Artifacts and musings throughout HS 3250G

A Current Event Reflection

I read an article on BBC News Wales today titled “13,000 cancer deaths  ‘can be prevented'” (found at http://www.bbc.co.uk/news/health-21299550).  The World Cancer Research Fund ran a study on public conceptions about cancer and evidently 28% of Britons believe that there isn’t anything that can be done to prevent cancer (BBC News). They found that there were a lot of myths surrounding what causes cancer and prevention and proposed that they government take immediate action to improve public knowledge and increase awareness about actions they can take to prevent cancer and to eradicate the myths. Without such action, the WCRF posited that there could be up to 6 million preventable cancer deaths per year by 2025 (BBC News).

This piece relates to health promotion because of the fact that it entails public health promotion programs but also because of the fact that the common myth is that cancer is a condition that affects developed nations. This is completely untrue- cancer is a world-wide killer. However, through proper sun protection, being active and eating healthy, so many cases of cancer could be prevented but people don’t realize this. As such, governments need to immediately develop promotion strategies that partner with existing ones about activity and proper diet and tailor them to be more effective in directly addressing the needs of the population in a way that is manageable for these people to affect the healthy changes needed. Millions of health care dollars are already being spent dealing with the health effects that occur from not being active or eating well (i.e. obesity leading to coronary heart disease and diabetes), however to learn that by eradicating obesity, we could also be cutting down on cancer deaths, makes the issue seem that much more important in terms of health promotion. Getting the public educated is a major first step in the cancer prevention goal because cancer itself is often a major motivator for change. People are terrified of it and everyone has been touched by cancer in some way.

This article stuck out to me as being important as my grandfather recently passed away from colon cancer, after having beaten prostate cancer several years before. Cancer research is a huge issue in medicine and receives a lot of attention and I believe that cancer prevention should receive equal focus in the media because it is extremely important.

I wanted to reflect on the first meeting that my CSL group had with our community partner, Western Heads East.

Firstly, I am so excited that for our involvement in this project we will have the opportunity to learn Swahili, which is something I have always wanted to do. It was also an awesome discovery that one of the members of our group is already fluent in Swahili as she was born in Tanzania.

We began the meeting by learning about the foundations of Western Heads East and I was amazed at how far reaching the project is. I was previously unaware that in Tanzania alone they have about ten sites and they have a few in Kenya as well and are hoping to expand further through Africa. I also didn’t realized that they addressed issues like the transmission of waterborne diseases in their programs as I had previously thought that they were just about using yoghurt to combat HIV/AIDS. I also didn’t realize just how widespread this initiative was through Western in the fact that not only do they have the Faculty of Health Science involved through this class partnering with them but they also have Schulich involved and the Faculty of Education and also the affiliate colleges. Which is amazing considering that Western Heads East was only founded in 2002.

It was decided that since the two task group’s projects overlapped, we would combine to form one group and prepare one report at the end together. Bob, our community partner, was very pleased at the “synergy” and I really liked the use of that word because it felt very apt in the moment. The two groups came together very well and it seems so far that cooperation will be easy.

Towards then end, we had a discussion which reminded me of the McWilliam’s article and the other pieces on effective partnering. We discussed how to work cross culturally without silencing the people that we’re working with by asking them what they see themselves needing instead of us telling them how we intend to solve “their” problems. It was brought up that the issues that we’re working with as part of Western Heads East are not just “their” problems but the problems of the world and we also discussed having to let go of our own culture and be open to learning to foster the partnerships. We also discussed the idea of the “power of a single story” which one group member heard of in a TED talk and how the stories we tell people of travels shape others perceptions of that place so we all come into this with a “story” of Africa but we have to be prepared to let go of that story and write a new one as we learn from our experiences working with WHE.

