How does one define health? If the question was posed to a group of people, expected answers would possibly include, the absence of illness, feeling “good”, a constant battle and maybe you would hear challenges of access to the health system in general. Health is such a broad term used in so many contexts it is difficult to get the same answer twice. To help set the stage for this blog, let me introduce you to George, he is a 45-year-old male, from Nain Newfoundland and Labrador. He has Chronic COPD, diabetes, father of 2, married for 15 years, currently unemployed, has grade 8 education, smoker, uses alcohol 2-3 times a week, member of the town council, a proud indigenous man.
As this learning journey began the challenge was to look at the World Health Organization (WHO) definition of Health. Misslebrook, (2014) talks about the WHO’s definition of health as a "State of complete physical, mental, and social well being, and not merely the absence of disease or infirmity”. The research was showing that people’s definitions of health can sometimes be relative to their current environment, and if needs are being met, then the feeling of health was more prevalent. Kent et al (2018) shows other research that health can exist when illness and wellness both exists. The challenge of keeping health when faced with chronic illness is now more of a contemporary way to look at health. But let’s take this issue and look at if from a different lens, what if you have a chronic illness and are facing other stressors in life that are impacting access to care? Is George healthy, he would say yes, very much so. Is this anything that can increase his health?
We then researched the parts of society that impacted health status. Many issues impact George’s perception of health. The social determinants of health say that George need’s income, employment, education, supports, healthy behaviours, and access to health services. His community has a visiting physician and health services are accessed at the clinic with a RN. Mendez, I., Jong, M., Keays-White, D., & Turner, G. (2013) writes about Nain. Nain recently added “Rosie the robot” a technological advancement to help people in the community access higher levels of services when needed via telehealth. This advancement has been life saving for members of the community. However, with NL’s high unemployment rates, no work on the horizon, the lifestyle choices that complicate health, George needs more than “Rosie”
So how can things change for George? If we look to the literature, The Social Ecological Model allows us to look at this issue through a multi level approach. It involves looking at each of the four levels individually recognizing that each level impacts the other. This model considers the contentedness between individual, relationship, community and society. While George has ownership for his health choices, there are things within the framework that can provide the environment needed for George to have a healthy life. The connections within communities, governments all need to be strong to help add the resources George needs to have in Nain to live his healthy life. Educating the community on health is needed, ensuring the mutual support is there for people to be encouraged to maintain a healthy lifestyle. Access to funding to advance education, for community programs on addiction issues, and for wellness initiatives all are factors in creating a supportive community network.
Would George be viewed as vulnerable? In looking at the factors that can influence one vulnerability, the answer to this has to be yes. George’s day starts off quite different than most people. His community has limited access to fresh food in winter, getting to the hub community that has the most services is always impacted by weather, the lack of recreation contributes to boredom that grows habits that counter the progress made in his health journey. The suicide rate in his town is amongst the highest in Canada, the leftover feelings from non aboriginal influences linger on from previous generations, finding the way forward is difficult. The community/political leaders are beginning to address the concerns raised by the people, mental health services are expanding and the people are happy to see this change.
Why did we talk about George in this blog? Every community has a “George”, George is a fictional person who has many of the characteristics of the general population that needs the attention of today’s health leaders. George are the reason that health leaders are in pursuit for change. Change does not come with wishful thinking, change comes from research, learning from others, and taking that knowledge and moving it all forward through the advocacy opportunities provided to us. Completing a course with a variety of health professionals allows for the interaction and challenge of existing thinking and having exchanges within the group, makes one reflect on how they can start the change in their part of the world. Sharing in digital dialogue with health leaders, raises one’s accountability and will help the group continue challenging the status quo.
Going forward, the new way is focused on patient engagement. Person centered care is the path health care providers are challenged to provide. If George’s primary health care provider were to ask George what he feels his priority in his health plan, George might quickly speak of having employment and how that impacts on his self esteem as a husband, father and member of the community. The patient at the core of intervention creates a trust in the relationship that helps build the foundation for the future interactions. As health leaders we need to set the example of stopping and seeking the patient’s voice in any decisions made at the board room table. When you speak with the voice of the client at the center, you are never wrong. When you advocate for improvements in a system that has flaws, every small victory is a celebration. It sometimes takes only one person to start talking about what is needed, back it up with research, and soon momentum begins.
The challenge to each of us, is to find the chance to impact change, be current in what is trending in health care, and have the bravery to speak up. Speak up for the system of the future, speak up for George.
References
Gessert, C., Waring, S., Bailey-Davis, L., Conway, P., Roberts, M., & VanWormer, J. (2015). Rural definition of health: a systematic literature review. BMC Public Health, 15(1), 1–14.
Kent L Bradley, Thomas Goetz, Sheila Viswanathan; Toward a Contemporary Definition of Health, Military Medicine, Volume 183, Issue suppl_3, 1 November 2018, Pages 204–207
Mendez, I., Jong, M., Keays-White, D., & Turner, G. (2013). The use of remote presence for health care delivery in a northern Inuit community: a feasibility study. International Journal Of Circumpolar Health, 72.
Misslebrok,David ( 2014) British Journal of General Practice, W is for Wellbeing and the WHO definition of health https://bjgp.org/content/64/628/582
Murray, C. J., Gakidou, E. E., & Frenk, J. (1999). Health inequalities and social group differences: what should we measure?. Bulletin of the World Health Organization, 77(7), 537. Conference Board of Canada report
von dem Knesebeck, O. (2015). Concepts of social epidemiology in health services research. BMC Health Services Research, 15(1), 1–4.
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