nurs 201 final
Wilkinson & Marmot
( 2003) study commissioned by the WHO
diversity
(n.) difference, variety; a condition of having many different types of forms
following a cultural path
(private and personal journey) involves: 1) Losing culture (residential schools and leaving the reserve) 2) Regaining culture (participate in traditional ceremonies)
advocacy
üEngaging others, using our voice and knowledge to influence policy and practice üSpeaking out against inequity üDirect and indirect engagement with political processes; being aware of power, policy and politics
temporary residents
ØTemporary foreign workers- classified by skill level and type ØForeign students ØHumanitarian population (asylum seekers): Claim refugee protection upon or after arrival to Canada
Universalists vs Relativists
- all human rights = intrinsic value vs - no common humaity - diversity, cultural differences have value
Globalization from above
-corporates angle on things -exploiting workers -neo-liberalism
risk factors for suicide in abgn youth
1) Prejudice experienced in school 2) Impact of colonization 3) Poverty (unemployment) 4) Conflicts with police 1) Sense of alienation in school 3) Friends involved with drugs and alcohol 4) Coercive parents and caretaker rejection 5) Perceived discriminationè;alcohol weapon availability Protective Conditions: 1) A friend or adult with whom to discuss concerns 2) Strong cultural beliefs 3) Supportive adults 4) Friends who do well in school 5) Neighbors who care
social exclusion
Denies people the opportunity to participate in meaningful activities as members of their society Increased rates of premature death, depression, increased pregnancy with complications and increased levels of disability with chronic illness
3 key issues of global health, austin, 2001
1.Challenge of devising a universal ethic that is respectful of diversity 2.Advances in technology and the associated outcomes 3.Equity and justice in global resource allocation
Sustainable Development Goals
17 goals adopted by the UN in 2015 to reduce disparities between developed and developing countries by 2030 poverty hunger health quality education gender water + sanitation energy work + economic development industry + infrastructure reduced inequalities sustainable communities responsible consumption climate protection life below water life on land peace, justice, strong institutions partnerships for goals
Alma Ata Declaration
1978, Brought health as a fundamental human right back to the agenda. Also emphasized the need to address the gross disparities in health status between developed and developing countries.
# of nurses worldwide
20 million
Whitehall Study
20th century: investigated social determinants of health, specifically the cardiovascular disease prevalence and mortality rates among British male civil servants between the ages of 20 and 64.
% of cnadians using CAM
70 71% of Canadians use natural products such as vitamins, minerals, herbal remedies or teas, and other CAMs. 81% think that the use of natural health products will increase over the next 10 years (cultural diversity) 62% of Americans used one CAM therapy in 2002 85% of US cancer patients reported having used at least one form of CAM The increased use of CAM has increased out-of-pocket expenditures on CAM therapies and services ($33.9 billions in the USA)
Camphina-Bacote's model of cultural competency
= PROCESS "Is a model that views cultural competence as the ongoing process in which the nurse/health care provider continuously strives to achieve the ability to effectively work within the cultural context of the client •Cultural awareness •Cultural knowledge •Cultural skill •Cultural encounters •Cultural desire
3 qualities of globalization
?
race
A group of human beings distinguished by physical traits, blood types, genetic code patterns or genetically inherited characteristics.
Ethnicity
A social division based on national origin, religion, language, and often race.
