Climate Change and Planetary Health PDF

# Climate Change and Planetary Health ## Aims - Understand the fundamental concepts of climate change, including its causes, mechanisms, and global impact. - Evaluate the role of healthcare professionals in mitigating climate change and promoting planetary health. - Recognize the relationship betwee...

# Climate Change and Planetary Health ## Aims - Understand the fundamental concepts of climate change, including its causes, mechanisms, and global impact. - Evaluate the role of healthcare professionals in mitigating climate change and promoting planetary health. - Recognize the relationship between climate change and human health, identifying the key health risks associated with a changing climate - Explore mitigation strategies in healthcare settings, review sustainable healthcare practices and develop advocacy for policy change and public health interventions ## What is Climate Change? Climate change refers to long-term shifts in temperatures and weather patterns. Human activities have been the main driver of climate change, primarily due to the burning of fossil fuels like coal, oil and gas. - A global issue that requires worldwide, international collaboration to address. - The climate has always been changing, but since the Industrial Revolution global Warming has accelerated. - Greenhouse Effect: Human activity has drastically increased greenhouse gas emissions, creating a heating blanket layer around the planet. - Increase in temperature causes ice caps to melt, sea levels to rise and flooding to occur, which destroys infrastructure as well as crops and farms which act as food sources. - Oceans warm up and evaporation also increases, causing more storms and heavy rainfall. - Global warming creates more extreme weather such as high temperatures and heatwaves, causing droughts, fires and destruction of habitats and ecosystems, resulting in mass migration and extinction. - How can we address it? * Communities need to collectively engage in environmentally friendly practices. * Switching to renewable energy: Solar, hydroelectric, wind etc. * Reducing industrial emissions by investing in green technology. * Reducing deforestation of land eg. by switching to vertical farming. * Individuals: Live sustainably, eat more vegetables than meat, recycle, reduce emissions. ## The Paris Agreement - A legally binding international treaty on climate change - Adopted by 196 Parties at the UN Climate Change Conference (COP21) in Paris, France, on 12 December 2015 - Health only mentioned once; in preamble! - Goal is to hold “the increase in the global average temperature to well below 2°C above pre-industrial levels" and preferably 1.5°C ## In South Africa: ### Excellence in Patient Care: - Durban Floods / Cape town Storms / Heatwaves / Air pollution / Fires / Earthquakes ### Innovation in Healthcare Solutions: - Embracing cutting-edge technologies and medical advancements to provide state-of-the-art healthcare solutions - Fostering a culture of continuous improvement and learning. # Health Promotion / Salutogenesis ## Aims - Define Salutogenesis - Clarify the principles of health promotion - Apply the concept of a salutogenic approach to health care engagements with people, families and communities from a health preventative paradigm. ## Health Promotion ### The Ottawa Charter: - World’s first international health promo conference - Based on growing need for new public health approach (esp. industrialised countries.) - Defines health promotion as: The process of enabling people to increase control over and improve their health. - **Health Prerequisites (SDOH)**: - Peace - Shelter. - Education. - Food. - Income - Stable eco-system - Sustainable resources - Social justice and equity - Health promotion empowers individuals to take control of their health. - It involves social and environmental strategies aimed at enhancing health and wellbeing. - It addresses the underlying causes of disease as opposed to illness itself. - **Characteristics of health promotion**: - Strengthening the skills of individuals. - Encourage healthy behaviors. - Build healthy social and physical environments – supports healthy behavior. - Combines health education, economic action, and political interventions. - Facilitates environmental and behavioral changes conducive to health. - Health promotion programs target specific issues through a broader set of upstream interventions. ## HP Key Action Areas: 1. **Build healthy public policy.** - Health must be in the agenda of policy makers in all sectors on all levels. - Health promoting policies combines diverse but complementary approaches incl. legislation/fiscal measures/taxations and organisational change. - Requires identification and removal of obstacles to the adoption of public health policies in the non-health sector. 2. **Create supportive environment for health.** - Strategies should aim at creating safe, stimulating, satisfying and enjoyable living/working conditions. - Need for systematic assessment of the ever-changing environment esp. in areas like technology, work, energy production and urbanization to ensure positive impact on the health of the public. 3. **Strengthen community action for health.