Health of the Unhoused Population

March 24, 2026

The Public Health Agency of Canada (2022) identifies the social determinants of health (SDOH) as the various personal, social, economic and environmental factors that can determine and cause barriers for individual health. These factors influence how healthy a population may be and can create health inequities for various reasons. Being unhoused can create many barriers to health and well-being. Having access to housing is an important aspect of living a healthy life, however, there are many other considerations for those who are unhoused, such as access to services and resources, social support, safety, and policies that protect health (Lee et al., 2023).  The causal pathways to being unhoused are not linear, for example a person could be low income, have a chronic disease, mental health concerns, face gender biases, have substance use issues, etc. that could lead to being unhoused (Frankish et al., 2005). Inversely, being unhoused could also lead to substance use, facing stigma and discrimination, increase of chronic diseases like diabetes, TB, COPD as well as acute infections that exacerbate physical and mental health issues and continue the cycle of being unhoused.

While there are many faucets of change and implementation needed to support this population, one change would be policy and legislation to support, create, and enhance healthy communities (Frankish et al., 2005).  Creating infrastructure for affordable or transitional housing and supporting communities in navigating these challenges would provide more positive outcomes.  The Canadian institute of Health (2024) highlights that most connections with the health care system is through the emergency department and results in stays that are twice as long, the average around 15 days, and costs about $16,000 per stay. Treatment and resources are provided but without stable housing to continue treatment, access to community services and primary care, the cycle continues. More research and policy development is needed to support the unhoused population in enhancing their personal health which would enhance environment and social factors while simultaneously reducing health care costs.

References

Canadian Institute for Health Information (2024) Hospital data sheds light on patients experiencing homelessness. https://www.cihi.ca/en/hospital-data-sheds-light-on-patients-experiencing-homelessness

Frankish, C. J., Hwang, S. W., & Quantz, D. (2005). Homelessness and Health in Canada: Research Lessons and priorities. Canadian Journal of Public Health, 96(S2). https://doi.org/10.1007/bf03403700

Lee, J. J., Jagasia, E., & Wilson, P. R. (2023). Addressing health disparities of individuals experiencing homelessness in the U.S. with Community Institutional Partnerships: An integrative review. Journal of         Advanced Nursing, 79(5), 1678–1690. https://doi.org/10.1111/jan.15591

The Behavioural Health Consultant: The Answer to Primary Care?

March 10, 2026

Primary care works within a “quadruple aim” framework to address needs of the health system (Valaitis et al. 2020). The four aims of primary care look to improve the patient experience, reduce costs, improve the provider experience and advance population health. Primary care is the first connection with the health system and looks to support patients in health promotion and prevention to reduce health challenges and the impacts and risk of disease in the long term.

The Primary Care Behavioural Health (PCBH) Model utilizes a biopsychosocial approach to enhance population health with the overall goal to enhance primary care, prevent and reduce chronic disease (Reiter et al., 2018). The model highlights the integration of team-based care within one location to prevent illness and promote well-being while reducing health disparities. This paper will review the PCBH Model as a multilevel approach focusing on improving population health through health behaviours. The PCBH model offers a transformative solution to healthcare fragmentation by generating positive outcomes across multiple levels: the patient, interpersonal, community and systemic levels.

The Patient and Interpersonal Level

Krahn et al. (2021) proposed that health is the “dynamic balance of physical, mental, social, and existential well-being in adapting to conditions of life and the environment" (p. 2). The concept of health is closely tied to population health, which the Public Health Agency of Canada (2023) defines as a strategy focused on enhancing the health of entire communities while addressing and reducing health disparities among different groups. Population health is viewed as a resource or capacity instead of merely a state, aligning with the idea that health facilitates the pursuit of goals, the attainment of skills and education, and personal growth.

Research shows that patients who have a trusting relationship with their family doctor are more likely to have more positive outcomes and better management of chronic conditions (Alberta Medical Association, 2023). Patients are more likely to seek care and continue care where their doctor is located, known as the “medical home”.

