PPN 302 - W2 - Health promotion, health equity, and SDOH

definition of health

• Complete harmony in mind, body, spirit

• A resource for everyday living

• Bound within political, economic and religious domains

• Having supportive social network

• Having support to live to one’s full potential and aspiration

• Living in a just and fair society

• Evolving and holistic--A dynamic process

• Health is subjective

focus on social justice

• focuses on relative position of one social gorup in relationship with others

• the fair distribution of societys benefits, resources, opportunities

• acknowledges that systemic barriers exist and creates inequities across groups

• acknowledges that we all have a responsiblity to understand our own role in creating disparity and to identify and address issues of inequity

equity vs inequity vs equality vs inequality

• equity - being fair

• inequity = unfair

• inequality - not about fairness, but instead differences - not telling whether the difference is fair vs unfair

• equality

equity vs equality vs justice diagram

everyone gets the same thing, everyone is given support based on their needs, obstacles removed so people do not have the same barriers to access resources

health disparities and inequities

• differences in health status

  • occurs among population groups

  • defined by specific characteristics

• avoidable, unfair and systematically related to social inequalities and disadvantage

• most often results from inequalities in teh distribution of the underlying determinants of health across populations

• vary by income, race gender, abilities, sexualities, age…

• roots lie in the wider social, eocnomic, political, environemntal, and cultural context

health equity commitment

canada:

• generally high standards of lviing

• promise of universal access to high quality of health care

• commitment to equity, access to health and opportunity

health inequity and disparity gaps

• •3 times as many people with low-income report poor or only fair health than those with high income

• Burden of chronic illnesses follows a social economic gradient, e.g., diabetes x 2 as high for low income

• Areas where disadvantaged populations have greater access needs

• Indigenous peoples are twice as likely to report fair or poor health status than non-Indigenous people with the same income levels. '

• People facing homelessness are at risk for premature death, infectious diseases, mental illness & substance abuse

• Immigrants who arrive in Canada are on the whole healthier than native born Canadians, yet within the first decade their health deteriorates

immigrants 5 years later reporting poorer health because they deteriorate in Canada because on the inequities

about intersectionality

• “Intersectionality considers how systems such as racism, classism, sexism, homophobia and other forms of discrimination overlap and interact with one another to advantage some and disadvantage others at an individual and social-structural level.”

critical social justice and health inequities

• Need a moral commitment to critical justice in nursing practice to tackle systemic injustice and oppressive social and political processes that sustain health inequality Towards Critical Social Justice and Health Inequities

• Liberation from oppressive structures is a necessary part of marginalised groups’ pursuit and attainment of health equity

• Critical social justice go to the root of societal power hierarchies, interrupt practices of oppression and structural violence that cause human suffering – Peel back the layers of the onion”

• “Critical social justice is a natural extension of nursing ethics.” (p.6)

• Moving beyond the Eurocentric biomedical perspective

  • moving beyond solely looking at Western and euro ways of thinking, anti-colonial

    trying to make systems more indigneity to incorporate

TEST* a critical social justice lens includes multiple theoretical perspectives that support social justice *

• critical theories

  • focus on power differentials, challenge the status quo

    • ex. critical social theory, feminist theory, anti-racist theory, queer theory, post colonial theory

• intersectionality theory

  • draws on critical perspective by recognizing that multiple, intersecting factors affect health and access to health

    • configuration of intersecting factors contributes to vulnerability as well as capacity building

  • social ecological/socio-environmental theory

    • recognizes interplay between people and their environment

see on test from a critical social theory perpsective.........

its a focus on the power differents who has power vs people who dont have power

not gonna ask abt femnist ofr queer theory

socio environment - another wya of thinking valuing SDOH and imapct on society

understanding that the way we think about the world and view it on the test from this perspective in this context

what is upstream thinking level perspective

macro level perspective

health promotion- upstream vs downstream thinking

health promotion as a solution to health inequity

• the process on enabling people to increase control over and to improve their health.

• reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and relatize aspirations to satisfy needs and to change or cope with the environment

give autonomy and the state of wellbeing

health promotion - thinking upstream

• thinking upstream - society as a locus of change vs the indivudla ex. SDOH

  • macro - broad scope

  • looking beyong the individual to where real problems lie

  • emphasizing issues that precede or play a role in the development of a health probem

• focus of upstream

  • sustaining health

  • the nature of collective vs an individual

  • consider economic, political and environmental factors - precusosrs of poor health - locally and globally

• downstream approaches - micro - narrow scope

  • short term

  • individual based interventions

upstream thinking!

