Earlier in this course, we were asked ‘what is health?’ Elaborating on an antiquated definition from the World Health Organization, the many facets of health were examined. Sartorius incorporated three definitions of health, surmising the absence of disease or injury, combined with the ability to cope with daily life, and a state of equilibrium between social and physical environments (2006). But defining health and living healthy are very different things. As mentioned above, there are different kinds of health that can affect a persons overall wellbeing. One does not simply become healthy and stay that way the rest of their lives, much like going to the gym once doesn’t make you fit. It is a constant effort needed to maintain different aspects of health. Factors outside of the person have an incredible impact on a persons health, sometimes within their control, but most often not. The goal of the Canadian healthcare system is universality. But to attain such universality, many intrinsic and extrinsic factors have to be addressed to achieve such a lofty goal. But what does it mean when we say our healthcare is ‘universal’?
Based on need versus ability to pay, the idea of universally accessed healthcare started in a single province in 1947, and spread across the country, unifying under the Canadian Health Act of 1984. Though not truly a centralized healthcare plan, provinces and territories are subsidized with federal funding to create local health plans provided they meet the principles of the 1984 Health Act (Martin et al., 2018). Those principles being: public administration, comprehensiveness, universality, accessibility, and portability (Government of Canada, 2019). Basically meaning that any medically necessary procedure should be covered by a public administration, and that should be equally accessible across the country, even in the most remote reaches. And though this is a great start to ensuring all Canadians have their medical needs met, like health it must be constantly worked on for it to endure.
There are many factors that affect a person’s health, both intrinsic and extrinsic. These are called determinants, and can affect how individuals are able to access care. The tenant of universal healthcare is that it should be equally accessible, but that is not always the case. To ensure equal access, it is important to provide increased aid or incentive to marginalized populations. For example, a person who is new to the country and not yet fluent in the official languages of Canada may not feel comfortable finding care for a medical issue. If this trepidation prevents them from seeking care in the early stages, it may lead to a more complicated health issue down the road. It is issues like this that determine their health. Determinants can be, but are not limited to; income, social status, employment, working conditions, education, literacy, childhood experiences, physical environment, social supports, coping skills, healthy behaviours, access to services, biology, genetic endowment, gender, culture, and race (Government of Canada, 2020b). These determinants can have a cumulative effect impacting a person’s health. But these determinants can also be used to improve health. By utilizing a multi-level approach to health, we can make healthy behaviours and lifestyles easier to achieve.
Known as the Socio-ecological model, this approach shares the weight of healthy behaviours from the person alone to all of society. A study by Nuss et al. determined that implementing a plan to create an asthma-friendly environment in a Louisiana high school only required a small amount of effort by all parties involved (2016). This included identifying students with asthma, ensuring the students were able to carry and administer their own inhalers, creating a scent free environment, and restricting bus-idling on school premises (Nuss et al., 2016). Another example is the Region of Peel using the socio-ecological model to decrease obesity in children under the age of six. The authors determined factors that affect weight in children, such as parental health beliefs, income, access to programs, physical environment, and culture. By identifying these factors, they can be manipulated and improved and have an overall beneficial impact of childhood obesity (Baker et al., 2011).
Despite best efforts, detractors to health occur whether we account for them or not. Genetics can plays as much of a role in health outcomes as conscious health behaviours. Chronic conditions arise and require specialized and meaningful management efforts by all involved. This is especially concerning as chronic conditions are often accompanied by comorbidities; separate but related health issues as a result of the initial chronic condition. Comorbidities, or multi-morbidities, increase complexity of care, requiring more specialized and direct care, often by multiple specialists (Roberts et al., 2015). Roberts et al. determined that 12.9% of Canadians are living with at least 2 comorbidities, and those with 3+ morbidities were more likely to be females, aged 75+ years old in low income areas who had never graduated high school (2015). There was also an increased correlation with multi-morbidity and age, particularly in low-income households with low education levels (Roberts et al., 2015). This in particular is why health acquisition and prevention of illness are of particular importance for the Canadian Health system. The presence of disease begets further disease, leading to an exponential decrease in health, and subsequent increase in health expenditures. This is also noticed in those who are identified as vulnerable populations.
As an extension of determinants of health, there are marginalized populations who are identified as particularly vulnerable to health issues. Patrick et al. define vulnerable populations as “those that experience adverse health outcomes compared with the general population by virtue of both internal and external factors” (2018, p. 307). This includes, but is not limited to: indigenous, immigrants, prisoners, LBGBTQ+, physically and mentally disabled, chronically ill, and low income to name a few (Waisel, 2013). It is especially important to reach this population in a meaningful way because without intervention, they are more likely to have decreased health outcomes and increase mortality rates (Patrick et al., 2018; Waisel, 2013). It is the job of the healthcare community to advocate for these populations because we are the first to see the ravaging effects that result from this vulnerability.
Moving forward, and coming full circle, the future direction of healthcare is taking all that we know about how the system works, how we fit within the system, and what needs to change, and using our interconnectedness to bring about change. Like with the socio-ecolgiocal model, if each person in the healthcare chain can advocate for health, regardless of the person, then the small changes can add up to a healthier population. As a paramedic, I am often the first person in the long chain of practitioners during an emergency. If I do my part to determine the root of the problem, and give my unique perspective on things like living conditions, support systems, and overall attitude towards health in addition to my assessments, the patient has a better chance of being seen by the right healthcare professionals. These efforts can mitigate negative determinants of health, and ideally improve quality of life. For more resources on these issues, you can visit the resources page that highlights the information used in this post, as well as the other blog posts.
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