Foundations of Health Systems - Summary

Introduction

I am a firm believer in lifelong learning. Our world is changing rapidly, if we do not continue to learn and grow, we risk being left behind. In 2017 I completed a degree in Health Administration, and after a short break decided to return to study in the Master of Health Studies program. Over the past 3 months, I have learned a great deal. I have learned about the social determinants of health, health equity and vulnerable populations. Some of the things I’ve learned I am embarrassed that I didn’t already know. Canada’s horrendous treatment of indigenous people for example, was new information to me but something I believe all Canadians should be aware of. Starting MHST601 was a bit unnerving at first. Learning about social media, my professional presence online and how to build a website that would become a personal e-portfolio, was a bit overwhelming. Fortunately, as the learning continued the website evolved. This small success was encouraging and motivated me to continue on.

Professionalism and Social Media

I learned about professionalism and reflected on my own online presence and use of social media. I existed on social media minimally before the course, but I have since learned to use social media platforms while maintaining a professional identity. The course helped me recognize the importance of social media, it’s networking capabilities and it’s value when used to increase stakeholder engagement and provide real-time learning opportunities (Ventola, 2014).

Federal and Provincial Health Systems in Canada

Canada is admired for providing universal health care (Bernie Sanders, 2017). The Canadian Health Care Act focuses on 5 key areas but does not include a requirement to measure outcomes. With no data to evaluate value for money, Canadians are unable to determine the effect their spending is having on the health of the Country (Veillard et al., 2015). Updates to the Act should include an outcome measurement component. In 2018, Canada spent $6,000 per person on health care, however, even when a country invests substantially; inequalities in health continue to exist (Health spending | CIHI,” n.d.).

Social Determinants of Health

Health inequalities exist when people experience situations in life that are unfair, imbalanced or unreasonable, yet changeable. Those who experience a low socio-economic status are likely to have an increased risk of poor health. Unemployment, ethnicity, food insecurity, housing and lack of education, can negatively impact a person’s health (PHAC, 2018). For more information on health inequalities see my previous blog post here.

Multilevel Approach

After learning about the social determinants and health inequality, I learned to identify areas in my practice or program service delivery that may pose barriers or challenges to those seeking care. Using the Social Ecological Model (SEM) I was able to find key factors in my program planning, that if addressed could improve the services provided by removing barriers to accessing vaccines. For example, at the community level the SEM identified that people are more motivated to get vaccines when they can access them locally (Buchan, et al., 2017). Also of importance is accessing care in a person’s native language (Farmanara, Sherrard, Dubé, & Gilbert, 2018). Both of these issues were identified as being significant factors to accessing the influenza vaccine. With this new knowledge I set out to pinpoint communities with limited access to health care and plan influenza vaccine clinics in those locations. In communities where newcomers reside there will now be interpreters available at the clinic. By using the SEM I was able to tailor services to better meet the needs of Niagara’s vulnerable populations.

Vulnerable Populations

I learned about vulnerable populations and was disheartened to learn about the challenges the Canadian Government has forced upon and continues to impose on indigenous people. Indigenous people still face racism and unequal access to health care in Canada today (Malone, 2018). Health care providers must be given the tools to identify and address their own biases. Cultural safety training should be made available for everyone who works in the health care sector including administrative and support staff.

Canada also has vulnerable refugee populations. Language and cultural barriers make it difficult for individuals new to the country to access services to meet their basic needs. It takes a minimum of 3 months, and possibly up to 2 years for refugees to access health insurance and medical care. As Canada continues to welcome newcomers, policies must be in place with funding attached to support refugees in accessing health care services (Not so universal health care: UBC Medical Journal, 2016).

Chronic Disease

In unit 5 we learned about chronic diseases. I decided to take a closer look at dementia. Dementia is not strongly promoted yet the number of people with dementia continues to increase drastically. Today there are over 500,000 people living with dementia in Canada. There is no care strategy to support people with dementia leaving over 56,000 people to be cared for in hospitals (“Dementia numbers in Canada,” 2019). There is no cure and no treatment that slows down the progression of dementia (“What Is Dementia?,” 2019). There are no clear answers on how to prevent it, some research points in the direction of a heart/head connection, meaning the factors that increase heart disease (high blood pressure, diabetes) can also increase the risk of developing dementia (“Prevention,” 2019). It is estimated that costs to the health care system and out of pocket expenses for caregivers reached $10.4 billion in 2016 (Alzheimer Society of Canada, 2018). Trends indicate that these costs will increase swiftly if the number of newly diagnosed cases doesn’t soon decrease (Chambers, Bancej, & McDowell, 2016).

The Future of Healthcare

Near the end of the course we looked at the future of healthcare. Portability is one of the 5 fundamental components of the Canadian Health Care Act and is a key factor in effective health care delivery (“Canadian Health Care: Canada Health Act,” n.d.). Canada’s 37 million people are spread over 9.9 million square km, this makes portability and continuity of health care challenging, especially when people move throughout the country (“Canada Facts”, n.d.). When a person moves across the country, their medical record does not normally travel with them. Even electronic medical records have little ability to move between health care providers. Currently there is no standard electronic medical record (EMR) system that is available to all providers in all provinces. Providers are using a variety of systems and none of them speak to each other. Care becomes inefficient and costly when a provider is unable to share medical records with colleagues. Tests are often repeated with unwarranted pain or discomfort for the patient and at an additional, unnecessary expense to taxpayers. The current process to transfer medical information between practitioners is managed manually or verbally which can lead to errors. This manual process is not timely; in the case of an emergency an attending physician must provide care with no medical history on the patient. The federal government needs to mandate a single EMR for use in all provinces by all providers to improve efficiencies in health care (Zhao, 2019).

