Week 1 - Sept 8th Class Slides PDF

NUSC 1P12 NURSING & HEALTH PROMOTION: THE CANADIAN CONTEXT Week 1 WELCOME Welcome & introduction Review of course syllabus and expectations Refer to Brightspace for syllabus, assignment details, additional readings and resources, and weekly lectures Setting a self-care goal for the term ☺ How c...

NUSC 1P12 NURSING & HEALTH PROMOTION: THE CANADIAN CONTEXT Week 1 WELCOME Welcome & introduction Review of course syllabus and expectations Refer to Brightspace for syllabus, assignment details, additional readings and resources, and weekly lectures Setting a self-care goal for the term ☺ How can you promote your own health (self) while you learn about health promotion (other + context)? TUESDAYS 1300-1500 GLN 116 (GLENRIDGE) LEARNING SERVICES/STUDENT SUCCESS CENTRE https://brocku.ca/student-life-success/learning-services/#workshops https://brocku.ca/student-life-success/learning-services/student-resources/ INTRODUCTION TO NUSC 1P12 This course will focus on philosophical and theoretical concepts of nursing and health, nursing professional standards and practice, Canadian Health Care System, primary health care, health promotion, and social determinants of health. What do you already know about these concepts? What do you hope to learn? o Have you lived in Canada your whole life, or are you new to the Canadian health care system? o Think of all of the interactions you have had with health care providers and health care settings (or been witness to, e.g. care of a family member) o Hospitals, clinics/offices, virtual, etc. o What messages have you been targeted with regarding health promotion (what have you been told to do or not to do to be “healthy”?) What do you want me to know about you and what knowledge and skills you bring to, and hope to gain from, this course? REFLECTION Write down all of the things influencing your health… As an individual… o What is it like when you are feeling “healthy or well”? What factors are at play? o What is it like when you are feeling “unhealthy, soso, or unwell”? What factors are at play? As a society… o Are we healthy? So-so? Unwell? Why? Why not? Who is? Who is not? o What goes on around us that moves us toward or away from improving our health and the health of our families and communities? WHAT IS HEALTH? (Potter et al., 2024) CONCEPTUALIZATIONS The word ’health’ is derived from the Old English word hoelth, meaning whole of body. Is health more than the absence of disease? Can someone with a chronic condition still have ‘health’? Some use ‘illness’ and ‘disease’ interchangeably, others suggest disease is a pathological process which detected by medical science (diagnosed), whereas illness is a subjective experience of loss of health (see Fig. 1-1) Definitions of health beyond the absence of disease are usually multidimensional and include physical, mental, social, and spiritual health. Many consider this = to ‘wellness’. Some argue health is an objective process characterized by functional stability, balance, and integrity, whereas ‘wellness’ is a subjective experience. What do you think? WORLD HEALTH ORGANIZATION Defines health as: “A state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” (WHO, 1947) In 1984, the WHO updated its conceptualization of health as: “The extent to which an individual or group is able, on the one hand, to realize aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources, as well as physical capacities.” (WHO, 1984) CLASSIFICATIONS & DIMENSIONS Let’s look at the dimensions that comprise the whole of a person’s life, and how they can be used to organize definitions of health: Health as Stability o Defined as maintenance of physiological, logical, functional, and social norms, and encompasses views of health as a state, a process, adaptation, and homeostasis (stability) Health as Actualization o Defined as the actualization of human potential (often using ‘health’ and ‘wellness’ interchangeably) (something you strive for and obtain/achieve) Health as Actualization and Stability o The realization of human potential through goal-directed behaviour, competent self-care, and satisfying relationships with others, while adapting to meet the needs of everyday life and maintain harmony with the social and physical environments (something you strive for and aim to achieve, while maintaining harmony/stability within your context/environment) CLASSIFICATIONS & DIMENSIONS Let’s look at the dimensions that comprise the whole of a person’s life, and how they can be used to organize definitions of health: Health as Resource o Capacities to fulfill roles, meet demands, and engage in the activities of everyday living (a means to an end, something useful to help us live and be and do) o emerged in the Ottawa Charter for Health Promotion (WHO, 1986) Health as Unity o Defined as reflecting the whole person as process and is synonymous with selftranscendence