By Sandra Bodenhamer

I believe in the philosophy “nothing about us without us” – in other words, people who are affected by policies should be involved in making decisions about those policies, especially when it impacts their health. That is why I chose to do my Master’s of Public Health practicum placement with Vancouver Coastal Health’s (VCH’s) Community Engagement (CE) Department (http://www.vch.ca/ce). This unique department has the mandate of bringing the voice of patients and the public to VCH decision-making.

My practicum project was to the placement of patient or public advisors on VCH working groups. CE had seen a sharp increase in requests for advisors (currently 46 advisors on 30 workings groups), and they wanted to get perspectives from both advisors and project leads on the benefits, challenges, impacts and potential areas for improvement in the advisory process. From May – June 2015 I interviewed 20 advisors and 17 projects leads.

Patient/Public Advisor feedback

The majority of advisor had overall positive experiences and were extremely grateful that their voices were being considered in healthcare planning. They noted several common factors that lead to positive or negative experiences.

Committee Chair and Staff Feedback

An overwhelming 94% of committee chairs and staff would recommend a patient/public advisor to a colleague based on their current experience. However, they also noted some common challenges listed below.

Challenges of working with advisors:

• Advisor focused on individual experience rather than the big picture
• Inadequate orientation for the advisor
• Advisor didn’t represent the target population
• Need for further staff training around engagement
• Scheduling conflicts

Value Added from the Advisors’ Participation

Advisors and committee chairs had slightly different views on impacts advisors made, as summarized below.

3 committee chairs and 1 advisor said that the advisor made no concrete impact, due to a lack of ability to engage the advisor, as well as the very technical clinical nature of some committees.

Lessons Learned

1). There is no cookie cutter formula for placing advisors – The strategy for each advisor placement must reflect the unique needs of the initiative.

2) Satisfaction generally increases as the advisor and committee get more experience working together – Working with an advisor is not always a smooth process, but their involvement often causes greater innovation and outcomes that better meet the patient/public needs.

3) The first few meetings are critical in creating a positive experience for advisors and committee members – Orienting advisors about the committee, promoting understanding of the advisor’s role, and offering increased support in the early stages is key.

These insights are being reflected in the creation of a resource for staff considering working with patient and public advisors.

Conclusion

Including patient and public advisors on VCH initiatives has been very valuable to the organization. Advisors and committee chairs both noted that one of the greatest benefits of working together is a culture shift towards people-centred care.

Get involved!

If you are interested in becoming a patient/public advisor for VCH please visit the Community Engagement Advisory Network webpage at: CEAN. If you live in BC but outside the Vancouver Coastal region you contact the Patients Voices Network at: https://www.patientsaspartners.ca/network

If you are a practitioner that is interested in promoting a culture of community engagement at your workplace, you may consider joining the National Healthcare Engagement Network (NHEN). Contact Belinda Boyd, Community Engagement Leader, VCH (Belinda.boyd@vch.ca).

References:

Bodenhamer, S (2015). Patient and Public Advisor Process Evaluation     Summary. Vancouver Coastal Health.

Vancouver Coastal Health. Community Engagement. Accessed at:          http://www.vch.ca/get-involved/community-engagement/

We often don’t think that the sense of belonging or feeling included have much to do with our health. During the holiday season we usually pay attention to how much sweets or alcohol we have been consuming, which we recognize as not being great for our overall health and wellbeing. We set out to create New Year’s resolutions accordingly. However, as it turns out research points out that social inclusion is one the most important factors that influences our health, especially our mental health.  Bridge for Health has invited Colin Easton to share his story about the Stranger Project as an innovative example of how we can find new ways to build healthy communities, by reaching out and connecting. We invite you to make connections and share your story during this holiday season to support your health. Use #sharingourselves. Wishing you a safe, happy and healthy holiday season!

