INTEGRATED UNDERSTANDING OF HEALTH IN A CONTEXT

Canadian Healthcare system:

The publicly funded healthcare system of Canada is a group of socialized healthcare insurance programs that provides coverage to all Canadian citizens, permanent residents of Canada and refugees. Canada’s Health Act is a piece of government of Canada legislation passed by parliament in 1984. The purpose of act is to make sure that all Canadian citizens, permanent residents and other protected status individuals such as refugees have necessary access to hospital and physicians on prepaid basis. The roles and responsibilities of healthcare system are divided between federal and provincial and territorial governments by Canadian constitution. The role of federal government in healthcare system is to establish national principles for the system under Canada health act, provide financial support to provincial and territorial governments and provide funds for delivery of primary and extra services to vulnerable populations. The provincial and territorial governments are responsible to deliver healthcare services through provincial and territorial health insurance plans if they meet national principles formed under Canada health Act. Provincial and territorial health insurance programs cover essential medical, hospitals and doctor services that are provided on prepaid basis (Government of Canada, 2018).

My Professional Identity in Canadian Healthcare System:

After completing my Masters from Athabasca University, I would like to pursue my career as a clinical researcher. I believe that clinical researchers have ability to bring change in people’s life. Clinical researchers can perform different roles in healthcare system: from clinician to administrator, researcher collaborator and coordinator. Clinical researchers working in different fields and specialities promote healthcare in hospital settings. They conduct clinical trials to find better ways to prevent, screen, diagnose or cure disease. Clinical trials are also beneficial in determining whether new treatment is better or has more side effects than the standard treatment and exploring alternative treatment. Clinical researchers are responsible for ensuring that these clinical trials are conducted in an ethical manner ensuring standard regulations of privacy and confidentiality (New scientist, 2017).

Health:

According to W.H.O, health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity (Wikipedia, 2018). Huber et al. (2011) challenges W.H.O definition of health by proposing a new concept of health as the individuals’ ability to adopt and self manage in the face of social, physical and emotional challenges. In the modern world, health is not only the physical and mental health, but it is the ability of the individual to maintain his/her physical mental, social and emotional attitude to cope with his/her current environment and can also adopt and self manage with the changing environment. According to this new concept of health, people with chronic diseases are also considered healthy if they learn to manage their illness to gain positive physical mental, social and spiritual outlook towards life through diet, exercise and medicines. The new concept by Huber et al. (2011) also highlighted the opportunities available to the individual to overcome their illness, rather than focusing on their limitations (Jambrose et al. 2015).

Determinants of Health:

Determinants of health are defined as a large range of factors that influence the health status of individuals and populations. The public health agency of Canada currently enlisted twelve determinants of health

1. Physical environment;

2. Employment and working condition;

3. Social environment;

4. Social support network;

5. Health services;

6. Culture;

7. Income and social status;

8. Education and literacy;

9. Personal health practices and personal skills;

10. Healthy child development

11. Biology and genetic endowment;

12. Gender.

Many of these determinants are grouped under the heading of socio-economic status (SES) (uOttawa, 2017).

Socio-economic status and childhood obesity:

Health inequality commonly exists in most nations of the World, including Canada. These inequalities exist due to differences in social, economic and other factors and is one of the reasons for its continuous presence despite strong efforts.

Childhood obesity is a medical condition which causes excessive accumulation of fat in the body resulting in health adverse outcomes. Body Mass Index (BMI) is a measure used to determine childhood obesity. Obesity is defined as BMI at or equal to 95th percentile whereas in overweight it is at or above the 85th percentile.

Children living in neighborhood with a lower socio-economic status are more likely to become obese (Statistics Canada, 2005). Children from families having high unemployment rates, below average incomes or fewer neighbours with post secondary education are at a greater risk of becoming overweight or obese (Statistics Canada, 2005). Children from low socio-economic neighborhood does not show much interest in participating physical activities as compared to children from high socio-economic neighborhoods. These findings illustrate that children living in poor neighborhoods have less opportunities to involve in physical activities as compared to children belongs from high socio-economic status (Statistics Canada, 2005).

Socio-ecological model:

The socio-ecological model (SEM) is a theory-based framework used to understand interrelationships between various personal, social and environmental factors and their affects on health promotion and health of population. At the core of the model is the individual surrounded by four levels: interpersonal, organizational, community and policy level.

