Inter-professional Connectedness

In this unit I will meet and introduce yourself to your instructor and classmates. As part of thinking about professionalism, you will reflect upon your professional identity and your professional values.

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• Social media guidelines for nurses: https://www.youtube.com/watch?v=i9FBEiZRnmo&feature=youtu.be

• ​Social media: Reflect before you post: https://youtu.be/VvTpnckfFyk

• Inter-professional connectedness: Blog post

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Federal and Provincial Health Systems in Canada 

In this unit I will explore how your profession fits within the Canadian health system and your province. 

 

This is a direct link to my portfolio website.

https://nina83ezra.wixsite.com

 

• Cancer Care Ontario (CCO) (2020). First Nations, Inuits,Metis and Urban Indigenous Cancer Strategy. Retrieved October 5, 2020 from, https://www.cancercareontario.ca/en/cancer-care-ontario/programs/aboriginal-programs/indigenous-cancer-strategy

• Simcoe Muskoka Aboriginal Cancer Plan (2016). Retrieved October 5, 2020 from, https://www.rvh.on.ca/smrcp/smrcp_library/NSM%20ACS.pdf

 

Health of Canadians - Understanding Health and Determinants of Health

In this unit I will focus on contemporary approaches to understanding health and to understand how health is broadly understood. Once I have an idea of how the understanding of health can vary, I will seek to understand and identify determinants of health. 

 

Resources for Understanding Health

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• Implications of health as 'the ability to adapt and self-manage' for public health policy: A qualitative study

  • ​To explore the implications for public health policy of a new conceptualization of health as ‘The ability to adapt and to self-manage, in the face of social, physical and emotional challenges’

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• Defining health and health inequalities​

  • ​To examine existing definitions of health and health inequalities and to synthesize the most useful of these using explicit rationale and the most parsimonious text.

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• Dimensions of wellness: Change your habits, change your life​

  • ​Wellness necessitates good self-stewardship, for ourselves and for those we care about and who care about us.

  • Wellness encompasses 8 mutually interdependent dimensions: physical, intellectual, emotional, social, spiritual, vocational, financial, and environmental. Attention must be given to all the dimensions, as neglect of any one over time will adversely affect the others, and ultimately one’s health, well-being, and quality of life. 

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• Emergent properties define the subjective nature of health and disease

  • ​Health and dis-ease by their etymological origins refer to an evaluative, not objective, state. Health is an adaptive state, constantly reestablishing itself through interactions between the many biological, social, emotional, and cognitive factors in a person’s life

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• It’s time to change the definition of ‘health.’

  • ​A definition of “complete” health as the absence of disease leaves little space for people with chronic diseases and for managing them in new ways.

  • Having disease and feeling healthy are no longer mutually exclusive, especially for older adults. Managing multiple diseases is the norm for older Americans — approximately two-thirds of adults over age 65 and more than three-quarters over age 85 are managing two or more diseases, while many report being in good or very good health. High blood pressure, diabetes, high cholesterol, arthritis, kidney disease, thyroid conditions, and osteoporosis are among the most common chronic conditions, but with regular access to continuous medical care, these and many more can be managed well, sometimes even without symptoms.

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• Health: How should we define it?

  • ​The WHO definition of health as complete wellbeing is no longer fit for purpose given the rise of chronic disease. Machteld Huber and colleagues propose changing the emphasis towards the ability to adapt and self manage in the face of social, physical, and emotional challenges

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Resources for Understanding Social determinants of health

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• Measuring social inequality in health amongst indigenous peoples in the Arctic. A comparison of different indicators of social disparity among the Inuit in Greenland.

  • ​The purpose of the article is to compare different indicators of social position as measures of social inequality in health in a population sample from an indigenous arctic people, the Inuit in Greenland.

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• Understanding and Changing the Social World, Comprehensive Edition

  • ​We usually think of health, illness, and medicine in individual terms. When a person becomes ill, we view the illness as a medical problem with biological causes, and a physician treats the individual accordingly. A sociological approach takes a different view. Unlike physicians, sociologists and other public health scholars do not try to understand why any one person becomes ill. Instead, they typically examine rates of illness to explain why people from certain social backgrounds are more likely than those from others to become sick. Here, as we will see, our social location in society—our social class, race and ethnicity, and gender—makes a critical difference.

