My Journey through MHST 601

What comes to mind when you think of health and healthcare? When reading the course introduction for Foundations of Health Systems in Canada (MHST 601), this is the first question asked. Over the past 13 weeks, through readings and interacting with my classmates and instructor, I have had an opportunity to examine health and the foundations of health systems in Canada. I have thoroughly enjoyed the material covered and the opportunity to share my perspective, experiences and leanings.

For this, my final blog post of MHST 601, I will compose an integrated and synthesized summary of the key health issues discussed throughout the course, drawing from the course material, previous blog posts and curated resources. Throughout the MHST 601, we were asked to choose topics reflecting our own professional practice. The coronavirus disease 2019 (COVID-19) has substantially impacted the healthcare system over the past year. I decide to explore the impact the global pandemic has had on the health of Canadians.

I will reflect on the topics covered each week, including reviewing my role within the health care system, federal and provincial health systems in Canada, understanding health and the determinants of health, chronic disease preventions and vulnerable populations, and finally, looking towards the future of health.

Unit 1: Inter-professional Connectedness

At the beginning of MHST 601, we were asked to take some time to reflect upon our professional identity and values and to develop our own method for curating and sharing digital resources related to professional practice, scholarly evidence and research. In my first blog post on professionalism and social media use, I examined my social media use and how social media can be used to promote positive health changes, share information, and engage in health-related discussions. Throughout the course, many of my classmates and I have been using social media to develop our online professional presence and share topics related to the course material or other health-related interests.

As a Registered Nurse currently working as the COVID response manager for Nova Scotia Health Authority, I have started to think about how I can continue to use my social media platforms to share informative and accurate content. Having joined Twitter, I have begun to explore this platform's use. I can see how social media is one of the quickest and easiest ways to disseminate information, especially targeting youth (D'Amore, 2020).

Unit 2: Federal and Provincial Health Systems in Canada

For unit 2, we were asked to develop a professional digital presence by creating an ePortfolio to house our professional accomplishments, curated resources, and artifacts created throughout the Master of Health Studies program (Athabasca University, 2018). I developed my ePortfolio using Wix, as I found this platform easy to navigate and visually appealing. While building my ePortfolio, we were asked to include: an introduction, an overview of our training and education, professional credentials, link and resource, and a blog. We were also to have a concise summary of our role within the health system and how our profession is regulated within our respective province. As a Registered Nurse in Nova Scotia, I belong to the Nova Scotia College of Nursing and must meet the expectations outlined in the Standards of Practice for Registered Nurses. While developing my ePortfolio, I have included resources on nursing in my home province.

Over the past 13 weeks, I have been continuously updating and adding information to my ePortfolio and look forward to seeing how my use of this platform evolves.

Unit 3: Health of Canadians – Understanding Health and Determinants of Health

After reflecting on our own professional identity, we looked to gain a greater understanding of what is health and how it is broadly understood (Athabasca University, 2018). In my blog, What is Health? I explored the history of health and look at how health could be defined today. In 1948, the World Health Organization (WHO) defined health as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity." Although this definition is more than 70 years old, it is still considered the most established modern health definition. When looking at the criticism of this definition and through our forum discussions, I believe we can acknowledge that health is more than the absence of disease.

CMHA Ontario

After defining health, we looked at what factors influence health. The social determinants of health (SDOH), the primary factors that shape Canadians' health are not medical treatments or lifestyle choices but rather the living conditions they experience (Raphael, 2010). Health and wellbeing are affected by income, genetics, gender, race and access to health services. Living in rural Nova Scotia, I reviewed the health of Nova Scotians and looked at how the SDOH affects the health of those living in my area. As discussed in my blog, compared to the rest of Canada, Nova Scotia has high rates of cancer, diabetes, respiratory disease, and high rates of the risk factors that lead to these diseases.

