Although I have been employed in healthcare for over twenty-eight years, taking the Critical Foundations in Health Disciplines course through the Athabasca University allowed me to explore more in depth the complexities of health and healthcare systems. This experience has given me a greater understanding of the healthcare field and introduced me to new digital tools and methods of resource curation. I will try and summarize some of my greatest takeaways from this course and how I can apply it to my current role.

          A very helpful approach was to first gain a clearer understanding of what health is. According to the World Health Organization (WHO), health is defined as a state of complete physical, mental, and social well-being. This definition emphasizes that health encompasses not just the physical aspects but also the emotional and social aspects of well-being. To explore further, it is essential to understand the determinants of health. As described by the Public Health Agency of Canada, determinants of health refer to the various factors that influence the health of individuals and communities. These factors may include social, economic, and environmental conditions, such as income, education, employment, social support, and access to healthcare services. Additionally, influences like genetics, personal behaviors, and the physical environment play a crucial role in shaping health outcomes. Understanding these determinants is necessary for developing effective public health strategies and promoting overall well-being in society. To allow thorough examination of the impacts of these determinants, it is also helpful to discuss different models of health, which we also explored in the course.

          Health is a surprisingly complex concept which can be better explained using various models, each offering a unique perspective. For instance, the biomedical model of health focuses on the physiological aspects of health, emphasizing the importance of biological factors and medical interventions. This is the traditional model followed in western medicine. However, as stated previously, one must also consider determinants of disease, such as the social situation and environment and so the biopsychosocial model of health, which highlights the impact of social determinants, such as income, education, and community support, on overall well-being may also be helpful. In general, these models show that those who are less advantaged have worse health outcomes. Each model of health provides insights and can be utilized alone or in combination to provide a more comprehensive understanding.

          Although there are multiple models that can be used to explore the components of health and wellbeing, a multilevel model, also known as a hierarchical model, may be the best way to describe it. This type of model considers how individual level factors, like genetics and lifestyle, interact with group level factors such as socioeconomic status and environmental components, as well as with higher-level considerations such as healthcare policies and systems all interconnecting to influence health outcomes. The Social Ecological Model (SEM) is an example of a multilevel model of health that provides a framework for understanding how the various layers act together to influence health, both on an individual level as well as on a community level. An example of this concept is illustrated in the diagram below which depicts a four-level model that the Centers for Disease Control and Prevention created to show the factors affecting health using social ecological theory.

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CDC (2007)

The CDC model is utilized to help stakeholders identify a comprehensive list of factors that contribute to health problems with the hopes of developing strategies and actions at various levels aimed at making positive change.

       Utilizing these concepts or models can help us address the health outcome disparities in marginalized populations as well. Marginalized groups can include any peoples or populations that experience discrimination, unequal treatment, or exclusion, leading to imbalances of power and disadvantages, including but not limited to inferior health outcomes. A marginalized group that I encounter in my healthcare role as a director in rural central Alberta, is Indigenous people. We have explored how health is influenced by a multitude of components, or determinants, that are complex and interrelated and often overlap and that is true for Indigenous communities as well. However, it is evident that most health models do not meet the needs and realities of indigenous populations. Many of these populations face higher rates of chronic illnesses, mental health issues, and substance abuse due to the intertwined social and historical factors that exist. Part of the challenge is that the approach to health and wellness in western culture differs greatly from that of the traditions of Indigenous groups. Their model of health encompasses a much more holistic view, that includes spiritual and cultural components, as depicted visually by this model created by the First Nation Health Authority in British Columbia.

www,FNHA,ca

We must respect these differences and work together with Indigenous groups to find ways to integrate their traditional model of health with our more western styled models. Alberta Health Services, the organization that I work for, has begun a call to action to explore new ways of approaching and involving indigenous peoples in their own care. The goal is to create a new framework that relies heavily on working together. By doing so, the hope is to reduce the currently existing health inequalities within the province of Alberta.