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• Social Determinants of Health

  • ​Black people in Ontario face disproportionately poor outcomes across the social determinants of health. The social determinants of health are the conditions in which people are born, grow, live, work and age. Early childhood development, income, employment, education, housing, racism are all key determinants. Disparities across several social determinants of health result in inequitable treatment and unequal outcomes in Justice, Education, and Child Welfare sectors, and poorer health outcomes. The position of the Canadian Medical Association is that the social determinants of health have the largest impact on individual and population health.

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• Affordable Housing in Ontario: Mobilizing Private Capital in an Era of Public Constraint

  • ​This Perspectives paper considers how to create the conditions for greater private participation in affordable housing in Ontario. The purpose of affordable housing is relatively simple: to provide adequate shelter for people at a range of incomes who cannot reasonably afford to pay the market rate. But the economics of affordable housing is complex and there is no “free lunch.” Somebody has to pay the difference between the affordable rates and the market price.

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• Care providers are using new tools to address social determinants of health

  • ​The more work that’s done in Canada to reduce health inequalities, the more we know that social determinants of health – including income security – have an important influence on outcomes. Yet, care providers don’t have a standardized way to collect this type of data and treat their patients accordingly

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• Social Determinants of Health: Housing and Income
  • Social determinants of health such as housing and income have a large impact on mental health. Community-based initiatives have worked to address across to housing, prevent homelessness and assist people who are homeless with mental health problems. There have been several large research projects to tease out multiple subgroups such as youth and veterans and other individuals experiencing long-term homelessness. The issue of poverty has been addressed by exploring issues related to employment. The use of social enterprises is a promising practice to address issues around poverty, social inclusion and employment. Similarly, the community has worked to move hospital-based employment programs to the community.

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• A Looming Crisis: Senior Hunger in Ontario

  • ​Through emergency food support, innovative programming, and a commitment to investigating long-term solutions to poverty, the provincial food bank network works tirelessly to improve the health and well-being of the adults and families it serves, while making recommendations to provincial leaders to invest in programs that help achieve its vision of a hunger free Ontario.

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• Canadian adolescent perceptions and knowledge about the social determinants of health: an observational study of Kingston, Ontario youth​

  • Upstream social determinants of health (SDH) have become widely acknowledged as lying at the root of poor health outcomes in Canada and globally. The Commission on the Social Determinants of Health maintains that educating the public about the SDH is a key step towards population health equity. Little is known about adolescent perceptions of the determinants of health. Curriculum in Ontario is lacking in SDH content, placing a much greater emphasis on individual, lifestyle behaviours, such as diet, physical activity, and safe sex practices. Identifying a gap in SDH knowledge within the adolescent population is required to advocate for health curriculum revision to include SDH material.

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• National Longitudinal Survey of Children & Youth

  • The National Longitudinal Survey of Children and Youth (NLSCY) is a long-term study conducted in partnership by Human Resources Development Canada (HRDC) and Statistics Canada. The primary objective of the NLSCY is to monitor the development and well-being of Canada’s children as they grow from infancy to adulthood.

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• Social Inclusion Health Indicators: A framework for Addressing the Social Determinants of Health

  • ​Social inclusion has been widely recognized as a key social determinant of health. The concept of social inclusion provides a useful means of better understanding how the social determinants of health (SDOH), such as low income, poor housing and food insecurity, are interrelated and negatively affect health

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• Public Health Responds to the Challenge to Reduce Poverty and Enhance Resiliency in Children and Youth

  • ​This position paper is a revised version of the original position paper, Towards a Public Health Approach to Reducing Child Poverty and Enhancing Resilience. OPHA position papers require revision every five years, and although there has been some change on this issue in the last year, sadly child poverty has persisted for over 30 years in Canada. It is thought that continuing the efforts and increased public health involvement is required to see a significant reduction in child poverty.

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• Simcoe Muskoka District Health Unit Approach To Addressing The Determinants of Health

  • ​The socioeconomic factors that affect health are complex and intertwined throughout the life course of individuals. Known as the social determinants of health, they include: income and social status, social support networks, education and literacy, employment/working conditions, social environments, physical environments, personal health practices and coping skills, healthy child development, and health services. To improve health and to narrow the health inequities created by these socioeconomic factors, we must look beyond health care and focus on understanding and finding solutions to these root causes of poor health.

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• Failure to acknowledge inequities in the social determinants of health

  • ​When we as health care providers present research regarding Indigenous patients and frame it with the lens of, for instance, potential parental neglect without expressly acknowledging the contexts and oppressions that the families face we are perpetuating stigma and colonization. When we state that an “extensive review” was conducted but do not discuss the barriers and strengths that were discovered, we are failing to adequately represent and advocate for our patients.

