(Health Canada, 2001).
For the partner portion of this week’s research, I paired up with Caroline as she lives in Ontario and I live in Newfoundland and Labrador (NL). Caroline had focused on the socio-ecological model with a focus on intimate partner violence, where as I focused on population health promotion: an integrated model of population health and health promotion with a focus on chronic illness, as we have a very high prevalence of chronic illness in NL. As I had remembered from being in nursing school in Ontario from 2007-2011 (wow, that seems like forever ago) I knew even then that Newfoundland and Labrador were so far behind Ontario. Through my MHST601 course learnings, correspondence with classmates and reading their posts and resources, my feelings have been solidified that NL is so far behind in health care, particularly in population and public health.
Having not read very much about the social ecological model I had to do some exploration on it for this post. The social ecological model looks at health broadly while focusing on what might impact one’s health. This style of looking at health, was brought to light in 1947 by the World Health Organization to include physical, mental, and social well-being (World Health Organization, 1947). The social ecological model theorizes that health is affected by relationships between the individual, the community, and the physical, social, and political environments (Israel et al., 2003).
The CDC developed a four-level model of the factors affecting health that is grounded in social ecological theory.
-The first level of the model includes individual biology and personal characteristics such as age, education, income, and health history.
-The second level of the model looks at relationships, such as friends, partners, and family members, all of whom influence a person’s behavior and contribute to his or her experiences.
-The third level, community, looks at where people have these relationships, such as schools, workplaces, and neighborhoods, and seeks to identify the characteristics of these settings that affect health.
-The fourth level looks at the broad societal factors that favor or impair health, such as cultural and social norms, economic, educational, and social policies that help to create, maintain, or lessen socioeconomic inequalities between groups (CDC, 2007).
As Caroline was focusing on intimate partner violence (IPV), which I wholeheartedly believe is a very important topic, but one I am not in good knowledge of, I looked at Caroline’s resources. The United Nations defines violence against women as "any act of gender-based violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life." (United Nations, 1993). If you look at the social ecological model you can see how intimate partner violence fits into it in terms of the levels. When I sat back to think on this more, I was able think of examples from each level in relation to IPV:
· Individual Risk Factors: Being a victim of physical or psychological abuse as a child increases risk of either being abused or being an abuser as an adult and/or living in a low income situation.
· Relationship Factors: Power struggle within a relationship; dominant, controlling partner.
· Community Factors: Lack of support group and community/neighbor relationships, having no outlet for anger or hurt such as a gym or activity class.
· Societal Factors: Absence of robust health, educational, economic, and social policies/laws on IPV or support for those experiencing violence.
(CDC, 2020). “Ontario uses a population health approach to plan health services that meet the health needs of the entire community. A population health approach focuses on improving the health of all people, regardless of social, economic, and/or environmental conditions”. (Public Health Ontario, 2018).
The population health promotion model looks at the “what”, “how” and “who” to improve health. The “what” focuses on what needs to be done to improve population health, while focusing on the health determinants. The “how” is how this will this be done using inclusive policies. An example would be The Ottawa Charter for Health Promotion. The “who” (stakeholders) are those you need to work with in various levels of society. Cooperation between individuals and groups needs to include a broad set of strategies to create positive change that will be sustainable. “(Government of Canada, 2001).
“In Newfoundland and Labrador, primary health care is typically a person’s first point of contact with the health care system. It encompasses a range of community-based services essential to maintaining and improving health and well-being throughout an individual’s entire lifespan. It includes services that promote health and wellness, prevent illness, treat health issues or injuries, and diagnose and manage chronic health conditions”. (Department of Health and Community Services, 2015). Newfoundlanders and Labradorians have the worst life expectancy, highest death rates from cancer, heart disease and stroke, and a very large senior population living with chronic illness (Health Accord, 2020). With all of this illness since 1981 health care spending has increased by 232%, while social spending has only increased by 6% (Health Accord, 2020). Think about how much money could have been spent on health promotion and prevention by educating people on healthy eating, exercise, managing illness, and providing them with resources to improve their health.
(Health Accord, 2020).
Centers for Disease Control and Prevention. The social-ecological model: a framework for prevention. Atlanta (GA): Centers for Disease Control and Prevention; 2007. Retrieved from https://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html.
Department of Health and Community Services. (2014). Healthy People, Healthy Families, Healthy Communities: A Primary Health Care Framework for Newfoundland and Labrador 2015-2025. St. John's, NL.
Health Accord Newfoundland and Labrador. (2020). Health Accord for Newfoundland and Labrador: A 10-year health transformation. St. John's, NL.
Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Annual Review of Public Health 1988;192:173-202.
Public Health Ontario, Strengthening a Population Health Approach for Health System Planning (2018).
The World Health Organization. (2020). Basic Documents (Forty-ninth edition).
United Nations. Declaration on the elimination of violence against women. New York : UN, 1993.
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