aboriginal philosophy
Aboriginal people's sense of self is rooted in their Indigenous philosophies that honor the Creator and the spiritual dimensions of humanity that sustains the connection to all living and nonliving things regardless of origin or identity
Primary health care Principles
Accessibility, public participation, health promotion, appropriate technology and intersectoral cooperation
Advantages of Globalization
Communication advances Economic growth Scientific and technological advances Improved life expectancy and health for some
SK FN suicide prevention plan
Community based solutions Incorporation of the WHO recommendations Quebec suicide prevention strategy - reduced by half
nursing mandate for 21st century
Elimination of health inequities. Requires two-pronged nursing approach: 1) Providing sensitive empowering care at the individual/community level to those experiencing inequities • 2) Working to change the environmental and social conditions that are the root cause of these inequities üProvide sensitive (culturally safe and socially conscious) nursing care, nonjudgmental care üAssist individuals and families to secure appropriate health-related services and support üAdvocate for policy through consciousness-raising: Explain how ideologies of power shape the access and the quality of the social determinants
health promotion
Enabling people to have control over their lives It is combined with elements that maintain "well-being": psychological, physical, the environment, societal, policy, experiential Access to services
principles of relational ethics
Environment Embodiment (both objective and subjective knowledge in the experience of health and illness) Engagement (Dialogue) Mutual respect "Who am I?" "Who are you?"
Criteria for adequate health care system
Equitable access (rural and urban) affordability sustainability (political, envt, financial)
relational ethics
From contextual theory, the fundamental dynamic force that holds families and communities together through reliability and trustworthiness. exposes the relational space between the client, nurse, and health care environments and within the broader context of society
Disadvantages of globalization
Health inequities in low resource countries Politically disadvantages areas Poverty and burden of disease unchanged Diseases travel
diversity of aboriginal people of canada
Impact of the 1867 Indian Act in Canada Aboriginals: First Nations, Métis, and Inuit peoples Aboriginal communities are diverse and represent 4% of the Canadian population Identification by linguistic groups: Dene, Cree, Metis, Abenaki, Miq'Maq Identification by community of origins: Beaver Lake Cree Nations, Standing Buffalo Nation, Metis Nations Impact of Treaty Rights in Western Canada
Jakarta Declaration
In 1997, added to and refined the strategies of the Ottawa Charter by articulating the following priorities. -Promote social responsibility for health - Increase investment for health developments in all sectors -Consolidate and expand partnerships for health -Increase community capacity and empower individuals -Secure an infrastructure for health promotion
Millenium Development Goals (MDGs)
In 2000, 191 UN member nations pledged to meet these 8 goals by year 2015 1.Eradicate extreme poverty and hunger 2.Achieve universal primary education 3.Promote gender equity and empower women 4.Reduce child mortality 5.Improve maternal health 6.Combat HIV/AIDS, malaria, TB, and other diseases 7.Ensure environmental sustainability 8.Develop a global partnership for development
population health promotion model
Integrates elements of socio-environmental approach and population health (Hamilton & Bhatti, 1996) Is concerned with the Social determinants of health PHPM focuses on social and environmental risk conditions and psychological risk factors that are known to affect health status, either directly or indirectly, via behaviours
Leading causes of disease (holtz. 2013)
Ischemic heart disease Unipolar major depression Road traffic accidents Stroke (CVA) Lower respiratory infections Tuberculosis War GI diseases/illness (diarrhea) HIV/AIDS Perinatal conditions Violence Congenital anomalies Self-inflicted injuries Trachea, bronchus, and lung cancer
global health
It is an area of study, research and practice that places a priority on improving health and achieving health equity in health for all people world wide Any issue that concerns many countries affected by transnational determinants i.e. climate change, urbanization, or solutions, such as polio eradication epidemic infectious diseases: influenza , HIV global health refers to the scope of the problems not their location
Globalization
It is the increased interconnectedness and interdependence of people and countries
Major global health concerns (holtz, 2013)
Life expectancy at birth Demographic aging in some countries Maternal and child health Environmental/Ecological threats War and militarization Gender inequity Lack of the prerequisites for health (water, food, sanitation) Mental health
medicine wheel
Medicine wheel illustrates balance and wholeness Illness occurs when balance and wholeness are disrupted wholeness Mental, emotional, physical, and spiritual Combines Eastern and Western philosophies Eastern philosophies: Cycles
historical roots of disease for indigenous people
Physical genocide (both US and Canada) Ethnic cleansing (displacement of populations to reservations) Cultural genocide (Residential schools) and public policies directed at forced assimilation Individual and institutional racism Land loss Colonialism and postcolonialism Oppression Poverty
inequity in health
Refers to differences that are unnecessary, unfair, and avoidable
5 key strategies for health promotion
Strengthening community action Building healthy public policy Creating supportive environments Developing personal skills Reorienting health services (sensitive to the needs of the population)
history of global health
The Marshall Plan to reconstruct Europe after World War II Establishment of the World Bank Declaration of Alma-Ata (Former USSR) in 1978 The principles of Primary Health Care (WHO, 1978)
Acculturation
The adoption of cultural traits, such as language, by one group under the influence of another. single most important factor in determining rates of screening for cervical cancer.