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Multilevel Approaches to Understanding Health - Beyond the Individual 

 

In this unit we will seek to understand the different types of determinants of health and how health is impacted by behaviour, context, genetics, policy, social structure and so on.We will begin to consider ways of understanding how these pieces fit together, by reviewing literature and resources addressing multiple levels of health influence

 

• Multilevel interventions to address health disparities show promise in improving population health

  • ​​Multilevel interventions are those that affect at least two levels of influence—for example, the patient and the health care provider. They can be experimental designs or natural experiments caused by changes in policy, such as the implementation of the Affordable Care Act or local policies. Measuring the effects of multilevel interventions is challenging, because they allow for interaction among levels, and the impact of each intervention must be assessed and translated into practice

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• Translating multilevel theory into multilevel research: Challenges and opportunities for understanding the social determinants of psychiatric disorders

  • ​The observation that features of the social environment, including family, school, and neighborhood characteristics, are associated with individual-level outcomes has spurred the development of dozens of multilevel or ecological theoretical frameworks in epidemiology, public health, psychology, and sociology, among other disciplines. Despite the widespread use of such theories in etiological, intervention, and policy studies, challenges remain in bridging multilevel theory and empirical research

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• A multilevel approach to modeling health inequalities at the intersection of multiple social identities 

  • ​Examining interactions between numerous interlocking social identities and the systems of oppression and privilege that shape them is central to health inequalities research. Multilevel models are an alternative and novel approach to examining health inequalities at the intersection of multiple social identities. This approach draws attention to the heterogeneity within and between intersectional social strata by partitioning the total variance across two levels.​​​

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• Bandura's social learning theory and socical cognitive learning theory

  • Albert Bandura is known as the father of cognitive theory. He was born December 4, 1925 in a small town in northern Alberta, Canada, located approximately 50 miles from Edmonton. Bandura’s early education consisted of one small school with only two teachers. Albert Bandura soon became fascinated by psychology after enrolling at the University of British Columbia. He had started out at biological sciences major, his interest in psychology formed quite by accident. He was working nights and commuting to school with a group of students who arrived much earlier than his other courses started

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• Bobo doll experiment

  • ​Bobo doll experiment, groundbreaking study on aggression led by psychologist Albert Bandura that demonstrated that children are able to learn through the observation of adult behaviour. The experiment was executed via a team of researchers who physically and verbally abused an inflatable doll in front of preschool-age children, which led the children to later mimic the behaviour of the adults by attacking the doll in the same fashion

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• Theory and practice: applying the ecological model to formative research for a WIC training program in New York State

  • ​The Health Belief Model (HBM) posits that messages will achieve optimal behaviour change if they successfully target perceived barriers, benefits, self-efficacy, and threat. While the model seems to be an ideal explanatory framework for communication research, theoretical limitations have limited its use in the field. Notably, variable ordering is currently undefined in the HBM. Thus, it is unclear whether constructs mediate relationships comparably (parallel mediation), in sequence (serial mediation), or in tandem with a moderator (moderated mediation). To investigate variable ordering, adults (N = 1,377) completed a survey in the aftermath of an 8-month flu vaccine campaign grounded in the HBM. Exposure to the campaign was positively related to vaccination behaviour. Statistical evaluation supported a model where the indirect effect of exposure on behaviour through perceived barriers and threat was moderated by self-efficacy (moderated mediation). Perceived barriers and benefits also formed a serial mediation chain. The results indicate that variable ordering in the Health Belief Model may be complex, may help to explain conflicting results of the past, and may be a good focus for future research.

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• Disparity in cancer prevention and screening in aboriginal populations: recommendation for action

  • ​Historically, cancer has occurred at a lower rate in aboriginal populations; however, it is now dramatically increasing. Unless preventive measures are taken, cancer rates among aboriginal peoples are expected to soon surpass those in non-aboriginal populations. Because a large proportion of malignant disorders are preventable, primary prevention through socioeconomic interventions, environmental changes, and lifestyle modification might provide the best option for reducing the increasing burden of cancers. Such efforts can be further amplified by making use of effective cancer screening programs for early detection of cancers at their most treatable stage. However, compared with non-aboriginal Canadians, many aboriginal Canadians lack equal access to cancer screening and prevention programs. In this paper, we discuss disparities in cancer prevention and screening in aboriginal populations in Canada. We begin with the relevant definitions and a theoretical perspective of disparity in health care in aboriginal populations. A framework of health determinants is proposed to explain the pathways associated with an increased risk of cancer that are potentially avoidable. Major challenges and knowledge gaps in relation to cancer care for aboriginal populations are addressed, and we make recommendations to eliminate disparities in cancer control and prevention.

