Week 2 Flashcards
define: population health
- an approach to health that aims to improve the health of the entire population and to reduce health inequities
- acts upon the broad range of factors and conditions that have a strong influence on our health
the experience of discrmination is a key factor in…
- producing poor health outcomes for visible minorities in Canada (chronic stress response leads to increased risk of CVD, obesity, diabetes, cancer)
define: racism
- systemic discrimination based on race, where health and social systems support racist policy and practices
institutional factors & HCP behaviors can produce…
- racial inequities in the delivery of healthcare and in health outcomes
what are some ways people covertly discriminate
- failure to recognize skin breakdown in people w darker skin tone
- “im colorblind” –> covert racism flourishes in ritualistic, unintentional, and unconscious ways due to dominant socialization processes
define: equality
- treating everyone the same, without considering their circumstances and attributes
- assumed that everyone will benefit from the same supports & benefits will be the same for everyone
define: equity
- focus on fairness and equality in outcomes, not just in supports and opportunity
- individuals are given diff supports to make it possible for them to have equal access and removing systemic barriers
define: health equity
- the fair distribution of resources needed for health, fair access to the opportunities available, and fairness in the support offered to people when ill
define social justice
- the process of ensuring fair distribution of society’s benefits, responsibilties, and consequences
what are the defining attributes of social justice (4)
- equity
- human rights
- democracy/civil rights
- just institutions
define health inequality
- measurable differences in health between individuals, groups, or communities
- health disparities
- may be due to biology
what are examples of health inequalities
- differences in cancer diagnosis between old & young
- differences in life expectancy between men & women
- differences in life expectancy between MB and SK
what is health inequity
- subset of inequalities/disparities that are associated with underlying social disadvantage due to unequal distribution or access to the SDOH
- inequalities that are systematic, unjust, and avoidable
health inequities do not occur… but rather due to…
- do not occur randomly or naturally
- due to unequal access to resources that are needed to be healthy
what are examples of health inequity
- differences in access to clean water for Indigenous people
- differences in longevity and wellbeing based on early childhood experiences
- the working poor
how can we address inequality and inequity?
- remove systemic barriers
significant health inequities were observed among which populations? (5)
- indigenous peoples
- sexual & racial minorities
- immigrants
- people living with functional limitations
- gradient of inequalities by socioeconomic status (income, education, employment, occupation)
many health inequalities in Canada are the result of?
- individuals’ and groups’ relative social, political, and economic disadvantages
to understand health inequalities between Indigenous and non-Indigenous peoples, we must…
- contextualize them within the historical, political, social, and economic conditions that have influenced Indigenous health
for someone with a substance use disorder, what are examples of interventions that meet the PHC principle of “maximum accessibility” (3)
- programs/services accessible geographically (location, transportation)
- financially
- appropriate hours
for someone with a substance use disorder, what are examples of interventions that meet the PHC principle of “maximum community participation” (2)
- individuals who will use program must have input into decisions about the program
- must engage the population group that needs it the most
for someone with a substance use disorder, what are examples of interventions that meet the PHC principle of “maximum emphasis on HP/PP (3)
- promoting healthier intoxification
- preventing harms to liver, etc.
- avoiding non-beverage alcohol
for someone with a substance use disorder, what are examples of interventions that meet the PHC principle of “maximum use of appropriate technology” (2)
- linking health data systems so MAP RN can keep track of liver enzymes & evaluate the program (trips to ER, encounters w WPS)
- database for in-house charting re: doses of ETOH and pt record
for someone with a substance use disorder, what are examples of interventions that meet the PHC principle of “maximum intersectoral/IP collab”
- with nutritionist, police officers, housing staff, Indigenous leaders & elders, city officials, etc.
what are proximal/surface/downstream determinants of diabetes in FN communities (4)
- poor nutrition
- lack of physical activity
- chronic stress r/t intergenerational trauma and/or poverty and/or experiences of racism & social exclusion
- lack of drinking water = drink pop
what are intermediate/core determinants of diabetes in FN communities (3)
- lack of cultural continuity at community lvl
- contamination of land, water, wildlife has reduced supply of traditional foods & activities
- limited community infrastructure resources (underfunded education systems, lack of access to health services, high lvls of unemployment and poverty, lack of grocery stores w nutritious, affordable food)
what are distal/root/upstream determinants of diabetes in FN communities (2)
-colonization (loss of land, language, residential schools)
- systemic racism and social exclusion
describe the impact that COVID has on inequities (6)
- has worsened inequities
- people in racialized and low-income communities have
been harder hit - an additional 8% of world’s population are predicted to fall into poverty
- impact planting, harvesting, mvmt of food = worsened food insecurity
- impact on mental health & personal safety
- impact on internal migrants, day laborers, urban slum dwellers
how do we right inequities through the health sector? (7)
- ensuring high-quality illness care is accessible to those living in poverty & other disadvntaged circumstaces
- providing evidence of the relationships between pop. health and social enviro
- assessing the potential health equity impacts of all gvmt policies
- institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions
- advocating for encouraging action across sectors to improve the social conditions that have an impact on population health status and the distribution of health
- ensuring that health services respond effectively to major causes of preventable ill-health and associated impoverishment among the socially disadvantaged
- developing approp tools to measure the extent of health inequities & progress towards their elimination (ex. equity audits, gauges, and assessment tools)
how do we right inequities thru the public health agency of Canada? (7)
- intervene across the life course w evidence-informed policies and culturally safe health and social services
- deploy a combo of targeted interventions and universal policies/interventions
- carry out ongoing monitoring and eval (ie. is this working?)
