Author Archives: Paola Ardiles

Wellbeing and Equity in Healthcare and Social Services – update

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In December 2020, Bridge for Health embarked on a new project in partnership with the Public Health Association of BC and with support from the Vancouver Foundation  to better understand the challenges that emerged in long-term care, non-profits, hospital settings, and in-home care during/after the pandemic.  The Wellbeing and Equity In Healthcare and Social Service projects gave us insights on what service providers experience on a daily level in relation to their work, their faced fear and worry about the future, their health, the wellbeing of their families, and their ongoing commitment to the people they promised to serve.

We appreciated listening to the lived experiences of services providers to learn firsthand what would make their work life more fulfilling, joyful, effective, equitable, and safe. We are very pleased to be able to continue this work into 2023! 

Stay tuned for more updates soon.

 

 

Self-care must be a strategic priority for the health system

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If we really want to reduce the burden on the illness-care system, we need to prioritize self-care, so people do not inappropriately access the system.

Dr. Trevor Hancock

The most important task in creating a health system is to keep people healthy, so they do not need to use the illness-care part of the system. My three most recent columns looked at ways in which we could keep the population healthy through societal change.

The next most important way to reduce the burden on the illness care system is self-care. If people know how to recognise and manage their own and their families’ minor ailments and injuries and chronic diseases, they will not need to use the health care system.

A couple of recent articles in this newspaper by local physicians have lamented the lack of healthy living and self-care skills and the lack of ‘common sense’ among the general public. This leads to people not making healthy choices in the first place, and not knowing how to care for minor problems when they occur, both of which result in an unnecessary burden on the illness care system.

But the real problem is that self-care has never been afforded the respect and attention it requires. Yet in reality, most care is self-care, a simple fact that the professionally-oriented illness care system has never fully recognised. A 2010 UK survey found half of those with a minor ailment self-treat, while almost one quarter do nothing.

Self-care is also hugely important in chronic illnesses. For example, a UK study found that “people with diabetes have on average about 3 hours contact with a care professional and do self-care for the remaining 8757 hours in a year”. Moreover, self-care is effective. A recent article in BMC Public Health noted: “In chronic illness, higher levels of self-care have been associated with better health outcomes, including decreased hospitalization, costs, and mortality.”

But it’s no good lamenting people’s unwise use of the illness care system if we have not trained them in self-care in the first place. In fact, not only have we not given them the knowledge and skills they need to look after their own minor ailments and injuries, we have only too often implied that they shouldn’t risk being wrong, but should consult a health professional.

So it should be a strategic priority for the health system to help people develop the knowledge and skills needed to stay healthy, to care adequately and appropriately for minor ailments and injuries and chronic illnesses, and to know when it is time to seek professional care. And when they do, they need to be secure in the knowledge that appropriate professional care will be there when they need it.

It is important  to stress that self-care is not about abandoning people to their own devices. As Swedish doctoral student Silje Gustafsson noted in her 2016 dissertation: “Just as health is more than theabsence of disease, self-care is more than the absence of medical care.”

Self-care does not just happen, we are not born with a set of self-care skills. We need both to train people in self-care from an early age and put in place a support system – including mutual-support groups – that enables them to practice self-care with confidence. People also need support from health professionals – who themselves need to be trained and supported so they can in turn support self-care.

Yet while self-care is arguably the largest and most important part of the entire illness care system, we do not have a robust self-care strategy. In fact, no province that I am aware of has prioritised self-care or created a proper self-care strategy. The only group I am aware of that has argued for a national self-care strategy is an industry association, Food, Health, and Consumer Products of Canada. However, unsurprisingly, their motivation is self-interest and focuses on improving access to, and reducing the cost of and taxes on their products

But if we really want to reduce the burden on the illness care system, we need to prioritise self-care, so people do not inappropriately access the system. At a time when the federal government and the provinces are squabbling over money for hospitals and primary care, we should demand that they also put money into a comprehensive national self-care strategy. Next week, I will discuss what that might look like.

© Trevor Hancock, 2023

thancock@uvic.ca

Dr. Trevor Hancock is a retired professor and senior scholar at the

University of Victoria’s School of Public Health and Social Policy

Originally published in Times Colonist

 

Deepest Well-Trauma and Social Inequities

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By Jennifer Wile

There are many facets to stories of childhood trauma, and many layers. When I was 4 years old, I developed, in rapid succession, strep throat, scarlet fever, and then rheumatic fever. My older brother started his 10 year journey of obesity. We had both been victims of violence and other abuse from my earliest memory. Then as a teenager and in my early twenties, I had multiple surgeries requiring general anesthesia for various rare but treatable physical ailments – strangely all in the same location, but caused by different factors. As an adult, I worked on the emotional effects of PTSD best helped through cognitive behavioral therapy. I discovered exercise helped my mood significantly. Even so, I did not consider the the stress of my childhood might have affected my body until I read Dr. Nadine Burke Harris’ book, The Deepest Well: Healing the Long-Term Effects of Childhood Adversity.