The PCBH model uses a behavioural health consultant (BHC) as a “generalist” within the primary care settings, placing the BHC within the medical home (Reiter et al., 2018).  BHC’s can be many different disciplines: Registered Nurses/Registered Psychiatric Nurses, Occupational therapists, Social workers and Psychologists. The role focuses on a 30-minute appointment aimed at a brief assessment to highlight current behaviours that may be impacting health. The BHC will then provide psychoeducation on current behaviours and how they may be impacting symptoms and well-being. Putting the patient in the driver’s seat, the BHC will work with the patient to identify and create 1-2 attainable goals and follow-up until mood stabilizes and health improves.

How does the PBHC Model improve the patient’s experience? Mental Illness and the stigma that can come with it can contribute to avoidance of treatment and support (Shim & Rust, 2013). With a co-located team, using preventative screening and a holistic health view, patients can be treated for mental health challenges within the medical home. Access to services can also be a hinderance for patients to seek care. The role highlights same day access with the doctor providing a “warm hand-off” to the BHC (Reiter et al., 2018). This integrated support works to improve patient outcomes by taking the time to educate and work on goals and support the clinic in more efficient workflows using team-based care and enhancing the interprofessional relationships between healthcare workers. Unlike more traditional therapy where wait times are longer and usually come with a high cost, the model uses same-day access and brief interventions to support more patients more effectively by improving symptoms and functioning for patients and their families within one location through their provincial healthcare. In addition to the benefits of the patient and their families, the role could reduce burnout of healthcare providers as they work more effectively as a team (Shim & Rust, 2013)

Community and Systemic Level

Health disparities can be described as the various personal, social, economic and environmental factors that can determine and cause barriers for individual health (Public Health Agency of Canada, 2022). Health disparities can include Income and Social Status, Social Support Networks, Education and Literacy, Employment and Working Conditions, Social Environments, Physical Environments, Personal Health Practices and Coping Skills, Healthy Child Development, Genetics, Health Services, Gender and Culture (Public Health Agency of Canada, 2024). As the BHC is considered a “generalist”, they can support in mild to moderate challenges within these health disparities (Reiter et al, 2018). The BHC, in addition to providing education, support and follow-up, will refer to other disciplines as appropriate and will coordinate services if other support or more complex needs are identified, further enhancing community interprofessional relationships. To name a few ways the BHC can provide support in reducing health disparity, they can provide tools and education to enhance relationships by effective communication, direct to services for funding or employment and teach healthy coping skills. When more patients within a community have access and support in enhancing mental well-being and reducing barriers to their health, you will have a healthier, thriving community. Reducing barriers to achieve a healthier lifestyle, health prevention and promotion at early stages can reduce the risk of chronic diseases and thus, high financial impacts on the health care system. Using the PCBH model effectively in primary care settings leaves specialized services available for those who need more complex support, further reducing wait times to emergency departments and specialists.  

In conclusion, increasing efficiency with the PCBH model in primary care settings would improve the patient experience by reducing stigma and treating the whole person to improve overall health and functioning. The model would also enhance interpersonal relationships within health care settings and leave more specialty services available for those who need it and, ultimately, improving access to care, reduced risk of chronic diseases and reduced cost to the healthcare system long term.

After posting my initial blog outlining the PBHC model and reading other classmates posts, I realized I need to be clearer on the health issue that I was speaking to. I also felt I needed to be more specific in certain concepts as what may seem like common knowledge to me, may not be to others. One classmate asked how the role incorporated a holistic approach, which I felt I have now addressed in this assignment.  

References

Alberta Medical Association. (2023). Primary Care 2030: The future is now – A white paper on building Alberta’s primary care system. https://www.albertadoctors.org/media/grwnmf4h/primary-care-2030-white-paper-full-report.pdf

Krahn, G. L., Robinson, A., Murray, A. J., Havercamp, S. M., Havercamp, S., Andridge, R., Arnold, L. E., Barnhill, J., Bodle, S., Boerner, E., Bonardi, A., Bourne, M. L., Brown, C., Buck, A., Burkett, S., Chapman, R., Cobranchi, C., Cole, C., Davies, D., … Witwer, A. (2021a). It’s time to reconsider how we define health: Perspective from disability and chronic condition. Disability and Health Journal, 14(4), 101129. https://doi.org/10.1016/j.dhjo.2021.101129      
        Public Health Agency of Canada. (2023, January 26). The population health approach. https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health-approach.html