Socio-ecological model and childhood obesity:

Intrapersonal: It is the first level of SEM and include personal factors such as age, gender and behaviors related to diet and exercise. The equilibrium between energy consumption and physical activity is the most direct determinant at this level. Children who eat less fruits and vegetables as compared to fat and carbohydrate rich food are more prone to obesity. Physical activity plays a vital role in preventing obesity. Children between 5 to 17 years of age should perform moderate to vigorous activity for at least 60 minutes in a day to reduce the risk of chronic diseases and for the maintenance of healthy weight (Government of Canada, 2016)

Gender and genetics also have a major role in childhood obesity. Many studies have shown that obesity run in families and is largely due to genetic factors. In Canada, it is found that boys are three times more obese as compared to girls. This difference may be due to different body structure, fat distribution and differences in physical activity patterns (Kirkey, 2012).

Interpersonal level: It is the second level of SEM and includes family members, home environment and social circle of peers. Developing healthy environment in home is one of the key responsibility of parents. Parents should have adequate knowledge about healthy diet plan, schedule for daily physical activity and avoid excessive screen time to prevent obesity. Studies have shown that children living with single parent have 50% more chances to become obese as compared to children living with both parents (AU News, 2018). Studies suggest that presence of healthy eating peers can influence healthier food selection in children and if peers are participating in physical activates it encourages children to participate as well. The latest study conducted by Canadian researchers in University of Manitoba shows that when senior students teach their juniors about importance of healthy diet and exercise, the latter seems to lose weight and become diet conscious (Secure teen, 2014).

Organization level: It includes health institutions and organizations working to promote health in population. YMCA and childhood obesity foundation are the organizations working in Canada to promote health of Canadians through physical activity, mental activities and encouraging healthy eating and active lifestyle to prevent obesity among children. The Canadian park and recreational association is an organization working to promote importance of parks and playgrounds for the health of individuals and populations.

When lifestyle modifications don’t work to overcome obesity in children then cognitive behavioral therapy, drug and surgery are recommended options. The goal of cognitive behavioral therapy is to change patterns of thinking which are responsible for obesity. Orlistat is the only U.S food and drug administered approved drug to treat obesity in children >12 years and adolescents. Surgery is recommended in children or adults suffering with severe co-morbidities like non-alcoholic fatty liver disease or life threatening cardiovascular diseases.

Community level: It describes interconnected businesses in communities and links between organizations. The community environment is becoming obesogenic gradually. Fast food outlets and convenient stores are available in every neighborhood which are also providing free delivery. Walking pathways are less prevalent because of increase in traffic and public transport is readily available. Community leaders, parents, childcare centres, schools and teachers must work together to create community environment which supports healthy lifestyle. School based prevention programs can easily encourage students to eat better (fruits, vegetables, cereals), stay more active and achieve healthier weights (Myrick, 2014).

Policy level: It refers to local, state and federal policies that regulate healthy actions and practices. The Canadian government is doing its best in providing access to healthy food, providing opportunities to physical activity by increasing park and playground access, quality and improvements, supporting active living initiatives, improving surveillance and evaluating interventions and innovations.

Chronic Disease Prevention and Management:

A chronic condition is a human health condition that has persistent or long lasting effects.

The primary risk factors for chronic diseases are obesity, alcohol or tobacco use, hypertension, unhealthy diet and raised blood glucose or cholesterol. Childhood obesity may result in serious chronic diseases in childhood such as diabetes mellitus, cardiovascular problems, liver diseases, eating disorders and asthma. Unfortunately, most obese children do not solve their weight gain problems and turns in to an obese adult. An obese adult has higher chances of mortality than adult of normal healthy weight (Childhood obesity Foundation, 2015). Being physically inactive can result in obesity and obesity is a risk factor for several chronic diseases which results in economic burden in the society. Katzmarzyk, Gledhill and Shephard (2011) estimated the direct health cost assigned to physical inactivity in Canada and the number of premature deaths due to lavish lifestyle. It was estimated that in 1999, 2.5% ($2.1 billion) of the total direct health cost were attributable to physical inactivity. In 1995, 21,000 people died prematurely due to sedentary life style. It was evaluated that 10% reduction in physical inactivity has the ability to cause reduction in direct healthcare expenditures by $150 million in a year (Katzmarzyk, Gledhill, & Shephard, 2000).

