Health and The Individual: Trends and Issues in Healthcare

OTP140 – Trends and Issues in Healthcare: Health and the Individual

2.0 Learning Objectives

• Explain individual health status influence: How it affects the demand for and use of healthcare services in Canada.

• Identify chronic conditions: Common conditions affecting Canadians and their impact on resource allocation, service delivery, and rehabilitation.

• Discuss population aging effects: Impact on healthcare infrastructure, including increased demand for long-term, home, and rehabilitation services.

• Apply conceptual models: Utilization of models like Medical Model of Disability, Social Model of Disability, Biopsychosocial Model, Determinants of Health, Wellness Model, and The Ottawa Charter for Health Promotion.

• Explain lifestyle choices effects: How physical activity, nutrition, smoking, etc., influence health outcomes and healthcare challenges.

• Evaluate early intervention: How rehabilitation and preventative services by interprofessional teams can reduce long-term burden on the Canadian healthcare system.

Health According to WHO

• The specific definition from WHO is mentioned as a reference point but not detailed in the provided text.

Wellness

• Definition: A personal, subjective feeling about one's health and quality of life.

  • It's how an individual perceives their daily functions and well-being.

  • Example: A client recovering from knee surgery may feel healthy and optimistic if they can participate in meaningful activities, even while using a walker.

• Subjective Nature: Each person interprets health differently.

  • Individuals with chronic illness, sensory impairment, or physical disability may still consider themselves well.

  • Example: A client with partial vision loss might report feeling healthy because they have adapted routines with assistive devices.

• Dynamic Interaction: Wellness is shaped by and influences physical, emotional, social, spiritual, and environmental factors.

  • These elements interact constantly.

• Active Process: Wellness involves awareness, making choices, growth, and change.

  • Example: Supporting a client in setting small, achievable rehabilitation goals (e.g., standing $5$ minutes longer each day, smoking less) empowers active participation in their own wellness.

9.0 Dimensions of Wellness

• Physical wellness: Maintaining a healthy body.

• Emotional wellness: Understanding oneself and recognizing personal strengths and limitations.

• Intellectual wellness: Making informed, appropriate, and beneficial decisions.

• Spiritual wellness: Contributing to society, potentially including commitment to religion or a higher power.

• Social wellness: Relating effectively to others.

• Environmental wellness: Engaging in a lifestyle that respects one's environment.

• Occupational wellness: Feeling secure, confident, and valued in one's workplace.

Disease, Illness, Disability

• Disease:

  • An objective condition identified by a healthcare professional.

  • Characterized by diagnosis, pathology, and signs.

• Illness:

  • A subjective experience of how a person feels and interprets their health.

  • Unique to each individual.

• Disability:

  • A deviation from normal function resulting from illness, accident, or genetics.

  • Can be physical, sensory, cognitive, or intellectual.

  • Emphasizes the use of respectful terminology.

Acute vs. Chronic Illness

• Acute Illness: Usually temporary in nature, with a rapid onset and short duration.

• Chronic Illness: Long-lasting conditions that may not have a cure, requiring ongoing management.

Sick Role Behaviour

• Definition: Changes in individuals' behaviours, roles, and attitudes when they are ill.

• Characteristics:

  • Usually temporary.

  • Can alter perceptions.

  • The majority of clients respond adaptively.

  • Behavioural changes are most visible in hospitalized patients.

  • More serious illness, longer hospitalization, and loss of autonomy lead to greater changes.

Stages of Illness on Client Behaviour

• A client's acceptance of diagnosis and treatment typically follows a predictable path:

  • Preliminary: Suspecting symptoms.

  • Acknowledgement: Sustained clinical signs.

  • Action: Seeking treatment.

  • Transitional: Diagnosis and treatment.

  • Resolution: Recovery and rehabilitation.

Signs vs. Symptoms

• Signs:

  • Based on objective assessment of body functions.

  • Basis for diagnosis and treatment.

  • Can be observed directly or through diagnostic imaging and technology.

  • Example: Rash, cough.