By Colin Easton

It doesn’t take a holiday for a day to be difficult to get through. For those of us living with depression or other mental health issues, it can be Monday, seven days a week. This year, I’ve worked at building connections with people. On a daily basis. Depression manifests in my life in part, as a desire to isolate, to not be around others, and sometimes, to stay in the perceived comfort of my apartment.

I needed to find a way to ensure I was making an effort daily, to get outside, and more importantly to connect with at least one other human being. Even on the darkest and most dreaded days, this connection left me feeling a little lighter, a little more connected, and allowed me to not be so hard on myself for hermitting away.

The holiday time can be a double-edged sword. There’s an expectation of gathering with others to celebrate. I’m not even going to talk about the potential for self-inflicted guilt about the buying of gifts (I don’t buy gifts). While I actively seek out connections with others daily, it doesn’t mean I want to sit down for three hours and have dinner with a large, boisterous, celebratory group of people. The other side of that is my own awareness that part of the reason I spend the holidays alone, is because of choices I’ve made. I have to accept responsibility for that. How do we find the balance?

This year, I’ve been working on The Stranger Project. I’ve been going out everyday, finding a stranger to chat with, and then writing about that person’s story. The connections have been profoundly moving. Everyone has a story. And contrary to popular belief, everyone wants to be heard. I’ve had people share all kinds of personal information with me, for my blog. Some stories are hilarious and uplifting, and others are stories of survival through darker times. Invariably, most people thank me for asking to chat with them. When we make genuine connections with people, and when they know we’re really interested in what they have to say, true connection happens. I’ve built an entirely new community of friends and connections, through talking to strangers. Some people I may never see again. Some of the strangers have become good friends. A few have made it into my inner sanctum. That’s for life.

I’m still going to go out and find a stranger to chat with every day over the holidays. Just as I choose to be alone and am okay with it. I might meet someone who won’t have anyone to connect with. I might be their holiday connection. Community and celebration don’t have to be an enforced, enduring experience. Connections that are real and mutual have been my sustenance this year. It’s just one tool in my kit to work through my depression. Helping others helps me.

Reaching out to someone, making a connection and letting them know I’m interested in what they have to say, has been invaluable. I’ve learned lots of things about places and people that I wouldn’t have learned, sitting by myself in my apartment. I feel better on a daily basis for getting out, for making contact with another human, and, talking. I don’t have to buy them presents. I don’t have to spend hours with them. I do have to make the first move. And on those days when I know I don’t want to or don’t feel like it, I remind myself of how much better I’ll feel afterwards. Helping me, help myself. #notastranger

Colin Easton

By Maggie de Vries

December 17 is the International Day to End Violence Against Sex Workers. In dozens of cities all over the world, people get out their red umbrellas and gather to show their support for sex workers’ rights and to remember those who have lost their lives. World-over, the movement is gathering force. New Zealand decriminalized sex work in 2003; parts of Australia are following close behind.

Sadly, in Canada, we have a different story to tell. One year ago, Canadian sex workers and sex-worker-rights activists rejoiced when the Supreme Court struck down our then laws around sex work because they violated the Charter by threatening sex workers’ rights to life, liberty and security of the person. Specifically, they struck down the ban on keeping or being in a “bawdy house” or brothel, the ban on “living on the avails of prostitution,” and the ban on communicating in public for the purposes of prostitution. At that time, Canada had a chance to move into a place of decreased stigma, greater safety and more choice for sex workers.

Instead, our government came up with Bill C36, the “Protection of the Community and Exploited Persons Act,” a set of laws that came into effect on December 6, 2014 and are already driving sex work even farther into the shadows. It is now illegal to pay for sexual services, to discuss the sale of sex in certain areas, to receive a financial benefit knowing that it comes from the sale of sexual services, and to knowingly advertise an offer to sell sexual services.

It will likely take years to successfully challenge this Bill; in the meantime, the stigma will stay in place and the violence will continue.