- intervene on both proximal (downstream) and distal (upstream) DOH and health equity
- address both material contexts and sociocultural processes of power, privilege, and exclusion (how social inequalities are maintained)
- adopt a human rights approach to action on the SDOH of health & health equity
- implement a “health in all policies” approach
how do we move towards anti-oppression, anti-racism community health nursing practice? (4)
- critical reflection –> seeing how the cycle of oppression unfolds in our everyday practice and seeing our own privileges & how they support the disadvantaging of our pts, colleagues, and racialized peoples
- cultural humility –> understanding & mapping the path from everyday acts of prejudice, colonialism, classism, racism, heterosexism in nursing practice to the societal structures and root causes that create these “isms”
- “two eyed seeing” –> confronting oppression & acting for change
- continually asking “how can I take action to confront my participation in oppression & my privileges?”
how can we right inequities thru our words? (3)
in community health we need descriptive terms to..
- identify groups that are affected by the inequitable distribution of power & resources
- describe & evaluate public health initiatives that seek to improve the health outcomes of specific groups of people
- clarify program objectives, set eligibility criteria, and allocate sufficient resources
what are some terms used to describe population groups who experience health inequities
- priority
- marginalized
- vulnerable
- hard to reach
- targeted
- disadvantaged
-under served - people who would benefit most from intervention
- disempowered
- underprivileged
- at risk
- high risk
- equity-seeking
- disenfranchised
what are some key considerations when describing population groups experiencing health inequities? (2)
- labelling pop groups may create or add stigma already experienced by people
- may focus our attention more on individuals than on structures that shape health inequities
being alert to the language we use to describe groups experiencing health inequities can.. (2)
- alter discriminatory beliefs and change practice to address unequal power relationships
- help us maintain attention at upstream, system-oriented actions
define: culture
- language, gestures, tools, customs, and tradition that define a group’s values and organize social interactions
culture is .. (6)
- social construction
- integrated system embedded in everyday life
- shared
- implicit and tacit
- fluid and dynamic
- expressed and intersects
what is one of the main barriers to nurse’s understanding of culture?
- the biomedical, eurocentric foundation of nursing practice
cultural safety is along a continuum. what exists on this continuum? (4)
- cultural awareness
- cultural sensitivity
- cultural competence
- cultural humility
define: cultural awareness
- based on the social locations of the dominant culture
- no responsibility to change
cultural competence suggests…
- action
define: cultural humility
- process of self-reflection where HCP make a commitment to understand their personal and systemic biases thru education and reflection, and to maintain respectful process and relationships based on mutual trust
describe white privilege
- seen as neutral, no race
- unearned current & historical advantaged
- invisible advantages across the lifespan
ex. easier access to pain meds, faith based practitioner, better birthing practices, pictures in books matching, theorists are white, colleagues of safe race, assessments often based on white settlers, representatives of the same race
anti-oppressive & anti-racist community health nursing practice involves… (3)
- constant engagement in examining our own values, assumptions, and ways of thinking
- understanding the cycle of oppression
- understanding privilege and acting for social change
anti-oppressive & anti-racist community health nursing practice involves committing to a sustained practice of asking ourselves…
- what is the path or map from everyday acts of prejudice, colonialism, classism, racism, heterosexism, and other isms in nursing practice to the societal supports or structures that create and support these isms
define: colonial
- the power exerted by the dominant culture of settlers of the Indigenous people to maintain authority w the interntion to replace the original population
what are distal determinants impacting indigenous health (7)
- colonialism & assimilation policies (ex. Indian act)
- systemic racism & social exclusion
- repression of self-determination
- Indian Act
- colonization
- gender inequities
- policies relating to governance of healthcare in First Nation communities
what are some midstream determinants impacting Indigenous health (13)
- barriers in accessing health services (ex. racism, poverty, social exclusion) leading to further oppression and poor health outcomes
- healthcare systems
- educational systems
- community infrastructure
- resources
- capacities
- enviro stewardship
- cultural continuity
- Indian residential schools
- remote communities
- intergenerational trauma
- sixties scoop
- deterioration of natural resources
what are some downstream/proximal/surface determinants impacting Indigenous health (13)
- low socioeconomic status
- education lvls
- employment indicators (rate)
