Primary Health Care, Health Promotion, Structural Violence, and Indigenous Health PDF

Primary Health Care, Health Promotion, Structural Violence, Indigenous Health Josée Lavallée BScN RN MSc Objectives • • • • • • Primary Health Care Health Promotion Population Health Promotion Model Structural Violence Indigenous Health Engaging with Humility Primary Health Care • Compare and...

Primary Health Care, Health Promotion, Structural Violence, Indigenous Health Josée Lavallée BScN RN MSc Objectives • • • • • • Primary Health Care Health Promotion Population Health Promotion Model Structural Violence Indigenous Health Engaging with Humility Primary Health Care • Compare and contrast Primary Health Care with Primary Care • Define health promotion and describe it according to the Ottawa Charter • Describe the Population Health Promotion Model Primary Health Care “Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and selfdetermination. It forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.” WHO, 1978 Primary Care • Mostly Individual • At point of careInteraction with the health care system • Informed by values of Primary Health Care PHC Principles Primary Health Care has 5 principles to enact its values: 1. 2. 3. 4. 5. Accessibility Public participation Health promotion Appropriate technology Intersectoral collaboration 1- Accessibility Preventative Curative • Promotive • Preventive • Curative • Rehabilitative • Supportive/palliative Primary Health Care Rehabilitative Supportive/p alliative Promotive 2- Public Participation People are invited to participate in making decisions about the health needs of their own community. This requires to be flexible, responsive, and have a respect for diversity including alternative approaches to address those needs. 3- Health Promotion ”Health promotion is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.” (WHO, 2023) Ottawa Charter • "Health for All by the Year 2000" A movement toward a • "new public health.” Ottawa Charter 1. Build healthy public policy Ottawa Charter 2. Create supportive environments for health Ottawa Charter 3. Strengthen Community Action Ottawa Charter 4. Develop personal skills Ottawa Charter 5. Reorient health services to prevention of disease and promote health Ottawa Charter Enable Mediate Advocate Upstream, Midstream + Downstream • Health prevention and promotion • Policy • Nurse Advocacy • Social Determinants of Health • Understand and address racism and oppression https://nccdh.ca/images/uploads/Moving_Upstream_Final_En.pdf • Examples from the National Collaborating Centre for Determinants of Health https://nccdh.ca/images/uploads/Moving_Upstream_Final_En.pdf 4- Appropriate Technology • Effective health care uses appropriate technology based on the needs of communities Examples: telehealth, electronic charts 5- Intersectoral Collaboration • Health and wellbeing are linked to economic and social policies • Education, transportation, agriculture, finance, housing, policing • Providers from accross health sectors, local, national Review PHC Principles 1. 2. 3. 4. 5. Accessibility Public participation Health promotion Appropriate technology Intersectoral collaboration 8 Elements of Primary Health Care: WHO Education on health problems and prevention Immunization against major infectious diseases Promotion of food supply and nutrition Prevention and control of locally endemic diseases Adequate supply of safe water and basic sanitation Appropriate treatment of common disease and injuries using the PHC principle of appropriate technology Maternal and child health care Provision of essential drugs Population Health Promotion Model Population Health Promotion Model “On what should we take action, how should we take action, and with whom should we act?” Structural Violence • Distinguish the different concepts of structural violence, oppression, and colonialism. • Define Anti-Racism and AntiOppression. • Describe how Anti-Racism and Anti-Oppression present in health care systems. What is Structural Violence? Social structure; econmic, political, legal, religious, cultural; that stop individuals, groups, and societies from reaching thier full potential » (Farmer et al., 2006) • Education system, healthcare system • « • Anti-Racism: The active effort to eliminate all forms of racism including individual, institutional, structural, and systemic racism. (Adapted from Glossary of IDEA Terms by Canadian Centre for Diversity and Inclusion and CRRF Glossary of Terms by Canadian Race Relations Foundation) • Anti-Oppression: Actions that challenge social, historical, and existing intersectional inequities and