For stigmatized and criminalized people living on society’s margins, health care experiences tend to be traumatizing. My sister, Sarah, lived on Vancouver’s downtown eastside for the last nine years of her life. She disappeared in 1998 and her DNA was found on serial murderer Robert Pickton’s property in 2002. At the time of her death, Sarah had been selling sex for half her life; she had been addicted to heroin and cocaine for years, and she was HIV positive and had hepatitis C. Too many times, when Sarah had no choice but to seek medical attention, she came away feeling diminished by the encounter, society’s judgements reinforced. On each of those occasions, an opportunity was lost. Sarah was stigmatized for her addiction along with her sex work. Often, when she was badly hurt and needed help, she didn’t seek medical attention at all.

We are working to sweep away the stigma and to challenge the laws once again. Get out your red umbrella and join us on Wednesday, December 17, at 5:30, in the Concourse at the Vancouver Public Library on Robson Street.  On this International Day to End Violence Against Sex Workers we hope to find renewed strength, new allies and innovative ways to work together and find solutions to deal with the complex social, health and legal issues faced by sex workers. Freedom from violence, discrimination and stigma are key factors to promote health for everyone.

(Photo by Ester Shannon)

Here’s are links to the event on Facebook and my TEDxSFU talk on the subject: The Red Umbrella: Sex Work, Stigma and the Law.

Hope to see you there!

If you have questions, you can reach me at maggiedevries@shaw.ca.

Maggie de Vries, Author & Advocate

By Jaskaran Dosange, Senior Project Manager of the Access Our Medicine Initiative

“Act as if what you do makes a difference. It does.” – William James

Every year 10 million people die each year because they can’t access the medicine they need. And it’s not just a developing world problem:  in Canada, one in ten people cannot fill a prescription due to cost. Medicine prices are rising – cancer medications that used to cost hundreds of dollars in the 1980’s are now hundreds-of-thousands of dollars and the latest Hepatitis C treatment can cost $1,000 per pill.

Bridge for Health invited me to write this blog because access to affordable medicine is an equity and a sustainability issue. We need to find new ways to come together and tackle this complex issue by using multiple strategies and many voices.

The Access Our Medicine Initiative was launched in April 2014 inviting people to sign an online declaration with a simple statement – everyone should have access to affordable medicine. Since then, over 75,000 from over 160 countries and a diverse range of organizations representing more than 400 million people have signed the Declaration at www.accessourmedicine.com. Being a tiny team trying to make a big difference, we’ve been ecstatic to also have the support of leading health experts such as Julio Montaner and Stephen Lewis, in addition to celebrities like Sarah McLachlan and Richard Branson!

Often the issue of affordable medicine is one that seems too complex for most people to even think about but I often recall the reminder from Alison Lawton, the founder of Access Our Medicine Initiative, “If we have medicine to treat people but they can’t access them, then we need to make changes,” It’s as simple as that.

What we need is for individuals to realize that they have a voice in making these changes to make health for all a reality. People don’t know about the issue, are too ashamed to admit they can’t afford their medicines or too busy trying to recover and pay their bills to spend time talking about it. That’s why a crucial component of the Access Our Medicine project has been to make it a conduit for the public voice. As citizens armed with stronger communication tools than ever before, we can all contribute in giving a voice to this issue.

While access to medicine can be seen as a daunting issue, solutions exist. We’re continually inspired by the social innovations in health – from a scientist encouraging open source cancer research to a woman starting a non profit pharmaceutical company to an organization who distributes surplus medications to people who can’t afford them. There are so many people doing amazing things in this area that we’re convinced there has to be a better way than the current approach. Even organizations that are typically fragmented because of diseases and borders are coming together to unite on this particular issue. Organizations like the World Hepatitis alliance, AIDS HealthCare Foundation, European Parkinson’s Disease Association and the Canadian Federation of Medical Students are coming together to state that their patients need access to affordable medicine…now.