What bothered me was the fact that the students who went on the intersession trip were upset by the African students always asking them for things, even at the end celebration when they had know each other for some time. Maybe it is because recently a professor for another class spoke to us about her anthropological work in very poor North American neighbourhoods and mentioned that people were always asking her for money but that we have to put aside things like this to be able to focus on the job at hand, but I didn’t understand how these students didn’t get that while they thought they were “poor students” they had so much more priviledge and more resources than some of these African students would ever have in their lives. It seemed spoiled to me that they didn’t get it. And I had a long discussion with my mother yesterday evening about foreign aid and Western priviledge and the complete lack of perspective and empathy or understanding that so many people, especially the upper class students at this school have towards people who are in different situations than them. It made me think that classes like this one, or at least a CSL credit, should be mandatory for all students so that maybe they would have somewhat a better sense of the world. For instance, I thought it was so mean that the intersession students talked about going on safari in front of students who, while having lived in Tanzania their entire life, had never been able to afford to do so but would have loved to. More must be done to teach youth to unpack their white-priviledged notions.

I was thinking a lot about the discussion topic from today’s class of social media’s impact on health and I disliked the coversation took a very negative turn towards people using the internet to become hypochondriacs and so on. I believed that social media can have a very positive impact on health promotion. For instance, people can become members of fitness support groups on Facebook or follow health experts on Twitter to find out facts about how to be healthy. There is also a huge health promoting trend on sites such as Pinterest where many people have boards devoted to the sharing of easy, time effective workouts and recipes for healthy food or tips on how to lose weight the healthy way or how to eat right or stay safe from the sun. Punchfork is an online recipe-sharing community that is coded to indicate allergens and dietary components and many of the main posters run health blogs and the recipes are health conscious. There are also a very wide array of health and fitness apps that track workouts or help you watch your calorie intake and see what nutrients are in the foods you are choosing (both are a function of the MyFitnessPal app)  and there are general wellness apps like Fig which allow you to set general wellness goals like to drink 8 glasses of water per day, to take the stairs instead of the elevator, or to sleep 8 hours per night. All of these tools put the power in the hands of people and yes, not everyone has access to the internet or a smartphone so that is a problem but for the general population who does, these are amazing tools and they are free.  Social media allows people to keep track of their health and also to keep up with health news through applications and social sites solely devoted to health promotion. It is a way for people to connect with people who have similar health promotion goals and views and gain social support. It is a clear example of creating power-within because social media promotes self-knowledge and a perceived control over one’s personal life.

Also, as for patients diagnosing themselves due to not being heard by physicians, I do believe this is somewhat the case. I do have WebMD app on my phone (mostly because it has first aid information) but I do sometimes check my symptoms online because there were two cases where physicans were not listening to what was actually wrong. The first was after my workplace accident. I went to the emergency room because we don’t have a family doctor and I was in Cambridge for the summer, the doctor hurriedly listened to me describe the accident and took x-rays of my ribs which he determined were likely cracked in a few places and said the pain in my shoulder was likely just temporary pulled muscles. I went back to a different emergency room, this time in my neighbouring town, three weeks later when I still couldn’t work  normally and the pain in my shoulder and spread down my arm and I couldn’t move my fingers in the hand on that side. This doctor spent more time examining my shoulder and listening to what I said and determined it was likely a rotator cuff injury and sent me to physio. However, after having physiotherapy and seeing a couple more doctors over the period of time between now and then (it’s been almost two years since my accident), I still have pain and limited range of movement and capabilities in my left arm. The internet tells me it could be a whole variety of things but I find it reassuring when doctors won’t give me any answers.

The other example is more simple: I found a lump in my neck and went to the doctor and told her that I had this lump and I’d been extremely tired lately to the point of falling asleep in all my classes. She said it was likely just a cold and sent me home. I went home and looked up my symptoms and found out it sounded a lot like I had mono. A week later when I was very ill, I went back to Student Health Services where a different doctor told me that I did in fact have mono.

Also, when it was mentioned about preventing accidents and taking prevention too far, it reminded me of the video I attached to this post which was sourced from Youtube and originally aired on Saturday Night Live, January 26

Source: Urafiki Kenya, http://www.urafikikenya.com/?page_id=114 Google images

So, the photo might be a bit of a cliche for “partnership” but at the same time, I do think it accurately represents what we are trying to do with global health promotion.