Unit 4: Multilevel Approaches to Understanding Health – Beyond the Individual

There are many determinants of health, which may differ in terms of impact on health. In unit 4, we explored the SDOH and how health is impacted by behaviour, context, genetics, policy, etc. (Athabasca University, 2018). We could choose a multilevel model of health and apply this to a population relevant to our current practice. As my current focus is around the COVID response, I used the social-ecological model (SEM) to explore ways to improve the overall vaccine rates. The SEM shifts the focus from an individual behaviour approach towards interventions directed at changing individual, interpersonal, organizational, community, and public policy, to influence health outcomes (Max et al., 2015). The model believes that interventions are more likely to be effective when they address all determinants of health. When writing my blog on increasing vaccine rates, I explored intervention at each level to show how this model can help health care professionals design plans to address the interaction between multiple levels.

Unit 5: Chronic Disease Prevention and Management

Chronic diseases are conditions that last a year or more. They not only do they reduce the quality and length of people's lives but are expensive to treat. Approximately one in three Canadians live with at least one major chronic disease and is expected to rise as the population ages (Roberts et al. 2015). Socio-economic causes such as poverty, inequality, poor education and environmental causes all contribute to chronic illness (Colman et al., 2002). For unit 5, I explored the primary determinants of chronic disease I see in Nova Scotia; some of the highlights are:

• Low-Income groups have high rates of smoking, obesity and physical inactivity, therefore putting them at an increased risk of cardiovascular disease.

7% of people in Nova Scotia are living low income

61% of the populating is overweight or obese

22% report smoking daily or occasional smoking

29% report smoking are from low - income households

46% of those living in low-income making time for physical activity

• In Nova Scotia, those without a high school diploma use 49% more physician services and have generally increased risk factors for chronic disease than those with a BA.

15% of Nova Scotians have less than a high school diploma

The department of health and wellness acknowledges that Nova Scotia has one of Canada's highest rates of chronic disease. The public health website has several protocols and documents that outline the plan for public health to address the root causes and social determinants of health to minimize health inequalities and improve the health of Nova Scotians. (Chronic Disease Prevention and Management. n.d.)

Unit 6: Vulnerable Populations

Unit 6 looked at vulnerable populations and the impact this has on an individual’s health. To be vulnerable means you are at an increased risk of being harmed. Vulnerable populations, such as persons living in poverty or homeless, are at an increased risk of health problems and face significant barriers when accessing health care services. Individuals who are homeless are at an increased risk of dying prematurely and suffer from a wide range of chronic health challenges, including chronic obstructive pulmonary disease, tuberculosis, seizures, skin and foot problems, and smoking.

In addition to the many health challenges the homeless population already faces, this year, COVID-19 has been hard on Canada’s homeless population. Many shelters have had to reduce capacity to facilitate physical distancing, making it harder for many to find a safe place to sleep (Fenn, 2020). Individuals experiencing homelessness often find it challenging to adhere to public health directives such as social distancing and self-isolation and are at an increased risk of severe COVID-19 due to the high prevalence of chronic health challenges (Perri et al., 2020).

Unit 7: Future Directions

Health care is ever-evolving. The last unit allowed us to look at some of the current and emerging health trends. From virtual reality to wearable technology, there are many new and exciting ways we can care for our patients. When looking to the future, I wanted to look at an innovation that we see more and more due to COVID-19. The coronavirus disease 2019 (COVID-19) has had a substantial impact on the healthcare system. Healthcare institutions have had to rapidly mobilize, organize and deploy resources to provide care for Canadians while also caring for non-COVID-19 patients.

Across Canada, there has been a growing interest in virtual care solutions. Virtual care – connecting with health care providers by e-mail, phone, or video call has not been a routine practice in Canada, despite its potential to offer timely access to care to all Canadians. Much of the messaging with the coronavirus disease 2019 (COVID-19) has been around "flattening the curve" or "staying the blazes home," asking individuals to maintain social distancing and limiting their interactions to those outside their 'bubble.' Many health care providers have implemented and adopted virtual health care resulting in millions of Canadians trying virtual care for the first time. A recent survey suggests that 47 percent of Canadians have used virtual care during the pandemic, and of those, 91 percent we satisfied with the experience (Zafar, 2020).