We’re hoping that 100,000 signatures will help influence the UN 2015 Sustainable Development Goals, which are currently being negotiated. There is no question that a strong show of public support can galvanize decision makers towards solutions that will make medicine affordable for all. We’re also starting to explore a series of public events designed to explore these issues in more depth and present opportunities for diverse partners to come together to secure public support for their solutions and engage the media to spark local and national conversations.

We’re on our way to 100,000 signatures and we’re inviting all of you to add your voices. USE YOUR VOICE. Please consider signing the Declaration  CLICK HERE TO SIGN

and also share the link and use #AccessOurMeds to help spread the word!

– Jaskaran Dosange, Senior Project Manager of the Access Our Medicine Initiative

By Naomi Armstrong

Noche de Salsa invites us all to build connections with one another and engage in the idea of a healthier society for all.

While many engaged citizens support the local food movement for the positive impact it can have on the environment and our local economy, it is not often recognized that much of our food system in British Columbia depends on imported labour. In BC, approximately 4,000 migrant farmworkers are brought in annually, often from Mexico or Guatemala, to work on local farms. These farm workers contribute greatly to the health of Canadians by supporting our local economy and helping to increase access to locally grown produce for BC residents. Yet they are often socially and physically isolated, as they usually work long hours, speak limited English, live in rural areas with limited transportation options, and are away from their families and support networks for many months at a time.

The Umbrella Mobile Clinic is an innovative project that helps to bring health services and social support to migrant farmworkers in BC’s lower mainland. This not-for-profit mobile medical clinic, staffed largely by volunteers including physicians, nurses and a diverse group of community members, offers culturally sensitive, low-barrier health services in Spanish for migrant farmworkers. The clinic operates from a trailer renovated as a small medical office, and travels to regular locations in the lower Mainland to hold clinics at times and in locations that are convenient for migrant farmworkers. Informal conversation, social connection and snacks are an important feature of every clinic as well, to help build a sense of community and support for our patients and friends.

The fact that the mobile clinic exists is thanks to the ongoing efforts of an entire community. Volunteers commit their time and medical services to the clinic, and funding comes primarily through donations, grants and fundraising efforts from individuals and organizations who value not only the health of the farmworkers, but the social connectedness and sense of community that the clinic promotes as well.

This Saturday, November 22^nd, the biggest mobile clinic fundraiser of the year is taking place. Noche de Salsa is a night of salsa dancing, socializing and community-building, with all proceeds going to the mobile clinic. While the event is of course about having a good time, at a deeper level it is about us coming together to build connections with one another, to learn more about health and social issues, and to demonstrate our commitment to health for all.

The event takes place at Astorino’s hall on Commercial drive, and will kick off with a free salsa lesson by Mas Movement – people of all genders and all levels of ability are invited to take part! Music for the whole night is being provided by DJ Tagle, and there will be a silent auction and drinks and snacks for purchase.

We invite you to find out more about the mobile clinic, get your dancing shoes on, and join us this Saturday! For more information and to purchase tickets online please check out the links below.

Umbrella Mobile Clinic website: http://umbrellacoop.ca/mobileclinic

Noche de Salsa event information on Facebook: https://www.facebook.com/events/825174420837429/

Noche de Salsa ticket sales and information: https://www.picatic.com/nochedesalsa

Naomi Armstrong,  Fundraising Committee Volunteer and past project coordinator of the Umbrella Mobile Clinic. 

By John Thornburn.

Engagement, inclusion, and relationships. I believe these three simple words are cleverly intertwined in their capacity to maintain change in our communities. Paolo Freire (2007) stated that “the ability to reflect, to program, to investigate, and to transform is unique to human beings in the world and with the world” (p. 34). When I hear the term Bridge for Health, I think of the intertwined relationships amidst mindfulness, spirituality, and wellbeing. I believe these equally simple words co-exist in a unique way to sustain our life energy among others. Although Paolo’s work focused on creating healthy dissonance (and maybe a little bit of a revolution), I think it also provided an opportunity for those who read his work to step back and ask oneself what their impact on the world is. In this sense I think that when he said that “without a vision for tomorrow, hope is impossible” he was trying to entice the reader to maintain the dream of what social impact could be if everyone was engaged (Freire, 2007, p. 45).