• Symptoms:

  • Based on subjective assessment.

  • Based on what the patient/client says and does.

  • Example: Headache, fatigue.

Health Models

Medical Model

• Definition of Health: Absence of disease.

• Focus: Emphasizes diagnosis and treatment, ignoring prevention.

• Limitations: Excludes social causes beyond a person's control (e.g., socioeconomic status).

• Rehabilitation Context (Stroke Example): Focuses on regaining muscle strength and improving mobility on the affected side (e.g., physiotherapy).

• Goal: Restore function, reduce disability, measure physical improvement (e.g., walking with a cane).

Holistic Model

• Definition of Health: Considers all parts of the person.

• Focus: Recognizes the impact of additional factors, such as spirituality.

• Acceptance: Widely accepted as a better alternative to the Medical Model.

• Rehabilitation Context (Stroke Example): Combines physiotherapy with occupational therapy (relearning daily activities), speech therapy (communication), and counseling (emotional well-being).

• Goal: Physical recovery coupled with emotional, social, and psychological support for quality of life.

Wellness Model

• Definition of Health: A continuous process and a state of feeling/experience.

• Focus: Emphasizes positive aspects of health, not negative aspects of illness/disease.

• Responsibility: People assume responsibility for their own health and make informed choices.

• Key Principles:

  • Holistic: Addresses multiple dimensions of wellness.

  • Self-Directed: Individuals take responsibility for their choices.

  • Positive Focus: Emphasizes strengths and potential.

  • Process-Oriented: Health is a continuous journey, not a destination.

  • Preventative: Proactive rather than reactive.

• Wellness vs. Health:

  • Health: A state of being (e.g., absence of disease), static.

  • Wellness: A process of living (e.g., optimal functioning), dynamic and changes over time.

  • Daily decisions impact wellness.

• Rehabilitation Context (Stroke Example): After discharge, the client joins a stroke survivor wellness program focusing on group exercise, nutrition guidance, stress-reduction strategies, and peer support.

• Goal: Long-term independence, participation in meaningful activities, and preventing future strokes.

Medical Model of Disability

• Core Premise: Disability is a medical problem or deficit that needs to be cured, fixed, or managed by medical professionals.

• Focus: Primarily on impairment, overlooking environmental or social factors.

• Key Characteristics:

  • Individual Pathology: Disability seen as a personal tragedy or medical condition.

  • Professional Control: Healthcare experts make decisions about treatment.

  • Cure/Fix Mentality: Goal is to return to "normal" functioning.

  • Deficit Focus: Emphasis on what the person cannot do.

  • Institutional Care: Segregation from mainstream society.

• Impact on Healthcare Delivery:

  • Service Focus: Rehabilitation aims to "fix" the person.

  • Goal Setting: Return to pre-injury/illness function.

  • Outcomes: Measured by reduction in impairment.

  • Client Role: Passive recipient of treatment.

  • Resource Allocation: Heavy investment in medical interventions.

• Example (Spinal Cord Injury):

  • Focus: Spinal cord lesion and resulting paralysis.

  • Goal: Maximize remaining physical function.

  • Intervention: Intensive physical therapy to strengthen unaffected muscles.

  • Outcome Measure: Improvement in strength or sensation.

  • Success: Defined by how close to "normal" function the person achieves.

• Limitations for Rehabilitation: While medical interventions are vital, this model can overlook environmental barriers, social participation, and the person's own goals and values. It may lead to frustration when a "cure" isn't possible.

Social Model of Disability

• Core Premise: Disability is caused by societal barriers, not individual impairments. The problem lies in social, physical, and attitudinal environments that prevent full participation.

• Key Characteristics:

  • Impairment: The actual loss or limitation of function (medical condition).

  • Disability: The social disadvantage caused by barriers.

  • Societal Problem: Disability is created by society, not the individual.

  • Environmental Focus: Change the environment, not the person.

  • Rights-Based: Equal access and participation as human rights.

• Types of Barriers:

  • Physical: Inaccessible buildings, transportation.

