This introductory course into a master’s in health studies, Critical Foundations of Health Systems, has assisted me in viewing an extensive and more comprehensive definition of health and health care. As a registered nurse I believe it is vital that I not only understand the individual I am caring for but understand their background and community in its entirety. It is a professional value of mine to treat my patients, families and populations thoroughly and to the best of my ability. I often find myself reflecting on the 1948 definition of health by the World Health Organization (WHO) that I assessed at the beginning of this course; health is defined as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” (Brook, 2017, p. 585). I wonder how, after all these years and advancements in medicine, we can use our knowledge further strengthen this explanation to be more inclusive of the many diverse cultures and communities.
After identifying and researching the Social Determinants of Health (SDOH) in depth, I have a better understanding of the numerous influences on the health of both individuals and whole populations. As our health care system grows and becomes more innovative, all of these contributing elements can change with it, and can affect health in both positive and negative ways. With my area of interest focussed on neonatology and the prematurity of newborns, this course has assisted me in understanding the many ways this vulnerable population can be influenced, illustrated on multiple levels of Dhalgren and Whiteheads “Rainbow Model” of health (Figure 1).
Figure 1. Dhalgren, G., & Whitehead, M. (1991). Rainbow Model- Social Determinants of Health [Online Image]. Retrieved from https://www.cdhn.org/factsheets
The elements of this course truly came together for me when comparing my recent knowledge to the developing health industry. Technology is becoming a very significant tool in health care and can influence health in all of its components. Even in the very beginning of life, medicine can help facilitate pregnancy through in vitro fertilization (IVF). Medical technology, including fertility medications, are now able to assist women who have problems conceiving due to genetics, maternal age or other biological elements, in the fertilization and development of a fetus. I cannot imagine the joy this could bring to parents who dream desperately of starting a family. Through my course research on the individual/biological level of the health care model, I read an article that identified the increased risk of delivering a premature baby with the conception of multiples (2 or more fetuses) or a higher maternal age, “older maternal age had a direct and independent effect on spontaneous preterm labor for both low- and high-risk nulliparous women.” (McIntyre, S.H., Newburn-Cook, C.V., O’Brien, B., & Demianczuk, N.N., 2009, p. 682). Despite the joy it brings, IVF technology is regrettably adding to the vulnerable population of premature infants. While working in the Foothills Medical Centre NICU in December of 2017, our unit had two sets of triplets and three sets of twins admitted and being cared for within the same couple weeks. All were born prematurely, and four out of the five groups of siblings were results of IVF. It is evident that both positive and negative outcomes may come from this growing technology.
Examining other determinants of health such as the lifestyles of our population, the innovation of health care can help assist individuals in maintaining fast-paced and busy lives. The idea of telemedicine becomes appealing to those who desire to skip the inconvenience of both travel and wait times for a simple 10 minute check-in or chat with their physician. “Many Canadians are unable to access same-day or next-day appointments with their family doctors, whereas services like telemedicine can potentially connect patients with a licensed Canadian physician in a matter of minutes.” (Belchetz, 2018, p. 25). This not only appeals to individuals with busy lives but can convenience those who are elderly or living with a chronic disease, preventing them from driving or easily travelling, those with children or newborns who dread the efforts of leaving the house, or individuals living in remote locations, a far travel from their health resources.
The innovation of health care is not a brand new discovery, but has been developing slowly for decades and even centuries. A great example of early changes was mentioned in the November 1879 edition if the medical journal ‘The Lancet’ where “a correspondent tells the story of a U.S. doctor who, over a phone call, listened to the chest of a baby with a troublesome cough and determined it was not serious enough to seek further medical attention” (Belchetz, 2018, p. 24). Resources such as this can significantly improve accessibility to health care and resources, especially to indigenous and remote populations such as the Inuit.
We cannot ignore or deny that there are several negative consequences of advancing health care in different populations. As I think about the Indigenous and distant populations, such as the Inuit and other northern communities, I wonder if they would have access to, or be able to obtain these types of resources. Telemedicine and online appointments would require a present and strong internet connection, unachievable by many remote groups. Location is not the only determinant of health that could prove to be a negative outcome, but as many populations lead a different lifestyle than I myself am used to, some individuals and communities do not own or have little interest in owning smartphones, tablets or laptops. When it comes to age and our elderly populations, medical technology may be extremely difficult to use, or even unachievable for those who are not technically savvy, or have any sensory loss such as sight or hearing. Being unable to utilize these new services could be detrimental to the quality of health care they receive, while also potentially witnessing a decrease in the in-person physician appointments available. It is important that we as health care professionals keep all populations and lifestyles in mind through this growth in health care, and ensure equality of care to the best of our abilities.
Equality in the accessibility of all health resources is necessary for the overall improvement of health. Through my research of indigenous populations, I discovered that equality is something we still need to achieve in Canada. “Aboriginal populations in Canada do not enjoy the same experiences of good health and wellbeing as non-Aboriginal Canadians.” (Sampa, 2014, p.30). In a report by the World Health Organization, they stated that “Universal coverage requires that everyone within a country can access the same range of (good quality) services according to needs and preferences regardless of income level, social status, or residence, and that people are empowered to use these services” (Sampa, 2014, p.33). Equality is difficult to achieve when examining the diversity in the SDOH for multiple populations, but is something we can aspire to as our health care system evolves and advances.
Throughout this course I was able to identify develop my understanding of different vulnerable populations. Through my practice as a registered nurse, I have always focussed on treating the patient in front of me, rarely evaluating the culture, support systems, communities and other resources behind them. In neonatology, I feel I have a better understanding of how to include all aspects of a baby’s and family’s health, now that I understand the significance of many influential factors. A premature baby is not just a small human, they are unique in their biology, and have parents and a family with specific lifestyles, living and work conditions, support systems and more. I will strive to consider all of these influences when treating both patients and communities in my future care.
By striving for equality in health care for every unique population, increasing access to resources, health education and illness prevention programs, and addressing the health of all individuals, I hope as a province and country we can achieve and maintain better health goals.
References
Belchetz, B. (2018). Can Telemedicine Change the Future of Health Care Delivery? Plans & Trusts, 36(6), 22–26. Retrieved from http://0-search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=bth&AN=133380380&site=eds-live
Brook. R. H. (2017). Should the definition of health include a measure of tolerance? JAMA, 317 (6), 585-586. doi:10.1001/jama.2016.14372
Dahlgren, G., & Whitehead, M. (1991). Policies and strategies to promote social equity in health: Background document to WHO - Strategy paper for Europe. Institute for Futures Studies, 14. Retrieved from https://www.researchgate.net/profile/Goeran_Dahlgren/publication/5095964_Policies_and_strategies_to_promote_social_equity_in_health_Background_document_to_WHO_-_Strategy_paper_for_Europe/links/569540f808aeab58a9a4d946.pdf
McIntyre, S.H., Newburn-Cook, C.V., O’Brien, B., & Demianczuk, N.N. (2009). Effect of older maternal age on the risk of spontaneous preterm labor: a population-based study. Health Care for Women International, 30(8), 670–689. Retrieved March 03, 2019 from https://0-doi-org.aupac.lib.athabascau.ca/10.1080/07399330802596473
Sampa, J. A. K. (2014). Evidence for Equity: Public Health Examples from Aboriginal Women in Canada. Health Law Review, 22(2), 28–39. Retrieved from http://0-search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=rch&AN=108526925&site=eds-live
Comentários