or actualization (achievement is beyond the individual) WHAT ABOUT YOUR SELF-CARE GOAL? According to Labonte (1993), if we consider a multidimensional conceptualization of health that reflects both actualization and stability perspectives, aspects would include the following qualities: o Feeling vitalized and full of energy o Having satisfying social relationships o Having a feeling of control over one’s life and living conditions o Being able to do things that one enjoys o Having a sense of purpose o Feeling connected to community What has shifted for you as a 1st year university student now studying nursing, possibly away from home? What opportunities and challenges for your health and well-being does that present? POPULATION HEALTH: APPROACHES TO HEALTHCARE (Potter et al., 2024) APPROACHES TO HEALTH CARE Historically, approaches to health care in Canada have been categorized as: o Medical o Behavioral o Socio-environmental Let’s look at each of these approaches to better understand the evolution of our health care system… APPROACHES TO HEALTH CARE: MEDICAL o Dominant approach in the 20th century o Focus on curing o Health problems pathologized (focus on cure) o Medical intervention emphasized to restore health o Heavy reliance on physicians/inpatient (hospital) care (funded by postwar economic growth) o No focus on prevention (reactive vs. proactive; downstream vs. upstream) o Payment was ‘out of pocket’ until the 1960’s when national health insurance was created to remove financial barriers to care o Tommy Douglas (please watch this video; a turning point for health care delivery in Canada) o https://www.youtube.com/watch?v=RSfvWiUt_l8 What is the risk of having a health care system focused on cure, treatment, and disease? APPROACHES TO HEALTH CARE: BEHAVIOURAL o 1970s: shift away from medical model approach to a more behavioural perspective (understanding health vs. just disease) o Government spending on healthcare was high, and not being reflected in health outcomes o Lalonde Report (1974/1981) o Promoted individual responsibility for health o Favoured health promotion strategies such as education and social marketing o De-emphasized medical intervention for restoration of health and proposed integration of health promotion and disease prevention o “Determinants of Health” were first introduced: environment, biology, health care organizations/access to care o Value of knowledge and education related to health (understood to be in individual’s control) o Criticized for suggesting individuals were to be blamed for their poor health; neglected to recognize socioeconomic, sociocultural, environmental, and geographic barriers to making healthy lifestyle choices (has since expanded to include social context and relationship between personal health and social physical environments) Is your health within your control? How is it? How is it not? THE TIPPING POINT OF “CONTEXT” In the mid 1980s, Canadians started to say… Wait a second… It isn’t my fault if I become sick, is it? It isn’t all in my control. It isn’t all my individual responsibility. My health risks are not ALL self-imposed… Where I live and work may cause barriers to engaging in health behaviours… right? THE TIPPING POINT OF “CONTEXT” Can you separate health-related behaviours from the social contexts (environments) in which they occurred? Remember “relational practice”: self + other + context? APPROACHES TO HEALTH CARE: BEHAVIOURAL TO SOCIOENVIRONMENTAL “THE TIPPING POINT” Achieving Health for All: A Framework for Health Promotion, 1986 o Aka “Epp Report” o Expanded Lalonde Report o Shift from lifestyle (‘self’) to environmental determinants (‘context’) o Assess health status of disadvantaged groups o Detect and manage chronic disease o Identify and prevent preventable diseases o Enhance individual coping o See Figure 1-3 on p. 4 Ottawa Charter for Health Promotion, 1986 o Based on Lalonde Report o Renamed Lalonde’s four health field concepts as ‘health prerequisites’ and expanded to include peace, shelter, education, food, income/employment, stable ecosystem, sustainable resources, social justice and equity o Health promotion actions mean to: o Build healthy public policy o Create supportive environments o Strengthen community action o Develop personal skills o Re-orient health care services to meet the needs of individuals/communities APPROACHES TO HEALTH: SOCIO-ENVIRONMENTAL o An understanding of social determinants of health (or health prerequisites) led the way for a socioenvironmental approach to health o Builds on the behavioural approach (how our choices, lifestyle, context influence health) but also emphasizes social context and environment (factors beyond the individual) o Acknowledges that health is self-defined or subjective (for example someone can be healthy and be diagnosed with a “disease”) o See Figure 1-4 on p. 6 (illustrates impact of