 

In An Introduction to International Health: Second Edition by Michael Seear, Chapter 19 explored how to go about developing an aid partnership, including how not to partner. I found it to be an extremely useful reading for a number of reasons. Firstly, it made me think of how Western Heads East (my Community Partner for the semester) approaches its mission and the partnership is exactly what my CSL group will have to be examining for our report! Needless to say, I will be referring back to this chapter a lot in the next several months. It also made me think about how I and my classmates approach group work in a variety of contexts, from class discussion to larger group projects, in this class and in others.  This chapter (and other chapters that have had to be read so far) expanded my knowledge on just how many foreign health promotion projects have been going on throughout modern history and I didn’t realize that there was such a wide variety of NGO/ aid organizations that one could possibly work for, as I want to when I am finished my education. The knowledge on partnering that I developed this week and will continue to develop this semester I hope will prove to be invaluable to my experiences in the work place and also in the Master’s program that I hope to pursue after my time at Western, which contains a lot of group learning and partnering in cross-cultural educational “pods”, often utilizing video-conferencing between students in Hamilton and in Maastrich.  However, I was surprised to see the comments on lack of post-departure training for aid workers and it made me think about whether people venturing out on Alternative Spring Break trips receive any training prior to leaving for their various service locations. I am not under the impression that they do, which made me question some of the effectiveness of the partnering and then I wondered if the Western Heads East interns receive training before heading to Africa, which is something I intend to investigate as part of the group report as I believe that it would have a huge impact on volunteers’ effectiveness. I was also disappointed to read about the lack of mental health supports in place for aid workers and the fact that so many develop various mental illnesses due to stress on the job. Needless to say, if it remains that way when I venture out into the workforce, I will want to keep that in mind so I can take care of myself in terms of my mental wellness when out in the international aid scene.

In relation to the Week 4 reflection questions that were posted in Sakai, I definitely think the values of autonomy and personal agency should be very much kept in mind when we are working with communities in the sense that people need to be able to feel like they are making their own choices and be treated like they are capable of changing and promoting their own health. I also think that cultural differences are extremely important in working with communities and that even means the distinct “culture” of that community, not neccessarily culture in the sense of different religions or race but how that community is different from any other community in the individual thoughts and actions of the people who make up that community and how they come together and interact. If we are sensitive to that, we can tailor a promotion strategy to truly meet the needs of the people by working with them so they feel a sense of ownership. I

It is this sense of ownership and responsibility that I think we can learn from McWilliam’s views on partnering as well. Empowerment is extremely important for health promotion as efficacy in a strategy increases when people have a say in what they believe they are capable of doing and taking control of their health without feeling like they are being blamed for their health status. It made me think of the example in the text of the attempt to erradicate a particular disease in Africa and Central America through a top-down strategy which largely failed until they got the people from these affected areas to take control and administer the program themselves with assistance from the “donor” agency. I definitely think that McWilliam’s views on partnering teach us that being relationship-centred provides a much deeper level of communication and understanding and reflects a much more holistic approach to health promotion in contrast with the tradition professional-patient dyad.

That being said, as per Narayan’s piece on empowerment, we  can empower members of a community. It definitely made it seem to some respects as if the empowerment was being done to the “poor people” instead of working with these groups so that they can empower themselves. Because in actuality, you cannot empower someone, they have to empower themselves. However, clearly the World Bank (who commissioned this article) does not view empowerment this way. But that is clear with their current organizational practices as well.

I would like to comment that I disliked the Narayan article very much because of its material-centred views and the referring to of people with little material wealth as poor people. I think there are more dimensions to leading a rich life such as personal satisfaction and interpersonal relationships. People with little material wealth can be very happy, sometimes much more so than people who are materially-rich and therefore should not unilaterally, almost condescendingly, be referred to as “poor people”. I found this article to be incredibly condescing and I very much hope it was an example of how not to approach health promotion as it even came off as somewhat imperialistic.

To Braverman and Gruskin, the difference between equality and equity in health is that equity is a broader term related to systematic issues in a wide socio-cultural sense related to health as a whole whereas equality refers more to a specific issue within equity. We should care about this distinction because in order to properly appreciate the meaning behind equality, we must look at the driving forces or causes of equity first. Equity provides a frame of reference for equality and without it, we cannot truly appreciate whether something is a fair or unfair inequality.

It should also be noted that the value of reflection in terms of evaluation of partnerships seemed to be one common to all of the articles on partnering in some form or another.