health inequities facing indigenous peoples
The leading cause of death among First Nations youth is accidental injury (22% of all deaths) Living on reserve involves higher risks of suicide and accidental injuries (Bearskin, 2011, p. 551) 35% of First Nations people reported less access to health care services 19% stated no access to doctor or nurse Non recognition of Metis as member of First nations by federal government (Indian Act) Lack of cultural competency and safety from the part of mainstream nurses and other health care providers Aboriginal health is a matter linked to federal government, not to provinces (result of colonialism and 1867 Constitution of Canada
conventional medicine
The usual practice of physicians and other allied health professionals, such as physical therapists, psychologists, medical assistants and registered nurses. Also known as western, or biomedical
Black Report (1980)
This report in the UK in 1980 reviewed the evidence on socioeconomic differences in health and discussed possible explanations for these differences.
Think globally, act locally
To successfully implement a global strategy requires that correct balance between central control and local management be obtained.
Ottawa charter, 1986, basic prerequisites for health
WHO §Food §Education §Shelter §Stable ecosystem §Sustainable resources (water) §Peace §Adequate income Social justice, equity, and gender equity
Ottawa Charter for Health Promotion
WHO, 1986 attempts to reduce inequalities in health developed from the social model of health and defines health promotion as 'the process of enabling people to increase control over, and to improve, their health' identifies three basic strategies for health promotion, which are enabling, mediating, and advocacy.
people likely to use CAM
Women People with higher household incomes and education People with many health conditions (co-morbidities) People who frequently visit their physician Older adults Men and women non-Western ethno-cultural groups People with concerns such as: anxiety, back problems, headaches, chronic pain, and urinary tract problems People with a holistic orientation to health People who cannot be treated by Western medicine People who have been hospitalized in the last year, indicating that health status is a significant predictor of CAM utilization
primary health care
a comprehensive system of essential health care that is focused on preventing illness and promoting health both a philosophy and a model for improving health care internationally accepted as the most effective way of meeting the health needs of people in communities around the world preventing illness and promoting health Addresses factors such as diet, income, schooling, literacy, employment, housing, workplaces, and environmental toxins involves citizens and patients on an equal footing with professionals
integrative health care
a form of health care that uses both mainstream medical treatments and complementary and alternative therapies to treat a patient
healthy immigrant effect
a pattern in which the initially positive health status of new immigrants declines following immigration as they adopt less healthy lifestyles in their new country of residence (10 yrs approx.) -> stress, poverty, language, employment, healthcare, racism, experiences with democracy does not apply to refugees
community
a set of people in interaction, who may or may not share a place or belonging; and who act intentionally for a common purpose may be defined by a location, cultural or demographic characteristic, or actual or potential health problem health of a community is a result of intersecting contextual factors or social determinants
health disparities
a statistically significant difference in health indicators that persists over time (Hotlz, 2013, p. 10). inform us about the burden of disease arise from unequal power relations and social inequities.
population health
approach to public policy that focuses on taking action on the interrelated conditions that influence population health status Gradients in health status across all economic levels. Health is defined in terms of traditional epidemiological indicators. Focus in on identifying determinants of disease and death rather than strategies for change
complementary and alternative medicine (CAM)
as yet unproven health care treatments intended to supplement (complement) or serve as alternatives to conventional medicine, not integrated to dominant HC system
marginalization
being outside the dominant group or majority product of symbolic violence
srna standard and competencies iii
ethical practice
Ethnocentrism
evaluation of other cultures according to preconceptions originating in the standards and customs of one's own culture.
