Understanding the health and health needs of Canadians is a complex topic that requires a multilevel approach. In the first weeks of this course, we were asked to define health. What I quickly discovered was the meaning of health and the concept of being healthy is specific to individuals and could look very different for different people and communities within Canada. Was I confusing health and wellness? And do they need to be looked at as two separate entities. In 1948 the World Health Organization defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. This definition was groundbreaking at the time as it discussed health beyond the mere absence of illness, but does this definition still hold up? The word “complete” in the WHO’s definition of health has received the most criticism (Huber, 2011) as complete is defined as “having all the necessary or appropriate parts” (Oxford dictionary,2023) and does not speak to wellness within the existence of chronic illness and disease. The immediate flaw that is not addressed in the previous outlined definitions of health is the failure to acknowledge that all Canadians are not starting on a level playing field to be able to achieve what has been defined as health.
In a previous blog titled Equity vs Equality- Examining the Social Determinants of Health, I discuss the important difference between the two terms. While the terms equity and equality may sound similar, the “implementation of one versus the other can lead to very different outcomes for marinized people” (Equity vs Equality: What's the Difference, 2023). You must examine the Social determinants of health, which are defined as the non-medical factors that influence health outcomes (WHO,2023) when looking at the health of Canadians and include this in conversations about policy development and resource allocation.
(United way Halifax, n.d)
The United way Halifax has an example on their website of how the Social determinants of health may impact or influence the health and wellbeing of a child into adulthood- “students who are discriminated against in the school system have poorer educational outcomes. Poor educational outcomes lead to fewer employment options, and working in more dangerous or precarious work. People who do this type of work are at higher risk of injury, are less likely to have paid sick time or benefits to support them, and may end up with a disability.”
Throughout this course I have been examining the health and wellbeing of Canadians living with disabilities. Again, looking back at the WHO’S definition of health “a state of complete physical, social and mental wellbeing” we are severely defunct in addressing the health needs of marginalized and vulnerable communities. Health inequities for Canadians living with disabilities leads to decreased life expectancy and poor health outcomes. The current life expectancy for people with disabilities range from 6.7 years shorter for a mild disability and up to 35.4 years for severe disability compared to the Canadian average (Bahk, J, Kang, H.Y, Kang, Y.H., 2019). Life expectancy inequities among people with disabilities cannot solely be attributed to the disability itself, we must also consider other social determents of health for this population. The World Health Organization has declared poverty to be the single largest determinant of health and I would argue this is one of the main contributing factors which leads to poor health outcomes for persons with disabilities in Canada. Poverty in itself yields many health disparities that can create an environment for poor health outcomes; higher stress, social isolation/exclusion, reduced access to health services, food insecurities and poor nutrition, inadequate housing and substance abuse, which ultimately can lead to a shorter life expectancy (Murray, 2006).In 2021, Disability Without Poverty released a report which stated that people with disabilities are twice as likely to live in poverty than those without disabilities, and disabled people typically live 30% below the poverty line (Disability Without Poverty, 2023).
The traditional medical model of health is built on the belief that science can cure all illness and disease but ignores other important environmental and social factors (CDHN n.d). As a nurse working in a hospital the medical model is at the forefront of policy and decision making. What I have learned in this course is there are several other models of health that I feel would better encompass the health and wellness of Canadians, while addressing health inequities that are ingrained in systemic discrimination and bias. The social- ecological model of health is a multilevel approach which understands health to be affected by the interaction between the individual, the group/community, and the physical, social, and political environments (National Institute of Health Publications, 2011). Addressing social determinants of health appropriately is "fundamental for improving health and reducing longstanding inequities in health, which requires action by all sectors and society" (WHO, 2023)
The Canadian Health act was erected in 1984 with the objective to “protect, promote, and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers” (Health Canada, 2015). This outdated act speaks to “equal” health care for all Canadians without addressing the huge disparity in equity of health services. The Canadian Health Act guides health care and funding in Canada and needs to be updated or replaced in order to advance health equity versus intensifying health inequities. March of dimes Canada suggests “Nothing About Us Without Us” as a guiding principle for policy development. By involving people with disabilities in policy development, the government can avoid creating experiences that are frustrating, exhausting and dehumanizing (March of Dimes, 2023). Allowing individuals from marginalized and vulnerable populations to have a voice at all levels is required for any sustainable change which will result in overall health and wellness.
References
Bahk, J., Kang, H. Y., & Khang, Y. H. (2019). The Life Expectancy Gap between
Registered Disabled and Non-Disabled People in Korea from 2004 to 2017.
International journal of environmental research and public health, 16(14),
Community Development and Health Network (n.d). Models of Health Fact sheet.
https://www.cdhn.org/sites/default/files/downloads/FACTSHEETS%201_Screen%20View%281%29.pdf
Disability without poverty (2023). https://www.disabilitywithoutpoverty.ca
Equity vs Equality: What's the Difference. (2023, October 16). Retrieved from Milken
Institute School of Public Health: https://onlinepublichealth.gwu.edu/resources/equity-vs-equality/
Government of Canada (2023, June 1). Social determinants of health and health
inequalities
Greaux, M., Moro, M.F., Kamenov, K. et al. (2023). Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services. International Journal for Equity in Health, 22, 11-16. https://doi.org/10.1186/s12939-023-02035-w
Health Canada (2015). Canada Health Act: Annual Report (2014-2015).
https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/hcs-sss/alt_formats/pdf/pubs/cha-ics/2015-cha-lcs-ar-ra-eng.pdf
Huber, M. (2011). Health: How Should We Define It? BMJ: British Medical Journal,343 (7817), 235-237.
March of Dimes (2023, May) A Benefit without Barriers. Principles and Recommendations for Canada Disability Benefit Administration. https://www.marchofdimes.ca/en-ca/aboutus/govtrelations/ourwork/Documents/Canada-Disability-Benefit-Report-plain-Summary_EN.pdf
Murray, S (2006). Poverty and Health. Canadian Medical Association Journal, 174 (7) 923. https://doi.org/10.1503/cmaj.060235
United Way Halifax (2021, November.25). What Are the Social Determinants of Health?
World Health Organization (2023). Constitution https://www.who.int/about/accountability/governance/constitution
World Health Organization (2019, May 30). Social determinants of health.
https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
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