 

Sources:

McWilliam, C. L. (2009). Patients, persons or partners? Involving those with chronic disease in their care. Retrived from: https://owl.uwo.ca/access/content/group/9ac87e36-4b9a-46fa-a48d-31d8cfa910e8/Week%204%20-%20Working%20with%20Communities/patients%2C%20persons%20or%20partners%20involving%20those%20with%20chronic%20disease%20in%20their%20care.pdf

Narayan, D. (2007). Empowerment. Retrieved from: https://owl.uwo.ca/access/content/group/9ac87e36-4b9a-46fa-a48d-31d8cfa910e8/Week%204%20-%20Working%20with%20Communities/empowerment.pdf

Braverman, P. ,Gruskin, S. (2003). Defining equity in health. Retrieved from: https://owl.uwo.ca/access/content/group/9ac87e36-4b9a-46fa-a48d-31d8cfa910e8/Week%204%20-%20Working%20with%20Communities/defining%20equity%20in%20health.pdf

Seear, M. (2007) An introduction to international health. Toronto: Canadian Scholars Press Inc. P. 463-475

 

For class this week, we had to read the Ottawa Charter for Health Promotion (World Health Organization, 1986) and the Millenium Development Goals (United Nations, 2010) and while the goals seem respectable and well-meaning, they fall almost laughably short.

 

The Ottawa Charter was made in the mid-1980s, around 25 years ago. That seems like reasonable time to be able to enact the sort of changes that are declared to be essential for health promotion. And yes, I realize that political climate plays a huge role in how much gets done in government, let us take a look more specifically at what areas we are still lagging in after all this time.

“The fundamental conditions and resources for health are peace, shelter, education, food,
income, a stable eco-system, sustainable resources, social justice and equity. Improvement in
health requires a secure foundation in these basic prerequisites”. (WHO, 1986)

We seem to be doing fine on the peace front here in Canada, but on the other “prerequisites”, not so much. In London alone there are massive cuts to public housing funding constantly and the numbers of homeless people in Canada are growing what with the prolonged economic downturn. And as the Idle No More movement reminded us, there are places in our own nation that people are living in what can only be described as “third world” conditions. It is not health promoting to have people permanently living in tents.

While higher numbers than ever are pursuing post-secondary education, the costs of education are rising to the point where it will soon be unafforable for many. With the teacher strikes going on around the province and constant government cuts to education funding and the removal of public health nurses from school in terms of health education, especially in rural areas, education is beginning to suffer as well.

With the economy being in its current state, food bank use is at record highs across Canada and because of summer droughts, food prices have risen, especially on healthy choices like fresh produce. Income for most can hardly be seen as reliable when people are constantly being laid off in many sectors like finance and manufacturing, or at the very least having their salaries slashed in order to cut operating costs. And this is not the first recession since the Ottawa Charter was made.

With global warming on the rise and the Harper government’s decision to lift protective measures on thousands of lakes and rivers in Canada, it is impossible to say that we have a sustainable eco-system or sustainable resources.

And one only has to look at the statistics on women in the work place or the staggering numbers of rapes that go unreported per year in Canada to know that we hardly have equality for all or social justice. And that is just for one group, nevermind inequality that still exists towards people with disabilities, LGBTQ people and ethnic or religious minorities.

It would seem that not much has been done to ensure equal opportunities for health for all (WHO, 1986) when these huge social issues still exist and there are still massive disparities in access to care and living conditions amongst the population.

Also, as I have learned in two health studies courses in my time here at Western, health policy is not intersectoral by any means and is continually being downgraded on the agendas and being push to lower levels of government. Policies are convoluted and piecemeal at best due to poor knowledge translation and a clear lack of focus.

It is very clear that Canada has not honoured its “Comitment to Health Promotion” (WHO, 1986).

And then there are the Millenium Development Goals. Developed in 1995, the nations who signed onto this plan gave themselves 20 years to eradicate some pretty lofty goals: eradicate extreme hunger and poverty, primary education for all, gender equality and empowerment for women, reduce child mortality, improve maternal health, combat malaria, HIV/AIDS and other major world killers, environmental sustainability, and global partnership (UN, 2010).

