As I began my Masters this year I was asked to evaluate. Evaluate my social media prowess and current understandings of my usage of social media regarding my professional identity. I used an analogy of a superhero discovering their powers for the first time. In terms of reflection just a short few months later I would place myself in the superhero category of puberty. Specifically, I’m thinking of current media portrayals of famous superheroes going through their awkward teenage years while seeking to understand their powers fully and gain control of them. I have grown in comfort in terms of using social media to further my health equity agenda, but I lose focus if I try to align my professional interests along one category. I prefer the experiment and react approach.
What I continue to believe is that health equity is important and is my main driving force. How I get there definitely remains in the awkward stages but could loosely be tied together through my community’s needs. Referencing the Local Health Integration Blueprint for the Northwest portion of Ontario is my jumping off point and states “In Northwestern Ontario, the population has poorer health outcomes yet more is spend to their healthcare than elsewhere in the province.” (Northwest Local Health Integration Network, 2012) This is a result of:
1) Higher rates of preventable diseases
2) Transitions between care settings could be more efficient and effective
3) Higher rates of acute hospital use compared to the rest of the province
4) Higher rates of hospitalization and Emergency department visits for chronic diseases
5) Higher health care costs in Northwest LHINs
(Northwest Local Health Integration Network, 2012)
As I dive into local issues I have built upon several concepts in this course that can assist me along the way. There are multiple levels of health and perceptions of health in existence today which was first evidenced by the World Health Organizations attempt to conceptualize it in 1946 as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (Spijk, 2015). This definition, however, has flaws and looks at the individual in black and white terms as either diseased or not with no room in between. Either a person remains completely healthy in absolutely every aspect of their lives always or they are considered diseased (Spijk, 2015).
If everyone is diseased according to the current definition from the World Health
Organization, it places a greater emphasis on providing equitable care for all individuals. A challenge to providing equitable care, however, is finding disparities in care that lead to disease in the first place. “Since the release of the final report by the Commission on the Social Determinants of health (SDHs) have been widely acknowledged as a central driving force of population health outcomes” (Ruckert & Labonte, 2016). Yet little work has been done to reduce health inequities as “Statistics Canada documents that life expectancy for men in the highest income quintile was 7.1 years higher than in the lowest income quintile in 1991, with no change in this health gap in 2006” (Ruckert & Labonte, 2016). We can all agree that something must be done to ensure the health equity is achieved and I would argue that there is currently a lot of individuals out there working towards just that. In fact, it’s where the main direction of my powers is focused. What continues to baffle the statistics I believe is a matter of complexities
What we currently know is that the WHO definition of health is antiquated. It does not capture the whole picture, so the next logical step would be to find a way to capture the picture in a way that’s relevant for everyone. I would argue, however, that this is impossible, and we should simply stop trying to sum a health issue to find more productive ways to move forward. Let me be clear this is not an argument for giving up but rather for freeing individuals to adapt to the situation. There are multiple models out there for health which all try to define and capture an issue. In my own arguments I have used the Social Ecological Model (SEM) to define a health issue and while I still admire that it looks at a health issue from 5 different levels (Individual, Interpersonal, Community, Organizational, Policy/Enabling environment) (Unicef, 2009) it fails in two major areas. Firstly, when applied to a province or a country the issues contributing to each level are so complex one must look for theme’s to truly move forward on an issue. This leaves the minority populations out of luck for the sake of the greater good. Secondly, it does not recognize how society weights each individual level, specifically the power of politics. The country is on board with improving SDHs but as evidenced by Kirst et al the programs that get the most support is what affects the decision-makers or majority of power (Kirst, et al., 2017).
At this point, I’m left feeling daunted and hitting the point in every superhero journey where I want to scream “What is the point?” no matter what I do it doesn’t seem to make a difference. Before I become too overwhelmed with this feeling (and my superhero comparisons for the class) I will point out that this feeling of not being able to make a difference just might come from our desire to treat causes as if they must equal 100%. Nancy Krieger in her journal article on this very issue argues “It is way past time to reject the false premises and logic of the idea that causes can be discretely apportioned among nature, nurture, and chance, and, related, that component causes must add up to 100%. Behind such approaches lie assumptions that involve deeper debates about causes of social inequalities, including in health, and untenable approaches to analyzing both biology and health, and, thus health inequities.” (Krieger, 2017). So, I think I will keep my awkward approach for the time being and maybe for as long as I can. As I continue to throw my research and career directions in multiple place I can continue to remain open to new solutions and different ways of not only looking at problems but how to solve them at different levels as well.
References
Kirst, M., Shankardass, K., Singhal, S., Lofters, A., Muntaner, C., & Quinonez, C. (2017). Addressing health inequities in Ontario, Canada: what solutions do the public support? BMC Public Health, 1-9.
Krieger, N. (2017). Health Equity and the Fallacy of Treating Causes of Population Health as if They Sum to 100%. AJPH Methods, 541-549.
Northwest Local Health Integration Network. (2012). Retrieved June 29, 2018, from Northwest LHIN: http://www.northwestlhin.on.ca/goalsandachievements/Health%20Services%20Blueprint.aspx
Ruckert, A., & Labonte, R. (2016). The first federal budget under Prime Minister Justin Trudeau: Addressing social determinants of health? Canadian Journal of Public Health, 212-214.
Spijk, P. v. (2015). On human health. Medical Health Care and Philosophy, 18, 245-251.
Unicef. (2009, June 30). What are the Social Ecological Model (SEM), Communication for Development (C4D)? Retrieved 2018, from Unicef.org.