Final Synthesis (The End is Upon Us)

FINAL SYNTHESIS BLOG POST

As the course draws to an end and reflections are being made, the topics of each week leading up to this point have broadened my understanding as it pertains to the foundations of health. Each week built upon the previous week’s information and helped to form the image that health is a multi-factorial concept, that is continuously evolving and that may not present the same for everyone.

I have provided a synthesis of the major topics covered through this course with embedded links to my previously posted blogs about the topic.

Background and Profession

As a nuclear medicine technologist, I act as a direct patient care provider in my clinical setting. I utilize radiopharmaceuticals in order to assess the function of organs through imaging techniques. I work in the Canadian healthcare system where public access to healthcare services are the responsibility of the provincial governments. This in turn can cause discrepancies in what is accessible and to whom, depending on the province or territory that the individual lives in. My understanding of health was formed originally during my bachelor’s degree based on the definition established in 1948 by the World Health Organization. “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. (WHO, n.d.)

Re-defining Health

We were challenged to find definitions that were more applicable which led me to the concept of positive health. This concept refers to an individual’s ability to self-manage and adapt to their environment (Huber, 2011). With the prevalence of chronic diseases (such as diabetes and hypertension) being a major health concern in Canada, assessing prevention and management is pertinent to reducing these disease rates. Frameworks have been established across the country with each province having their own (but often overlying) health priorities.

Determinants of Health

To aim for prevention, we needed to understand the determinants of health. The WHO lists three determinants that take a 'Big Picture' view:

•          Physical environment (including shelter; stable ecosystem; peace; sustainable resources);
•          Social Environment (income; education; social security; equity; social justice and respect for human rights; access to health care services);
•          Biological and Behavioural determinants (genetic factors; ethnicity; lifestyle, such as smoking, immigration, etc.)

(Colleaga, n.d.)

Whereas the Public Health Agency of Canada (PHAC) lists 12 determinants of health:

• Physical environments;
• Employment and working conditions;
• Social environments;
• Social support networks;
• Health services;
• Culture;
• Income and social status;
• Education and literacy;
• Personal health practices and coping skills;
• Healthy child development;
• Biology and genetic endowment;
• Gender. ("Determinants: Definitions and Core Concepts", 2017).

Chronic Kidney Disease

I have always had an interest in the kidneys and therefore, I chose chronic kidney disease (CKD) as my focus. As a chronic disease that often arises from the presence of other chronic diseases such as the ones mentioned above, the prevention of these underlying diseases could reduce the prevalence of CKD. CKD, as are other chronic diseases, is often seen in persons with lower socio-economic statuses (which is a major determinant of health). Prevalence tends to be higher in minority groups, older persons, persons with lower educational achievement and incomes. (Nicholas, Kalantar-Zadeh & Norris, 2015)

(Sieben, 2017)

Understanding a chronic disease such as CKD and how various physical and socio-economic health determinants influence the disease was done using the socio-ecological model. This model incorporates an inter-related influence at the intrapersonal, interpersonal, community, organizational and policy level.

Levels of Influence

The intrapersonal level refers to the characteristics of the individual that influences their disease and decision. The interpersonal level refers to social network surrounding the individual that has an influence on them. The community level refers to the physical environment and surroundings of the individual while the organizational and societal levels refer to establishments and policies that may directly or indirectly affect how a person’s disease is managed. (UNICEF, 2014)

After gaining further knowledge on the determinants of health and a basic idea of the category of persons who are more likely to report reduced health, the issue of vulnerability arises. Due to the correlation and causation of several health determinants on chronic kidney disease, many persons with the disease fall under the category of “vulnerable populations”.

Vulnerable populations are at risk for disparate healthcare access and outcomes because of economic, cultural, ethnic or health characteristics. Vulnerable populations include patients who are racial or ethnic minorities, children, elderly, socioeconomically disadvantaged, underinsured or those with certain medical conditions. Members of vulnerable populations often have health conditions that are exacerbated by unnecessarily inadequate healthcare. (Waisel, 2013)

Vulnerable Populations

The focus was then shifted to the Aboriginal community in Canada as these Indigenous persons are known to experience lower levels of health due to socio-economic factors such as lower education and income level, physical environment and accessibility and implemented policies. (Lendsay, n.d.). Indigenous persons’ health, unlike other non-Indigenous Canadians, fall under the federal jurisdiction, not provincial/territorial. These persons include First Nations, Inuit and Métis and who due to negative perceptions (e.g. alcoholism) can face racism at times while seeking treatment, leaving them under-served. (University of Ottawa, 2017)

This tied in well with my secondary focus of immigrant health as immigrants are often considered vulnerable populations, particularly refugees. Although most legal immigrants arrive in Canada healthier than the average Canadians (Healthy Immigrant Effect), these persons often arrive in Canada with no money and limited understanding of English or French. Refugees may present with physical ailments or impaired mental statuses due to traumatization and poor living conditions from time spent in war-stricken areas and refugee camps. (Gushula, Pottie, Roberts, Torres & DesMeules, 2011)

Future Health
We started by looking at the past, established Health Care Acts and Health definitions. We analyzed and criticized the present as we broadened our knowledge on current health issues within Canada (i.e. chronic disease management and prevention). Finally, we are on the topic of future health and technology.

