This last blog post for the course Foundation of health systems in Canada MHST 601 serves as an integrated review of the different topics we looked at during this Fall 2020 semester.

Unit 1: Interprofessional connectedness via digital-social media presence

At the beginning of this semester, we looked at what is a social media presence and what it entails professionally. At the time of my first blog I came across a short article that in my opinion summed up nicely what social media presence means. Haley Schluter (2014) mentions there are three elements to one’s social media presence: frequency, content and engagement. With this definition in mind, I can positively say that since this past September I have been regularly present on social media via my own eportfolio, and Twitter. I have been engaging with different content and topics at each posting, keeping in mind a critical analysis, an objective view about the content of my posts so to act responsibly and accordance to the codes of ethics of both provincial (OIIQ) and national (CNA) order of nurses. As I posted in my first blog I signed up to Twitter for the purpose of this course. I have been following a few classmates, our instructor and a few professional organisations of interest and relevant to my profession (operating room nurse) such as ORNAC, AORN, CNA, OIIQ. I have been using my Twitter account throughout the semester in order to fulfill the weekly learning activities and that of fellow classmates. I must say I am not at all impressed with this application and I do not intend to continue using it either for personal or professional purposes. My professional social identity will remain with LinkedIn which I have had for several years now.

At the start of this course, my intentions were to make use of this eportfolio for educational purposes, and maybe eventually for professional reasons. However, I wish I had known about the limitations of the webpage platform that I selected for my eportfolio. I chose Google Sites and although relatively easy to use it is very limited in the visual presentation aspect of creating a blog page. And if I can make a suggestion, I would not recommend it. Looking at my classmates eportfolios, the Wix app was definitely the most popular and I personally feel it gives a much more polish and professional look and feel, just a thought!

Unit 2: Health systems in Canada

The Government of Canada Health care system website is a good tool to understand the chronology of our health care system in this country. During this course we have looked at the most significant and defining political decisions that have structured our health care system thus far:

• 1867 British North American Act

• 1966 Medical Care Act

• 1984 the Canada Health

And as we have seen, it is also time to renew how we define our universal access to health care. The Ottawa Charter of 1986 is still a transformative platform for healthcare today as recalled by Potvin & Jones (2011) in Twenty-five Years After the Ottawa Charter: The Critical Role of Health Promotion for Public Health:

health promotion has started to permeate and transform public health systems. (... ) the most significant of these trends is the integration of health promotion as a specific function for public health. In the UK, Canada and Quebec, for example, laws and public health policy documents explicitly recognize health promotion as a core public health function, on par with more traditional functions such as protection, prevention or surveillance.

They go on to explain that two more objectives need to support “...health equity as an overarching objective for national public health programs” and “the adoption of (...) instruments that promote health in all policies as a principle of governance.”

From a practical perspective, the Canadian Nurses Association (CNA) proposes two key elements for a better health system: reducing the waiting time for access to service while managing a sustainable health system. CNA’s position in Registered Nurses: Stepping Up To Transform Health Care (2013) proposes that by reducing the waiting time for access to health service, Canadians' health will improve. A sustainable healthcare system has to be cost effective, of quality and accessible to all. Nurses have already put into motion that concept by going to the communities, by promoting a multidisciplinary collaborative practice approach and by being more efficient with resources. From the concept of coordination, where nurses hold a liaison position that allows them to better coordinate patient care while facilitating the continuity of care. And, the evolution of the act of prescribing as a means to a more efficient healthcare system for canadians. In the larger scope of things, Flood (2016) states in her presentation Modernizing the Canada Health Act, two main issues that must be addressed: 1- health services must remain universal (i.e. accessible to all) and encompass a broader array of health services such as to include dental, medications (prescription), mental health, community and home base services. Secondly, not all health services should be funded, but all should be based on “fair and open process”.

Units 3 & 4: Multilevel approaches to health: understanding determinants of health

Further than the definition of health by the World Health Organization (WHO), we now acknowledge that health is beyond the absence of disease. Health is multifactorial and encompasses individual and personal elements, geo-socio-economic factors, education, environment, etc. The main determinants of health according to the Government of Canada are

1. Income and social status

2. Employment and working conditions

3. Education and literacy

4. Childhood experiences

5. Physical environments

6. Social supports and coping skills

7. Healthy behaviours

8. Access to health services

9. Biology and genetic endowment

10. Gender

11. Culture

12. Race / Racism

The conceptual framework for health and its determinants as defined by the Ministry of Health and Social Services of Québec encompasses four areas : global context, systems, environment or life settings and individual characteristics; with the main focus being the health status of the population which concerns global health, physical, mental and psychosocial factors.

The fundamental premise of all multilevel models of health is health equity. Defined by the Government of Canada as “(the) absence of unfair systems and policies that cause health inequalities. Health equity seeks to reduce inequalities and to increase access to opportunities and conditions conducive to health for all.” The use of a model or framework is to structure and determine actions and/or interventions concerning the determinants of health. As noted by the Canadian Council in A Review of Frameworks on the Determinants of Health, there are six key points that have been identified “as relevant to advancing action on the determinants of health”. These are: the use of a 1- holistic and 2- intersectoral approach; 3- the recognition of social exclusion; 4- the role of individuals and communities; 5- the importance of upstream action; and 6- the clear identification of interactions between determinants. Furthermore, Magna (2017) discusses in Social Determinants of Health 101 for Health Care: Five Plus Five, that

In our endeavour to create models that help us determine the effectiveness and efficacy of social health interventions, we must take into consideration not to turn every program or action into a medical approach; instead community or local based interventions may ultimately prove to be more cost-effective.