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• Cervical cancer screening strategies for aboriginal women

  • ​British Columbia is home to the British Columbia Cancer Agency’s Cervical Cancer Screening Program (CCSP), a population-based cervical cancer screening program credited with achieving a 70% reduction in cervical cancer incidence in British Columbia over the past fifty years, largely by widely promoting screening and making screening services readily available and free of cost. While the CCSP has had enormous success in increasing rates of cervical cancer screening among most of the province’s female population, Aboriginal women in British Columbia are estimated to have Pap rates of 50% compared to 85% for all women in British Columbia. Mortality from cervical cancer is six times higher among Aboriginal women than other women in British Columbia.

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• ​Cervical cancer

  • ​Cervical cancer starts in the cells of the cervix. A cancerous (malignant) tumour is a group of cancer cells that can grow into nearby tissue and destroy it. The tumour can also spread (metastasize) to other parts of the body.

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• ​The health belief mode

  • ​Since the early 1950s, the Health Belief Model (HBM) has been one of the most widely used conceptual frameworks in health behaviour research, both to explain change and maintenance of health-related behaviours and as a guiding framework for health behaviour interventions. Over the past two decades, the HBM has been expanded, compared to other frameworks, and used to support interventions to change health behaviour. In this chapter, we review fundamental components of the HBM and examine other psychosocial constructs that further explain relationships within the model. First, origins of the HBM and the relationship of the HBM to psychosocial theories are explored. Second, we discuss issues related to the measurement of HBM constructs. Third, we give examples of applications of the HBM in breast cancer screening and AIDS-prevention behaviours. The applications describe how the HBM has been used CHAPTER 3  Health Behaviour and Health Education to explain these behaviours and also as a basis for interventions. We use these examples because they represent two very different public health problems in our society, each with behavioural implications.

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• ​Reduced cervical cancer incidence and mortality in Canada: national data from 1932-2006

  • ​High levels of participation in cervical screening are reported in Canada from the 1970’s as a result of early uptake of the Pap smear and universal Medicare. Despite recommendations to the contrary, the programs have featured early age of initiation of screening and frequent screening intervals. Other countries have achieved successful outcomes without such features. We analyzed national data to better understand mortality and incidence trends, and their relationships to screening.

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• ​Human papillomavirus and related cancers, fact sheet​​

  • ​Canada has a population of 15.32 millions women ages 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that every year 1434 women are diagnosed with cervical cancer and 586 die from the disease. Cervical cancer ranks as the 14th most frequent cancer among women in Canada and the 4th most frequent cancer among women between 15 and 44 years of age. About 6.2% of women in the general population are estimated to harbour cervical HPV-16/18 infection at a given time, and 74.0% of invasive cervical cancers are attributed to HPVs 16 or 18.

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• ​Cervical cancer screening behaviours among American Indian women: Cervical cancer literacy and health belief model.

  • American Indian women experience disproportionately high rates of cervical cancer morbidity and mortality, yet cancer screening services tend to be underutilized. Using the Health Belief Model (HBM) with a survey of American Indian women (N= 286) in South Dakota, findings indicate that only 59% received Pap test within the past 2 years. Significant predictors of Pap test included advanced age, higher BMI, greater aware- ness of Pap test, greater motivation, and lower barriers to screening. Findings highlight the importance of considering awareness of cancer screening and HBM constructs (barriers and motivation) in the examination of programs to improve screening among this population.

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• ​A qualitative study of provider perspective of structural barriers to cervical cancer screening among First Nation women.

  • ​In Canada, opportunistic screening programs have successfully reduced mortality from cervical cancer; however, minority or disadvantaged groups, as well as women in northern and rural areas, are inadequately recruited by this approach. Hence, we set out to examine the structural barriers that prevent First Nations women’s participation in cervical cancer screening.

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• Engaging Canadian First Nations women in cervical screening through education. International Journal of Health Promotion and Education. 

  • ​Recognition of the need to decrease cervical cancer rates in Indigenous populations has been ongoing—yet few successful interventions have been reported. In addition, literature addressing the challenges and barriers associated with designing screening programs aimed to specifically reach Indigenous women is limited. Here, we report findings from a mixed methods cervical cancer research project conducted in partnership with 10 First Nations communities in northwest Ontario, Canada. Individual interviews with community health professionals (the majority of whom identified as First Nations) stressed that awareness of cervical screening benefits is lacking. In contrast, focus group participants (women with no formal health education) emphasized the desire to learn more about the science of human papillomavirus (HPV), and that a positive HPV or abnormal Papanicolaou test need not mean a woman will undoubtedly develop cervical cancer.