Conclusion

This course has opened my eyes to the many aspects of healthcare that could be improved upon. I was pleased to find that the majority of materials covered in each unit were relatable and will be useful in my day-to-day work. In my own practice I will continue to investigate methods to address the social determinants of health and find solutions to improve the programs offered by my organization. I now recognize the importance of using social media for effective communication and have the knowledge to maintain a professional online presence. I believe the skills I have developed over the past 3 months are invaluable and will serve me well throughout my career.

References

Bernie Sanders’ Medicare-for-all plan should leave Canadians drooling with envy. (2017). Retrieved on July 23, 2019 from https://www.theglobeandmail.com/opinion/bernie-sanders-medicare-for-all-plan-should-leave-canadians-drooling-with-envy/article36289244/

Buchan, S. A., Rosella, L. C., Finkelstein, M., Juurlink, D., Isenor, J., Marra, F., … Kwong, J. C. (2017). Impact of pharmacist administration of influenza vaccines on uptake in Canada. CMAJ, 189(4), E146–E152. Retrieved on June 13, 2019, from https://doi.org/10.1503/cmaj.151027

Canada Facts – Facts About Canada. (n.d.). Retrieved July 23, 2019, from https://www.canadafacts.org/

Canadian Health Care: Canada Health Act. (n.d.). Retrieved July 24, 2019, from http://www.canadian-healthcare.org/page2.html

Chambers, L. W., Bancej, C., & McDowell, I. (Eds.). (2016). Population Health Expert Panel [Executuve Summary:Prevalence and Monetary Costs of Dementia in Canada]. Toronto, Canada retrieved on June 30, 2019, from https://alzheimer.ca/sites/default/files/files/national/statistics/prevalenceandcostsofdementia_en.pd

Dementia numbers in Canada. (2019). Retrieved June 30, 2019, from https://alzheimer.ca/en/Home/About-dementia/What-is-dementia/Dementia-numbers

Farmanara, N., Sherrard, L., Dubé, È., & Gilbert, N. L. (2018). Determinants of non-vaccination against seasonal influenza in Canadian adults: Findings from the 2015–2016 Influenza Immunization Coverage Survey. Canadian Journal of Public Health, 109(3), 369–378. Retrieved on June 15, 2019, from https://doi.org/10.17269/s41997-018-0018-9

Health spending | CIHI. (2019, March 1). Retrieved June 5, 2019, from https://www.cihi.ca/en/health-spending

Latest information and statistics | Alzheimer Society of Canada. (2018, June 29). Retrieved July 22, 2019, from https://alzheimer.ca/en/Home/Get-involved/Advocacy/Latest-info-stats

Malone, K. G. (2018, August 21). Indigenous patients still waiting for equity in health care: Canadian doctor. Retrieved July 23, 2019, from https://globalnews.ca/news/4398976/indigenous-patients-still-waiting-for-equity-in-health-care-canadian-doctor/

Not so universal health care: The neglect of immigrant and refugee health in Canada | UBC Medical Journal. (2016, December 18). Retrieved July 6, 2019, from https://ubcmj.med.ubc.ca/not-so-universal-health-care-neglect-of-immigrant-and-refugee-health-in-canada/

Prevention. (2019). Retrieved July 22, 2019, from Alzheimer’s Disease and Dementia website: https://alz.org/alzheimers-dementia/research_progress/prevention

Public Health Agency of Canada. (2018, September 25). Social determinants of health and health inequalities. Retrieved May 30, 2019 from https://www.canada.ca/en/public-health/services/health-promotion-health/what-determines-health.html

Veillard, Jeremy and Dhalla, Irfan and Fekri, Omid and Klazinga, Niek, Measuring Outcomes in the Canadian Health Sector: Driving Better Value from Healthcare (November 12, 2015). C.D. Howe Institute Commentary 438. Retrieved June 6, 2019, from: http://dx.doi.org/10.2139/ssrn.2689797

Ventola, C. L. (2014). Social Media and Health Care Professionals: Benefits, Risks, and Best Practices. Pharmacy and Therapeutics, 39(7), 491–520. Retrieved July 23, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103576/

What Is Dementia? (2019). Retrieved July 23, 2019, from Alzheimer’s Disease and Dementia website: https://alz.org/alzheimers-dementia/what-is-dementia

WHO | 10 facts on health inequities and their causes. (2017, April). Retrieved July 22, 2019, from WHO website: http://www.who.int/features/factfiles/health_inequities/en/

Zhao, E. J. (2019). RE: The future of EMRs in Canada. Retrieved on July 15, 2019, from http://www.cmaj.ca/content/re-future-emrs-canada