** - Ensure the full participation of the communities in identifying priority areas, planning, executing and monitoring the impact of interventions aimed at promoting their health. - Utilize existing human and material resources in the community. - Provide access to information and learning opportunities for health. - Provide the necessary funding and support 4. **Develop personal skills.** - Provide information. - Develop the necessary skills. - Provide the relevant tools. - Ensure continuous support. 5. **Reorient health services.** - Development of patient and community centred approach to health services delivery. - Development of well-coordinated multidisciplinary model of care. - Reorganization of the health services to facilitate HP initiatives - Development of the necessary knowledge and skills. - Provide the necessary motivation and support to the staft. ## Cross-Cutting Issues - Political commitment - Effective collaboration and partnerships - Clear understanding of social/environmental contexts. - Prioritse health setting approach ## HCP Challenges - Emergence and re-emergence of infectious disoases. - Increase inequality between communities and countries. - New patterns of consumption and communication - Comnmercialization - Global environmental changes. - Urbanization. ## HP Research Agenda - Understanding how social and environmental factors such as income, housing, education, racism, etc impact on health outcomes. - Understanding the social, cultural and economic contexts in which health promotion strategies are implemented. - Evaluation of the impact of policies aimed at addressing the health determinant of health. - Evaluation of the effectiveness of the health promoting policies and programmes. ## Key Elements of Health Promotion ### Good governance - Integrating health consideration into all government policies – multifaceted. - Strategies to prevent illness and protect against injury. - The health impact of political decisions needs to be considered. - Regulations should align private sector incentives with public health incentives – like sin tax. - Legislation to support urban development – walkable cities, and reduced air/water pollution. ### Health literacy - Equipping people with the knowledge, skills, and information needed to make healthy and informed decisions. - This includes granting individuals the opportunity to make these choices. - Individuals should be empowered to advocate for policies – further enhances health. ## Healthy cities - Effective municipalities are essential for healthy urban planning - The implementation of preventive measures and a community or primary health level. - These healthy cities contribute to healthier nations an overall healthier world. # Stages of Prevention “Preventive healthcare practices focus on preserving and enhancing health, mitigating risk factors that contribute to injury and disease, and encompassing a continuum of care beyond individual physician visits” ## The Continumm Of Preventative Medicine - Population-based and individual risk factors - Susceptibility to illness - Clinical manifestation of illness. - Recovery and disability. - 5 Stages: ### Primordial Prevention - *Modify population health determinants.* - Aim: to modify social determinants. - Disease stage: underlying health determinants. - Target population: the whole population. - Agencies & approaches: government legislation, fiscal measures, and social programs. ### Primary Prevention - *Actions aimed at preventing the occurrence of disease/injury* - Aim: to limit exposures that lead to disease. - Disease stage: risk and protective factors. - Target population: at-risk groups. - Agencies and approaches: public health approaches, community action plans, and counselling via family physicians (early treatment, risk factor changes). ### Secondary Prevention - *Actions aimed at early detection and treatment of disease (before signs/symptoms occur)* - Aim: to detect and treat pathological issues early - effective intervention. - Disease target: preclinical phase. - Target population: patients with disease. - Agencies and approaches: public health approaches, patient screening, and counselling via family physicians (early treatment, risk factor changes). ### Tertiary Prevention - *Actions aimed at preventing further issues, limiting disability avoiding mortality, rehabilitation.* - Aim: to modify risk factors and pathological factors - avoid relapse and further deterioration. - Disease target: post clinical phase. - Target population: recovering individuals. - Agencies and approaches: all clinicians via counselling, follow-up care, and rehabilitation. ### Quaternary Prevention - Actions taken to identify patients at risk of overmedicalisation (can be protected from more medical invasion by suggesting alternative interventions. Identify actions that can cause more harm than good. - Factors contributing to extensive exposure to medicine - Disease mongering e g. adult ADD, IBS, PTSD, Social Anxiety Disarder, etc - Widening disease definition - Lowering the normal thresholds relating to some chronic diseases - Practice Recommendations - Prevention should be discussed in each and every practice visit. - The FP is expected to perform a health risk appraisal for each and every individual patient. - The FP practice should have evidence-based guidelines and protocols for preventive services provided. - Reminder