Reflection: Critical Foundations in Health Disciplines
My first course for my Master of Health Studies at Athabasca University was Critical Foundations in Health Disciplines, or MHST 601. This self-directed online course allowed me develop skills in content curation, social media participation, and reflect weekly on different concepts in critical health foundations. It covered seven units which focused on key topics within the Canadian healthcare system. The purpose of essay is to provide a summary and reflection of my learning and how it relates to my current practice in the field of dietetics.
Interprofessional Connectedness
The first unit focused on interprofessional connectedness and allowed me to reflect on the importance of social media for the purposes of networking, advocating for my profession, and sharing credible information. By using social media as a health care professional, it provides me with a great opportunity to establish credibility as a nutrition expert and provide evidence-based education about the importance of nutrition. Having a social media presence can also help with maintaining a professional identity and connecting with other professionals. This course allowed me to reflect on my current methods of social media presence and update my professional digital identity. I established a curation plan for my resources, created a website to share my professional background and blog posts, and engaged in Linked In.
Federal and Provincial Health Systems in Canada
In this unit I reflected on my role within the Canadian healthcare system. As a registered dietitian, I am part of the College of Dietitians of British Columbia. This professional organization is dedicated to public protection and ensures that dietitians in British Columbia are up to date with competencies and providing safe nutrition care. The Code of Ethics set out by the College of Dietitians of BC provides the foundations for my professional identity, beliefs, and values (College of Dietitians of BC, 2023).
This unit also focused on the Canada Health Act and how it could be modernized based on our profession. The Canada Health Act is Canada's federal legislation for publicly funded health care insurance (Health Canada, 2015). The Canadian health care system has faced challenges in recent years due to the rising rate of chronic disease including changes in the way services are delivered (Government of Canada, 2019). I believe the Canada Health Act could be modernized by placing more emphasis on preventative care. One way of addressing this could be enhancing coverage for nutrition services in outpatient settings for those at higher risk for lifestyle related chronic diseases, as dietitian services are only covered by in hospital and other government facilities. Nutrition interventions at this point are coming from a place of reactivity once a diagnosis already exists and is being treated for and could be more effective preventively.
Health of Canadians: Understanding Health and Determinants of Health
The meaning of health has changed greatly from a previous definition set out in 1948 by the World Health Organization (WHO, n.d., para.1) as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” After doing independent readings and a forum discussion with classmates, a new perspective of defining health as how one adapts to their illness and subjectively feels about their quality of life was agreed to be more updated than an absence of illness. The meaning of being healthy looks different for every individual, and with an increased older population and chronic disease rates, the focus should shift towards how one feels about their own health and is able to cope with life’s demands despite certain limitations. As a dietitian who also works in diabetes care, this is especially true when I assist with leading summer camps where children with type 1 diabetes can experience a camping with friends and all the physically demanding activities that entails, despite having to be mindful of their blood sugars.
Multilevel Approaches to Understanding Health: Beyond the Individual
This unit discussed different models that can be used to understand the relationship between health of an individual and health at a population level. I applied the Social Ecological Model (SEM) to health in cancer care. The SEM typically consists of five interconnected levels: Individual level, interpersonal level, community level, institutional/organizational level, and societal/policy level (McLeroy et al., 1988). This interconnectedness emphasizes that changes or interventions at one level can have ripple effects throughout the entire system, which could then be helpful towards developing policies and protocols to improve health (Stokols, 1992).
Chronic Disease Prevention and Management
Cancer is the leading cause of death worldwide, and globally, cancer accounts for 10 million deaths, or nearly one in six deaths (World Health Organization, n.d.). In Canada, cancer is also the leading cause of death with one in every four Canadians expected to die from cancer (Canadian Cancer Society, n.d.). The evidence indicates that as much as 30-35% of cancers are linked to diet (Ananda et al., 2008). Oncology nutrition teams tend to work in a reactive manner where the goal is to help manage weight loss and side effects from treatment to maintain nutrition status. Reviewing this unit provided me the opportunity to reflect on the importance of prevention as well, and I investigated the current recommendations set out by the American Institute for Cancer Research for cancer prevention and discuss with this most patients after they are completed treatment to prevent any recurrences.