Public Health Agency of Canada. (2022, October 18). What determines health? Canada.ca. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Reiter, J. T., Dobmeyer, A. C., & Hunter, C. L. (2018). The Primary Care Behavioral Health (PCBH) model: An overview and operational definition. Journal of Clinical Psychology in Medical Settings, 25(2), 109–126. https://doi.org/10.1007/s10880-017-9531-x 

Shim, R., & Rust, G. (2013). Primary care, behavioral health, and Public Health: Partners in Reducing Mental Health Stigma. American Journal of Public Health, 103(5), 774–776. https://doi.org/10.2105/ajph.2013.301214

Valaitis, R. K., Wong, S. T., MacDonald, M., Martin-Misener, R., O’Mara, L., Meagher-Stewart, D., Isaacs, S., Murray, N., Baumann, A., Burge, F., Green, M., Kaczorowski, J., & Savage, R. (2020). Addressing quadruple aims through primary care and Public Health Collaboration: Ten canadian case studies. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-08610-y

Chronic Disease Surveillance

March 10th, 2026

Dual blog post with Cam Streicher

The management of chronic diseases is one of the largest expenditures of any healthcare system. According to the Canadian Public Health Association, approximately 44% of Canadians are diagnosed with a chronic disease (Canadian Public Health Association, n.d.). The economic burden of chronic disease is immense. As an example, diabetes costs roughly $30 billion per year in direct and indirect costs (Canadian Public Health Association, n.d.). In Canada, provinces are the sole administrators of healthcare in their domain. This post seeks to explore how two provinces, Alberta and Ontario, compare in their management of chronic disease.

In Ontario, chronic disease is monitored through various avenues including the Prevention System Quality Index (published by Ontario Health). These reports provide data to the Ministry of Health and healthcare organizations to aid in the development of health related legislation, policy and programs. In 2023, the prevention system quality index reported on seven chronic disease risk factors and exposure domains (Prevention System Quality Index, n.d.). Another key player in chronic disease monitoring is Public Health Ontario which in 2019 published a report titled "The Burden of Chronic disease in Ontario." This report had several key findings including the observation that chronic diseases such as cancer, cardiovascular disease, chronic lower respiratory disease and diabetes cause about two-thirds of all deaths in Ontario (Public Health Ontario, 2019). In Ontario, the total economic cost of chronic disease is approximately $21.5 billion Public Health Ontario, 2019).

Ontario's Ministry of health's 2025-26 strategic plan is built on three main pillars (Published Plans and Annual Reports 2025-2026, 2025):

• Providing the right care at the right place and at the right time

• Deliver faster access to care (reduce surgery wait times, build new hospitals, add more beds, invest in long-term care etc.)

• Hire more healthcare workers (invest in education and workforce training)

In the 2025-26 budget, the ministry of health has allotted approximately %3 billion (4% of the total $75 billion budget) towards health policy research and population and public health programs. The 2025-26 budget also mentions investing $1.8 billion to support the Primary Care Action plan (Expenditure Estimates for the Ministry of Health (2025 - 26), 2025).

In recent years Ontario has taken an interest in evaluating interprofessional teams and engagement of healthcare teams with patients. In 2023 a study utilizing a qualitative case-study approach interviewed 22 health professionals working established family health teams in Southwestern Ontario. Family Health Teams were primarily developed to improve chronic disease management and patient outcomes in primary care. The focus of this study was to evaluate the effectiveness of interprofessional collaboration and chronic disease management. The conclusion of the study was that interprofessional chronic disease management requires both formal and informal structures for patient assessment, case-management and communication between team members to be effective (Brooks et al., 2023). Another large-scale study being performed is the "Building Engagement-Capable Environments" study. This study aims to understand how to best support Ontario health teams become engaging environments for patients, families and their caregivers (Creating Engagement Capable Environments in Ontario Health Teams, 2024).

Like Ontario, Alberta has focused on how to strengthen primary care services and chronic disease prevention using various avenues of surveillance of chronic diseases to drive positive change. In 2000, Alberta implemented the Alberta Tomorrow Project, one of the biggest studies done to monitor and better understand the development of cancer and other chronic diseases (Alberta Health Services, N.D.). The study recruited 55,000 men and women across Alberta between the ages of 35 and 69 to be followed for 50 years. Alberta Health Services collected “billions of points of data” including genetics, lifestyle, environment and health history (N.D.). Participants were asked to repeat screeners and questionnaires every 4 years (Ye et al., 2021). The collection of the data released between March 2000 to October 2018 included 53, 770 participants from the cohort identified the highest prevalence of hypertension (18.5%), depression (18.1%), chronic pain (12.8%), osteoarthritis (10.1%) and cardiovascular diseases (8.7%) (Ye et al., 2021).