Units 5 & 6: Prevention, management of chronic diseases & Vulnerable populations

In 2017, the Chronic Disease Prevention Alliance of Canada (CDPAC) forecasted that “chronic diseases and other illnesses cost the Canadian economy $190 billion annually, with $122 billion in indirect income and productivity losses, and $68 billion in direct health care costs”. As further discussed by Fortin et al. (2013) “chronic diseases represent a considerable challenge for the health care system owing to their prevalence, their direct and indirect costs, and their effects on patient health outcomes and quality of life”. Their article Evaluating the integration of chronic disease prevention and management services into primary health care explains that chronic disease prevention and management aka CDPM was made a priority by the Quebec Ministry of Health and Social Services

by developing a reference framework for CDPM based on the chronic care model (CCM).The purpose of this framework was very broad: to advocate CDPM as a key feature of primary care, to support best practices in relation to CDPM, to better integrate CDPM into a continuum of services, and to mobilize all stakeholders concerned with chronic diseases.

As we will see in the future directions of health, the prevention and management of chronic diseases remains an health objective by all levels of government.

Vulnerable populations

When looking at vulnerable populations, we see that there is a clear link between chronic diseases and vulnerable populations especially the Indigenous communities in Canada. First Nations suffer disproportionately higher rates of chronic disease such as diabetes and infant mortality when compared to non-Indigenous people. The Kelowna Accord of 2005 had opened a doorway to bridging the gaps in the health inequities with aggressive objectives, as cited by Richmond & Cook (2016):

targets were established to reduce infant mortality, youth suicide, childhood obesity and diabetes by 20 % in five years, and 50 % in 10 years. Targets were also set to double the number of Aboriginal health professionals in 10 years to 300 physicians and 2400 nurses.

With the newly elected conservative government of Stephen Harper in 2006, the accord was pushed aside and instead the Health Council of Canada was established. It too was dismantled by the Conservative government not long after. As pointed out by the Frontline Health Care in Canada: Innovations in Delivering Services to Vulnerable Populations (2006) report, there is jurisdictional ambiguity in the division of power when it comes to indigenous health, a tug-of-war between federal, provincial and territorial governments.

Unit 7: Future directions _ Trends in health

When researching the topic of health trends, I was fascinated by the new technological advancements presented. Even though I truly believe that some of these scientific applications can propel health and medicine to new heights, they also bring forth ethical issues that our society has not dealt with. In practical terms, I think the reality is that we are far from being able to use these technologies in our professional practice any time soon. Wearing personal sensors transmitting data to our physician, artificial intelligence (AI) assisted robots taking vital signs, or DNA sequencing to rule out if we are carriers of a certain disease are fabulous innovations that can certainly revolutionize the way we understand health and the roles of health professionals. Despite the fact that these new technological innovations may be affordable to some; the Canadian reality is that we must deal with an increasing financial burden of our health expenditure, and make the most of our money. Canada's health care system has been faced with challenges that will persist in the near future. These factors are the delivery of services, the financial significance of those services, the aging of our population, and “the cost of new technology”. In order to confront these challenges, the federal government has defined four directions to favor:

1- primary care :

reforms have focused on primary health care delivery, including setting up more community primary health care centres that provide on-call services around-the-clock; creating primary health care teams; placing greater emphasis on promoting health, preventing illness and injury, and managing chronic diseases; increasing coordination and integration of comprehensive health services; and improving the work environments of primary health care providers.

2- ehealth or electronic health records (EHR);

3- reducing the wait times for access to acute care,

4- patient safety: “including the avoidance of medical errors or adverse events, is one of the most significant issues facing health systems globally.

To conclude this integrated analysis of Foundations of Canadian health systems (MHST 601) and in particular when discussing health trends in Canada, we should look at what the federal government decided to focus on. The video Health of Canadians 2019 explains clearly what are the federal government’s health priorities: chronic diseases, vaccination, drug resistant bacteria, sexually transmitted infections, alcohol consumption, vaping, opioid usage, health inequities due to sex, gender, race, sexual orientation, and the impact of climate on health.

We are still trying to manage the unbalanced universal access to health care in this country especially concerning the vulnerable populations. According to the Health and Well-Being of Quebec’s population webpage (2014) “These inequalities (...) related to poverty, result among other things in a lower life expectancy and higher rates of chronic disease, drug and alcohol dependency and Youth Protection interventions”.

Professionally speaking, we have seen in these last few years a shift from tertiary-focus-care to primary care with greater efforts deployed towards home-based health services. In the province of Quebec, the aging population 65 and over is expected to reach 25% by 2031. This projected reality imposes political choices concerning the health priorities of our province knowing fully that an aging population suffers more from “chronic diseases, cognitive disorders and disabilities in daily life”, we need to adapt and evolve our health care services to reflect that upcoming future.

Let us use technology and scientific discoveries to help mind the gap, reduce inequalities to access to health care, and to promote global holistic health care. Subscribe to and apply the “Health in All Policies” framework by the World Health Organization (WHO) both at federal and provincial jurisdictions.