The Upstream View
focus on modifying economic, political, and environmental factors that have been shown to be the precursors of poor health throughout the world' (p. 2). Society is seen as the locus of change. It is the range of available health choices, rather than the choices made at any one time, that is paramount in shaping the overall health status of a society Choices depend on individuals' personal and societal resources
Health inequities
inequalities that are avoidable, unfair, and unjust üExposure to unhealthy, stressful living and working conditions üInadequate access to essential health and other public services üHealth-damaging behaviors (where choice is restricted) üHealth-related social mobility involving the tendency of sick people to move down the social scale
mind-body treatments
involve both - yoga, meditation, etc.
social justice
justice in terms of the distribution of wealth, opportunities, and privileges within a society.
srna standard and competencies ii
knowledge based practice
Canada Health Act (1984)
lists the conditions that provincial/territorial health insurance plans must respect to receive federal transfers. ■Public administration ■Accessibility ■Comprehensiveness ■Universality ■Portability
institutional racism
patterns of discrimination based on ethnicity that have become structured into existing social institutions
Market Justice
people are entitled only to those goods and services that they acquire according to guidelines of entitlement Entitlements and privileges enable, maintain inequities Injustice creates and perpetuates inequities in health health care is not a moral obligation nor a right of citizenship
health inequities in canada
socioeconomic status, Aboriginal identity, gender, and geographic location
traditional medicine
sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health, as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness
Globalization from below
takes the form of individual actors, and groups of actors, opposing and acting to oppose globalization in both developed and less developed countries.
social determinants of health
the economic and social conditions that influence the health of individuals, communities and jurisdictions determine the extent to which a person possess the physical, social and personal resources to identify and achieve personal aspirations , satisfy needs and cope with the environment
Racialization
the formation of a new racial identity by drawing ideological boundaries of difference around a formerly unnoticed group of people
ottawa charter on health promotion 1986
the process of enabling people to increase control over, and improve, their health Prerequisites for health: Peace, shelter, education, food, income, stable ecosystem, sustainable resources, social justice, and equity.
vulnerability
unprotected, exposed, undefended, sensitive or immature (infants) The vulnerable are susceptible to or at risk of harm, damage, loss, injury, or victimization Is a general concept meaning "susceptibility" and has specific connotation in health care for "at risk for health problems Anyone can also be vulnerable at any given point in time as a result of life circumstances or responses to illness and events"
Indicators of health disparities
vBurden of disease vMortality rate vInfant mortality rate ** vLife expectancy vBirth rate vTotal fertility rate vDisability vNutritional status (body habitus, access to adequate nutrition)
metaparadigm
vPerson vEnvironment vHealth vNursing
ethical principles
vRespect for autonomy vBeneficence vNon-Maleficence vJustice
permanent resident
ØEconomic class (skilled workers) ØFamily class (sponsored by relatives) ØRefugees: Government-assisted or privately sponsored refugees and their dependants
Strategies for political action in nursing
ØLobbying politicians ØInvolving those directly affected by the issue ØCreating public support ØSpeaking from your experience ØUsing the media/Get on a committee ØTaking a multi-faceted approach (educating the public, write a letter) ØTake a stand for nursing! Health in All Policies Toolkit - CNA
Jakarta, 1997, pre requisites for health
ØPeace ØShelter ØEducation ØSocial security ØSocial relations (network) ØEmpowerment of women (gender equity) ØStable ecosystem ØRespect for human rights ØEquity
Why PHC?