The idea of social innovation is not new. Kurt Lewin, the founder of Action Research wrote an interesting article in 1946 titled “Action Research and Minority Problems” in the Journal of Social Issues. In it, he posited that change was a slow process unless driven by crisis which could radically speed up change (Burnes, 2004, p. 230). In our current state we have coined the word social innovation to focus people’s attention to the need to re-engage with our communities. Have we done this because social justice issues have become a crisis?

In the meantime, Bridge for Health is urging us to embrace civic engagement, as an activity that can promote social innovation and health equity. I agree. Mahjabeen, Shrestha, and Dee (2009) believed that “the voices of the traditionally voiceless groups … are critical for plans to succeed in terms of achieving equity, efficiency and sustainability” (p. 46). They further went on to promote their facilitative activities in order to decrease political tokenism and increase civic engagement in Australia. I developed the Building Better Practice model after being influenced by these authors, among others. When I was encouraged by Paola Ardiles to write this blog I felt that our messages were along a similar path. In fact, Bridge for Health is hosting a holiday party that includes a Photovoice Exhibit that engages youth to express their views and perspectives on the social conditions that shape our health.

I am delivering a workshop in Vancouver out of Creekside Community Center on Friday November 21st. There is a cost for the workshop but if you mention Bridge For Health in your email to me I will reduce the cost by 50%. You can register at www.communityinc.tk but first let me describe the model…

The Building Better Practice model is built on a foundation of Participatory Action Research (PAR). PAR as described by Swantz (2008) promotes that “knowledge gained through research needs to become part of people’s lives” (p. 45). To this effect I promote the value of engagement, inclusion, and mindfulness when developing strategies to create civic engagement. The Building Better Practice model promotes the values of Dialogue, Governance, Planning, and Leadership.

When we convene with others, there is value in fostering DIALOGUE. In the workshop I aim to teach the participants how to engage in creative dialogue with all sizes of groups. I teach two specific techniques: Open Space, and Transformative Planning. In each, the participant (you) will learn how to engage others, include their voice, and build momentum in strengthening a community that cares. As part of the second component, I promote our role of Community GOVERNANCE. We are all governors: Governors of our Non-Profit societies, our Faith communities, and our child’s sports groups. As we create a Community Governance Model, I will teach you how to promote social inclusion and leverage individual strengths of those that participate in community group activities. Thirdly, I aim to help participants look at ways to create non-traditional partnerships through a lens of inclusive strategic PLANNING that utilizes networks and outreach practices as the key to building healthy relationships that hope to result in a higher quality of community life and individual social health. Finally, the last leg of the workshop is focused on using performance management techniques to ensure that shared LEADERSHIP is developed in the relationships you are building with your colleagues and those who will soon be your new partners. By sharing simple outcome frameworks and ways to create meaningful terms of reference with your committees, boards, and social groups I strive to put you in the driver seat of social innovation in your community.

As Daniel Pink stated in his novel Drive (2009), the value of intrinsic rewards far outweigh those of extrinsic motivators. I hope that you will join us for this workshop on Friday, November 21^st not because I say it will provide you with new insights, but because you know that it will.

Visit the website to register www.communityinc.tk or email me at johnthornburn@shaw.ca

John Thornburn, M.A.
Organizational Leadership Consultant
www.BuildingBetterPractice.com

References

Burnes, B. (2004). Kurt Lewin and the planned approach to change: A reappraisal. In Burke, W., Lake, D. G. & Paine, J. (Eds.). (2009). Organization change: A comprehensive reader. (pp. 226-246). San Francisco, CA: Jossey-Bass.

