During the first unit of this course, I reflected on my professional identity and the image of myself that I want to project through my social media postings. An interesting discussion began between my classmates and I on the topic of sharing political opinions on social media and whether or not this should be done when trying to maintain a professional image. I began the discussion with a statement that I am not ashamed to share my political leanings when it comes to advocating for health care for Canadians--health care is connected to health policy and I believe it is necessary to “get political” in order to make important changes to policy. This was met with agreement from classmates, however, there was some anxiety and hesitation expressed surrounding the declaration of political leanings on social media and possible arguments and other negative repercussions that could stem from this. My response to this was as follows: “Whether we like it or not, health care is political. Health care funding comes from health policies, so I do feel that it is important for us to have a political voice. I try to think of it this way: if you are using politics on social media to educate others and advocate for improved health care for people then it is a worthy cause. Of course, people will disagree with you. You can't make change without making some enemies along the way.” The professor also chimed into the discussion and he said the following: “Does it matter if it reveals political leanings? Is there a reason you wish to hide your political affiliation? ‘Not discussing politics’ as a policy is something that benefits the status quo. ‘This isn't the right place’ and ‘this isn't the right time’ are statements you'll hear a lot when someone wants to shut you down for getting political - though I'd argue that they don't mind you being political - they mind that you are speaking contrary to their beliefs.” I thought about this statement a lot throughout the semester, and learning more about topics such as vulnerable populations helped to reinforce my position. The Indigenous woman who experiences racism as a barrier to accessing adequate prenatal care in her community needs us to speak out about health policy. The man who has become homeless due to lack of support for his disability needs us to speak out about health policy. I feel that maintaining the “status quo” when there are blatant injustices within the health care system is exactly the opposite of what I want to accomplish during my career. I want to use what I have learned during my education in health care to make positive changes for the most vulnerable--even if there are people who will argue and make me feel uncomfortable along the way. As a registered nurse in neonatology, my learning interests throughout this course have focused mostly on topics related to maternal and newborn health. Social determinants of health have always been a key interest for me, and in unit 3 I was able to learn more about this topic through curation of resources. Many of us think of Canada as a leader in publicly-funded health care services, however, I learned in a paper by Bryant et al. (2011) that only about 70% of health care costs in Canada are publicly funded, which is lagging behind many European countries. The authors also found that income inequality in Canada has increased within the past few decades, and that the infant mortality rate in Canada is significantly higher than in many European countries with socialized health care such as France and Germany (Bryant et al., 2011). These findings emphasize how much work still needs to be done in Canada in regards to creating an equitable, universal health care system. We learned in this course about “spheres of influence”, and that health can be affected by many factors that may or may not be obvious. The Biopsychosocial Model of Health can be used to demonstrate that multiple factors (biological, psychological, social) influence a person’s health care outcomes, many being beyond the individual’s control. I used this model to explain how a woman’s risk of developing gestational diabetes mellitus (GDM) can be influenced by biological factors such as ethnicity (Dyck et al., 2020), diet and exercise (McIntyre et al., 2019), as well as psychological factors such as stress and mental state (Hosler et al., 2011), and social determinants such as income and education (Rönö et al., 2019). This model emphasizes how complex the path to positive or negative health care outcomes can be, and has encouraged me to think deeper and more critically in my research moving forward.
(Hart, 2018)
For unit 5, the class looked at chronic disease prevention and management in Canada. This is not a topic that I usually gravitate towards, however, I was able to tie my learning back to my topic of interest by looking at chronic diseases that affect premature newborns such as bronchopulmonary dysplasia and retinopathy of prematurity. These are diseases that I encounter frequently at my place of work, and researching the details of each disease for this course definitely enhanced my knowledge and my ability to explain the diseases to parents of premature infants. I also completed a partner exercise during this unit and compared chronic disease prevention, screening programs, and funding within Ontario and British Columbia. It was interesting to learn about programs in Ontario that I wasn’t aware existed, such as the 2011 Smoke-Free Ontario Strategy. This strategy uses public health interventions with the goal of decreasing the incidence of tobacco smoking in Ontario, therefore helping to prevent chronic diseases such as lung cancer and cardiovascular disease (Cancer Care Ontario, 2012).