Another system used in the Alberta Health Services Public health surveillance is a continuous system in reporting and analyzing health data and trends (Alberta Health Services, N.D). The information serves as a base to survey and drive health care changes toward effective primary and secondary prevention strategies and ultimately helps reduce illness and death while fostering research in chronic diseases.

The initiative of Modernizing Alberta’s Primary Health Care System (MAPS) focuses on the restructuring of Primary Care Networks for consistency and improved access to primary care services. (Alberta Health Services, 2024). A driver of the restructuring is largely focused on the increasing aging population, ensuring indigenous and rural areas have access to culturally safe, competent care.  Based on the surveillance of health challenges in Alberta, the AHS Health and Business Plan (Alberta Health Services, 2024) focuses on the following social determinants of health to prevent chronic disease:

• Developing Personal Skills

• Strengthening Community Action

• Creating Supportive Environments

• Building Healthy Public Policy

• Community Needs Assessment and Program Planning

The framework also identifies improving health behaviors for Alberta by providing education on choosing healthy foods, reducing substance use including tobacco and alcohol, and increasing immunizations. Alberta’s frameworks and legislation plans look to reduce barriers to access health care services and increasing education on health promotion (Alberta Health Services, 2024).

Managing chronic disease presents a significant health and economic challenge for Canada, with provinces taking unique but similar approaches to address it. Both Ontario and Alberta utilize data surveillance through reports like Ontario’s Prevention System Quality Index and long-term studies like the Alberta Tomorrow Project to inform and guide strategies.

While Ontario’s recent efforts focus on funding primary care action plans and enhancing interprofessional collaboration within Family Health Teams, Alberta is emphasizing the modernization of its primary care system (MAPS) to foster the same change. Ultimately, both provinces share a common goal: strengthening primary and preventative care and using data-driven insights to reduce the burden of chronic illness on their healthcare systems.

References

Alberta Health Services. (2024). AHS health plan and business plan 2024–27. https://www.albertahealthservices.ca/assets/about/org/ahs-org-health-plan-2024-27.pdf

Alberta Health Services. (n.d.). Public health surveillance. https://www.albertahealthservices.ca/services/Page13513.aspx

Alberta Health Services. (n.d.). Provincial population and public health. https://www.albertahealthservices.ca/findhealth/service.aspx?Id=3677

Brooks, Laura, Jacobi Elliott, Paul Stolee, et al. “Development, Successes, and Potential Pitfalls of Multidisciplinary Chronic Disease Management Clinics in a Family Health Team: A Qualitative Study.” BMC Primary Care 24, no. 1 (2023): 126. https://doi.org/10.1186/s12875-023-02073-x.

“Creating Engagement Capable Environments in Ontario Health Teams.” McMaster University, 2024. https://ppe.mcmaster.ca/engagement-capable-oht-framework/.

Canadian Public Health Association. “Chronic Disease and Public Health in Canada.” Accessed March 9, 2026. https://www.cpha.ca/chronic-disease.

“Expenditure Estimates for the Ministry of Health (2025–26).” June 4, 2025. http://www.ontario.ca/page/expenditure-estimates-ministry-health-2025-26.

“Ontario’s Primary Care Action Plan, January 2025.” January 27, 2025. http://www.ontario.ca/page/ontarios-primary-care-action-plan-january-2025

“Prevention System Quality Index.” Accessed March 7, 2026. https://www.ontariohealth.ca/system/reporting/disease-prevention/psqi#contact-us.

Public Health Ontario. “Burden of Chronic Diseases in Ontario.” 2019. https://www.publichealthontario.ca/en/Data-and-Analysis/Chronic-Disease/cdburden.

“Published Plans and Annual Reports 2025–2026: Ministry of Health.” December 12, 2025. http://www.ontario.ca/page/published-plans-and-annual-reports-2025-2026-ministry-health.