Ontario’s Chronic Disease Prevention and Management framework consist of a chain of mutually dependent practices and systems that are beneficial in preventing and managing chronic diseases. It consists of eight interconnected components:

1) Healthcare organizations that make organized and planned efforts for prevention and management of chronic diseases.

2) Delivery system design maintains continuous and flawless delivery of care and services to patients.

3) Provider decision support incorporates evidence-based guidelines into daily practice.

4) Information systems that improve the quality of information for healthcare providers, so that they can deliver quality care that support individuals in managing their diseases.

5) Personal skills and self management support that encourages individuals to develop skills for healthy living and coping with disease.

6) Healthy Public Policies that improve individual and population health and address inequalities.

7) Supportive Environments responsible for promoting safe and healthy living.

8) Community action support communities to resolve issues affecting the health of their residents.

The ministry has also developed Chronic disease and Prevention Management (CPDM) logical model. It is an optical presentation of CPDM framework showing that how the specific activities adding to promote better health and system outcome and can be used to develop performance indicators (Ministry of Health and Long Term Care, 2013).

Vulnerable Population:

Vulnerable population include patients who are racial or ethnic minorities, children, pregnant women, seniors, socioeconomically disadvantage, uninsured, immunocompromised and people with certain medical conditions. During pregnancy, vulnerability to stress and depression is increased in women. Being obese during pregnancy increases the risk of pregnancy-related complications including miscarriages, still birth, pre-eclampsia, gestational diabetes and antenatal depression and anxiety. Biaggi, Conroy, Pawlby and Pariante (2016) identified the main risk factors involved in the onset of antenatal depression and anxiety. Obesity, Lack of spouse or social support, history of abuse or domestic violence, unwanted pregnancy, history of mental illness, past pregnancy complications and miscarriages are the factors which have a direct effect on the development of antenatal depression and anxiety. Screening tools should be used to identify women at risk of antenatal depression to promote the health of mothers and babies (Biaggi et al., 2016).

Studies have shown that obese women are more vulnerable to antenatal and postpartum depression. Molyneaux, Poston, Khondokar and Howard (2016) studied the relationship between obesity and antenatal depression and found that obese women had significantly higher ratio of antenatal depression as compared to normal weight women. Every unit increase in Pre-pregnancy BMI was linked to 3% higher odds of antenatal depression (Molyneaux et al., 2016). Interventional programmes working to prevent disastrous effects of obesity during pregnancy should include pshyco-educational program specially tailored to this high-risk group.

Future of Health and Healthcare in Canada:

Canada’s healthcare system is one of the best healthcare systems in the world, but some areas in healthcare system needs further improvement. Data management needs to be more functional and effective. According to lan Moore, the rate at which data is growing is exponentially faster than the people (Personal health news, 2018). Health care system need to introduce new methods and technologies that can upgrade Canada’s health care system.

eHealth is a term used to describe the application of communication and information technologies in health system. Its introduction in Canada’s healthcare system will result in benefits to Canadians through betterment in system’s accessibility, quality and efficiency. Currently, health Canada is focusing on addressing policy issues and challenges in establishing eHealth services within Canadian healthcare system and monitoring progress in the deployment and investment of these services (IT World Canada, 2006).

REFERENCES:

Biaggi, A., Conroy, S., Pawlby, S., & Pariante, C, M. (2016, Feb). Identifying the women at risk of Antenatal Anxiety and depression: A systematic review. J Affect Disorder, 191, 62–77. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879174/

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Katzmarzyk, P. T., Gledhill, N., & Shephard, R. J. (2000). The economic burden of physical inactivity in Canada. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 163(11), 1435-40.

Kirkey, S. (2012, sept 21). Study finds Obesity rates three times higher among Canadian boys than girls. Retrieved from https://o.canada.com/news/national/obesity-rates-three-times-higher-among-boys-than-girls-new-canadian-study-finds

Molyneaux, E., Poston, L., Khondoker, M., & Howard, L. M. (2016). Obesity, antenatal depression, diet and gestational weight gain in a population cohort study. Archives of women's mental health, 19(5), 899-907.

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Secure Teen. (2018). Positive peer pressure encourages obese kids to have healthy life style. Retrieved from https://www.secureteen.com/peer-pressure/positive-peer-pressure-encourages-obese-kids-to-have-healthy-lifestyle/

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Wikipedia. (2018, Jun 29). Health. Retrieved from https://simple.wikipedia.org/wiki/Health