  • Attitudinal: Prejudice, stereotypes, discrimination.

  • Communication: Lack of sign language, accessible formats.

  • Policy: Exclusionary laws and practices.

  • Economic: Poverty, employment discrimination.

• Example (Spinal Cord Injury):

  • Focus: Barriers preventing participation (inaccessible buildings, transportation).

  • Goal: Full social participation and inclusion.

  • Intervention: Environmental modifications, advocacy for accessibility.

  • Outcome Measure: Level of community participation and life satisfaction.

  • Success: Defined by ability to participate in chosen life activities.

• Impact on Rehabilitation Practice: Shifts focus from "fixing" the person to removing barriers. Emphasizes advocacy, environmental assessment, assistive technology, and supporting the person's right to participate in society.

Biopsychosocial Model

• Core Premise: Health and illness result from the complex interaction of biological, psychological, and social factors. All three domains must be considered for comprehensive understanding and effective intervention.

• Biological Factors: Genetics and heredity, physical health conditions, neurological functioning, medication effects, age-related changes, pain and fatigue, immune system function.

• Psychological Factors: Mental health status, coping strategies, health beliefs and attitudes, motivation and self-efficacy, cognitive functioning, fear and anxiety, personality traits.

• Social Factors: Family and social support, socioeconomic status, cultural background, employment status, housing conditions, community resources, healthcare access.

• Example (Chronic Low Back Pain):

  • Biological: Disc degeneration, muscle weakness, inflammation.

  • Psychological: Fear of movement, depression, catastrophic thinking.

  • Social: Work demands, family stress, cultural beliefs about pain.

• Gold Standard for Rehabilitation: Considered best practice because it addresses the complexity of human experience and leads to more effective, holistic interventions.

Social Determinants of Health (SDOH)

• The $50$ Factor: SDOH, healthcare, genetics, and physical environment are key contributors to health.

• Detailed Determinants:

  • Economic: Income, employment & job security, working conditions, food security.

  • Social: Education & literacy, social support networks, culture and language, gender and social exclusion.

  • Physical environment: Housing quality and stability, geographic location, environmental quality, transportation access.

  • Health Services: Access to healthcare, quality of care, cultural appropriateness, health literacy support.

• Canadian Reality:

  • Life expectancy gap: Richest vs. poorest Canadians is $7$ years.

  • Hospitalization rates are $2.5$ times higher in the lowest income groups.

  • $40$ of Indigenous adults report fair/poor health vs. $12$ of the general population.

  • $1$ in $7$ Canadians experience food insecurity (Statistics Canada, $2025$).

• Rehabilitation & Healthcare Implications:

  • Lower Income: Higher emergency use, lower preventative care.

  • Poor Housing: Increased respiratory and injury rehabilitation needs.

  • Food Insecurity: Diabetes and chronic disease management challenges.

  • Social Isolation: Higher healthcare utilization, poorer outcomes.

  • Rural Location: Limited access, travel barriers, delayed care.

Ottawa Charter for Health Promotion (1986)

• Origin: Developed in $1986$ at the first International Conference on Health Promotion in Ottawa.

• Significance: Established the foundation for modern health promotion practice worldwide and remains the most influential framework.

• Health Promotion Defined: The process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental, and social well-being, individuals or groups must identify and realize aspirations, satisfy needs, and change or cope with the environment (Government of Canada, $2017$).

• Five Action Areas:

  • Build Healthy Public Policy: Goal is to put health on the agenda of policymakers in all sectors.

    • Examples: Accessibility legislation, smoking bans, injury prevention laws, universal healthcare policy.

  • Create Supportive Environments: Goal is to make the healthy choice the easy choice.

    • Examples: Accessible community centres, safe walking paths, workplace wellness programs, barrier-free design.

  • Strengthen Community Action: Goal is to empower communities to set priorities and make decisions.

    • Examples: Community-led health initiatives, peer support programs, local health committees, grassroots advocacy.

  • Develop Personal Skills: Goal is to support personal and social development through education.

