For my final blog post I will be reflecting upon my journey through Athabasca Universities Critical Foundations in Health Disciplines course. Over the last 13 weeks, I have had the opportunity to learn more about ‘health’ and the foundations of health systems in Canada. I have also had the chance to conceptualize and analyze factors that influence the health of Canadians. Throughout this course, I have explored my professional and ethical values as a nurse as well as expanded upon my online professional identity. I was able to explore inter-professional connectedness through knowledge exchange and idea-sharing by interacting with classmates and the course instructor through several different online platforms. In developing my ePortfolio, I've laid the groundwork for a digital collection that will continue to highlight my academic and professional achievements overtime. During the course we were asked to reflect upon a variety of topics related to our professions or research interests. This blog post will focus on the current health issue, substance misuse and the opioid crisis and provide an integrated and synthesized summary by reflecting on concepts learned throughout #MHST601.
Understanding Health & Chronic Disease
This course has provided a contemporary overview of health in Canada and has allowed me to explore the meaning of health and chronic disease on a deeper level. The World Health Organization (WHO) defines health as "... a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO, 1948). One researcher argues that the word “complete” in reference to well-being is a significant flaw in the WHOs definition (Huber, 2011). The WHOs definition classifies individuals who have a chronic disease as ill, and I strongly believe that living with a chronic disease should not define one’s overall health. The WHOs definition of health is practically impossible to attain (Leonardi, 2018). Mental health is often assessed on a continuum, perhaps it would helpful to look at overall health through the same lens.
"Just as environmental scientists describe the health of the earth as the capacity of a complex system to maintain a stable environment within a relatively narrow range, we propose the formulation of health as the ability to adapt and to self manage" (Huber, 2011).
The current opioid crisis is a growing public health concern that has significant impact on the health of Canadians. Saitz et al. (2008) argue that a substance use disorder is a chronic disease that affects a large number of adults, many of whom do not receive treatment or intervention. The Government of Canada suggests that the opioid crisis has been exacerbated by the current COVID-19 pandemic due to increased mental health concerns, isolation and limited access to treatment and services (Government of Canada, 2021).
Image 1
Dimensions of Wellness
Although substance use disorders can have an impact on many aspects of one's well-being such as social, emotional, spiritual, environmental, occupational, intellectual, and physical well-being, having a substance use disorder should not imply that one is unhealthy. Bradley et al. (2018) recommend that a future definition of health incorporates the dimensions of wellness such as spiritual, emotional and social context as well as take into consideration the influences of behaviour and overall surroundings. I believe that a new definition of health should be tailored to best reflect the larger population, while keeping in mind that the definition of health is highly subjective.
Determinants of Health & Vulnerable Populations
As previously stated in my blog post on the social determinants of health, society must do more to analyze and address barriers to health equity in our communities. This course has given me the opportunity to broaden my understanding of the social determinants of health (SDoH) and appreciate how complex and interconnected they are (See Video 1).
Video 1
Social Determinants of Health
When looking at substance use and the current opioid crisis, it is important to examine the SDoH and determine how they contribute to opioid misuse. Factors contributing to opioid misuse include lack of education, food insecurity, unemployment, stigma, inadequate housing as well as isolation (van Draanen et al., 2020). These factors may lead to socioeconomic marginalization and significantly increase one’s risk for opioid overdose (van Draanen et al., 2020). Researchers define socioeconomic marginalization as “a set of conditions that contribute to exclusion from social and economic opportunities and create vulnerability” (van Draanen et al., 2020 p.1). When assessing these contributing factors, it is also important to determine how our most vulnerable groups are affected. There are specific populations who are considered at higher risk for opioid related overdose such as people experiencing homelessness, indigenous people and those of lower socioeconomic status (van Draanen et al., 2020). Genetic factors can also increase ones vulnerability when it comes to substance use, due to altered receptors in the brain (Jalali et al., 2020). It is important to note that the devastating impacts of the opioid crisis disproportionately affects our most vulnerable populations. The opioid crisis has been going on for decades, but the current COVID-19 pandemic has significantly increased the number of opioid overdoses in Canada (See Infographic 1). The increasing toxicity of the opioid supply, barriers to accessing treatment and services, and public health constraints such as physical distancing and isolation have all contributed to the rise in opioid-related deaths (The Ontario Drug Policy Research Network, 2020).
Infographic 1
Opioid Related Harms in Canada
Multilevel Approaches to Understanding Health
Earlier in this course we explored multilevel approaches to understanding health, where we analyzed a multilevel model of health and applied it to a particular health issue or population. I chose to focus my research on the Social Ecological Model of Health and the opioid crisis while taking into account the affects of the current COVID-19 pandemic. According to researchers, utilizing the Social Ecological Model of Health can help analyze the impact the COVID-19 pandemic has on access to treatment and services, opioid use and risk for opioid overdose (Cowan et al., 2021). Research by McLeroy et al. (1988) outlines a 5-level structure of the Social Ecological Model of Health, these levels include intrapersonal, interpersonal, institutional, community and public policy. Figure 1 outlines the various factors that contribute to opioid misuse while utilizing the 5-level structure.
Figure 1
Factors Contributing to Opioid Misuse
Note: Figure adapted from Jalali et al (2020), The opioid crisis: A contextual, social-ecological framework. Health Research Policy and Systems.
When examining the Social Ecological Model of Health, it is critical to assess each level in order to understand the influencing factors contributing to the opioid crisis. It is evident that each level of this model has been directly impacted by the COVID-19 pandemic. Jalali et al. (2020) highlight that the opioid crisis is a complex issue that requires a thorough examination of each contributing factor in order to inform future health directions and assist in the development of effective strategies to combat this growing issue.