Trauma is no stranger to anyone: if we haven’t experienced ourselves, we know a loved one who has experienced or witnessed violence, abuse or neglect. When I read this book, I could not help but think of the children who are now separated from their parents at the borders as well as of children fleeing Syria. There are sadly many places where trauma is a fact of life, and the inner city can be one of them. It is a matter of public as well as individual health.

WHO recognizes that social conditions are important factors in health, and the all contribute to our total health. Nadine Burke Harris gives a gripping account of her exploration of the link between adverse childhood experience or (ACE) and toxic stress. She is a social innovator in public health and serves a vibrant and economically disadvantaged community, in San Francisco’s Bayview Hunters Point (BHP). She describes the challenges she faced personally and professionally when she opened the Center for Youth Wellness (CYW) as well as her attempts to have ACE and toxic stress, recognized as serious issue in children’s health, which included getting pediatricians to use screening protocols for ACE in pediatric assessments.

Burke Harris, a pediatrician with a Master’s in Public Health, writes with passion about connecting the stress of her patients with their emotional and physical well-being. When offering free pediatric care to children via her clinic, CYW, in BHP, an area that is on the extreme end of San Francisco’s social and economic inequality, Burke Harris saw clear relationships between the trauma that the community’s children experienced and their emotional and physical health. Toxic stress can, and often does, manifest itself in disease and poor health. Her examination discusses how poverty in the inner city can result in greater incidence of poor health with difficult living conditions, more exposure to violence, and untreated mental illness. While San Francisco’s median income was above $100,000 in 2016, City-Data shows that 31% of residents of Bayview Hunters Point live below the poverty line as of the last U.S. Census.

Poverty contributes to trauma, but Burke Harris reminds her audiences that trauma crosses all socio-economic boundaries. She tells us not only the stories of the children that she treated, and still treats, at the BHP Center, but also about her personal journey of trauma. Trauma does not stop in the wealthier neighborhoods. Helping overcome childhood trauma depends on your caregiver. There are engaged and nurturing caregivers in every community, just as there are neglectful caregivers in any community; however, if you live in inner city poverty, your chance of seeing violence randomly outside the home is likely. In one of Burke Harris’ case studies, a teenage boy, recovering well from childhood abuse, sees his best friend is killed on the street in front of him. Understandably, this incident is a setback for his health. The children Burke-Harris treated suffer from multiple adverse reactions, and have debilitating physical and psychological challenges ranging from asthma, obesity, failure to thrive, to stunted growth.

Although Burke-Harris’ accounts of traumatic experience can be shattering, such as the boy who stopped growing at age four when he trauma is exclusive to inner city poverty. Burke Harris reminds her audience repeatedly that toxic stress is an issue in any income bracket. Bringing this to a wider audience, Burke Harris shows us that society suffers when it ignores childhood trauma.

Thankfully, something can be done to help children (and adults) suffering from toxic stress. In fact, according to Burke Harris, part of the antidote to toxic stress is truly integrated health treatment including a combination of healthy relationships, counselling, meditation, exercise, and nutrition. The caregiver and their response to trauma play a huge role, but, sadly for those in underserved areas, so do the resources available to the child.

Though the subject matter is tough, the book and its author are inspiring, positive and passionate. This title comes as a hardcopy, eBook and is also available as an audiobook narrated by the author, which I highly recommend.

Watch Dr. Nadine Burke Harris here: https://www.youtube.com/watch?v=95ovIJ3dsNk or find her book at your local library in audio, eBook or hardcopy: Burke Harris, Nadine. (2018) The deepest well: Dealing with the long-term effects of childhood adversity. Houghton Mifflin Harcourt

 

Congratulations to Bridge for Health changemakers!

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Bridge for Health Co-operative is very pleased to announce that Larissa Chen, our newest board member and Marco Zenone, long standing youth engagement lead at Bridge for Health have both been awarded Surrey’s Top 25 under 25 Awards by the Surrey Board of Trade  on Thursday April 26th, 2018.  The two youth are soon to be graduates from Simon Fraser University (SFU), Faculty of  Health Sciences. During their time at SFU they have both demonstrated excellent leadership skills and engagement qualities during their time at the University. Bridge for Health board is very fortunate to continue working with Larissa and Marco to fulfill our mission and vision. We invite all of our members and friends to extend a very warm congratulations to both of these inspirational young people creating a better tomorrow. #25U25

Does Mental Health matter most?

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By Dr. Trevor Hancock

There is an interesting common thread underlying many of my recent columns. It is the question in my title: Does mental health matter most? By which I mean, in high-income countries in the 21st century, does mental health matter more than physical health? Which in turn means, in terms of public health, does mental health promotion and the prevention of mental disorders matter more than preventing heart disease, cancer and other physical disorders?

There are many threads to my emerging argument. To begin with, the 70 year-old definition of health from the World Health Organisation is that health is a state of complete physical, mental and social wellbeing. Since social wellbeing is primarily about how we feel about and respond to our links to and relationships with others in our families and communities, it means a significant part of the definition is really about our mental wellbeing.