    • Examples: Health education programs, self-management training, life skills development, health literacy initiatives.

  • Reorient Health Services: Goal is to move beyond clinical care to prevention and promotion.

    • Examples: Primary health care focus, community-based services, interprofessional teams, prevention programs.

• Rehabilitation Implication: The Ottawa Charter expands the role of rehabilitation professionals beyond individual treatment to include health promotion, advocacy, community development, and working upstream to prevent health problems.

Psychology of Health Behaviour

• Health Belief Model: People's beliefs about their health and susceptibility to illness affect their health behaviour.

• Protection Motivation Theory: Self-preservation motivates changes in health behaviour through fear of illness or death.

• Socio-Ecological Model of Health: Multiple levels of influence (education, social support, environment) shape health behaviour.

• Transtheoretical Model (Stages of Change): People progress through stages before health behaviour completely changes.

  • Stages:

    • Precontemplation: Unaware a problem exists.

    • Contemplation: Aware of a problem, thinking about change.

    • Preparation: Confident change is possible, planning.

    • Action: Making the change.

    • Maintenance: Continuing new behaviour, avoiding relapse.

  • Rehabilitation Example (Home Exercise Program): Illustrates progression from "I don't need exercises" (Precontemplation) to "Exercises are routine" (Maintenance).

  • Important Note: Relapse is normal and should be framed as part of the change process, not failure.

• Rehabilitation Examples for Models:

  • Health Belief Model: Success by addressing multiple levels.

  • Protection Motivation Theory: Home Exercise Program Compliance.

  • Socio-Ecological Model: Falls prevention program.

  • Transtheoretical Model: Cardiac Rehabilitation.

How Health Models Shape Utilization

• Defining Health and Wellness: Models define what constitutes "health" and "wellness."

• Intervention Targets: Determine appropriate targets for intervention.

• Service Delivery: Influence approaches to service delivery.

• Expectations: Shape patient and family expectations.

• Resource Allocation: Guide decisions on resource allocation.

• Outcome Measurement: Inform outcome measurement priorities.

Individual Lifestyle Choices

• Impact: $85$ of chronic diseases are preventable through lifestyle changes.

• Physical Activity:

  • $48$ of Canadians don't meet activity guidelines.

  • Positive Impact: Reduces chronic disease risk by $30-50$, improves mental health and cognitive function, maintains functional independence, reduces healthcare utilization.

  • Cost: Annual cost of physical inactivity is $S 7.5$ billion.

• Healthy Nutrition:

  • Positive Impact: Prevents diabetes, heart disease, stroke; supports healthy aging and recovery; reduces inflammation and pain; improves medication effectiveness.

• Smoking:

  • $13$ of Canadians smoke tobacco.

  • Negative Impact: Dramatically increases chronic disease risk, impairs wound healing and recovery, increases healthcare costs by $S 16.2$ billion annually, reduces rehabilitation effectiveness.

• Excessive Alcohol:

  • Negative Impact: Contributes to injuries and falls, interferes with medication management, increases emergency department visits, complicates rehabilitation planning.

Self-Imposed Risk Behaviour

• Smoking: Leading preventable cause of death and disease.

• Unhealthy Eating Habits: Contributing to obesity, diabetes, and heart disease.

• Physical Inactivity: Linked to chronic disease and mental health issues.

• Alcohol or Drug Abuse: Contributing to injuries, liver disease, mental health challenges.

• Sexual Promiscuity: Risk for STIs.

• Dangerous Driving: Leading to injuries.

• Canadian Statistics:

  • $85$ of chronic diseases are preventable through lifestyle changes.

  • $13$ of Canadians smoke tobacco.

  • $48$ don't meet physical activity guidelines.

  • The annual healthcare cost of smoking is $S 16.2$ billion.

• Impact on Healthcare System: Health promotion and illness prevention initiatives aim to reduce self-imposed risk behaviours to ease the financial burden and promote health.

  • $S 1$ spent on prevention equals $S 7+$ in treatment costs.