Ye, M., Vena, J., Johnson, J., Shen-Tu, G., & Eurich, D. (2021). Chronic disease surveillance in Alberta’s Tomorrow Project Using Administrative Health Data. International Journal of Population Data Science, 6(1). https://doi.org/10.23889/ijpds.v6i1.1672

Government Structure to Enhance Individual & Community Health in Rural Areas

March 3, 2026

A dual blog post with Charnelle W.

Health is determined by the conditions by which individuals and communities develop, live as well as their access to and availability of resources (World Health Organization, 2025; Raphael et al., 2020; Chelak & Chakole, 2023). Despite Canada’s commitment to global health equity policies and the existence of a universal health system, longstanding challenges with governance and legislation exacerbate health inequities for those living in rural regions (Jawad et al., 2026). Close to 20% of the Canadian population reside in non-metropolitan areas yet these regions are the most underserviced and face greater barriers to healthcare access (Jawad et al., 2026; Raphael et al., 2020). Our dual blog post compares the governmental health structures in Alberta and Ontario and how they address health in rural communities.

The Ministry of Health is the governing agency responsible for the provision and delivery of health services in Ontario (Ministry of Health, 2025). The Ministry of Health comprises of 1 minister, 1 associate minister, 2 parliamentary assistants, 1 primary care action team chair, 11 assistant deputy ministers, 2 associate deputy ministers, and 51 directors (Ministry of Health, 2025). In contrast, Alberta has been restructuring the health system from one organization to four agencies (Alberta Health Services, 2024) to provide timely access and increase the quality of care provided to support an inclusive, patient-centered health system. The four public health agencies are: Recovery Alberta, Continuing care, Primary care and Acute care. The Ministry of Health focusing on primary care is the Primary and Preventative Health Services under Primary Care Alberta. One of the main focuses of Primary Care Alberta is to provide equitable and sustainable health care to rural communities (Alberta Health Services, 2024).

Alberta’s Rural Health Action Plan highlights that rural Albertans experience significantly poorer health, with higher rates of chronic illness and injury (Alberta Health, 2024). These disparities stem from geographic isolation and socioeconomic challenges. The impacts are worse for the indigenous communities, who also face systemic racism and limited access to culturally safe healthcare. In comparison with Ontario, the ministry’s document Your Health: A Plan for Connected and Convenient Care attempts to address the health disparities that arise from geographic location and interrelated characteristics (Ministry of Health, 2025). Challenges in both regions include extreme distances from rural areas to care services and workforce shortages (Alberta Health, 2024; Ministry of Health, 2025).

Alberta Health (2024) identifies the need for strategies that attract and retain providers, expand after-hours and specialist care, develop tailored care models, and address social and environmental factors influencing health such as housing and food security.  The document emphasizes the need for health care worker recruitment, retention and service delivery by increasing funding and grant support in rural areas to enhance community supports, telehealth, air ambulance and investments in new infrastructure (Alberta Health, 2024). The Rural Health Action Plan also identifies the need to implement policies to reduce cultural barriers by hiring more indigenous health providers (Alberta Health, 2024). Disease prevention is another area identified as the plan aims to improve health outcomes through supporting maternal and youth initiatives, as well as addressing risk factors like tobacco and vaping (Alberta Health, 2024).

According to the Ministry of Health (2025), the main target areas identified in their plan are workforce and education, expanding scope of practice for certain healthcare workers, oversight mechanisms, funding equity and further investment in emergency and primary services in rural regions (Ministry of Health, 2025). Among the implemented solutions are the increase of the number of physicians, primary care clinics and ambulances available in remote areas, staggered investment in the Northern Health Travel Grant program and expansion in the digitalization of health services and records (Ministry of Health, 2025). According to the ministry’s plan, investments have been made towards improving access to culturally appropriate health services for 2SLGBTQIA+, Indigenous and people of colour and French speaking individuals (Ministry of Health, 2025).

