My academic journey has evolved into a reflection on our current health care system and my path as a health leader, a nursing professional, and impact within my community. These reflections have brought me to consider the future of health care and the importance of inter-professional collaboration, analyze different health systems using multilevel approaches while considering the social determinants of health. In this blog, I will share my reflections on this in relation to supporting and promoting children's health as we move towards planning the recovery of our health care system post COVID-19 pandemic.
Inter-professional connectedness
As a nurse, working and collaborating with multiple disciplines is a core value in our profession. Through my journey in the MHST 601 course, I have a higher appreciation for inter-professional connectedness in learning from my peers from other disciplines, provinces and working in a variety of roles and settings. COVID-19 has highlighted the importance of collaboration at all levels of government and throughout the health system. I value the importance of having a professional digital presence to further expand and share knowledge. Communication is key, and addressing misinformation with transparency and ensuring it is evidence-based has been one of the key factors for public health.
This video from the College of Nurses, provides some great tips to consider when posting on social media:
An example of the importance in communicating clear language is all the work done to address vaccine hesitancy for parents with young children. Key considerations to promote vaccine confidence is the importance of consistent messaging across our health system and to use an integrative model in addressing factors of age, race, ethnicity, gender, education and socioeconomic status (Cenat et al., 2022).
Multilevel approaches & determinants of health
It has been clear that health needs to encompass a multilevel model with a focus on the health of both the individual and the population. As a health promotion specialist in public health, I use the socio-ecological model and the Ottawa Charter for Health Promotion as fundamental elements in my practice. This model (Figure 1) from CDC (2022) depicts how risk factors can influence each level and considers the interaction between the individual, relationship, community and society. Looking at this from a public health perspective, this model supports the need to identify social, cultural and economic forces through population health strategies that addresses the interplay between the ecological and social determinants of health (CPHA, 2015).
Figure 1: The National Centre for Disease Control and Prevention (CDC, 2018)
As a public health professional, my practice is based on the Ontario Public Health Standards (see Figure 2). Following these standards ensures the programs and services provided are evidence-based and informed for effective public health practice. Using the most up-to-date evidence available allows public health professionals to be responsive and address the needs and emerging issues of their community. This includes integrating population health assessments and focusing on health equity when delivering services.
Figure 2: Ontario Public Health Standards (2021); page 6
It is important to have a strategy based on population and public health principles of working collaboratively with internal and external partners to support children and families across their life span in a culturally safe and equitable manner.
From a child health perspective, we know that children thrive when they have regular interactions with caring and supportive adults – parents, family members, caregivers and educators. Children’s social connectedness to their community, school, family, and other caring adults can build resilience, which can buffer the impact of adverse events or stressful life circumstances (Gadermann et al., 2021). As we move forward from this pandemic, our health system needs to continue to be committed to building partnerships with the community to promote healthy childhood development that fosters resilient families and thriving communities.
Chronic disease prevention & management
The COVID-19 pandemic has impacted the mental health of many Canadian families (Gadermann et. al, 2021; Chanchlani, 2020). Food insecurity and financial strain are determinants of mental health for individuals and families (Alegría et al., 2018) and highly important to intervene at the community and societal levels. According to a report by Statistics Canada (Polsky & Gilmour, 2020), one in five Canadian households experience challenges meeting their financial needs and food insecurity were linked to increased rates of mental health symptoms.
Mental health, financial stress, and food insecurity have been long-standing public health issues (Public Health Ontario, 2019). As a nurse working in public health, advocating for adequate income, affordable housing, and access to nutritious and culturally appropriate food has been a long-standing priority.
Vulnerable populations
COVID-19 created rapid change in our society – closing businesses, forcing children and families to stay home, adapting learning environments, and limiting available community services and supports. The resulting social and economic instability has created an overload of stress for many families. The weight of poverty especially, can overload parents’ abilities to provide the material and supportive relationships children need (Pinto et al., 2022)). By acting now, we can ensure that children and families thrive emotionally and physically.
Lifting families out of poverty should be an urgent priority. According to Statistics Canada (2022), the poverty rates in 2020 for children 0 to 5 years (9.1%), 6 to 10 years (8.5%) and youth 11 to 17 year (7.9%) were all less than half their levels in 2015. This is a good sign but we need to continue to advocate for policy changes and develop strategies to support families. Every policy we set—from tax credits to paid leave—should reduce financial pressures on families and increase the time and capacity for supportive family relationships.
Living in poverty can overburden families with stress and result in both physical and mental health concerns. The causes and solutions are well understood, and through concentrated efforts, we can work together to bring about profound change so all children have a fair opportunity to thrive.
