AT A GLANCE: HOW HEALTHY ARE CANADIANS?

Updated: Dec 8, 2020

REFLECTING ON MY JOURNEY THROUGH MHST 601

INTRODUCTION:

Being a nurse with more than seventeen years of experience, and having a chance to practice my profession in different places and various fields, more and more I agree with F. Nightingale to never consider ourselves finished nurses…we must be learning most of our lives. Taking a first step towards the graduate degree, I sincerely enjoyed the dynamic of the class, the interactions with my classmates and my tutor, the material covered, and, especially, not as much revaluation of values, but mostly strengthening of my professional identity and values.

For my final blog posting, I decided to compose an integrated and synthesized summary, drawing from all course material and concepts, including my curated resources and previous blog posts. While covering different subjects during the course, there is a health issue that I would like to focus on, because its like an umbrella term for different health problems with complex root causes. In this blog I would like to put into perspective the health of Canadians in relation to chronic diseases. I will cover the changing definition of health and how it might impact the way we manage chronic diseases. I will also cover the determinants of health, multi-level model of health, and the role nurses play in the prevention and management of this health issue.

CANADIANS AND CHRONIC DISEASES:

As per Dr. T. Tam, 2020, life expectancy in Canada is one of the highest in the world. Today, on an average Canadian woman are expected to live up to 84 years, and the men 80. But the life expectancy plateaued for men and women. Nearly half of all Canadian adults live with at least one chronic condition, such as hypertension, arthritis, osteoporosis, COPD, asthma, diabetes, heart disease, cancer, or dementia. Chronic diseases are the single greatest burden on Canada’s population. Treatment of chronic diseases consume 67% of all direct health care costs, and cost the Canadian economy $190 billion annually - $68 billion is attributed to treatment and the remainder to lost productivity. Health expenditures to treat chronic diseases are rising faster than our economic growth (K. Elmslie, 2016).

CHANGING DEFINITION OF HEALTH:

Earlier during the course, we all shared our opinions about the WHO health definition of 1948, and how relevant it is today. It seems to me, that my classmates unanimously agreed that the definition is inconsequent for our present times, and does not help with health reality of today’s world. The 72 years old definition from WHO, defines health as something absolute and complete, and insinuate absence of diseases (WHO, 2020). As humans we always learn, improve, progress, which leads to changes in our life conditions, patterns, expectancy, and quality. Life expectancy in Canada has greatly improved since the early 20th century. The life expectancy at birth for men has increased by 20.5 years, from 58.8 years in 1920–1922 to 79.3 years in 2009–2011. During the same period, the life expectancy of women increased by 23.0 years, from 60.6 years to 83.6 years (Statistics Canada, 2018). As we can see, the life expectancy increased, as death from communicable diseases and other causes decreased. As people live longer, the likelihood of developing chronic diseases are also increased. The problem with the definition of complete health - it does not leave much space for people with chronic diseases and for managing them in new ways. Currently, managing the disease, and not necessary its absence, is an arsenal to a healthier life, especially for older population and people with chronic diseases.

In my previous blog I included a couple of newer definitions that I believe are more accurate for our times. They are also more serviceable, as they are focusing on adaptation, functioning, and enhancement of coping mechanisms.

DETERMINANTS OF HEALTH AND MULTI-LEVEL MODELS:

While talking about health and chronic diseases, it is important to address the factors that reduce our likelihood of developing certain health issues and to eliminate the risk factors that predispose to those diseases, such as smoking, bad eating habits, sedentary lifestyle, poor hygiene, and so on (N. Sartorius, 2006). Those factors are known as determinants of health. As noted by W. Cockerham et al., 2017, social determinants can initiate the onset of the pathology and in this way serve as a direct cause for a number of chronic diseases. Smoking, for example, is associated with more diseases than any other health-related behavior, as seen in its association with more than 21 chronic diseases, including at least 12 types of cancer, six types of cardiovascular disease, diabetes, chronic obstructive pulmonary disease, and others (W. Cockerham et al., 2017). At first, it might seem that it is a tar and nicotine in smoke that causes diseases, but smoking is a learned behavior that usually begins socially, from the parents who smoke, or from socializing with smokers. As a consequence, it is a social environment that start the path to tobacco-related diseases. Socioeconomic factors, such as debt, stress, unemployment also predispose to smoking, as it is uncommon for individuals from higher and middle levels of society to smoke, but very common for those toward the bottom of social ladder. Some other important social determinants are income, education, and inequality based on race and ethnicity. These variables have direct effects on unhealthy and healthy lifestyles, high- or low-risk behavior, living conditions, food security, environmental factors that influence biological outcomes through gene expression, and other connections to chronic diseases (W. Cockerham et al., 2017).

All mentioned above factors brings us to the multi-level models, where the determinants of health could be applied within each layer and demonstrate the broader interplay of influencing forces beyond the personal, and correlation among the individual, interpersonal, organizational, community, and societal/policy factors. In one of my previous blogs, I demonstrated the application of obesity and diabetes to Ecological Model of Health, in another one I put diabetes through the lens of Social Ecological Model in a form of case study, while offering interventions for each level. The goal was to display how the model can help to change behavior for the positive by making early detection, proper treatment and more possible, providing to a state of overall better health in a population (K. Aronika et al., 2015).

NURSING ROLE IN PREVENTION AND MANAGEMENT OF CHRONIC DISEASES:

With the advances in the prevention, treatments, and management of chronic diseases – multidisciplinary team is a key factor. Nurses play an important role in chronic disease management and well positioned to enhance the planning and delivery of healthcare resources in primary care. E. Wagner, 2000, pointed out that most successful interventions in chronic disease management entail the delegation of responsibility by the primary care doctor to team members for ensuring that patients receive proved clinical and self management support services.

There are many reasons the nurses are well-positioned to be involved in the management of chronic diseases. One of them, most doctors have no time to engage in counselling on behavior change or to give self management support, but having a nurse trained in behavioral counselling solves that issue. Close follow ups ensure early detection of adverse effects, problems in compliance, failures to respond to treatment. There are many evidence demonstrating the effectiveness of telephone or office follow ups by nurses in chronic illness care (E. Wagner, 2000). While searching the literature, it is apparent that most successful interventions involve a nurse with additional experience or training in the clinical and behavioral treatment of chronic diseases. This growing literature provides increasing support for the role of nurses in delivering interventions such as evidence-based guidelines, self-care/management, medication teaching, depression screening, and treating to target goals to improve clinical outcomes, medication adherence, and self-management (B. Trehearne et al., 2014). The nurses may be nurse practitioners, advanced practice nurses with additional degree in medical areas, or with additional credentials in a particular chronic disease. The nurses personally “manage” patients by protocol, adding clinical and self management skills, as well, as greater intensity of care (E. Wagner, 2000).

As per B. Trehearne et al., 2014 nursing is one of the most versatile occupations in health care and can fill many needs; not only do nurses have knowledge in the science of diagnosis and treatment of disease, but they also play central roles in assessing and triaging patient’s needs, care planning, monitoring, coaching, providing self management support, educating and supporting caregivers, and coordinating with medical, community, and social resources. Nurses are well suited to advance patient-centeredness in chronic disease care because of their traditional holistic perspective that attends to patient comfort, preferences, psychosocial needs, and the interplay with family and community.

CONCLUSION:

As mentioned in Health and Welfare Commissioner report, 2010, chronic diseases generate a broad spectrum of needs, most of which are complex and require different forms of care and services. The health and social services system, as it is currently designed, is struggling to meet that challenge. Yet, we do have potential solutions to choose from, given the fact that our health and social services system already has solid foundations upon which to build the necessary changes. By focusing on determinants of health to improve the socio-economic status of population in combination with the multi-level models of health, by properly allocating resources, and wisely delegating tasks among multidisciplinary team members, we can alleviate the impact and burden of chronic diseases on Canadian healthcare system and economy.