• this is keeping people out of the river

• prevention, protection

• targets SDOH

• helps to address health inequities, issues of social justice

  • policy, laws environmental protection

downstream thinking

• pulling people out of the river

• focus on the individual

• fixing ro reducing the impact of the problem once it has occured

what is the problem with a behavioural approach

• it places the responsibility on the individual rather vs it being society

moving beyond the biomedical model but also problems with bx model

• 1974 Lalonde Report = New Perspectives on the health of Canadians

  • human biology, health organizations, lifestyles, environment

• Critique of bx model

  • focuses too much on lifestyle and not tackling the SDOH

  • focuses on victim blaming

  • driven by ‘fiscal’ interest and cost control

variance between biomedical, behavioural, harm, reduction, socio-environmental

• biomedical - individual level

  • downstream thinking

• behavioural - individual/group level

  • midstream

• harm reduction - individual level

  • mid stream

• socio-environmental - community

  • upstream thinking

down stream vs upstream approaches

• downstream - microscopic

  • assessment focuses on individual responses to health and illness emphasizing bx and coping responses to illness or lifestyle pattern

  • nursing interventions aimed at modifying an individuals bx (including cope bx) through changing their perceptions or belief system or providing information

• upstream - macroscopic

  • assessment focuses on interfamily and intercommunity themes in health and illness

  • identifies social, economic and environmental factors in the commmunity and population that perpetuate the development of illness or foster the development of health

  • nursing interventions may include modifying social or environmental variables - working remove barriers to care or improving sanitation or lviing conditions - this amy include social or political action

health promotion - personal, social, political

• personal

  • coping/skill building health education

    • sex health promotion

    • good nutrition

    • physical activity

    • cancer prevention

    • tobacco use prevention

    • heart health promotion

• social

  • community developmental

  • program development

  • service access

  • capacity building

• political

  • policy change/development

  • equity policy

  • welfare policy

  • poverty reduction policy

  • minimum wage policy

SOCIAL JUSTICE TO EQUITY/EQUALITY TO EMPOWERMENT

principles of alma-ata primary care

• Based on practical, scientifically sound & socially acceptable methods & technology

• •Universally accessible healthcare to individuals & families in the community

• • Requires full participation of citizens • Consider the cost that community & country can afford to maintain

• Considers all stages of development • Focuses on self-reliance & self determination

**TEST* PRIAMRY HEALTH CARE PRINCIPLES - ALMA ATA

• PHC interconnected principles - absed ona ccess to health and health care, equity and community empowerment

• 5 principles

  • accessibility

  • health promotion

  • community/public participation

  • appropriate technoloy

  • intersectoral collaboration

what are the 5 principles of primary health care

• 5 principles

  • accessibility - access to healthcare and resources can be hindered by racism

  • health promotion - addressing SDOH

  • community/public participation - getting people involved with their decision making

  • appropriate technology - right care, provider, right service at the right time, appropriate people as well

  • intersectoral collaboration - this is the interaction ebtween diff sectors like education, finance, health, transportation, immigration..

USE IN THE TEST:

ex. which of the following are principles of this

never asked to define them but they are important to know

know of different ex as they are applied

what is primary care

• Primary care

  • narrower focus

  • related to the first place of entry into the system

  • does not address issues of sustainability, community focus/ublic participation, approrpiate technology, to same extent, appropriate mix hcp

  • THIS IS ONE ELEMENT OF PHC

what is primary hc

• Primary health care

  • universally accessible

  • PHC provides full spectrum needs

  • addresses main determinants of health

  • relevant to the social, cultural, economic and political context

  • addresses community prorities

  • promotes individual and community self reliance and participation

what is the difference between primary care and primary health care

• primary care

  • firs point fo entry into the health system

  • focus on clinical care fo disease prevention/treatment, cure, rehab, palliation (smoking cessation)

  • not necessarily comprehensive approach (cultural, intersectoral, affordable, appropriate)

  • goal is to assist client to manage primary health issue

  • professional driven (top-down approach)

  • understanding of physiological, psychological, emotional aspects of client, disease , injury, diagnosis and treatment

• primary hc

  • focusing on promoting health by creating changes in the environment to improve equity of resources for a population

  • includes access to health services but also factors to improve quality of life (income, housing, education)

  • comprehensive

  • can include primary care

  • goal is to create environments where clients can make better choices about health as resources are accessible

  • client driven - bottom up approach

  • understanding of determinants of health

  • incorporates the health promotion strategies of the ottawa charter

application question:

Which of the following indicate that the CHN is integrating principles and values of PHC into their practice?

a) A CHN engages with the community in a planning process

b) A CHN tells members of a remote community that they should advocate for an MRI machine in the local health centre

c) A CHN works with local community leaders in developing a sexual health program

d) A CHN advocates for an e-health information system in a community with limited internet access

e) A CHN reflects on her own biases and assumptions when she disagrees with a community-identified priority problem

a) A CHN engages with the community in a planning process

Canadian communtiy health nursing standards of practice

• health promotion

• prevention adn health protection

• health maintenance, restoration and palliation

• professional relationships

• capacity building

• health equity

• evidenced informed practice

• professional responsibility and accountability

OTTAWA CHARTER *

• prerequisities to health - peace, shelter, education, food, income, a stable ecosystem, sustainable resurces, social justice and equity