As discussed earlier, I am very interested in learning about health inequities in vulnerable populations such as the Indigenous and the homeless/underhoused. I was able to learn more about these populations as they relate to inequities in maternal and newborn care. I was aware when I began this course that Indigenous women and newborns experience higher rates of adverse pregnancy and childbirth-related outcomes, however, it was unsettling to learn that some First Nations populations experience an infant mortality rate up to four times the national average (Whalen, 2017). Increased funding for health care services for this population, as well as improved education on Indigenous experiences for both health care practitioners and the general public, is crucial for addressing and solving the inequities present.
Infographic retrieved from: https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/science-research-data/5.Infant_Mortality_EN_final.pdf I also learned that an estimated 300 babies are born per year in Toronto to homeless or “underhoused” women, and that many of these pregnancies go missed due to inadequate data collection methods and barriers to seeking prenatal care (Shah et al., 2017). There is a dire need for increased funding for affordable housing in Toronto and social service/health care service programs for this population. Housing status and early childhood care are important social determinants of health (Raphael, 2009) that need to be addressed in this population so that children can have a better chance for positive health outcomes from the very beginning of life. Reflecting back on the start of this course and the discussion with classmates regarding expression of political positions, I feel an even stronger desire to become involved in health policy and speak out about these issues after learning what I have throughout this semester. I will end this reflection with the following quotes: “You must never be fearful of what you are doing when it is right.” - Rosa Parks “If you’re not outraged, you’re not paying attention.” - Last social media post by Heather Heyer, a human rights activist killed during a protest References: Borrell-Carrió, F., Suchman, A. L. Epstein, R. M. (2004). The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry. Annals of Family Medicine, 2(6), 576-582. Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2011). Canada: A land of missed opportunity for addressing the social determinants of health. Health Policy, 101(1), 44-58. Cancer Care Ontario, Ontario Agency for Health Protection and Promotion (Public Health Ontario). (2012). Taking action to prevent chronic disease: Recommendations for a healthier Ontario. Queen’s Printer for Ontario. Retrieved from https://www.publichealthontario.ca/-/media/documents/t/2012/taking-action-chronic-diseases.pdf?la=en Dyck, R. F., Karunanayake, C., Pahwa, P., Stang, M., & Osgood, N. D. (2020). Epidemiology
of diabetes in pregnancy among First Nations and non-First Nations women in Saskatchewan, 1980-2013. Part 2: Predictors and early complications; results from the DIP:ORRIIGENSS project. Canadian Journal of Diabetes, 44, 605-614. Hart, I. (2018). Biopsychosocial model of health. Safety & Health Practitioner. Retrieved from https://www.shponline.co.uk/occupational-health/common-health-issues-in-the-workplace/attachment/biopsychosocial-model-of-health/ Hosler, A. S., Nayak, S. G., & Radigan, A. M. (2011). Stressful events, smoking exposure
and other maternal risk factors associated with gestational diabetes mellitus. Paediatric
and Perinatal Epidemiology, 25, 566-574. Raphael, D. (2009). Social determinants of health: Canadian perspectives, 2nd edition. Canadian Scholars' Press. Rönö, K., Masalin, S., Kautiainen, H., Gissler, M., Raina, M., Eriksson, J. G., Laine, M. K.
(2019). Impact of maternal income on the risk of gestational diabetes mellitus in primiparous women. Diabetic Medicine, 36(2), 214-220.
Shah, S., Bernstein, J., Moore, A. M., Thompson, G., Sohail, S., Ford-Jones, L., & Vandermorris, A. (2017). Three hundred babies born to underhoused mothers in Toronto--understanding the problem and how we can help. Paediatric Child Health, 22(5), 282-284.
Whalen, J. (2017). “We can’t do it alone”: Indigenous maternal health program aims to address inequality of health care. CBC. Retrieved from https://www.cbc.ca/news/canada/toronto/indigenous-maternal-health-program-1.4130303
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