          In addition to working with Indigenous peoples I also work within various rural communities, and these communities also experience a disadvantage with regards to health outcomes. Like with Indigenous populations, utilizing models can assist in gaining clarity around the causes of the disparities between rural and their urban counterparts. As discussed, multisystem models are a useful way to study healthcare systems, but since healthcare services are more difficult to provide in rural areas, the models used to describe them must also be unique to rural. Comparing the determinants of health in rural versus urban inhabitants, such as education, income, health behaviors, employment conditions, social supports and access to healthcare is crucial. As you can see in the image below, from the Rural Health Professions Action Plan (RhPAP) in Alberta, the factors are similar.

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​   RhPAP.com

Despite these similarities, research has shown that a disparity exists between the health of individuals living in these two different types of communities, in that rural inhabitants are on average less healthy than their counterparts in cities. To better understand this phenomenon, the Canadian Institute for Health Information (CIHI) created a Rural Health Systems Model that includes a set of determinants that better describe the uniqueness of rural health systems. There are individual components including age, gender, socioeconomic status, language and culture but it also includes things such as geography, infrastructure, population fluctuations, available resources, and governance. Something as seemingly simple as having a functioning vehicle can greatly impact an individual’s ability to access healthcare services for example. This model can assist groups in dissecting the issues experienced in rural healthcare, with the aim of finding solutions. One group that is aware of the existing disparities, and is solutions focused, is the Rural Healthcare Professionals Action Plan or RhPAP. RhPAP is funded by the Government of Alberta, and their mandate is to achieve greater access to safe, high-quality health care for rural Albertans in their own communities. They support this objective by providing educational opportunities and financial support to physicians and other rural healthcare providers. They are not only advocates for the current rural healthcare workforce, but they play a crucial role in the attraction of new professionals to these communities. They provide Rural Community Consultants (RCCs) who sit on community-based local committees whose primary focus is the attraction and retention of healthcare professionals. I work closely with these consultants and together we have provided some exciting events for high school and post-secondary students to help motivate them to consider a career in health care, thereby growing the workforce locally. However, improving healthcare access in rural areas requires a multifaceted approach, involving

geographical, professional, and technological solutions. My goal is to work collaboratively with all stakeholders to ensure that everyone, regardless of their location, has access to the healthcare they deserve.

          The information I have gleaned from the Critical Foundations in Health Disciplines course, and briefly summarized in this blog, has provided me with new knowledge and insights that I plan to incorporate and utilize in my current role.

References

          Government of Canada. (2024). What is Health. Canada.ca. URL: https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health-approach/what-is-health.html

          Public Health Agency of Canada. (2024) Social determinants of health and health inequalities. Government of Canada. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

          Swannack, M., & Appleby, B. Models of Health. SimpleMed – Medical Learning, Simplified. URL: https://simplemed.co.uk/subjects/population-and-social-science/models-of-health#abstract

          Agency for Toxic Substances and Disease Registry. (2015). Models and Frameworks for the Practice of Community Engagement. The Social Ecological Model of Health. www.atsdr.cdc.gov. URL: https://www.atsdr.cdc.gov/communityengagement/pce_models.html

          Jungcurt, S. (2022). Who is being left behind in Canada? International Institute for Sustainable Development (IISD). www.iisd.org. URL: https://www.iisd.org/articles/insight/who-being-left-behind-canada

          Chino, M., & Debruyn, L. (2006). Building True Capacity: Indigenous Models for Indigenous Communities. American Journal of Public Health. 96(4), 596-599. doi/10.2105/AJPH.2004.053801

          Fish, S. (2019). Integrating two models of health. How systems are changing to meet the needs of Indigenous peoples. Applied Health Sciences news to you. University of Waterloo. URL: https://uwaterloo.ca/applied-health-sciences-news-to-you/news-you-2019/feature/integrating-two-models-health

          Williams, K., Potestio, M.L., Austen-Wiebe, V. (2019). Indigenous Health: Applying Truth and Reconciliation in Alberta Health Services. Canadian Medical Association Journal. 191(Suppl 1), S44-S46. DOI: https://doi.org/10.1503/cmaj.190585

          Rural Health Professions Action Plan. (2024). RhPAP U. rhpap.ca. URL: https://rhpap.ca/rhpap-u/

          Canadian Institute for Health Information. (2024). Rural Health Systems Model. www.cihi.ca. URL: https://www.cihi.ca/en/rural-health-systems-model