Lifestyle Impact on Service Delivery

• Service Delivery Challenges:

  • Complexity: Multiple risk factors compound health problems.

  • Non-adherence: Lifestyle habits resist change.

  • Repeated Admissions: Poor lifestyle choices lead to exacerbations.

  • Resource Intensity: More complex, longer interventions needed.

  • Team Coordination: Multiple disciplines required.

• Critical Point: Poor lifestyle choices create a cascade of healthcare needs requiring intensive rehabilitation, highlighting the importance of prevention and health promotion.

• Cost Implications:

  • Direct Costs: Treatment of preventable conditions.

  • Indirect Costs: Lost productivity, disability support.

  • System Strain: Emergency services overwhelmed.

  • Rehabilitation Load: Increased need for restorative services.

  • Long-term Care: Earlier and more intensive needs.

World Practice Scenarios

• Scenario 1: Multiple Chronic Conditions (Biopsychosocial Approach)

  • Challenge: $68$-year-old client with diabetes, arthritis, and mild cognitive impairment not following an exercise program.

  • Biological: Pain, fatigue, cognitive load.

  • Psychological: Overwhelmed, low confidence.

  • Social: Limited support, complex instructions.

  • Solutions: Simplify the program, address pain first, build confidence with small wins, involve family, use visual aids.

• Scenario 2: Community Prevention (Socio-Ecological Model)

  • Challenge: Pattern of falls in community practice; how to contribute to prevention?

  • Individual: Balance training, education.

  • Social: Group classes, peer support.

  • Environment: Home assessments.

  • Policy: Advocate for programs.

  • Your Role (as OTA/PTA): Lead community exercise classes, conduct home safety assessments, educate families and caregivers.

The Health of Canadians Today

• Life Expectancy: Continues to rise.

  • $83.9$ years for women.

  • $79.5$ years for men (Statistics Canada, $2025$).

Canadians' Leading Health Concerns

• The specific ranking of concerns is shown via a graph but not detailed in the text, indicating a visual representation of top health issues.

Cancer

• Prevalence: $30$ new cases; leading cause of death in Canada.

• Statistics (approximate, $2020$ data):

  • $~225,800$ new cases annually.

  • $~83,300$ deaths annually.

  • $~617$ diagnoses every day.

  • $~228$ daily deaths (Statistics Canada, $2025$).

• Common Cancers:

  • Prostate: Most common for men.

  • Breast: Most common for women.

  • Lung: Leading cause of cancer deaths.

  • Colorectal: Among the top for both sexes.

• Rehabilitation Implications:

  • Physical: Fatigue, weakness, mobility issues.

  • Cognitive: "Chemo brain."

  • Psychological: Anxiety, depression, fear.

  • Social: Return to work, relationships.

  • Functional: Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).

Cardiovascular Disease (CVD)

• Prevalence: #$2$ leading cause of death in Canada.

  • $2.4$ million (or $1$ in $12$) Canadians live with heart disease.

  • $12$ Canadians per hour over age $20$ die from heart disease.

  • $1$ in $10$ Canadians have excellent cardiovascular health (Statistics Canada, $2025$).

• Modifiable Risk Factors: Not smoking, physical activity, healthy eating, healthy body weight, limiting alcohol.

• Rehabilitation Implications:

  • Cardiac Rehabilitation: Exercise-based programs.

  • Lifestyle Modifications: Diet, activity, stress management.

  • Medication Adherence: Education and monitoring.

  • Risk Factor Reduction: Smoking cessation, weight management.

  • Psychosocial Support: Anxiety and depression management.

Respiratory Disease

• Prevalence: Over $3$ million Canadians suffer from respiratory disease, costing the healthcare system over $S 8$ billion annually.

• Common Respiratory Diseases:

  • Asthma: $2.4$ million Canadians affected ( $4.4$ of the population).

  • COPD (Chronic Obstructive Pulmonary Disease): Primarily from smoking.

  • Lung Cancer: Leading cause of cancer deaths; higher rates in Indigenous communities.

  • Tuberculosis (TB): Specific information not detailed for Canada.

