Health is a dynamic state of physical, psychological and social well-being (Bircher, 2005). There are many factors that affect health, some of which include genetics, income, and education level, which are known as the determinants of health (‘Determinants of health’, n.d.). Most determinants of health cannot be controlled, such as genetics and culture, whereas others such as education level and income can be controlled to a certain extent.
In my opinion, the healthcare system in Canada does a decent job of maintaining individuals and communities’ health, although there are many barriers within the healthcare system that cause health inequities and inequalities. For example, health inequities can be perpetuated when policies, such as the Indian Act, still prevail within the Canadian government. This gives certain stakeholders the right to control Indian lands, moneys and resources, as well as decide what rights come along with being a ‘status-Indian’ (Henderson, n.d). On the other hand, health inequalities can be perpetuated when, for example, this same population has reduced access to healthcare services due to factors such as geographical location, language barriers, and a lack of health resources on native reserve lands.
Through the analysis of the Canadian healthcare system, I have gained an increased awareness of its effects on Canadians health, and my place as a nurse within it all.
In nursing, a professional identity is socially constructed through the adoption of certain norms, values, behaviours and beliefs, which largely underpin the professional behavior of nurses (Elliott, 2017). Some of my personal values include integrity, altruism, care and compassion, although my drive to help others is what ultimately lead me to choosing nursing as a career.
Throughout my education, core nursing values and ethics were heavily emphasized throughout the curriculum, which eventually led me to internalize them and behave accordingly. I had not realized until I created my blog post on my professional identity and values, to what degree education socializes individuals into a profession. I have realized that individuals are heavily shaped by their education, but are also shaped by their own personal values, their environment, and their social circles among other things, and all these factors combined play an important role in the development of professionals and professional identity.
Part of becoming the professional one aspires to be entails making decisions that will influence the future of their career and themselves as a person. As for myself, I have chosen to further my education to learn more about health, increase my awareness of current trends in healthcare, and learn how to create change within the healthcare system with the knowledge I have acquired. Through my thorough analysis of the Canadian healthcare system, I have uncovered much information about its advantages for Canadians health, as well as its flaws.
The Canadian Healthcare System
The healthcare system in Canada is publicly funded and each province and territory have their own healthcare insurance plan which enables Canadians to have access to medically necessary hospital and physician services without paying out-of-pocket (‘Canada Healthcare’, 2016).
Under the Canada Health Act, universal coverage is limited to medically necessary hospital and physician services, which excludes outpatient pharmaceuticals, dental care, long-term care and certain mental health services (Flood & Thomas, 2016). That said, what are Canadians supposed to do if they cannot afford services that are not covered by the healthcare system? These simple words, medically necessary, place many Canadians at a disadvantage and cause inequities in health. In order to comprehensively understand the causes of inequities and inequalities in health, I have realized how essential it is to take the determinants of health into consideration when analyzing any health issue.
The Determinants of Health
The determinants of health comprise a myriad of factors that when combined affect the health of individuals and communities. Some of these factors include income and social status, level of education, the physical environment, culture and traditions, employment, personal behaviours, social support networks, genetics, and access to health services (‘Determinants of health’, n.d.). Individuals are unlikely capable of directly controlling many of the determinants of health because the context of people’s lives determines their health (‘Determinants of health’, n.d.).
The following is an example as to how the determinants of health can influence health. More information can be found here.
"Why is Jason in the hospital? Because he has a bad infection in his leg. But why does he have an infection? Because his cut on his leg got infected. But why does he have a cut on his leg? Because he was playing in the junk yard next to his apartment building and there was some sharp, jagged steel there that he fell on. But why was he playing in a junk yard? Because his neighbourhood is kind of run down. A lot of kids play there and there is no one to supervise them. But why does he live in that neighbourhood? Because his parents can't afford a nicer place to live. But why can't his parents afford a nicer place to live? Because his Dad is unemployed and his Mom is sick. But why is his Dad unemployed? Because he doesn't have much education and he can't find a job. But why ...?"
('What determines health?', 2011).
Social Determinants of Health: Claire Pomeroy at TEDxUCDavis
Source: https://www.youtube.com/watch?v=qykD-2AXKIU
In order to more comprehensively understand which determinants of health are causing inequities and inequalities in health, it can be useful to equally apply a multilevel model of health. Through its application to a certain health issue, I have learned how inherent certain determinants are in shaping the context of people’s lives.