Add to this the relationship between the mind and the body – our state of mind affects our neuro-hormonal and immune systems, and the latter is involved in allergy, auto-immune disease, and the detection and elimination of both infection and abnormal cancer cells – and our state of mind assumes an even greater importance.

Another important issue is the changing pattern of disease and death. Globally, the World Health Organisation noted last year, “Depression is the leading cause of ill health and disability worldwide” – depression, we should note, is only one form of mental ill health. WHO also notes that there are “strong links between depression and other non-communicable disorders and diseases” and that “depression increases the risk of substance use disorders and diseases such as diabetes and heart disease”, while pointing out that “the opposite is also true . . . people with these other conditions have a higher risk of depression”.

We can also see the importance of mental health in the decline in life expectancy in the USA in each of the past 2 years, the first time this has happened in more than 60 years. But that decline is driven not by physical disorders such as heart disease and cancer but from the so-called ‘diseases of despair’; alcohol and drug use and suicide, which are largely mental and social disorders. And as I pondered in my last column, we may need to consider whether the growing concern about the state of our environment is adding to that despair.

Another factor to consider is the impact of poverty and inequality. Absolute poverty is unhealthy because people lack the basic necessities for life and health – clean water, food, shelter and so on – and we have some of that in Canada. But for the most part our problems are now those of relative poverty. Kate Pickett and Richard Wilkinson, in their book “The Spirit Level”, showed that in high-income countries, a range of health and social outcomes are not related to national income per person, but to the degree of inequality.

It seems that being lower in the ‘pecking order’ of society is harmful to health because we experience inequality as a lower sense of self-esteem and self-worth, relative powerlessness and even helplessness. All of which are mental and social experiences that, again, can translate into physical conditions.

The implication is that if we want to have a healthy population we need to pay much more attention to mental and social wellbeing than we have been doing. We need to provide more funding to research focused on understanding the root causes of mental and social health problems, and to policies and programming for preventing mental and social health problems, as we do to understanding and preventing heart disease and cancer – because we have under-invested on the mental health side.

Beyond that, we need to give at least as much attention to promoting mental and social wellbeing as we do to promoting physical wellbeing and fitness, recognizing that they are mutually beneficial. What would it take to create mentally healthy families, schools, workplaces, colleges and universities? How do we help people maintain mental wellbeing in the face of adversity, or as they age? How do we re-focus our society – including public health – to ensure mental health matters at least as much as physical health – maybe more.

© Trevor Hancock, 2018

Originally published in Times Colonist, 20 March 2018

Health Promotion Canada Mid Career award for our Founder Paola Ardiles

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Welcome to 2018!

Bridge for Health co-lead & founder Paola Ardiles sets off the year in positive light as she emerges winner of Health Promotion Canada 2017 Mid-career Award!
Paola was described as a current leader in health promotion in Canada, who is destined to be a future one as well, and was hailed for a stellar track record of accomplishments in #publichealth and a strong history of progressive advancement in leadership & management roles!

We are beyond proud and inspired!

Click to see full awards

Photo: (left to right) Trevor Hancock, Irving Rootman, Paola Ardiles, Ann Pederson at the launch of Health Promotion in Canada: New Perspectives on Theory, Practice, Policy and Research (4th edition) November 2018, Vancouver, BC.

Being part of the Canadian Co-operative movement

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By Marco Zenone

As we start the new year I wanted to share some reflections of one of my highlights for 2017. This past November, I was exceptionally fortunate to be invited to represent Bridge for Health co-op at the Canada Co-operative & Mutuals National Meeting in Ottawa and be recognized as an emerging co-operative champion. We were invited to the conference for our exceptional contributions to meaningful youth engagement and emerging recognition of our innovative, process based outlook on workplace health and well-being.

The conference was an informative and engaging 4-day event, that included a parliamentary reception with several Members of Parliament. Our role in the conference was to share our story as an emerging cooperative to the conference attendees and provide a glimpse into our rationale for utilizing the cooperative model. It was a fantastic experience to share the work of Bridge for Health to the participants of the conference. I shared the story of how Bridge for Health was developed: from the idea that health is more than just healthcare. I further explained that all our work is socially minded and we collaboratively and empirically rally around common causes to promote holistic and upstream change in local, national, and international contexts. Conference participants were very impressed by how much our cooperative has accomplished in the just over a year since we were formally created.

I learned that the number of cooperatives has been increasing and that there have been sizeable investments from the private sector to support the cooperative movement in Canada. The federal government has noted that cooperatives are clearly the best type of organization to work towards the UN’s Sustainability Development Goals; and this conference had a clear focus to create an actionable strategy to obtain more concrete federal support for cooperatives.

To me, this conference solidified how innovative the Bridge for Health model is and how strong a force we can be to genuinely ignite sustainable change. Utilizing the cooperative model is innovative; however, I think we are redefining what a cooperative model can accomplish. We are adopting an approach that is focused on setting a platform for equity and well-being that can be adopted in any context and on any issue. As Bridge for Health grows and continues to inspire future members, I have no doubt we will be continued to be seen as a field leader and be recognized as true innovators.