Vulnerable Populations
Canada’s indigenous population has long been marginalized and therefore a vulnerable population due to the impact of inadequate social determinants of health as reviewed in previous units. Nishri et al., (2015) found that there are poorer survival rates for cancer diagnosed in 1992 or later for First Nations people. It was found that other than cancer site, the main determinant of survival is stage at diagnosis. The lack of access to health care services in rural areas where indigenous reserves typically exist could be a contributor to poor outcomes in this population. Within my organization, starting this year of 2023, the San'yas Anti-racism Indigenous Cultural Safety Training Program became a mandatory requirement for training for anyone working within the Provincial Health Services Authority (PHSA). Acknlowedging the importance of the ongoing unlearning and learning journey to provide culturally safe care for Indigenous patients, clients, families and create safer work experiences for Indigenous staff. PHSA does not however have official practices or guidelines pertaining to addressing the needs of indigenous peoples. I reflected on how this could be improved in my area of work by developing more culturally appropriate nutrition handouts that include common indigenous food ideas, and possibly having an educational cooking class with an expert in indigenous foods.
Future Directions
In this last unit, the focus was on future directions in health care. I started reflecting on the growing area of eHealth, and how wearable medical devices is an emerging technology that is revolutionizing how people live and stay healthy. Wearables (such as fitness watches) are now expanding from measuring health, to predicting health as well. What was once more simple devices designed to track signs such as heart rate and walking steps can now detect blood pressure, blood oxygen levels, temperature, falls, and risk of heart attacks (Hill, 2023). With this increased focus on early detection of health issues, there is room for wearables to help reduce healthcare costs and improve patient outcomes.
Conclusion
This course has allowed me to strengthen my skills in content curation, clear writing, and establishing a digital professional identity. I was able to further understand the Canadian health care system and its gaps, then apply this learning to cancer care. I will keep the lessons I learned regarding the larger scope of health such as social determinants of health, vulnerable populations, and using frameworks to understand the complexities of relationships between various levels of health at the forefront to make me a more well-rounded clinician.
References
American Institute for Cancer Research. (2023, October 18). Cancer prevention. https://www.aicr.org/cancer-prevention/how-to-prevent-cancer/
Anand, P., Kunnumakkara, A. B., Sundaram, C., Harikumar, K. B., Tharakan, S. T., Lai, O. S., Sung, B., & Aggarwal, B. B. (2008). Cancer is a preventable disease that requires major lifestyle changes. Pharmaceutical research, 25(9), 2097–2116. https://doi.org/10.1007/s11095-008-9661-9
Canadian Cancer Society. (n.d.). Cancer Statistics at a Glance. https://cancer.ca/en/research/cancer-statistics/cancer-statistics-at-a-glance
College of Dietitians of BC. (2023, April 5). https://collegeofdietitiansofbc.org/
Government of Canada. (2019). Canada's Health Care System. https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/canada.html
Health Canada. (2015). Health Canada Act Annual Report 2014 - 2015. https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/hcs-sss/alt_formats/pdf/pubs/cha-ics/2015-cha-lcs-ar-ra-eng.pdf
Hill, R. (2023). Smart Wearables: The Overlooked and Underrated Essential Worker. William & Mary Law Review, 64(5), 1583–1615.
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An Ecological Perspective on Health Promotion Programs. Health Education Quarterly, 15(4), 351–377.
Nishri, E. D., Sheppard, A. J., Withrow, D. R., & Marrett, L. D. (2015). Cancer survival among First Nations people of Ontario, Canada (1968-2007). International journal of cancer, 136(3), 639–645. https://doi.org/10.1002/ijc.29024
San’yas Indigenous Cultural Safety Online Training. (n.d.). https://sanyas.ca/
Stokols, D. (1992). Establishing and Maintaining Healthy Environments: Toward a Social Ecology of Health Promotion. American Psychologist, 47(1), 6–22.
World Health Organization. (n.d.). Constitution of the World Health Organization. World Health Organization. https://www.who.int/about/accountability/governance/constitution
World Health Organization. (n.d.). Cancer. https://www.who.int/news-room/fact-sheets/detail/cancer
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