The Game Changer
We want health care that is there when we need it, and even want it. In fact, the focus of the pandemic is mainly to save the system so it IS there for the broken leg, the birth of a baby, and that heart attack. We want care to be safe and up to date. We want the caregivers to think about US and our needs, being respectful of our choices. We want all this from our government and we want it from birth until death.
But we aren’t getting what we want… are we? Many of my patients and others are not happy with the care that they are getting. Many have not seen their doctor face-to-face in over 2 years. Even before the pandemic were you satisfied with the options when you were sick? Were you able to seek out timely advice on prevention measures? Do you feel that our health care system is helping you with your “health” or just when you are ill?
The complexity of health
What really determines how well we live and how long we live is what our grandparents always knew: find a safe place to live, eat good food, take care of what is yours, and always be ready to help your family and friends. We could just run with these four points. We should just live by these four simple rules, but we have made the list more complex because humans are that way – complicated.
Health Canada has established a detailed list of things that can affect how well we live. This list is officially called “determinants of health” and includes a broad range of personal, social, economic, and environmental factors that affect your health and the health of your community.
What does personal health have to do with your neighbourhood?
Healthy people work together to create healthy “hoods”, and strong, healthy neighbourhoods attract people who want to be healthy.
Determinants of health
Health Canada provides us with this list:
Income and social status
Employment and working conditions
Education and ability to read (literacy)
Childhood experiences
Physical environments
Social supports and coping skills (having “peeps” to help you manage)
Healthy behaviours
Access to health services
Biology and inherited family traits (genetic endowment)
Whether you are a man or a woman (Gender)
Culture
Race or Racism
During my nearly three decades in health care, I have identified a few more to add:
Access to good food (Food security)
What gives you peace (Spirituality)
How you handle stress (Emotional intelligence)
Ability to make and communicate your own decisions (Mental capacity)
How you celebrate the creator (Religious commitment)
Other organization have even included:
Behaviours you chose
Quality of relationships
Random events
The Canadian healthcare system – what you don’t have to pay for – helps with some of these things in the list above, but almost always only when you become ill (or have a baby). So this means that your visits to the family doctor (who is usually assigned not chosen), most diagnostic services, specialist appointments, and hospital visits are what is government funded. To be sure, you only get what is available – when available – in your area which, and many times you have to wait months to specialist appointments or tests to help figure out what is wrong with you. How long have you had to wait to see a dermatologist, or a neurologist, or a gynecologist?
Your real-life options
Life does not follow a plan, and certainly many more events occur that affect our feeling of comfort, courage, and safety. The determinants of health list does a pretty good job of covering the majority of life’s highlights, but here’s the thing…many if not most of the resources that will benefit you are NOT covered under a publicly funded system. This is a good-bad news moment: yes it means you will have to pay for what you want, but you get to pay for WHAT you want. You get to select your care provider, your genre of care, your comfort level of service, on your schedule, and you get to put into action what makes sense to YOU.
Here are some of the gaps in our public health care system that I have seen. It is interested to look at deficits alongside the “determinants of health” (listed above). You may want to sit down for this…here you go:
Income and social status services NOT covered
Budgeting for financial wellbeing
Understanding how to live beyond just paycheque to paycheque (aka. Financial coaching)
Skills to identify social bias and to foster respectful relationships in our workplaces and in our communities
Employment and working conditions services NOT covered
Job preparedness
Job placement (outside of Employment Services)
Teaching respect of fellow employees and employers to increase workplace health and enjoyment
Education and literacy services NOT covered
Post-secondary education – not in Canada ‘eh
Educating about the determinants of health, so it’s not a secret
Teaching people how to talk face to face and how respectful communications contributes positively to society
Childhood experiences that may need but are NOT covered
Mental health services for children outside the school system
Mental health services for adults of childhood abuse
Parental preparedness to reduce negative impact on children and stress on parents
Non-judgmental support for under-prepared parents, especially when parenting alone
Teaching children respectful behaviours and solutions for disrespect
Physical environmental benefits that are NOT covered
Access to safe housing
Exposure to sunlight and fresh air
Protection of UV skin damage as a cancer prevention at the workplace
Understanding the influences of your environment on your health
Social supports and coping skills that are NOT covered
Learning to live alone after loss
Access to non-critical support to prevent escalation of a harmful event
Conflict resolution BEFORE harm
Acceptance of various family units and singleness (at any age) in society and understanding the negative impacts of exclusion
Healthy behaviours that are NOT addressed
Physical activity and nutrition guidance on a one-on-one basis
Teaching self-respecting behaviours
Learning personal safety and protective skills
Understanding DIS-respect and how it can influence health
Understanding the impact of sexuality on wellness
Including sexual health in treatment care
Chronic disease state management outside of prescription therapy
Access to health services that is NOT available
Transportation to appointments
Social supports to assist in navigation (outside of cancer treatment)
Covering of medical devices like monitoring devices, compression wear, specialty garments for rehabilitation post-cancer or post-surgery
Chronic pain manage other than through prescription therapy
Cannabis counselling for medical conditions
Biology and genetic endowment factors that are NOT covered
DNA testing for genetic predispositions for disease detection
Discussion about mitigating risk factors with lifestyle modifications
Treatment options based on DNA assessment
Physiotherapy (outside acute care)
Occupational therapy
Gender issues that are NOT covered
Identity validation and support
Gender specific health care during the lifecycle
Cultural Issues that are NOT addressed
Cultural sensitive acknowledgements and adjustments to care
Language translation
Access to Naturopathic Medicine, Traditional Chinese Medicine, Ayurvedic Care, or other culturally sensitive practitioners
Race / Racism attention needed
Unilateral access to care and expertise
Food security that is insufficient
Access to healthy and affordable food
Skills to prepare meals and store food
Understanding food sensitivities and their links to illness
Spirituality that is NOT addressed
Inclusion of spiritual influences during care
Documenting to preserve continuity of individual care
Emotional intelligence that is ignored
Addressing emotional spectrums and teaching skills to improve quality of life
Understanding and incorporating emotional influencers to help detect illness
Mental capacity that is NOT attended to
Awareness of abilities and capacity of skills training to increase quality of life
Religious commitment that is NOT looked at
Acknowledging religious influences and potential politics involved
Parameters of care that may be effected
What now?
If we can agree that health is complex and that our universal health care system does not address all that determines the state of health or illness, then here is the question:
“Who IS taking care of the rest?”
ANSWER:
“It’s your house, your home, your body – ‘til death do you part. Grab it, know it, and understand it.
Own your health…no one else can do it better.”