. A city has three times more park space per resident in its east part than in its west part. 2. Access to computers and to the internet is not the same in all schools in the city. 3. A city is having financial problems and has made a decision to cut its budget for its 25 community centers. It cuts the budget by having the same reduction in closing hours for all centers. 4. A community with lower income and a higher percentage of people of color compared to the rest of the city has the highest air pollution levels and the highest asthma hospitalization rates in the city. 5. A meeting has been planned to discuss the cleanup of a contaminated site in a community; it will be held in English. However, approximately 25% of people in the community do not speak English as a first language. Justicehealthaction.org 28 Population Health Promotion (1 of 6) Population health promotion is a process of taking action on the interrelated conditions that affect a population’s health to create healthy change. Collaborative and partnership approaches are effective community- development and relationship-building strategies employed by CHNs. Population Health Promotion (2 of 6) Builds trusting relationships and rapport, builds personal confidence and skills through valuing clients’ expertise and knowledge Engages in empowering educational strategies, connecting to broader social networks, and tapping into clients’ strengths Population Health Promotion (3 of 6) Population Health Promotion (4 of 6) The PHPM incorporates a number of values and assumptions: Comprehensive action needs to be taken on all the determinants of health Multiple entry points for planning and implementing are essential Health problems may affect some groups more than others Solutions to problems involve changing social values and structures Population Health Promotion (5 of 6) one’s health is a result of a combination of one’s own health practices plus the impact of social and physical environments in which we live, work, and play Health promoting opportunities arise in environments with social justice and equity and where relationships are built on mutual respect and caring (rather than on power and status) Population Health Promotion (6 of 6) The PHPM incorporates a number of values and assumptions: Meaningful participation of community members is needed Population Health Promotion Pgs. 151 – 152 Stamler textbook Review in pairs to make sense of the four sides of the cube.  COMMUNITY HEALTH NURSING Practice examples from Specialties of CHN practice Public Health (PHN) e.g., Identifying that their smoking cessation messaging is not culturally safe nor considerate of the Indigenous realities and culture. Acknowledging the recommendations from the Truth and Reconciliation Committee, the PHN with other colleagues include Indigenous peoples to begin a community consultation process. Home Health (HHN) e.g., Advocating with families caring for medically fragile children by seeking respite care for families or by contacting their local MPP. Offering the flu vaccine to house bound individuals. RN in Primary Care/Family Practice Nurses e.g., Collaboration to enhance accessibility to resources. Coordination of pharmacy and social worker to seek financial assistance that will provide drug coverage. Collaboratively address barriers and challenges with and within the community.  Equity informed response to COVID-19 Image: (National Collaborating Centre for Determinats of Health, 2022)  Use of marketing principles and techniques to advance a social cause, idea, or Four ‘Ps’ behaviour to promote changes in social behaviours. of The goal of social marketing is Marketing to encourage health- (1 of 2) promoting behaviours, or to eliminate or significantly reduce behaviours that negatively impact a population’s health.  Product Four ‘Ps’ of Price Marketin Place g (2 of 3) Promotion  Other Ps might include: Four ‘Ps’ “policy change” “people” (e.g., training is provided to of intervention delivery agents). Interventions that only use the Marketing promotion P are social (3 of 3) advertising, not social marketing. Why are we talking about marketing  Share 1. Each person should look up a research article about a health promotion and marketing campaign. Pair 2. Identify how the 4 P’s of Learnin Marketing were used. g Activity 3. Share with your partner. Levels of Prevention (1 of 3) Prevention interventions can occur at Primordial level focuses Primordial on the avoidance of Primary illness or injury, Secondary Tertiary addressing issues at a Quaternary levels distal level before they become risk factors, or by identifying specific risk factors Levels of Prevention (2 of 3) Secondary Primary prevention uses prevention promotes the identification of health through the early potential risk factors and identification of the mobilization of policy diseases and conditions and public awareness to and timely treatment of avoid injury or illness. them and focus is to halt an illness if possible Levels of Prevention (3 of 3) Tertiary prevention is initiated Quaternary prevention identifies once an individual becomes people who may be at risk for symptomatic, or disease or injury is medical mishaps and addresses evident patient safety and necessity of Focus is on maintaining or evidence-informed decision making restoring function and In quaternary prevention the preventing further disability focus shifts to ethical practices from the disease or injury.  