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• ​Feasibility of self-sampling and human papillomavirus testing for cervical cancer screening in First Nation women from Northwest, Ontario, Canada: a pilot study.

  • ​The incidence of cervical cancer is up to sixfold higher among First Nation women in Canada than in the general population. This is probably due to lower participation rates in cervical cancer prevention programmes.

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Chronic Disease Prevention and Management

In this unit I will look at the role of a variety of factors such as tobacco use, diet, physical activity, mental health, medical screening, etc and their relationship to chronic disease prevention and management. Specific topics may include the burden of chronic disease in Canada and globally; multi-morbidity; inter-professional teamwork in the prevention and management of chronic disease; health literacy; digital and technological approaches to screening, prevention, and management; and chronic disease prevention and management in First Nations and Aboriginal people.

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• The Mange Care Model -  Developing an evidence-based and expert -driven chronic care management model for patients with Diabetes

  • ​Most current care models are disease- or symptom-focused and mostly do not account for the individual needs of patients with chronic diseases. The aim of this study was to develop an innovative, evidence-based and expert-based practice model for the management of patients with type 2 diabetes mellitus.

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• A systemic review of chronic disease management interventions in primary care​

  • ​Primary and community care are key settings for the effective management of long term conditions. We aimed to evaluate the pattern of health outcomes in chronic disease management interventions for adults with physical health problems implemented in primary or community care settings.

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• Nutrition, child growth, and chronic disease prevention ​

  • ​Countries undergoing the nutrition transition are experiencing a progressive increase in obesity and nutrition‐related chronic diseases (NRCDs). In transitional countries, stunting (shortness for age) and micronutrient deficiencies (iron, vitamin A, and zinc) in children coexist with obesity and NRCDs originating the double burden of nutritional disease. The causal web for obesity and NRCDs is complex and multifaceted; changes in diet and physical activity of the population are likely the main concurrent determinant factors. However, recent evidence suggests that specific patterns of prenatal and postnatal growth are also potential contributors. Evidence indicates that intervention strategies to prevent malnutrition should emphasize improvements in linear growth in the first 2–3 years of life rather than aim at gaining weight. Avoiding excessive weight gain relative to height gain (BMI) is especially relevant after the first 2 years of life. Routine assessment of child growth based on the new World Health Organization (WHO) standard, defining energy needs based on the recent Food and Agricultural Organization (FAO)/WHO norms, and providing critical micronutrients to support lean mass growth are critical to prevent obesity and NRCDs starting early in the life course. These actions should contribute in the prevention and control of obesity in childhood and thus help prevent NRCDs in future generations of adults.

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• A tool for strengthening chronic disease prevention and management: Through dialogue, planning and assessment​

  • To prevent chronic disease and related health problems, investment is needed in a full set of strategies and actions that make it easier for people to take care of their health. This includes creating environments that promote and protect health, as well as shifting how we plan and manage our health services. ​

  • Chronic disease efforts in public health, primary care and community are important parts of a comprehensive approach, but have tended to move along parallel tracks. With growing interest in ‘thinking like a system’, this planning and assessment tool (the Tool) provides a structure and process for bringing together those working to prevent and manage chronic disease in health regions across the country. It helps us to think about, discuss and assess current practice, capacities and opportunities for action.

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• Adaptation of the chronic disease self-management program for cancer survivors: Feasibility, acceptability, and lessons for implementation​

  • ​Self-management in chronic disease has been shown to improve patient-reported and health care-related outcomes. However, relatively little information about its utility in cancer survivorship is known. We evaluated the feasibility and acceptability of the delivery of an adaptation of the evidence-based Chronic Disease Self-management Program (Stanford) called Cancer Thriving and Surviving (CTS)

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• From life-threatening to chronic disease: Is this the case for cancers? A systematic review​

  • ​In recent years, improvements in the identification of risk factors, earlier diagnosis and new treatments have resulted in an increase of the number of cancer patients living longer; even in the case of malignancies that cannot be cured, but can be controlled, current treatments enable many patients to live for years after the diagnosis.