- physical enviro (ex. poor housing conditions)
- trauma and injury
- chronic illness
- depression
- family violence & violence against Indigenous women
- alcohol & addiction as a contributing factor
- personal health practices/behaviors
- coping skills
- food insecurity, no access to clean water
- barriers to accessing health services
CHN must reflect …. r/t Indigenous individuals
- how colonialism has impacted education, employment, and mental health
- and how colonialism has disrupted Indigenous people’s cultures, families, and communities = poorer health outcomes
what are some Indigenous specific determinants of health (7)
- participation in traditional activities
- balance
- life control
- enviro education
- material resources
- social resources
- enviro & cultural connections
define: decolonization
- an interactive process to expose, resist, and transform colonial processes
- disrupts the continued coloninzation and oppression and instead affirms and supports the strength & knowledge within Indigenous cultures
define: cultural humility
- support the continual self-reflection of beliefs by acknowledging person & systemic biases while adopting a philosophy as a learner in relation to another’s experience
define: cultural safety
- reflecting upon your own beliefs, practices, and history, and how they impact the people you service
define: two-eyes seeing
- a concept to describe an approach of using two worldviews to “see community care
- out of one eye = see with Western knowledge
- second eye = consider Indigenous ways of knowing centered in the practices and healing traditions of the community
what impact does homophobia, biphobia, transphobia, heterosexism, and cissexism have on the LGBT2SQ+ community? (1)
- bullying
- harrassment
- violence
- discrimination
- may lead to dropping out of school
- chronic minority stress
- loss of self-worth by internalizing the negativity
- low self-esteem
- reduced self care
- health compromising activities
describe heterosexism in healthcare system
- in healthcare system includes asking clients about marital status & relationships using gendered terms or asking all women about birth control
describe cissexism in healthcare
- includes only offerring male or female on forms
- segregated spaces only for male or female = inaccessible for trans people
what role do community health nurses have on addressing health inequities ? (6)
- dont be neutral, acknowledge disclosure
- reflect acceptance and caring
- use includive language
- thank clients when they share their context
- consider if forms are inclusive
- let clients know about lvl of confidence
what are examples of primordial prevention of primary cause of health inequities? (6)
- shift societal attitudes
- reduce stigma
- foster respect
- prevent harrassment and violence
- focus on the structural enviro of laws and policies
- recommend policies that foster community inclusion and connectedness and address bullying and harassment
what are examples of primary prevention for health inequities? (2)
- focus on healthy living & stress management
- LGBT2SQ+ inclusive sexually health education in secondary school & accurate info
what are examples of 2ndary prevention lvl for health inequities? (6)
- screen for HTN
- accessible STI testing
- outreach to the trans community about screening
- smoking cessation programs
- violence screening
- suicidal ideation screening
what are examples of tertiary prevention for health inequities (6)
- help w med adherence
- referals
- substance abuse treatment programs
- advocate for development of appropriate programs
- interventions for chronic health conditions
- outreach in LGBT2SQ+ venues
what are examples of quaternary prevention for health inequities
- prevent over-medicalization
what is the “web of causation”
- illustrates the complex interrelationships of numerous factors sometimes interaction in subtle ways to increase (or decrease) the risk of disease
see diagram in ppt of web of causation
..
questions in the seminar that I dont have answers to since i didnt go (lots are obvious)
- what is the connection between health and wealth (kinda obvious)
- how does chronic stress increase the risk for illness
- what does comparing rates of disease from area to area to reveal
- what is the connection between power, subordination, and health?
- how does racism impose an additional health burden
- what are the connections between SDOH and health
- what are the benefits of affordable housing
what is superficial reflection
- non-reflective
- very basic, mainly a description
- makes reference to an existing knowledge base but does not integrate, comment on, or critque them
what is considered “middle of the road” reflection
- starts to explore thoughts, feelings, assumptions, and gaps in knowledge as part of the problem solving process
- the reflector makes sense of what has been learnt from the experience and what future action might need to take place
- no connection to literature source of knowledge
what is deep reflection
- most depth
- shows that the experience has created change in the person
- considered multiple perspectives and connections to sources of knowledge or lack of knowledge & action needed to acquire more knowledge
what is gibbs model of reflection
- description –> feelings –> evaluation –> analysis –> conclusion –> action plan