systems in the form flow charts and/or automated computer. # Salutogenesis - Salutogenesis is the study of the origins of health. - It considers the systems and networks in which we live in order to promote health and resilience. - Coined by Antonovsky - our historical, social, cultural, and physical environmental conditions impact our ability to live a healthy and resilient life. - It focuses on interconnection and nuance denounces the linear health approach (reductionist approach). - It acts as an opposition to pathogenesis it takes the focus away from illness and disease and places it on the promotion and attainment of health, resilience, and wellbeing. # Communication and Culture ## Aims - Identify your communication style as a person. - Recognize the role of effective communication in patient care, including the impact on patient outcomes and satisfaction. - Demonstrate proficiency in basic communication skills. ## Contextual Component Aspects Of Health - Family and workplace - Relationships and social habits - Community resources - War and displacement - Legislation - Cultural beliefs and practices - Religious values - Socio-political climate - Cross cutting: Lifestyle habits (diet, exercise, substance use, smoking) ## Culture - "learned, shared and transmitted values or norms." - Practices and what they imply vary between cultures. (eye contact being rude vs polite) - We don’t know every person’s customs - So communicate - It is okay to ask instead of assuming something. - Patient help seeking varies. - COMMUNICATION and CONSENT is key. Avoid your biases. ## Communication and Interaction - **Sender (Clinician)** - Verbal Communication - Metaphors - Labels - Jargon - Nonverbal Communication - Kinesics (nodding, gestures) - Haptics (handshake, hug) - Proxemics (distance) - Vocalics (pitch, speed) - Listening - Therapeutic - Active - Attentive - Holistic - **Psychological Processes** - Cognitive - Concept mapping, attention, memory, identity activation - Affective - Positive and negative feelings - Motivational - Empowerment, agency, approach-avoidance intentions - Person-perception - Judgments of a clinician’s warmth, competence - **Receiver (Patient)** - Psychological Outcomes - Self-perception - Group membership, self-esteem - Situation-perception - Perceived risk or threat - Perceived quality of service/care - Attitudinal - Satisfaction, confidence, acceptance, persuasion - Relational - Behavioral Outcomes - Communication - Disclosure, conversation - Action - Treatment adherence, appointment keeping, service utilization - **Engage with patients** - **Reflective practice** - **Show empathy** - **COMMUNICATE** - **An individual patient’s characteristics, personality traits, values, preferences, and cultural beliefs, as well as perceptions and level of trust, influence communication/interaction.** - **Filters in communication and response:** - Distort - Delete - Generalise - Misunderstandings and miscommunication. - Understand that beliefs influence perception of diseases. - “Meet you at your level.” - Cultural competence - Cultural humility # Cultural Competence and Humility ## Cultural Competence - The ability of an individual to understand and respect values, attitude, beliefs, that differ across cultures, and to consider and respond appropriately to these differences in planning, implementing, and evaluating health education and promotion programs and intervention. ## Cultural Humility - Cultural humility may be defined as a process of being aware of how people’s culture can impact their health behaviours and in turn using this awareness to cultivate sensitive approaches in treating patients. ## Components of Intercultural Communication Competence - Empathy - Cultural Awareness - Open-mindedness - Adaptability - Linguistic Ability - Patience - Active Listening - On-Verbal Communication Skills - Conflict Resolution Skills - Self-Awareness - Tolerance for Ambiguity - Cultural intelligence (CQ) - Respect for Diversity - Perspective Taking - Curiosity ## Components of Cultural Competence - **Awareness** : Awareness of cultural influences on communication, health literacy, help-seeking, and sick role behaviour. - **Common Ground:** Common words /slang, mannerisms, clarify if you do not understand. - **Ask:** Learn about the culture before hand – more important, ASK, as sub-cultures may deviate from the original culture. - **Observation:** Be observant – during the consultation, and during community interaction. - **Listen:** Active listening and reflection. - **Introspection:** Be aware of and monitor /correct your own reactions. - **Empathy:** Imagine their illness journey. - **Humility:** Be cooperative, respectful and open-minded. # Reflective Thinking: - NB skill to ensure continuous professional development of healthcare practicioners. - It essential that reflective thinking becomes a habit in order to ensure competency development. ## The Family in Health and Disease ## Aims - Explain and give examples of the complex nature of the 'family' - Explain how and why this is the case in South Africa - Critically reflect on assumptions that underlie the concept of the ‘family’ - Identify and explain the 5 levels of physician involvement in the ‘family’ - Consider the roles SA physicians may play - Begin to imagine what it is