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• Canadian Cancer Society​

  • ​Cancer statistics tell us how many people in Canada are diagnosed with and die from cancer each year. They show us the trends in new cancer cases and cancer deaths. Cancer statistics also tell us the likelihood of surviving a cancer diagnosis and the percentage of people who are alive years after a cancer diagnosis.

  • Canadian provinces and territories collect data on cancer cases and cancer deaths. These data are combined to provide a picture of the impact of cancer for all of Canada

  • Statistics are an important part of healthcare planning and measuring the success of cancer control.

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• Cancer Care Ontario​

  • ​Cancer incidence refers to the number of new cases of cancer diagnosed within a specific period. This chapter presents actual (non-projected) incidence rates and trends based on counts considered complete as of 2016 – the latest available year.

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• Simcoe Muskoka District Health Unit

  • ​Snapshots are a collection of interactive map-based dashboards showing both geographic and temporal trends for key public health indicators by public health unit (PHU) and Ontario overall. Select Snapshots also include Local Health Integration Network (LHIN) and/or LHIN sub-region (LHIN SR) data. All Snapshots provide dynamically linked tables, graphs, and maps with pre-calculated statistics.

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• Childhood cancers from kids cancer care ​

  • ​Childhood cancers differ from adults cancers. They develop in different parts of the body, look different under the microscope and respond differently to treatments.

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• Emerging infectious determinants of chronic diseases​

  • ​Evidence now confirms that noncommunicable chronic diseases can stem from infectious agents. Furthermore, at least 13 of 39 recently described infectious agents induce chronic syndromes. Identifying the relationships can affect health across populations, creating opportunities to reduce the impact of chronic disease by preventing or treating infection. As the concept is progressively accepted, advances in laboratory technology and epidemiology facilitate the detection of non-cultivable, novel, and even recognized microbial origins. A spectrum of diverse pathogens and chronic syndromes emerges, with a range of pathways from exposure to chronic illness or disability. Complex systems of changing human behavioural traits superimposed on human, microbial, and environmental factors often determine risk for exposure and chronic outcome. Yet the strength of causal evidence varies widely, and detecting a microbe does not prove causality. Nevertheless, infectious agents likely determine more cancers, immune-mediated syndromes, neurodevelopmental disorders, and other chronic conditions than currently appreciated.

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• Environmental and Climate Change​

  • ​Environment Canada administers over a dozen Acts of Parliament, either in whole or in part, and is responsible for meeting numerous obligations spelled out in legislation. Under its various acts, the Department works to address and report on a wide range of complex environmental issues.

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• Environment, Health & Safety Policy - Contaminated Sites Program​

  • ​This Environment, Health and Safety (EHS) Policy provides direction in order to meet the requirements of the Canada Labour Code, applicable environmental regulations and policies, and related policies of the Treasury Board in the implementation of the Northern Affairs Program (NAP) Contaminated Sites Program (CSP). The policy will serve as an integral component of NAP's CSP and applies to all individuals involved with NAP contaminated sites.

  • The purpose of this policy is to ensure that all program activities meet EHS requirements, and to ensure that staff, contractors, visitors, and local communities are not adversely impacted by environmental, health, and/or safety risks associated with contaminated sites.

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• Ontario's Environmental Health Climate Change Framework For Action

  • ​Climate change is more than an environmental phenomenon. Humans are directly exposed to climate change and its related health hazards through changes in weather patterns. Humans are also at risk of adverse health outcomes from the impacts of climate change.

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• Canadian Environmental Policies and Legislation​

  • ​Canada is part of many international agreements and partnerships that deal with addressing the issues related to climate change.

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• ​Improving pathways to primary health care among LGBTQ populations and health care providers: key findings from Nova Scotia, Canada

  • ​This study explores the perceived barriers to primary health care as identified among a sample of Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) identified individuals and health care providers in Nova Scotia, Canada. These findings, based on a province-wide anonymous online survey, suggest that additional efforts are needed to improve pathways to primary health among LGBTQ populations and in deepening our understanding of how to advance the unique primary health needs of these populations.​​

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• ​Chronic disease prevention and management

  • ​When Canadians need health care, most often they turn to primary health care (PHC) services.1 PHC is the first point of contact with the health care system, and traditionally has focused on the role of family physicians. In the past, Canadians visited their family physicians when in need of health care and their physician either provided services directly or, if more specialized care was required, coordinated patients’ needs with specialists, hospitalized-based services, or other parts of the health care system.

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Vulnerable Populations

In this unit I will investigate an array of vulnerable population relevant to my practice, research or health region. 