Future Directions
In the last unit of this course we explored emerging health trends currently affecting our areas of practice or areas of interest. I chose to focus my research on the virtual delivery of health care services. The current COVID-19 pandemic has forced the rapid expansion of virtual care across the country and throughout the world. There are numerous advantages to virtual care such as increased flexibility, improved access for individuals living in remote areas and the decreased risk of transmission of COVID-19 (Hardcastle & Ogbogu, 2020). While there are several advantages in utilizing virtual care, we must also consider whether we are leaving anyone behind as we increase access to these services. Evidence suggests that after transitioning from in-person to virtual care, individuals of lower socioeconomic status are much more likely to discontinue accessing substance-related treatment or prevention services (Public Health Ontario, 2020). According to researchers, pandemics often reveal society's shortcomings and highlight the inability to adapt and support the most vulnerable populations (Picchio et al., 2020). Harm reduction services provided by pharmacies, outpatient clinics, and safe consumption sites have been directly impacted by public health measures implemented to prevent the spread of COVID-19, such as physical distancing (ODPRN, 2020). Many of these services cannot be provided in the same capacity when switching to a virtual format. According to Public Health Ontario, “the Works in Toronto had 3853 visits in February 2020 prior to the public health restrictions related to COVID19 and declined to 127 visits in April 2020” (Public Health Ontario, 2020, p.8). This reduction in visits is a direct reflection of the impact that the COVID-19 pandemic has had on harm reduction services and the overall opioid crisis. When looking at the future of harm reduction and the opioid crisis, it will be imperative to look for new ways to provide services while still ensuring public health advice is adhered to.
In completing this course, I have appreciated the opportunity to explore a contemporary overview of health and health systems in Canada. I have a better understanding of where I fit as a public health nurse in the broader health care system and how this influences my daily practice. I was fortunate to collaborate with classmates from a variety of health backgrounds and disciplines in order to enhance my knowledge of key concepts related to critical foundations in health disciplines. The skills I have gained related to developing an online digital identity are invaluable and I hope to utilize my ePortfolio for future professional and academic endeavors.
References
Bradley, K. L., Goetz, T., & Viswanathan, S. (2018). Toward a Contemporary Definition of Health. Military Medicine, 3, 204. https://doi.org/10.1093/milmed/usy213
Cowan, E., Khan, M. R., Shastry, S., & Edelman, E. J. (2021). Conceptualizing the effects of the COVID-19 pandemic on people with opioid use disorder: an application of the social ecological model. Addiction Science & Clinical Practice, 16(1), 4. https://doi.org/10.1186/s13722-020-00210-w
Government of Canada. (2021). Data, surveillance and research on opioids and other substances. Retrieved April 4, 2021 from https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/data-surveillance-research.html
Hardcastle, L., & Ogbogu, U. (2020). Virtual care: Enhancing access or harming care? Healthcare Management Forum, 33(6), 288–292. https://doi.org/10.1177/0840470420938818
Huber, M. (2011). Health: How should we define it? British Medical Journal, 343,(7817), 235-237. https://doi.org/10.1136/bmj.d4163
Jalali, M. S., Botticelli, M., Hwang, R. C., Koh, H. K., & McHugh, R. K. (2020, August 6). The opioid crisis: A contextual, social-ecological framework. Health Research Policy and Systems. BioMed Central Ltd. https://doi.org/10.1186/s12961-020-00596-8
Leonardi, F. (2018). The Definition of Health: Towards New Perspectives. International Journal of Health Services, 48(4), 735–748. https://doi.org/10.1177/0020731418782653
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An Ecological Perspective on Health Promotion Programs. https://doi.org/10.1177/109019818801500401
Picchio, C. A., Valencia, J., Doran, J., Swan, T., Pastor, M., Martró, E., Colom, J., & Lazarus, J. V. (2020). The impact of the COVID-19 pandemic on harm reduction services in Spain. Harm Reduction Journal, 17(1). https://doi.org/10.1186/s12954-020-00432-w
Public Health Ontario. (2020). Substance Use-Related Harms and Risk Factors during Periods of Disruption. Retrieved March 3, 2021 from https://www.publichealthontario.ca/-/media/documents/ncov/main/2020/08/substance-use-related-harms-disruption.pdf?la=en
Public Health Ontario (2020). Rapid Review: Strategies to Mitigate Risk of Substance Use-Related Harms during Periods of Disruption. Retrieved April 6, 2021 from https://www.publichealthontario.ca/-/media/documents/ncov/he/2020/09/mitigation-strategies-substance-use.pdf?la=en
Saitz, R., Larson, M. J., LaBelle, C., Richardson, J., & Samet, J. H. (2008). The Case for Chronic Disease Management for Addiction. Journal of Addiction Medicine, 2(2), 55–65.
The Ontario Drug Policy Research Network. (2020). Preliminary Patterns in Circumstances Surrounding Opioid-Related Deaths in Ontario during the COVID-19 Pandemic. Retrieved February 22, 2021, from https://www.publichealthontario.ca/-/media/documents/o/2020/opioid-mortality-covid-surveillance-report.pdf?la=en
World Health Organization. (1948, April 7). Constitution of the World Health Organization. https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1
van Draanen, J., Tsang, C., Mitra, S., Karamouzian, M., & Richardson, L. (2020). Socioeconomic marginalization and opioid-related overdose: A systematic review. Drug and Alcohol Dependence, 214. https://doi.org/10.1016/j.drugalcdep.2020.108127
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