like to enact these ## What is the Family? - A social institution found in all societies that unities people in cooperative groups to care for one another, including any children. - Primary agent of socialisation ## Kinship - A social bond based on common ancestry, marriage or adoption and commitment. ## Household - A group of people who live together and provide themselves jointly with food and/or other essentials for living. ## The Family in South Africa ### Historical factors that have shaped families: - Globally: Industrialisation, modernity & gender equality - In South Africa specifically - geographical separation of families led to the ruralisation of traditional family forms and childcare - Influx control and male migrancy - In the 1980s: this pattern began to shift ### Now: - We see a reduction in fertility rates, change in marriage patterns, urban migration, high unemployment, HIV and AIDS, and the growing acceptability of alternative forms of domestic partnerships. - Decline in nuclear families, family constituted by families across generations. - Family size is also decreasing, household heads are increasingly becoming younger and male. - Rural-based families often in distress – due to poverty and migration and chronic illness of the elderly and teenage pregnancy. - They rely on remittances, grants, home-based economies. - Churches and community networks become pivotal, these reflect gendered and elderly burden of care. - Stokvels, burial societies and building societies act as economic safety net. - Neighbours often first port of call - Gap in services that are family-centred ## Role of Physicians In South Africa - **Care provider.** Competent in being able to work throughout the district. - **Consultant:** Acts as a consultant to the primary care and district hospital services. - **Capacity builder:** Teaches, mentors, supports and develops other practitioners. - **Clinical trainer.** Provides workplace place based training and supervision to registrars, interns and medical students. - **Clinical governance leader.** Leads the team in improving the quality of care. - **Champion of community-orientated primary care:** Supports community-based services. ## Levels of Physician Involvement (LPI) With Families ### Medical Issues - What is needed to make the correct diagnosis & design a treatment plan? - Bio-medical information about patient - Family context / history of others with relevant condition/s ### Collaborative information exchange - What information should be exchanged to make the correct diagnosis, to reach consensus and design a treatment plan? - Individual focus [on and with the patient – opinions & expectations] - Family context [patient & family: opinions & expectations] ### Dealing with affect - What emotional issues are potentially affecting the patient’s health? - Individual focus [on patient’s feelings & fears] - Family context [patient & family’s feelings & fears] ### Basic psychosocial interventions - What systematic approach will help the patient make desired changes in the psychosocial realm in relation to their health? - Brief individual counselling [changes the patient & physician can make] - Brief family counselling [changes the patient, the family & physician can make] ### Individual &/ Family Therapy - What systematic approach will help the patient in ongoing psychotherapy to help change behavioural and interpersonal patters that may be resistant to change? - Individual therapy [patient focused, on long-standing individual patterns] - Family or relationship therapy [patient and family focused, psychotherapy targeting the family or relationships and unhealthy patterns within the family system] ### Interviewing For LPI - **For Level 3 interviews:** - The BATHE technique - *B*: the physician inquires about the background of the patient’s concerns, - *A*: the patient’s affect, - *T*: what is most troubling about the situation (from the patient perspective), and - *H*: how the patient is handling the problem, - *E*: with empathic responses from the physician to facilitate the patient’s disclosure. - **Level 4 interviews:** - gather data to understand the patient’s problems, - develop rapport and respond to the patient’s emotions, and - provide patient education and work with patient’s motivation. ## Scenarios ### Scenario 1 A 4-month-old African boy has had vomiting and diarrhoea for 20 hours. His mother accompanies him to the hospital, after being transferred from a rural clinic. The child is irritable, drowsy and severely dehydrated with poor peripheral circulation. ### Scenario 2 Whilst on rotation in a GP’s office, you see a 15-year-old white girl who has not had a menstrual period for 2 months. She feels unwell, particularly in the morning. She is healthy and has previously had a regular menstrual cycle roughly every 30 days. This is the first time she has visited her GP without her parents. ### Scenario 3 A blind Coloured patient came with his brother to receive training on a new glucose meter. His brother helps him check his blood sugar, gives him his medications, and his insulin shots as he is also diabetic. During the discussion, you find out that the brothers have been using lancer needles several times as well as sharing them, to save money. They thought this was okay as they are related. ### Scenario 