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References

Alberta Health. (2024). Rural Health Action Plan 2024–2027. Government of Alberta.       https://open.alberta.ca/dataset/49fc0a42-68d2-4af7-abf7-051bbc6ad039/resource/1cdd6591-b827-43c2-9707-d2fd3160b25d/download/hlth-rural-health-action-plan-2024-2027.pdf

Alberta Health Services. (2024). AHS health plan and business plan 2024–27. https://www.albertahealthservices.ca/assets/about/org/ahs-org-health-plan-2024-27.pdf

Chelak, K., & Chakole, S. (2023). The Role of Social Determinants of Health in Promoting Health Equality: A Narrative Review. Cureus, 15(1), e33425. https://doi.org/10.7759/cureus.33425

Jawad, A., Ibhawoh, B., Schwartz, L., & Kapoor, A. (2026). Barriers to access to healthcare service in rural Ontario: qualitative study through the lens of the right to development. Journal of Rural Studies, Vol 123, 104024.  https://doi.org/10.1016/j.jrurstud.2026.104024

Ministry of Health. (2025). Published plans and annual reports 2025-2026: ministry of health. King’s Printer for Ontario. https://www.ontario.ca/page/published-plans-and-annual-reports-2025-2026-ministry-health

Raphael, D., Bryant, T., Mikkonen, J. and Raphael, A. (2020). Social determinants of health: the canadian facts. Ontario Tech University Faculty of Health Sciences and York University School of Health Policy and Management. https://thecanadianfacts.org/The_Canadian_Facts-2nd_ed.pdf

World Health Organization. (2025). Social determinants of health. World Health Organization. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1

The Public Health Agency of Canada (2022) identifies the social determinants of health as the various personal, social, economic and environmental factors that can determine and cause barriers for individual health. These factors include Income and Social Status, Social Support Networks, Education and Literacy, Employment and Working Conditions, Social Environments, Physical Environments, Personal Health Practices and Coping Skills, Healthy Child Development, Genetics, Health Services, Gender, Culture. These factors influence how healthy a population may be and can create health inequities for various reasons. Across Canada, population health and strategic frameworks and legislation are created based on the population they serve. Health inequities can also vary between a population within the same geographic location, those who may live in the same area may have access to the same healthcare and resources, however, income, age, education and culture may impact health outcomes. There may be challenges in healthy eating due to lack of education and lack of income for healthy food. Culture may impact access to health care based on limited culturally appropriate services and challenges with those who may not speak English. Those living in rural communities may also not have access to the same services as one might within a large city.

Chelak and Chakole (2023) identify that inequities created in communities are often based around historical societal and political challenges. In creating health equity, the focus should not just be on access to health care but also address the underlying social, economic, and environmental inequities that contribute to health disparities. Public health and public health promotion aim to decrease these health inequities among the population but policy and commitments to the well-being of the community need to include increasing access to nutritional food, improving and increasing education opportunities, reducing poverty and ensuring safe housing and community.

References

Alberta Health Services. (2024). AHS health plan and business plan 2024–27. https://www.albertahealthservices.ca/assets/about/org/ahs-org-health-plan-2024-27.pdf

Alberta Health Services. (n.d.). Provincial population and public health. https://www.albertahealthservices.ca/findhealth/service.aspx?Id=3677

Alberta Health and Wellness. (2003). Alberta’s health and wellness: A framework for health. Open Government Program. https://open.alberta.ca/dataset/eb0e7fb7-d5b8-4cea-bd39-26fbb1433a50/resource/46223716-bb2e-4cae-8a0f-e09f4879e2d5/download/framework-for-health-2003.pdf

Chelak, K., & Chakole, S. (2023). The role of Social Determinants of Health in Promoting Health Equality: A narrative review. Cureus. https://doi.org/10.7759/cureus.33425

Government of Alberta. (2023). Modernizing Alberta’s primary health care system (MAPS): 2-year implementation plan. Open Government Program. https://open.alberta.ca/dataset/f4fa02aa-9d85-48a4-bd72-240e873e5509/resource/3f1a65c4-b302-421a-ba66-19b54697f2ce/download/hlth-modernizing-albertas-primary-health-care-system-2-year-implementation-plan.pdf

Health Alberta. (n.d.). Conditions: Health conditions and treatments. My Health Alberta. https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=acq4591&lang=en-ca

Public Health Agency of Canada. (2022, October 18). What determines health? Canada.ca. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

The original definition of health defined by the World Health Organization (WHO) in 1948 where health is defined as a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (Krahn et al., 2021). Understandably, it is difficult to capture what health looks like in a single definition as there are many other factors to consider in determining one as “healthy”. While health can change based on personal behavioural habits and absence of disease, there are determinants of health that can impact one’s ability to be healthy and, potentially, outside of the realm of control. The Public Health Agency of Canada (2022) identified determinants of health as the broad range of personal, social, economic and environmental factors that determine individual and population health. The twelve most common are income, employment, education, childhood experiences, physical environment, social support and coping, healthy behaviours, access to health services, genetics, gender, culture and race.