  • Cystic Fibrosis: Genetic condition requiring specialized care.

• Risk Factors: Smoking, environment, occupational exposures, infections, genetic factors.

• Rehabilitation Implications (Pulmonary Rehabilitation):

  • Reduces hospitalizations by $~25$1$vs. Type$2), Physical inactivity, Childhood obesity, Mood disorders, Dementia, Pandemic viruses, Lyme disease, Alcohol Abuse, Smoking, Youth substance abuse (Cannabis, drinking, drug use), Opioid crisis, Vaping.

  Chronic Diseases & The Canadian Healthcare System

  • Prevalence:

    • 60%$of Canadians have more than one chronic condition.</p></li><li><p>$~42%$have multiple chronic conditions.</p></li></ul></li><li><p><strong>Impact:</strong></p><ul><li><p>Account for$~67%$of healthcare costs.</p></li><li><p>Account for$~89%$of deaths.</p></li></ul></li><li><p><strong>Systemic Shifts:</strong></p><ul><li><p><strong>Service Focus:</strong> From acute treatment to chronic management.</p></li><li><p><strong>Care Models:</strong> Integrated, continuous care approaches.</p></li><li><p><strong>Setting Changes:</strong> Community-based services.</p></li><li><p><strong>Professional Roles:</strong> Exploring scope of practice.</p></li><li><p><strong>Technology Use:</strong> Remote monitoring, telehealth expansion.</p></li></ul></li><li><p><strong>Rehabilitation Implications:</strong> Increased demand, complex cases, longer relationships with clients, prevention role, family involvement.</p></li></ul><h5 id="e4cc18c6-f55f-4797-a621-c823f136975e" data-toc-id="e4cc18c6-f55f-4797-a621-c823f136975e" collapsed="false" seolevelmigrated="true">Population Aging (The Demographic Tsunami)</h5><ul><li><p><strong>Increased Demand For:</strong> Long-term care, emergency services, home care, specialist services, rehabilitation.</p></li><li><p><strong>Service Delivery Changes:</strong></p><ul><li><p>Community programs.</p></li><li><p>Technology integration.</p></li><li><p>Interprofessional teams.</p></li><li><p>Caregiver support.</p></li><li><p>Accessibility enhancements.</p></li></ul></li></ul><h5 id="40bca8dc-9782-47a1-840a-6a107d436a3a" data-toc-id="40bca8dc-9782-47a1-840a-6a107d436a3a" collapsed="false" seolevelmigrated="true">Healthcare Utilization</h5><ul><li><p><strong>Healthy Lifestyle:</strong> Decreased utilization through preventative care, screening, and early intervention.</p></li><li><p><strong>Risk Factors:</strong> Moderate use through regular management.</p></li><li><p><strong>Chronic Disease Complications:</strong> Intensive services, high cost, healthcare worker shortage, etc.</p></li><li><p><strong>Diabetes Example:</strong></p><ul><li><p><strong>Prevention Stage:</strong> Annual check-ups, lifestyle counseling ($~S 500/ ext{year}$).</p></li><li><p><strong>Complication Stage:</strong> Amputation, dialysis, intensive rehabilitation ($~S 50,000+/ ext{year}$$).

  • Predictors:

    • Health Status: Number and severity of conditions.

    • Age: Increased age equals increased utilization.

    • Socioeconomic Status: Lower income equals higher emergency use.

    • Social Support: Isolation affects utilization.

    • Health Literacy: Ability to navigate services.

  Prevention and Early Intervention Impact

  • Levels of Prevention:

    • Primary Prevention: Prevent disease/injury.

      • Examples: Vaccination, exercise programs.

      • OTA/PTA Role: Health promotion, community programs.

    • Secondary Prevention: Early detection and treatment.

      • Examples: Screening programs, early intervention.

      • OTA/PTA Role: Assessment, early intervention.

    • Tertiary Prevention: Minimize the impact of established disease.

      • Examples: Mobility rehabilitation, disease management.

      • OTA/PTA Role: Restoration, maintenance of function.