First of all, global partnership is not going to be achieved when there are so many wars still being waged and so many sanctions on nations due to internal wars or actions that we disagree with.

As long as there are toxic levels of air pollution in China and an innumberable amount of other offences being committed against the environment currently, we are not going to reach the sustainability goals. Also, with 8 billion people on Earth and so many people against the idea of growing food in labs through genetic modification, we will never be sustainable- the carrying capacity of the Earth is just not high enough without artificial measures being taken.

Gender equality and empowering women is the one that disappoints me the most. With three years to meet the goal and this: http://thediplomat.com/2013/01/09/indias-women-problems-its-not-just-about-rape/ still needing to be pointed out, never mind this: http://www.rolereboot.org/culture-and-politics/details/2012-12-a-letter-to-the-guy-who-harrassed-me-outside-the-bar we are ludicrously far from equality for women, even in the so-called “first world”. There are still nations where women are being shot in the head for demanding the right to education (one of the Millenium Goals, might I add) and as long as language is still gendered and as long as rape still happens, whether it be through gang-rape on a public bus or date-rape at a frat party, women will never be truly equal. And that is a problem that cannot be fixed in three years. Why more progress hasn’t been made in 20 years is sickening and confusing to me.

As for the others, yes, it is nice to be able to point out that some progress has been made in a few nations. However, reaching 70% of a goal or a 90% reduction in something bad in three or four places mentioned is a) not 100% completion in these isolated examples with three years to go and b) forgetting about the other 200-odd countries in the world where far less progress has been made.

All I can say is the world needs to get its act together. These articles made me disappointed in humankind. History keeps repeating itself but no one seems to be paying attention to that fact.

 

Sources:

World Health Organization (1986). Ottawa Charter for Health Promotion. Retrieved from: https://owl.uwo.ca/access/lessonbuilder/item/8946065/group/9ac87e36-4b9a-46fa-a48d-31d8cfa910e8/Week%203%20-%20Global%20Health%20Promotion:%20foundational%20concepts%20and%20historical%20perspectives/WHO%20-%20ottawa%20charter%20for%20health%20promotion.pdf

UN Department for Public Information (2010). Millenium Development Goals at a Glance. Retrieved from: https://owl.uwo.ca/access/lessonbuilder/item/8946086/group/9ac87e36-4b9a-46fa-a48d-31d8cfa910e8/Week%203%20-%20Global%20Health%20Promotion:%20foundational%20concepts%20and%20historical%20perspectives/MDG%20fact%20sheet.pdf

Getting Started: Caught in a Web of Health Concepts

For the first class of Global Health Promotion 3250G, we were asked to draw a representation of what health meant to us. I chose to draw a mind map. Health is in the centre as the main concept and the sub-concepts came afterward. The main sub-concepts to me are mental health, equity, access to care, safety from harm, legalities, the absense of illness, and the ‘holistic’ view. The holistic view and the health as the absence of illness came to me from other classes that I have taken in Health Studies and that is what I have been taught as to what health should be considered to be. I thought of what health/lack of health depends on such as access to care and the social determinant of equity. And how due to equity issues, there is often reduced access to care. I thought that a main tenant of health is mental health as it is hard to maintain physical health if your mental health is suffering and vice versa. Mental health affects many areas of your life. I also thought of it because I personally have recently had some mental health struggles which has made me far more aware of the issues in mental health care and made me want to find out more about mental health care in other countries. My health care law class made me think of health in terms of legalities and how health has become more about the rights of the patient and less about what is in their best interests. It also made me think about the Charter of Rights and Freedoms in terms of medical rights and health care ethics. And safety from harm made me think of how health is affected by a person’s experiences and environment. If one lives in a dangerous environment or has experienced many mentally or physically harmful situations, that will change how they live. It could also affect their access to care. They could be experiencing harm due to systemic violence and inequity as well. What came to my mind most with safety from harm was freedom from sexual violence. After I graduate, I hope to become involved in an NGO that works to help rape survivors in countries where sexual violence is unbearably prevalent such as many African nations and India.

This is just a start to my adventures in global health and I cannot wait to see how my perceptions of health change as the semester progresses!