Harm reduction focuses on protecting the health of, and reduce Harm secondary harm for, individuals who Reduction engage in high-risk activities associated with poor health Philosoph outcomes. y Goal: to reduce the more immediate and related harms (1 of 2) arising from engaging in that behaviour. What are examples of harm reduction you have seen in the community?  Integrated care hub Needle exchange Harm Supervised consumption services Reduction Sharps containers Programs What is harm reduction ? (CATIE, 2022a)  Strategies seek to address health Harm inequities and bring meaningful Reduction health care to individuals who might otherwise be marginalized by Philosoph some health care providers. y Goal of care is to protect health by reducing harm while recognizing complexity of social issues Harm Reduction in action – Care Hub in Kingston (CATIE, 2022) What is Indigenou s Harm Reduction (CATIE, 2022b)  It’s important for nurses to seek Promotin partnership with and promote the health of individuals and g Health communities. in Advocacy is a social justice issue and a mandatory component of Commun public health and community ity nursing practice. Health equity is undermined when Health social conditions interact to prevent people from making decisions or Nursing taking actions that would support their health.  Activism as a public health intervention has been used to: Importan effect change for the people living in poverty; ce of changes for child labour; Activism fight for women’s right to vote; and distribute birth control information to women  It’s important for research and Importan action to seek partnership with and promote the health of individuals ce of and communities. Activism, Advocacy is a social justice issue and a mandatory component of Research public health and community , and nursing practice. Nursing practice within Advocac communities will create more opportunities for nursing practice y focused on health promotion and different forms of advocacy and activism. Did we accomplish our objectives  Assignment 1 1. Identify a need for a social determinant of health to be addressed in a community that is meaningful to you. This could be any region in Canada. Refer to the chart on SDOH in Table. 8.1 for a list of social determinants of health (Lind and Baptiste, 2020). 2. Once you identify the relevant SDOH, you will propose an intervention and advocate for its uptake through a briefing note. Identify one strategy you could implement as a community health nurse to improve circumstances in the community using a population health approach 3. Provide evidence as to why you picked that determinant of health for your community and link the SDOH to the Community Health Nurses of Canada standards of practice. 4. Acknowledge the strengths and weaknesses of the proposed intervention(s). Sections on template Summary Background Current status Key consideration Recommendatio ns References References 1. Appuhamy, R. (2017). Let’s learn public health series: An introduction to health promotion and the Ottawa charter. https://www.youtube.com/watch?v=G2quVLcJVBk 2. CATIE. (2022a). Harm reduction fundamentals- what is harm reduction? https://www.youtube.com/watch?v=enY3EBanQyI&list=PLkC348-BeCu5r-Hfbxwfn_LOfpSKO9IhF&ab_channel=CATIE 3. CATIE (2022b). Indigenous harm reduction. Harm Reduction Fundamentals - Indigenous Harm Reduction. https://www.youtube.com/watch?v=UL8FECpNg_U&list=PLkC348-BeCu5r-Hfbxwfn_LOfpSKO9IhF&ab_channel=CATIE 4. CATIE. (2022c). Supportive practices for service providers working with people who use drugs. https://www.catie.ca/sites/default/files/2022-03/CATIE-IG-Supportive-practices-EN-03-2022.pdf 5. Etowa, J., Ashley, A., & Moghadam, E. (2020). Policy, politics, and power in health care. In L.L. Stamler, L. Yiu, A. Dosani, J. Etowa, & C. van Daalen-Smith (Eds.), Community health nursing: A Canadian perspective (5th ed., pp. 25-26). Pearson, Canada. 6. Peter, E., Sweatman, L., & Carlin, K. Advocacy, ethical, and legal considerations. In L.L. Stamler, L. Yiu, A. Dosani, J. Etowa, & C. van Daalen-Smith (Eds.), Community health nursing: A Canadian perspective (5th ed., pp. 88-91). Pearson, Canada. 7. Let's Learn Public Health. (2017). An Introduction to Health Promotion and the Ottawa charter. https://www.youtube.com/watch?v=G2quVLcJVBk&ab_channel=Let%27sLearnPublicHealth 8. Lind, C., & Baptiste, L. (2020). Health promotion. In L.L. Stamler, L. Yiu., A. Dosani, J. Etowa, & C. van Daalen-Smith. (Eds). Community health nursing: A Canadian perspective (5th ed., pp. 137-162). Pearson, Canada. 9. National Collaborating Centre for Determinants of Health. (2014). Public health speaks: Social determinants of health. https://www.youtube.com/watch?v=BKnWvy-ggjE 10. National Collaborating Centre for Determinants of Health. (2022). Prioritizing health equity in Hastings Prince Edward Public Health’s COVID-19 response. https://nccdh.ca/images/uploads/NCCDH-Equity-in-Action-Prioritizing-Health-Equity-Hastings-Prince-Edward-EN.pdf 11. National Collaborating Centre for Determinants of Health. (2014). Let’s talk: Moving upstream. https://nccdh.ca/images/uploads/Moving_Upstream_Final_En.pdf 12. National Collaborating Centre for Determinants of Health. (2013). Let’s talk: Health equity. Antigonish, NS: National Collaborating Centre for Determinants of Health, St. Francis Xavier University. ISBN: 978-1-926823-32-4 https://nccdh.ca/images/uploads/Lets_Talk_Health_Equity_English.pdf 13. World Health Organization. (2020). Primary health care. https://www.who.int/health-topics/primary-health-care#tab=tab_1