Linking back to chronic disease management and the concept of positive health and self-management, there has been a push to allow patients and their families to be key participants in their treatment. The use of digital devices and portable equipment allows patients to be more involved in their own healthcare and allows a better flow of communication between patient and healthcare practitioner. (De Guzman, 2017)

Arcus Consulting Group (n.d.) further expands on this utilization of technology by stating,

In the future, the patient will be able to manage much of this from her home and mobile phone–a convenience that not only saves her time and money, but also gives her peace of mind. With the wireless monitoring devices and community networks, she will have access to more tailored and complete information to assist her in making the best health and financial choices. Ongoing management and awareness also helps prevent costly, time consuming, and perhaps life-threatening emergencies for her and her family.

Advances are also being seen in the world of nuclear medicine with major impacts to renal health. Geist et al. (2018) have concluded that the newest imaging modality of PET/MR can be used to accurately represent renal health in healthy subjects based on glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) which are both major indicators of kidney function. This new study could be proven to be transferable to those with acute and chronic kidney disease.

Conclusion

As a healthcare professional, it is my duty to remain abreast of changes and advances within my field and within the Canadian (and possibly global) health system. This course has provided me with the tools to research and curate resources that are not only beneficial to me professionally as a nuclear medicine technologist, academically as a master’s student but also personally, as a healthcare consumer. Throughout the weeks and in this final synthesis, I feel like I truly possess a better foundation in the Canadian Health System.

References

Arcus Consulting Group. (n.d.). Healthcare Trends in Canada. Retrieved from https://arcusgroup.ca/services/non-profit/hospitalshealthcare/healthcare-trends-in-canada/

Colleaga. (n.d.). What are the Determinants of Health? [Image]. Retrieved from https://www.colleaga.org/article/what-are-determinants-health

Constitution of WHO: principles. (n.d.). Retrieved from http://www.who.int/about/mission/en/

De Guzman, M. (2017). Health care trends to watch for in 2018. Retrieved from https://www.canadianchiropractor.ca/leadership/health-care-outlook-4798

Determinants: Definitions and Core Concepts. (2017). Retrieved from https://www.med.uottawa.ca/sim/data/Pub_Determinants_e.htm

Geist, B., Baltzer, P., Fueger, B., Hamboeck, M., Nakuz, T., & Papp, L. et al. (2018). Assessing the kidney function parameters glomerular filtration rate and effective renal plasma flow with dynamic FDG-PET/MRI in healthy subjects. EJNMMI Research, 8(1). doi: 10.1186/s13550-018-0389-1

Gushulak, B., Pottie, K., Roberts, J., Torres, S., & DesMeules, M. (2011). Migration and health in Canada: health in the global village. Canadian Medical Association Journal, 183(12), E952-E958. doi: 10.1503/cmaj.090287

Huber, M. (2011). Health: How should we define it? British Medical Journal, 343, (7817), 235-237. https://doi.org/10.1136/bmj.d4163

Lendsay, K. (n.d.). Indigenous Health Issues in Canada [Blog]. Retrieved from https://www.express- scripts.ca/raising-health/Indigenous-Health-Issues-in-Canada

Nicholas, S., Kalantar-Zadeh, K., & Norris, K. (2015). Socioeconomic Disparities in Chronic Kidney Disease. Advances In Chronic Kidney Disease, 22(1), 6-15. doi: 10.1053/j.ackd.2014.07.002

Sieben, A. (2017). Chronic Kidney Disease Facts [Image]. Retrieved from https://villa-medica.com/cell-therapy-for-ckd/

UNICEF. What are the Social Ecological Model (SEM), Communication for Development (C4D)?. (2014). Retrieved from https://www.unicef.org/cbsc/files/Module_1_-_MNCHN_C4D_Guide.docx

University of Ottawa. (2017). Indigenous health. Retrieved from http://www.med.uottawa.ca/SIM/data/Vul_Indigenous_e.htm

Waisel, D. (2013). Vulnerable populations in healthcare. Current Opinion In Anaesthesiology, 26(2), 186-192. doi: 10.1097/aco.0b013e32835e8c17