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• Insiders' Insight: Discrimination against Indigenous people through the eyes of health care professionals

  • ​Discrimination in the health care system has a direct negative impact on health and wellbeing. Experiences of discrimination are considered a root cause for the health inequalities that exist among Indigenous peoples.

  • Experiences of discrimination are commonplace, with patients noting abusive treatment, stereotyping, and a lack of quality in the care provided, which discourage Indigenous people from accessing care.

  • This research project examined the perspectives of health care providers and decision-makers to identify what challenges they see facing Indigenous patients and families when accessing health services in a large city in southern Ontario.

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• Indigenous people don't feel safe accessing health care. Here's what has to change

  • ​ The B.C. Association of Aboriginal Friendship Centres and the Métis Nation BC called for a public inquiry into Indigenous-specific racism in health in B.C. and said that all health-care providers should be required to take Indigenous-focused training.

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• Under suspicion:Issues raised by Indigenous peoples

  • ​Racial profiling is an insidious and particularly damaging type of racial discrimination that relates to notions of safety and security. Racial profiling violates people’s rights under the Ontario Human Rights Code (Code). People from many different communities experience racial profiling. It is often directed at First Nations, Métis, Inuit and other Indigenous peoples, as well as people in racialized communities. It is often influenced by the distinctly negative stereotypes that people in these communities face.

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• First peoples, second class treatment: The role of racism in the health and well-being of Indigenous peoples in Canada.

  • ​Racism has played a foundational role in the development and maintenance of the Canadian nation state. The colonization of Indigenous lands and peoples was fueled [sic] by racist beliefs and ideas about Indigenous peoples, values, ways of knowing and being, customs and practices.

  • These race-based beliefs served to justify acts of racial discrimination, including violence, cultural genocide, legislated segregation, appropriation of lands, and social and economic oppression enacted through such policies as the Gradual Civilization Act and the Indian Act.

  • Policies and practices emerging from imperialistic and colonial ideologies have been extremely destructive to the health and well-being of Indigenous peoples, cutting across the broad spectrum of social determinants of health, impacting access to education, housing, food security, employment and health care, and permeating societal systems and institutions that have profoundly impacted the lives and well-being of Indigenous peoples including the child welfare and criminal justice systems.

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• The Indian Act​

  • ​The Indian Act is a Canadian federal law that governs in matters pertaining to Indian status, bands, and Indian reserves.  Throughout history it has been highly invasive and paternalistic, as it authorizes the Canadian federal government to regulate and administer in the affairs and day-to-day lives of registered Indians and reserve communities. This authority has ranged from overarching political control, such as imposing governing structures on Aboriginal communities in the form of band councils, to control over the rights of Indians to practice their culture and traditions. The Indian Act has also enabled the government to determine the land base of these groups in the form of reserves, and even to define who qualifies as Indian in the form of Indian status.

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• COVID-19 effects on the mental health of vulnerable populations​

  • ​New national survey from the Canadian Mental Health Association and UBC exposes troubling pandemic mental health vulnerabilities across various groups

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• Opening eyes, opening minds: The Ontario burden of mental illness and addictions report​

  • ​Most Ontarian's are affected, either directly or indirectly, by mental illness and addiction issues. According to the Mental Health Commission of Canada, one in five Canadians is affected by a mental illness or addiction issue every year. Onset often occurs at a young age and can persist throughout life, with a significant impact on social connections, educational goals and workforce participation. The impact of mental illness and addiction on life expectancy, quality of life and health care utilization is significant—in many cases, more so than with other medical conditions—yet is often under-recognized.

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• Mental health of communities during the COVID-19 pandemic​

  • ​The objective of this article is to examine the potential impact of the COVID-19 pandemic on mental health of the population, suggest areas of focus for further research, and outline strategies to support their care. As Governments attempt to mitigate the impact of the viral pandemic, we urge that investments in mental health interventions and research also be prioritized and woven into system-wide measures in order to address its mental health aftermath.

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• COVID-19 and mental health: Policy responses and emerging issues​

  • ​The lessons learned to date from COVID-19, and from earlier disasters and epidemics, suggest that planning and reforms are needed to stay ahead of mental health impacts that will be long term, complex, and may take time to fully emerge. This preliminary scan offers an overview of developing issues for policy makers and the mental health sector to consider. Over the coming months, the Mental Health Commission of Canada (MHCC) will work with its key partners to provide additional policy advice in response to COVID-19, in keeping with its mission to support the mental health of people in Canada.