physiological, behavioural, psychosocial, and risk conditions on health status) o In a population health approach, “the entire range of known individual and collective factors and conditions that determine population health status, and the interactions among them, are taken into account in planning to improve health” PULLING IT ALL TOGETHER How can we realize our aspirations (for health), maintain our current health status/ needs, and cope with or change our socioenvironment (‘context’) to benefit our own health (‘self’) and the health of those around us (‘other’)? Do you see: relational practice + dimensions of actualization and stability? SOCIAL DETERMINANTS OF HEALTH (Raphael, 2016) Ch. 1 (Brightspace) (Potter et al., 2024) RAPHAEL (2016) CHAPTER 1 - SDOH: KEY ISSUES & THEMES o Knowledge of SDOH dates back to the mid 1800s when living conditions were recognized as the primary determinants of health o In 1845, Engels, a political economist, studied how poor housing, clothing, diet, and lack of sanitation led directly to infections and diseases associated with early death among working-class people in England (Raphael, 2016, p. 5) o Important to consider quality and distribution of SDOH and resources available o Not just what people have/don’t have, but how much they have, and how good what they have is o i.e. food security, access to fresh fruits and vegetables for rural communities; access to good/safe working conditions, access to quality education, housing, etc. So, if we have known about this for almost 200 years, what are we doing about it? What can we do about it? What should we be doing about it? 3 KEY PROBLEMS (RAPHAEL, 2016) The study of the SDOH deals with 3 key problems according to Raphael (2016): o What are the societal factors (e.g. income, education, employment conditions, etc.) that shape health and help explain health inequalities? o In your life experience, which of these factors has jeopardized or improved your health and the health of your family? (self + other) o What are the societal forces (e.g. economic, social, political) that shape the quality and distribution of these factors? o How has where you lived, and the things going on around you in that place, shaped what was available to you, and how good or lacking those resources were? (context) o What is it about Canada’s economic and political systems that make addressing the SDOH through public policy so difficult? o Let’s think about and discuss this a bit more… ROLE OF PUBLIC POLICY What do you see as the role of government policy as a mechanism to reduce inequities between income groups? What are the responsibilities, opportunities, limitations, and challenges related to governments moving forward with healthy public policy as a recommended strategy to affect SDOH? What is your role as an individual person and future nurse? THINK-PAIR-SHARE 4 CRITERIA (RAPHAEL, 2016) In determining what would be identified as a social determinant of health, 4 criteria were used: 1. Consistent with most existing formulations of SDOH and associated with existing literature as to its relevance to health o All these SDOH are important to the health of Canadians 2. Consistent with lay/public understandings of the factors that influence health and well-being o All these SDOH are understandable to Canadians 3. Clearly aligned with existing governmental structures and policy frameworks o All these SDOH have clear policy relevance to Canadian decision makers and citizens 4. Are of either active governmental policy activity (e.g. health care, education) or policy inactivity that has provoked sustained criticism (e.g. food security, housing, social safety net, etc.) o All these SDOH are especially timely and relevant. RAPHAEL (2016, P. 11, BOX 1.2) THE SOCIAL DETERMINANTS OF HEALTH FRAMEWORK o Indigenous ancestry o Health care services o Disability o Housing o Early life o Immigrant status o Education o Income and its distribution o Employment and working conditions o Race o Food security o Social safety net o Gender o Social exclusion o Geography o Unemployment and employment security SOCIAL DETERMINANTS OF HEALTH (POTTER ET AL., 2024) Major determinants of health affecting Canadians as presented in your course text (Potter et al., 2024, pp. 7-14): o o o o o o o o o o o o Income and social status (income and its distribution) Social support networks Education and literacy Employment and working conditions (unemployment and employment security) Physical environments (geography, housing, food security) Biological and genetic endowment Individual health practices and coping skills Health child development (early life) Health Services (health care services) Gender Culture (immigrant status, race, indigenous ancestry) Social Environments (social safety net, social exclusion, disability) How have these SDOH impacted your life, and your families lives? Your community? How might this change for you