4 A 70-year-old Indian man attends the clinic with his middle-aged daughter. She has flown to see her father as neighbours reported being increasingly concerned. She asks you if her father might be developing Alzheimer’s. Previously, you saw the patient annually, he has a history of having been active, independent and of having been in good health. You have not seen him in 18 months. In the discussion, you learn that was when his wife died. ## Family Influence on Health and Disease - Family is a social organization or system, sharing features with other social systems. - Family systems change over time as members grow older, requiring adaptation to these changes. - Physicians should be attentive to the needs of all family members and vigilant of communication barriers, which may indicate dysfunctional family systems. - “Thinking family” means being aware of unspoken family stresses contributing to physical or mental symptoms and understanding how the physician’s actions may affect the family dynamic. ## McWhinney Identifies Six Key Influences Of Family On Health - Genetic influence - Impact on child development - Family vulnerabilities: disengagement, enmeshment, well-being of members - Spread of infectious diseases within the family - Family factors affecting morbidity and mortality (e.g., bereavement, marital status) - Family support in recovery from illness ## Family Assessment Tools - **Structure**: Genogram/Family Tree - **Development**: Family Life Cycle - **Function**: Family APGAR, Family Lifeline, Family Circle - **Resources**: SCREEM, SCREEM-RES, Ecomap - **Interactions and relationships**: Family Map ## The Family and Stress - The family (as individuals and a unit) are exposed to stress regularly and on an ongoing basis - Family stress: imbalance between the demands on the family and their ability to meet these ## Stressors - Any factor that triggers the stress response - **Source:** (internal/external) - **Type:** (normative/catastrophic, developmental/situational, predictable/unexpected ambiguous/clear, chosen/not) - **Duration:** (acute/chronic) - **Density:** (isolated/cumulative) - **Risk factors vs hassles vs strains:** - minor/Short-term - long-term - exposure to stress ## Effects - **Positive**: - enhance coping/skills/provide energy - **Negative**: - prolonged/lead to vulnerability and conflict - can manifest in mental health conditions, behaviour problems and medical illness ## ABCX Model - Stress can evoke a family crisis (X), dependent on: - **A**: The stressor event - **B**: The family’s resources to respond/cope - **C**: The family’s perception - The usual skills-set and behaviour patterns do not address the concern and new responses are needed - Crises can be both a challenge and/or an opportunity for families ## Resilience Model (McCubbin & McCubbin) - A stressful situation / crisis does not need to be detrimental - The family may need to make fundamental changes to adapt to an adverse situation - **Adjustment phase** - **Adaption phase** - Responses: occur along a spectrum from optimal [bon]adjustment to [mal]adaptation ## FAAR Model - *Family Adjustment and Adaptation Response Model (sources, mediators, and outcomes of stress)* - FAAR Model: # Stress and Conflict in the Family ## Aims - Purpose of session is to critically appraise the typical and atypical crises and conflict situations that can affect health and illness in a family. - Consider how stress impacts the family unit. - Critically appraise the typical and atypical crises and conflict situations that can affect health in a family context. - Use examples to illustrate learning. ## Five Key Questions: ­“Thinking Family” 1. **Has anyone else in the family had a similar problem?** (similar illnesses and how did the family cope?) 2. **What do family members believe caused the problem and How do they think it should be treated?** (family’s explanatory model & how it may influence the resolution of illness) 3. **Who in the family is most concerned about the problem?** (patient’s interaction may be driven by family members [vs own] concerns) 4. **Have there been any other recent changes or stresses? Are any family members experiencing any difficulties presently?** 5. **How can family/friends assist with this problem?** (this helps identify those who may help with the caring and healing process) ## Common Social Stressors and Contextual Problems - Recent loss: bereavement; of employment; of important possessions - Family conflict: domestic violence; abuse [emotional/verbal/physical/ sexual] - Recent major change: in employment status; parental separation/residence or change in health status. - Substance abuse: within the family - Isolation: following bereavement; onset of chronic illness or disability - Entrapment: dependence on someone who is abusive - Financial hardship, unemployment, poverty - Poor / inadequate/ lack of housing - Stress ## Family Assessments 1. Review initial information. 2. Consider the family structure. 3. Determine where in the family is in its life cycle. 4. Reflect on family relationships. 5. Ask what is/are the problem/s. 6. How does the family view/understand this. 7. What resources does the family have. 8. Are further specialised assessments needed. 9. How would the family like things resolved. 10. Develop a focused plan of action.