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• Mental health in Canada: COVID-19 AND BEYOND CAMH policy advice ​

  • ​COVID-19 is having a negative impact on Canadians’ mental health, with many seeing their stress levels double since the onset of the pandemic.4 People are struggling with fear and uncertainty about their own health and their loved ones’ health, concerns about employment and finances, and the social isolation that comes from public health measures such as quarantining and physical distancing.

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• Struggling to connect: white and black feminism in the movement years

  • This article discusses the struggles between white and black feminist movement.

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• Racial inequality, social cohesion and policy issues in Canada  ​

  • we review some research findings specifically related to racial inequality and discrimination in Canada as well as to the social integration of racial minori- ties in Canadian society; we then examine the relation between the two. Our review suggests that racial inequality is a significant issue in Canada, and that the extent of discrimination is a point of dispute between racial groups. This creates a potentially significant racial divide and prompts us to ask whether existing pol- icy responses are adequate to bridge the gap.

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• Understanding inequalities in access to health care services for Aboriginal people: A call for nursing action​

  • ​In this article, vulnerable populations refer to those individuals who experience a heavier burden of disease and suffering than other population groups. In Canada, Aboriginal people are a vulnerable population given that they bear a higher number of inequalities than their non-Aboriginal counterparts. While inequalities in health and social well-being for vulnerable groups persist, the current debate is about what we, as nurses, can do about them.

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Future Directions

In this unit I will explore novel trends currently affecting my practice or area of interest. I will also explore emerging trends in health and health care. Current trends include: demographic changes; the acknowledgment of historical injustices and a desire for a

more inclusive society; and several technological approaches to health and health care.

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• Virtual health care in the era of COVID-19

  • ​In shifting towards virtualized care in response to COVID-19, health-care planners worldwide are drawing from China’s experiences. In China, patients were advised to seek physicians’ help online rather than in person after the pandemic first emerged in Wuhan in December.

  • Government to implement virtual care technologies.

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• The future of healthcare depends on a new vision to fuel innovation​

  • ​Ontario’s recently announced strategy to expand digital and virtual healthcare over the next couple of years is encouraging for all of us working to create a brighter future for our ailing health system.

  • he government’s Digital First for Health Strategy promises to introduce more patient access to video visits with physicians, enable patients to book appointments online and improve healthcare provider access to electronic patient records.

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• Technology and the future of healthcare​

  • ​Healthcare changes dramatically because of technological developments, from anesthetics and antibiotics to magnetic resonance imaging scanners and radiotherapy. Future technological innovation is going to keep transforming healthcare, yet while technologies (new drugs and treatments, new devices, new social media support for healthcare, etc) will drive innovation, human factors will remain one of the stable limitations of breakthroughs. No predictions can satisfy everybody; instead, this article explores fragments of the future to see how to think more clearly about how to get where we want to go.

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• Six healthcare technologies coming in the next 10 years​

  • ​Experts agree that forecasting the future of healthcare technology isn’t difficult-machine learning, artificial intelligence (AI), cloud technologies that apply to clinical, workplace, and financial processes will have better and richer incorporation into the industry.

  • But to get there, healthcare executives need to be laying the cultural foundation today for upcoming technology changes in the next decade.

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•  Improving access to health care among the poor-the neighborhood [sic] health center [sic] experience

  • Utilization, cost, and productivity patterns at neighborhood health centers are examined on the basis of data from 82 centers. Minority groups and reside the South and rural areas are found to have achieved levels of care and b closer to equality with other groups at NHCs than has been their health care experience generally. Continuity and comprehensiveness of care and the u paramedical personnel are shown to be important contributory factors to utilization of NHCs. The impact of alternative cost-saving devices at NHCs is consider appears unlikely that professional productivity can be markedly improve creasing third-party payments is the most likely means of reducing dependence operating grants without deleterious effects on utilization. The problem NHC had in maintaining stable professional staffs is shown to be a problem which further attention if the program is to expand.

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• Innovation in healthcare delivery systems: A conceptual ​framework

  • The healthcare industry has experienced a proliferation of innovations aimed at enhancing life expectancy, quality of life, diagnostic and treatment options, as well as the efficiency and cost effectiveness of the healthcare system. Information technology has played a vital role in the innovation of healthcare systems. Despite the surge in innovation, theoretical research on the art and science of healthcare innovation has been limited. One of the driving forces in research is a conceptual framework that provides researchers with the foundation upon which their studies are built. This paper begins with a definition of healthcare innovation and an understanding of how innovation occurs in healthcare. A conceptual framework is then developed which articulates the intervening variables that drive innovation in healthcare.