ØRisks of global recession / negative impact of globalization ØContinued calls for health care reform ØOur health care indicators/ outcomes are slipping relative to international comparisons ØAn aging population ØAs a means to ensure health equity
domains of IPE
•1) Interprofessional communication •2) Patient/client/family/community-based care •3) Role clarification •4)Team functioning •5) Collaborative leadership •6) Interprofessional conflict resolution
demographic changes in canada
•20.6% of the Canadian population were foreign-born, the second highest proportion in the world after Australia •Since 2013, Canada received about 250,000 immigrants per year •In 2011, 19.1% of Canadians come from visible minority groups (non-Caucasian and does not include Aboriginal) •3 out of 4 immigrants settle in BC, ON, and QC. •Toronto, Vancouver, Montreal: Homes of 71% of visible minorities in Canada •25% : percentage of refugees to Canada are Syrian •51% :percentage of refugees under 18 years old
reasons for migration
•Address shortages in various labour sectors and skill levels •Temporary workers programs (agriculture, services industries) •War, conflicts, globalization, poverty •Lack of freedom and liberty (dictatorial regimes) •Improved economic and quality of life opportunities
Distributive Justice
•equal distribution of goods and services in society •Is based on the principle of equality •Focuses on giving the same access and resources to different groups in society •Major flaw: Equality does not mean equity health care represents a "right of citizenship but not necessarily a moral responsibility
factors affecting IPE
•Complexity of the situation •Contextual issues (different areas of practice) •Quality improvement (working together may help improving care and effectively address complex situations and contextual issues)
Canadian Collaboration for Immigrant and Refugee Health
•Evidence bases Preventative Care checklist for New Immigrants and Refugees •Specific assessment for different countries
Barriers for utilization of healthcare services
•Financial costs for uninsured services •Geographical distance and problems of accessibility •Lack of SDHs •Lack of public transportation •Lack of physicians and nurses and primary care clinics •Lack of fluency in English or French •Lack of congruence b/w immigrants' and refugees' social values vs. the welcoming country's values) •Gender of health care providers
interprofessional collaboration
•Is the process of developing and maintaining effective interprofessional working relationships with • learners, • practitioners, •patients/clients, • families, and communities -> to enable optimal health outcomes
main health concerns for immigrants
•Maternal health •Depression and PTSD (war/violence) •Children's health (immunization) •Diabetes type 2 •Cervical cancer •Breast cancer
barriers to addressing health inequities
•Nurses' education: Lack of knowledge in public policy analysis and political economy affecting the SDHs •Nurses' working conditions (lack of safety for agents of change) Fear of speaking truth to power
top immigration countries canada (2011)
•Philippines •People's Republic of China •India •USA •Iran
Immigrant health coverage
•Refugees: Interim Federal Health Program (IFHP) until they receive the provincial or territorial health card •3 months waiting period to get provincial health card •Dental care, prescription medications, eye exams by optometrists vary according to provinces
factors facilitating refugee settlement
•Resiliency •Reinforcement of strengths •Address barriers (communication, language, customs) •Formal and informal networks of support
Canadian Charter of Rights and Freedoms (1982)
■ guarantees the rights and freedoms set out in it subject only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society.
principles of primary health care
■Accessibility ■Public participation ■Health promotion ■Appropriate skills and technology ■Intersectoral collaboration
fundamental freedoms
■Everyone has the following fundamental freedoms: ■(a) freedom of conscience and religion; ■(b) freedom of thought, belief, opinion and expression, including freedom of the press and other media of communication; ■(c) freedom of peaceful assembly; and ■(d) freedom of association
Why implementation of PHC in Canada slow?
■PHC is not the focus of the Canadian health care system ■Many Canadians see the health care system as an illness care system that focuses on providing curative care ■Many Canadians value expensive technology and 'quick fix' cures. ■The Canadian health care system does not focus on health promotion and primary prevention