While virtual care will never wholly replace in-person consultations and exams, the pandemic response inadvertently sped up virtual care implementation in Canada. Hopefully, this will lay the groundwork for widespread uptake in the future (Tang & Zhou, 2020).

Conclusion

In taking the time to reflect on my journey through the Critical Foundations in Health Disciplines (MHST 601) course, I thankful to have gained a greater understanding of the power of social media, the concept of health, health determinants, and the impact of chronic disease and vulnerability have on health. Looking to the future, I believe this course has provided me with the foundation to build upon as a continue my Masters in Health Studies.

References:

Athabasca University. (2018, April 16). Unit 2: Federal and Provincial Health Systems in Canada. http://charon.athabascau.ca/cnhsgrad/mhst601_w2018/unit2.htm

Athabasca University. (2018, April 16). Unit 3: Health of Canadians - Understanding Health and Determinants of Health. http://charon.athabascau.ca/cnhsgrad/mhst601_w2018/unit3.htm

Athabasca University. (2018, April 16). Unit 4: Multilevel Approaches to Understanding Health – Beyond the Individual. http://charon.athabascau.ca/cnhsgrad/mhst601_w2018/unit4.htm

Colman, R. (2002). The cost of chronic disease in Nova Scotia. Genuine Progress Index for Atlantic Canada. https://novascotia.ca/dhw/publications/cost_chronic_disease.pdf

D'Amore, R. (2020, October 1). Why social media is a 'missed opportunity' as coronavirus spreads among young people. Global News. https://globalnews.ca/news/7368544/coronavirus-canada-youth-social-media/

Fenn, K. (2020, October 12). Pandemic is creating a new type of homelessness, says outreach worker. CBC Radio. https://www.cbc.ca/radio/thecurrent/the-current-for-oct-12-2020-1.5757769/pandemic-is-creating-a-new-type-of-homelessness-says-outreach-worker-1.5757770

Government of Nova Scotia (n.d.). Chronic disease prevention and management. https://novascotia.ca/dhw/primaryhealthcare/chronic-disease-management.asp

Max, J. L., Sedivy, V., & Garrido, M. (2015, March). Increasing our impact by using a social-ecological approach. Washington, DC: Administration on Children, Youth and Families, Family and Youth Services Bureau. https://teenpregnancy.acf.hhs.gov/sites/default/files/resourcefiles/Increasing_Our_Impact%20508.pdf

Roberts, K. C., Rao, D. P., Bennett, T. L., Loukine, L., & Jayaraman, G. C. (2015). Prevalence and patterns of chronic disease multimorbidity and associated determinants in Canada. Health promotion and chronic disease prevention in Canada: research, policy and practice, 35(6), 87–94. https://doi.org/10.24095/hpcdp.35.6.01

Perri, M., Dosani, N., & Hwang, S. W. (2020). COVID-19 and people experiencing homelessness: challenges and mitigation strategies. In CMAJ (Vol. 192, Issue 26, pp. E716–E719). Canadian Medical Association. https://doi.org/10.1503/cmaj.200834

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July, 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April, 1948.

Raphael, D. (2010). Social Determinants of Health: The Canadian Facts Juha Mikkonen. http://www.thecanadianfacts.org/

Tang, D., Zhou, L. L., (2020, September). COVID-19: An accidental catalyst for change in the Canadian health care system. British Columbia Medical Journal. 62(7): 242-243, 246. https://bcmj.org/premise-covid-19/covid-19-accidental-catalyst-change-canadian-health-care-system

Zafar, A. (2020, June 8). Many Canadians used virtual medical care during COVID-19, a poll suggests. CBC News. https://www.cbc.ca/news/health/virtual-care-cma-survey-1.5603713