injustices within systems and institutions that privilege groups to dominate over others. (Adapted from Glossary of IDEA Terms by Canadian Centre for Diversity and Inclusion and CRRF Glossary of Terms by Canadian Race Relations Foundation) Structural Violence in Nursing? Indigenous Health • Indigenous strengths, beauty, and resistance • Explain the implications of federal and provincial influences on Indigenous health and well being. J.Lavallée Norval Morriseau Jennine Krauchi Kenojuak Ashevak By Dawn Setford of Pass the Feather https://passthefeather.ca/sharing-circles/?v=3e8d115eb4b3 Indian Act “The great aim of our legislation has been to do away with the tribal system and assimilate the Indian people in all respects with the other inhabitants of the Dominion as speedily as they are fit to change.” – John A Macdonald, 1887 Treaties • We have sovereignty • We have rights to the land and air • We have spiritual beliefs, customs, and traditions • We have our own languages • We have our own justice systems • Self-determination Scrip • Dominion Lands Act • Attempt at assimilation and eradication • Land or monetary certificates for Red River Métis E Numbers https://youtu.be/w-b373nCHlk Engaging with Humility • Define Cultural Humility and Cultural Safety. • Describe how to apply Cultural Humility and Cultural Safety in nursing practice. • Define distinction-based approaches of health and wellbeing. • Define the Indigenous Determinants of Health. • Reflect and acknowledge personal bias, power, and privilege. FIG. 8.1 Engaging with humility. Art concept source: Dr. Sheila Blackstock. (2021). Gitxsan First Nation. Communication and Knowledge Sharing • Verbal and Non-verbal • Holisitc • Land based • Stars and Sky • Dreams • Storytelling • Song + Dance • Ceremony Cultural safety Key Concepts “When nurses consider the historical and social contexts as well as structural and interpersonal power imbalances that shape health and health care services” (Blackstock, 2022). “Healthcare organisations and authorities need to be held accountable for providing culturally safe care, as defined by patients and their communities, and as measured through progress towards achieving health equity” (Curtis et al., 2019) Cultural humility “Cultural humility is a stance of being open to the cultures of other individuals and communities (Blackstock, 2022).” Reflection + Reflexivity • Reflection is used to examine our interpretations of events that happened, our role, and the role of others. This reflection process is a valuable tool to examine our nursing practice for strengths and areas of improvements (Blackstock, 2022) • Reflexivity is a reflective practice described as the ability to understand and question your own contexts, attitudes, values, beliefs, assumptions, and experiences of advantage and disadvantage that have shaped the way you understand the world and in relation to others (Landy et al., 2016; Verdonk, 2015). Your personal and cultural history and contexts influence your practice (Blackstock, 2022) Simon Gull lives and works in Toronto and is Indigenous. He has been feeling unwell with nausea, always being thirsty, increased fatigue, and frequently having to urinate. As his symptoms worsen, he decides to seek out medical attention at an emergency department at a downtown Toronto hospital. When the triage nurse assesses him, he finds Mr. Gull confused, slurring his speech, and with his breath smelling like alcohol. The nurse makes the assumption that Mr. Gull has alcohol intoxication because he is Indigenous and puts him in a room to sleep it off. Another nurse checks on Mr. Gull a few hours later and finds him unresponsive. Blood work is ordered, and the lab results indicate Mr. Gull has diabetic ketoacidosis, not alcohol intoxication. (Chapter 7 p.122) The Power of Nursing Self-Determination • Reclaiming and define land, language, cultural traditions, laws, political and economic rights, ways of being/knowing, and healing practices • The United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) states that Indigenous peoples have the right to self-determination. • This guarantees the right to freely determine political condition and the right to freely pursue their form of economic, social, and cultural development (U.N. General Assembly, 2007). First Nations Honouring DistinctionsBased Approaches Métis Inuit Nation Community Land and Location Indigenous Determinants of Health Red River Métis Bartlett, J. 'A Métis Woman's Journey of Discovery'; in "Métis Rising; Living Our Present through the Power of Our Past" (2022) edited by Yvonne Boyer and Larry Chartrand. pg. 234-256.