Freire, P., & Freire, A. M. A (2007). Pedagogy of the heart. New York, NY:The Continuum International Publishing Group.

Lewin, K. (1946). Action Research and Minority Problems. Journal Of Social Issues, 2(4), 34-46. Retrieved from SocINDEX

Mahjabeen, Z., Shrestha, K. K., & Dee, J. A. (2009). Rethinking community participation in urban planning: The role of disadvantaged groups in Sydney Metropolitan strategy. Australasian Journal of Regional Studies, 15 (1), 46-63. Retrieved from http://www.anzrsai.org/download.pl?param=289

Pink, D. H. (2009). Drive: The surprising truth about what motivates us. New York, NY: Riverhood Books.

Swantz, M. L. (2008). Chapter 2: Participatory action research as practice. In Reason, P., & Bradbury, H. (Eds.). The SAGE handbook of action research. (2nd ed.), (pp. 31-48). London, UK: SAGE Publications. doi:10.4135/9781848607934.d8

By Patrick Lee & Paola Ardiles

Voting is one of the most fundamental actions a citizen takes in a democracy. The act of voting is both a right and responsibility, and the extent to which citizens choose to exercise those rights and responsibilities is often seen as an indication of the health of a democracy. Indeed, voter turnout is one of the Canadian Index of Wellbeing‘s (CIW) headline indicators of democratic engagement. The CIW is a measure of quality of life that incorporates indicators in eight key categories, including democratic engagement, health, education and environment. CIW is emerging as an alternative to GDP as a measure of wellbeing in Canada. Bridge for Health recognizes the holistic nature of health and the importance of democratic engagement, among other factors, in the health of individuals and communities.

Election day is the one day every three or four years where regardless of age, ethnicity, gender, and social and economic status, each citizen has an equal voice in the direction of his or her community. Each ballot is equal to every other ballot cast. Casting that ballot is an expression of self-determination and participating in the electoral process empowers individuals and their communities. Voting gives voice to those who are historically marginalized in political conversations. However, voter turnout in Canada has dropped to record lows in recent years — as low as 33% in some major cities. Turnout is so low that everyone knows someone who does not vote. It’s time to reverse this trend.

No matter what your political colours, voting at the municipal, provincial and federal level is an important step you can take to promote the health and well-being of your family and community.  On Saturday November 15th, 2014 citizens in British Columbia will have a chance to use their voice to shape their next municipal governments. Municipal governments play a very important role in terms of addressing issues that impact neighbourhoods such as housing, employment, child-care, arts, library & community services. Community centres and neighbourhood houses also provide public spaces that promotes physical health and a sense of belonging which is critical for our overall health. Visit Election 2014 or your local government’s website to get informed about your candidates and polling stations.

Take a pledge today to have a conversation about voting with someone you know who does not vote. Share why voting is important to you, and seek to understand their perspective. Listen and build upon common ground, knowing that promoting the vote is about creating dialogue and engagement, together.

Although voting is perhaps the most common expression of citizen engagement, other civic actions are equally as important. Ongoing citizen engagement through volunteering and participation in civic activities, both during and between elections, builds knowledge, skills and networks of individuals who create more resilient communities. Those communities are better able to respond to challenges facing them, whether they be health issues, environmental problems or economic challenges.

Many groups of people who have been historically marginalized in politics, such as immigrants and those living in poverty, also face health inequities in British Columbia. Bridge for Health is taking an active role in increasing citizen engagement, and in doing so, Bridge for Health not only empowers people to contribute to the physical and mental health of their communities, but their political health as well. In tackling these complex issues, we all have knowledge to share and Bridge for Health’s work creates space for learning and collaboration.

Join the conversation and share your story about how you promote health & well-being in your community by using #sharingourselves

And…don’t forget to vote!

Patrick Lee is the Founder for Promote the Vote , a non-partisan movement you can follow @VotePromote