Future directions
Shifting social and cultural norms can be used to strengthen protective factors within families by promoting the value of responsive parenting practices and gender roles. Parenting practices may differ between cultures and the overwhelming amount of parenting advice is confusing. Our beliefs around parenting may mean that parents/caregivers are less likely to seek help, because they feel that they will be viewed as “bad”, or perhaps because they fear intervention by child welfare services. We, as health care professionals, need to be aware of our cultural biases and open communication with individuals/communities to listen and rebuild trust in our health system. The pandemic has highlighted the importance for clear and transparent communication at all levels.
As we look forward and develop strategic plans for COVID-19 recovery, we must remember and address the impact the pandemic has had on health care workers. It has affected all workers in our health system in a way that we have not seen before. We need to focus on the health, safety and welfare of our health care workers in order to build a resilient health care system. During this pandemic, we have seen a rapid increase in nurse practitioners with the decline in physicians providing health care services and a decrease in the number of registered nurses remaining in the profession especially in long-term care settings (Canadian Institute for Health Information, n.d). The Government of Canada (2022, June 3) have also reported that many health care workers intend to leave or change jobs in the next three years (see Figure 3).
Figure 3: Public Health Ontario (2019)
In conclusion, collaboration is a key factor. In my recent academic, professional and personal journey, these inter-professional collaborations have given me the strength and motivation to be a public health leader. If we are to protect our youngest population and support them to be resilient and thrive as we recover from the impacts of this pandemic, we need to stay inter-connected. Our concerted efforts will move us closer to achieving our goal of preventing and building resilience to buffer the effects that COVID-19 has had on our children and our health system.
References
Alegría, M., NeMoyer, A., Falgas, I., Wang, Y., & Alvarez, K. (2018). Social Determinants of Mental Health: Where We Are and Where We Need to Go. Current Psychiatry Reports, 20(11), 95. https://doi.org/10.1007/s11920-018-0969-9
Canadian Institute for Health Information. Overview: Impacts of COVID-19 on health care providers [report]. Accessed December 3, 2022. https://www.cihi.ca/en/health-workforce-in-canada-in-focus-including-nurses-and-physicians/overview-impacts-of-covid-19-on
Canadian Public Health Association (CPHA). (2015, May). Global change and public health: Addressing the Ecological Determinants of Health. Canadian Public Health Association: Discussion Document. Retrieved October 23, 2022, from https://www.cpha.ca/sites/default/files/assets/policy/edh-discussion_e.pdf
Cénat, J. M., Noorishad, P.-G., Moshirian Farahi, S. M. M., Darius, W. P., Mesbahi El Aouame, A., Onesi, O., Broussard, C., Furyk, S. E., Yaya, S., Caulley, L., Chomienne, M.-H., Etowa, J., & Labelle, P. R. (2022). Prevalence and factors related to COVID-19 vaccine hesitancy and unwillingness in Canada: A systematic review and meta-analysis. Journal of Medical Virology, n/a(n/a). https://doi.org/10.1002/jmv.28156
Centre for Disease Control and Prevention. (January, 2022)The Social-Ecological Model: A Framework for Prevention |Violence Prevention|Injury Center|. https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html
Chanchlani, N., Buchanan, F., & Gill, P. J. (2020). Addressing the indirect effects of COVID-19 on the health of children and young people. Canadian Medical Association Journal, 192(32), E921. https://doi.org/10.1503/cmaj.201008
Gadermann, A. C., Thomson, K. C., Richardson, C. G., Gagné, M., McAuliffe, C., Hirani, S., & Jenkins, E. (2021). Examining the impacts of the COVID-19 pandemic on family mental health in Canada: Findings from a national cross-sectional study. BMJ Open, 11(1), e042871. https://doi.org/10.1136/bmjopen-2020-042871
Government of Canada, S. C. (2022, June 3). The Daily—Experiences of health care workers during the COVID-19 pandemic, September to November 2021. https://www150.statcan.gc.ca/n1/daily-quotidien/220603/dq220603a-eng.htm
Ottawa Charter for Health Promotion. (1986).
https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population-health/ottawa-charter-health-promotion-international-conference-on-health-promotion/charter.pdf
Pinto, A. D., Gandhi, K. M., Hapsari, A., Sunderji, A., & Cohen-Silver, J. (2022). Integrating health and social care for children in Canada. Canadian Family Physician, 68(10), 726–728. https://doi.org/10.46747/cfp.6810726
Polsky, J.Y., Gilmour, H. (2020). Food insecurity and mental health during the COVID-19 pandemic. Government of Canada, Statistics Canada. https://www150.statcan.gc.ca/n1/pub/82-003-x/2020012/article/00001-eng.htm
Public Health Ontario. (2019). Homelessness and Health Outcomes: What are the associations? Key Messages. https://www.publichealthontario.ca/-/media/documents/E/2019/eb-homelessness-health.pdf
Statistics Canada. (2022, November 9). Disaggregated trends in poverty from the 2021 Census of Population. https://www12.statcan.gc.ca/census-recensement/2021/as-sa/98-200-X/2021009/98-200-X2021009-eng.cfm
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