While a few of these determinants of health can be out of one’s control, it does not necessarily mean that the inability to access health care or poor genetics will lead to poor health. Krahn et al. (2021) proposed a new working definition of health, stating that "health is the dynamic balance of physical, mental, social, and existential well-being in adapting to conditions of life and the environment" (p. 2). In my opinion, this definition encompasses autonomy in managing one’s own health, while recognizing that there will be changing conditions in life and the ability to adapt and focus on what is in our control and what we choose to focus on, to be able to determine our own health needs and choices. Poor genetics and low socioeconomic status may put one at risk for increased risk for metabolic syndrome, but the ability to exercise and eat well can create this “dynamic balance”.

The Lancet (2009) identified Goerges Canguilhem’s definition of health from his book published in 1948 where he defined health as not a fixed entity but rather as the ability to adapt to one’s environment. Health is defined by one’s own needs, not the idea of what one needs.

  -Theresa J.

References

Krahn, G. L., Robinson, A., Murray, A. J., Havercamp, S. M., Havercamp, S., Andridge, R., Arnold, L. E., Barnhill, J., Bodle, S., Boerner, E., Bonardi, A., Bourne, M. L., Brown, C., Buck, A., Burkett, S., Chapman, R., Cobranchi, C., Cole, C., Davies, D., … Witwer, A. (2021a). It’s time to reconsider how we define health: Perspective from disability and chronic condition. Disability and Health Journal, 14(4), 101129. https://doi.org/10.1016/j.dhjo.2021.101129

The Lancet. (2009). What is health? the ability to adapt. The Lancet, 373(9666), 781. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2809%2960456-6

Public Health Agency of Canada. (2022, October 18). What determines health? Canada.ca. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

After reflecting on my practice and gathering resources related to legislation and organizations, I have been reminded about the importance of regulation and guidelines for health disciplines. As a psychiatric nurse, I am registered with the College of Registered Psychiatric Nurses of Alberta.  Legislation and regulatory bodies are to provide guidance, consistency and safety for those we come into contact within healthcare settings. Many may believe that regulatory bodies and legislation are there to protect health care professionals, when they exist to protect the public. As a healthcare professional, in addition to providing safety for the public, building trust is equally important.

When I think about my professional values, I consider myself to be trauma-informed, empathetic, patient-centered and using best practices to enhance the well-being of those I encounter, as well as service delivery in projects I oversee. At the center of all those values is the building blocks of trust.

While reflecting on my social media presence and how health care professionals should be presenting themselves, it should always be centered around building trust with the public. Working and living in a small community, professional conduct and how I show up outside of work matters. I work with many clinics and family physicians in my community in addition to many different health disciplines. I connect with medical office assistants, admin, pharmacists, exercise specialists, registered nurses, Registered psych nurses, licensed practical nurses, dietitians, psychologists and psychiatrists. I work to build community connections between the Primary Care Network and other service providers to enhance delivery in our area. I also have direct reports that I provide support and direction to; trust and respect is important in all these relationships.

Many health services are working as a multi-disciplinary team and work together for a common goal; to provide the best outcome for the patient. Many disciplines cross paths, multiple times a day, some are likely to be service users. Working relationships are crucial in healthcare and at the base of a successful working relationship is building trust.

It is often said that health care is a “small world” and people are connected in many ways, especially through social media. There is a peer in my current class who also works within primary care and while we may not know each other, the regionalization of Primary Care Networks will place us under the same zone. Something simple like showing up for a class and writing a post has value in how it’s interpreted and how I present myself.

How I show up at work matters and highlights my professional values, I believe health care providers should always be working to foster trust with other service providers and users. Equally as important is how we are showing up outside of work, whether on social media, school platforms, or in person. It's a small world and small choices have big impacts.