• 5 strategies

  • build healthy public policy

  • create supportive environments

  • strengthen community action

  • develop personal skills

  • reorient health services

what are the strategies of the OTTAWA CHARTER *** TEST**

• 5 strategies

  • build healthy public policy - changing laws and policy

  • create supportive environments - either physical or social ex. free of violence

  • strengthen community action - getting people together and creating action and get change in their community

  • develop personal skills - ex. health education, treatment, knowledge to eat healthy, ahve the skills for their conditions

  • reorient health services - not just about curative treatment but prevention and more accessible in places outside of hospitals and clinics

population health promotion model

ottawa charter strategy - strengthening community action

• Engaging communities from the grassroots or bottom up

• Working in partnership and in collaboration to improve issues which fall outside of the health care system (sectors)

• Raising the social awareness/ social consciousness of issue (emancipatory knowledge- freedom and giving people the autonomy from care - dont get caught up on memorzing this)

• Involving community members to participate in identifying health issues, planning, initiating interventions to improve the health of their community

ottawa charter strategy - creating supportive envrionments

• Working with community/ stakeholders to create environments in all settings (home, work, play, learn, pray) which are safe, stimulating, satisfying and enjoyable

• Ensuring that environments have appropriate and necessary material, social, economic supports/ resources (safe playgrounds, walking trails, sufficient mix of social housing, employment, schools, efficient transportation, free of violence etc.

• Remember: consider both the physical and social environment

ottawa charter strategy - develop personal skills

• Skills may be increased knowledge, changes in attitude and beliefs, increased knowledge of group dynamic skills, how to organize political action events, improved decision making

• Allows more control over health and environment by making choices which are conducive to health

ottawa charter strategy - reorienting health services

• Involves moving beyond health sector’s responsibilities of providing clinical and curative services

• Health care services need to consider the SDH, where people live, work, play, pray, learn and how these impact health outcomes of individuals

ottawa charter strategy - building healthy public policy

• • Policies are created by federal, provincial and municipal governments but also by organizations

• Policies created by all sectors must have “health” on the agenda (housing, income, transportation, education, social services, employment etc.) = create healthy living conditions that improve the health of community eg. smoking ban on campus, decrease speed limits in school zones in Toronto

not going to see this on the test: bangkok charter for HP in globalized world - 2005

• Reinforced the need to focus on determinants of health and inequities across and between countries because of:

  • increasing inequalities within and between countries

  • • • • • new patterns of consumption and communication

  • Commercialization

  • global environmental change,

  • urbanization.

• “Acting Locally in our communities, while thinking globally”

• • HP as key strategy –responsibility of gov’t and corporate sectors

• • Scope:

  • Identifies actions, commitments, & pledges required to address the determinants of health in a globalized world through health promotion.

• Purpose:

  • It affirms that policies & partnerships to empower communities, & to improve health & health equality, should be at the centre of global & national development.

• It complements & builds upon

  • - values, principles, & action strategies of HP - established by the Ottawa Charter for Health Promotion

capacity building

• Processes and activities that maximizes individual and community potential.

• Developing and strengthening skills and abilities Strengthening process and providing resources

• Capacity building –individual and community survival, adaption, thriving

• Health related issues are complex with their roots embedded in SDOH and other structural injustices

• To improve health wellbeing requires building capacity of individual and communities to address the root of causes of poor health and navigate the complex issues impacting on their health

empowerment

• Process of enabling individual/community to increase control over their lives.

• Community ownership and action that explicitly aims at social and political change.

• Not just involvement but participation or engagement of communities

• People are endowed with assets, and the role of the CHN is to facilitate and support individual/community to the acquire the power to bolster their ability to take control

• To empower people, CHN have to negotiate and share existing power for individuals/community to gain more control

intersectoral vs intersectionality

• Intersectoral collaboration refers to the combined actions of agencies in and outside of the health sector.

• Intersectionality refer to ways in which person's social and political identities combine to create different modes of discrimination, privilege, and disparities in health outcomes. Eg race, class, sexism, income, ethnicity, ableism

application question:

Which of the following indicates a capacity building approach?

a) A CHN tells the community that they can participate in planning for a new playground if they are available during her working hours

b) A CHN works with a group of youth who want to learn how to advocate for themselves within the school system

c) A CHN helps a group of unemployed men develop new skills in resume writing

d) A CHN provides menus to immigrant mothers who want to learn more about healthy lunches for their children

b) A CHN works with a group of youth who want to learn how to advocate for themselves within the school system