in the future? Imagine the impact of your nursing education, a full-time income, working conditions, health benefits, etc. after you graduate compared to your time as a student… SDOH & THE WORLD HEALTH ORGANIZATION (WHO) HTTPS://WWW.WHO.INT/HEALTH-TOPICS/SOCIAL-DETERMINANTS-OF-HEALTH#TAB=TAB_1 “The social determinants of health (SDOH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems” (WHO, 2021, para 1) SDOH & WHO CONT’D “Research shows that the social determinants can be more important than health care or lifestyle choices in influencing health. For example, numerous studies suggest that SDOH account for between 30-55% of health outcomes. In addition, estimates show that the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector. Addressing SDOH appropriately is fundamental for improving health and reducing longstanding inequities in health, which requires action by all sectors and civil society” (WHO, 2021, para 4-5). STRATEGIES TO INFLUENCE HEALTH DETERMINANTS (POTTER ET AL., 2024) HEALTH PROMOTION (POTTER ET AL., 2024) Health promotion definitions: o Directed toward increasing the level of well-being and self-actualization (Pender et al., 2015). o The process of enabling people to increase control over, and improve, their health (WHO, 1986). o A comprehensive social and political process which not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health. Health promotion is the process of enabling people to increase control over the determinants of health and thereby improve their health. Participation is essential to sustain health promotion action (Nutbeam, 1998). DISEASE PREVENTION (LEVELS) & POINTS OF CARE Disease prevention definition: action to avoid or forestall illness/disease (Pender et al., 2015) PRIMARY o Range of services and supports to promote health and well-being (upstream efforts) o e.g. Office of Dr./ NP; Public health; Community rehab. Clinic; Telehealth SECONDARY o Focus on diagnosis and treatment of health challenges and varying complexities o (specialized, often based on referral from primary provider) o e.g. Physician specialist, specialized care (short-term or longer-term) TERTIARY/QUATERNARY o Specialized care involving dedicated supports and resources based on referral from primary or secondary providers. o Highly technical and involved health care interventions including diagnosis and treatment of disease and disability (downstream efforts) o e.g. Acute care (hospital) HEALTH PROMOTION: GUIDING PRINCIPLES Strategies are often political, emphasize addressing inequities, and have a strong philosophy of social justice. Health promotion is guided by the following principles (Canadian Public Health Association, 1996): o Health promotion addresses health issues in context o Health promotion supports a holistic approach o Health promotion requires a long-term perspective o Health promotion is multisectoral o Health promotion draws on knowledge from social, economic, political, environmental, medical, and nursing sciences, as wall as from first-hand experiences What is an example of a health promotion strategy you have seen/witnessed, been involved in, or would support, or maybe be interested in from a community development/ advocacy perspective? POPULATION HEALTH MODEL (FIG 1.7 ON P. 16) Model explores four major questions (each with important relationships to each other): WHO o With whom can we act? (the levels within society where action can be taken) HOW o How can we take action to improve health? (strategies on last slide) WHAT o On what can we take action? (SDOH) WHY o Why take action to improve health? (using the best available information to make decisions consistent with community needs, values, and resources) HEALTH PROMOTION: STRATEGIES The Ottawa Charter identified five broad strategies to enhance health: 1. Build Healthy Public Policy o Advocating for policy change, implementation, modification related to distribution of resources (context) 2. Create Supportive Environments o Reciprocal maintenance, to take care of each other, our communities, and our environments where we live and work (self + other) 3. Strengthen Community Action o Community development: identifying local issues and working together to make changes that will enhance health (other + context) 4. Develop Personal Skills o Enhancing coping strategies, gaining control over health and environments to make healthy lifestyle choices (self) 5. Reorient Health Services o Health system reform to shift emphasis from treating disease to improving health and make the system more efficient and effective. Upstream approaches (context) HEALTH CARE REFORM: LOOKING INTO THE FUTURE If we were to write a new version of a “landmark report” to inform health care reform, what ideas might we start with or consider? What are our priorities for the future of healthcare? What changes do we hope to see (to policy, practice, etc.)? Let’s brainstorm!