I chose to apply the Social Ecological Model of health (SEM) to analyze a particular health issue which was the development of type-2 diabetes in Aboriginal Canadians. Using the SEM to analyze this particular health issue has enabled me to comprehend how health is truly dependent on multiple levels of influence. For example, social, physical, and cultural aspects of any given environment have a cumulative effect on health, thus influences people differently (Golden & Earp, 2012). Furthermore, issues are extremely complex and determinants of health are heavily intertwined, making efforts for change seem almost impossible. Of course, creating sustainable health improvements is most effective when all factors are targeted simultaneously, but unfortunately this is an impractical and unrealistic goal (Golden & Earp, 2012). That said, Golden and Earp (2012) recommend that interventions focus on at least two levels of influence at any particular given time.
As a health professional, I am well placed to help create strategies and to implement change within each level of a social system. For instance, the development of type-2 diabetes in the Aboriginal population is an extremely complex, multifactorial and delicate health issue, as it includes accepting that policies from the past have marginalized and colonized this population, and continue to marginalize the same at-risk population. Moreover, many health issues developed as a consequence of such policies. As a result, there have been and continue to be detrimental effects on this populations mental, social and physical well-being. More needs to be done to target and create positive change for vulnerable populations.
Refugees are another vulnerable population in Canada. Analyzing the context in which they live made me realize how many health problems refugees face during their journey, as well as after they are settled in Canada. Refugees face many of the same barriers other vulnerable populations face, one of the main barriers being access to healthcare services.
Barriers can include language, unfamiliarity with the health system, lack of transportation, medical expenses and much more. Learning about vulnerable populations and the challenges they face has made me realize how important it is for healthcare staff to be properly trained in order to provide culturally safe and culturally competent care. This care includes having knowledge about different cultures, traditions and languages, as well as ways in which they approach and can better serve vulnerable populations (Morris, Popper, Rodwell, Brodine & Brouwer, 2009). This awareness and learning should begin early on within their professional educational curriculum. As healthcare professionals, we must promote the ability to access preventive and curative health services to Canadians and ensure barriers to accessing healthcare are recognized, and efforts put in place to facilitate vulnerable populations access to these services.
To conclude, we must keep in mind that health is dynamic and is heavily dependent on multiple levels of influence. Most determinants of health cannot be controlled, although some can. Currently, those who work for the healthcare system in Canada are trying their best to prevent illness, promote health and manage disease. As healthcare professionals, one of our goals should be to address the barriers causing health inequalities and health inequities, and subsequently create strategies for change. Only with this recognition and effort, can there be positive change in the health of Canadians.
References:
Bircher, J. (2005). Towards a dynamic definition of health and disease. Medicine, Health Care
and Philosophy, 8(3), 335-341. https://doi:10.1007/s11019-005-0538-y
Canada's health care system. (2016, August 22). Retrieved March 29, 2018, from
https://www.canada.ca/en/health-canada/services/canada-health-care-system.html
Determinants of health. (n.d.). Retrieved March 29, 2018, from
Elliott, A. M. (2017). Identifying professional values in nursing: An integrative review. Teaching
and Learning in Nursing, 12(3), 201-206. http://doi:10.1016/j.teln.2017.02.002
Flood, C. M., & Thomas, B. (2016). Moderninzing the Canada Health Act. Dalhousie Law
Journal, 39(2), 398-411.
Golden, S. D., & Earp, J. A. (2012). Social ecological approaches to individuals and their
contexts. Health Education & Behavior, 39(3), 364-372.
https://doi:10.1177/1090198111418634
Henderson, W. B. (n.d.). Indian Act. Retrieved March 30, 2018, from
Morris, M. D., Popper, S. T., Rodwell, T. C., Brodine, S. K., & Brouwer, K. C. (2009). Healthcare
barriers of refugees post-resettlement. Journal of Community Health, 34(6), 529-
538. https://doi:10.1007/s10900-009-9175-3
What determines health? (2011, October 21). Retrieved March 29, 2018, from
https://www.canada.ca/en/public-health/services/health-promotion/population-
health/what-determines-health.html