Throughout my academic journey in the MHST/NURS 601 Philosophical Foundations of Health Systems courses, I have had the opportunity to learn multiple concepts for understanding health and the healthcare system in Canada. These concepts include: the determinants of health, the multiple levels of influence on health, chronic disease prevention and management, vulnerable populations as well as current and emerging health issues and the future of health care. The integration of these concepts will be used to analyze the key health issue of diabetes and the Indigenous population in Canada.
Diabetes – A Chronic Disease
According to the Government of Canada (2017), diabetes is, “a chronic condition that stems from the body’s inability to sufficiently produce and/or properly use insulin which the body needs to use sugar as an energy source” (“Diabetes”, 2017). Diabetes Canada (2018), explains that, “insulin is a hormone that controls the amount of glucose in the blood. Diabetes leads to high blood sugar levels, which can damage the bodies’ organs, blood vessels and nerves” (“Types of Diabetes”, 2018). Diabetes Canada (2018) further explains that, having high blood glucose levels can cause diabetes related complications such as: chronic kidney disease; foot complications; non-traumatic lower limb amputation; eye disease which can lead to blindness, heart attack, stroke, anxiety, nerve damage and even erectile dysfunction (in men) (“Types of Diabetes”, 2018). These diabetic related complications can become very serious and even life threatening especially if proper management to control this disease is not taken.
Below is a quick video provided by 3D4Medical describing diabetes.
Source: [3D4Medical]. (2017, April 29). What is Diabetes? [Video File]. Retrieved from https://www.youtube.com/watch?v=_hAKAF5Ex1s
In Canada, diabetes is one of the most common serious chronic diseases that is currently on the rise (“Chapter 1- The Burden of Diabetes in Canada, 2011). In fact, Diabetes Canada (2018) states that the estimated prevalence of diabetes in 2015 was 3.4 million people and will increase to 5 million in the year 2025, that’s 12.1% of the total Canadian population. Furthermore, the estimated prevalence of prediabetes in Canada was 5.7 million in 2015 and will increase to 6.4 million in 2025 (“Diabetes Statistics in Canada, 2018). The Government of Canada expresses that diabetes poses a challenge not only to those living with the disease but also to their families, communities and the health care system on a whole (“Chapter 1- The Burden of Diabetes in Canada, 2011).
Table 1: Diabetes Statistics in Canada
Source: “Diabetes Statistics in Canada”. (2018). Diabetes Canada. Retrieved from www.diabetes.ca/how-you-can-help/advocate/why-federal-leadership-is-essential/diabetes-statistics-in-canada
Does Having Diabetes = Being Unhealthy?
Now, just because one has diabetes does not mean that they can’t live a long, happy, active life and be healthy. The Government of Canada emphasizes that although diabetes can lead to serious complications and premature death, those who have this disease can take the necessary steps needed to control and lower the risk of complication (“Diabetes”, 2017). The WHO’s definition of health as, “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 2018) is misleading. Complete is defined as “having all necessary parts, elements or steps” (Merriam-Webster, 2018). Huber (2011) expresses that, “the requirements for complete health would leave most of us unhealthy most of the time...as using the word “complete” in the definition of health makes it impracticable as this word is not operational or measurable” (Huber, 2011). For example, because ones’ body does not sufficiently produce or use insulin in the manner it is supposed to, thus missing the necessary steps to regulate blood glucose, then that would mean that someone with diabetes is automatically deemed unhealthy. Chris Kresser suggests a more compelling definition of health as, “the ability to live your dreams” (Kresser, 2015). As this definition focuses on quality of life and a way for one to be in the world regardless of one’s circumstances rather than referring to the absence of pain, discomfort or disease (Kresser, 2015).
What Determines and Influences the Development of Diabetes?
The Social Determinants of Health
The Government of Canada (2011) explains that “at every stage of life, health is determined by complex interactions between social and economic factors, the physical environment and individual behaviour… referred to as social determinants of health (SDOH). They do not exist in isolation from each other. It is the combined influence of determinants of health that determine health status (“What Determines Health, 2011). The SDOH consists of: income and social status; social support networks; education and literacy; employment/ work conditions; social environments; physical environments; personal health practices and coping skills; healthy child development; biological and genetic endowment; health services; gender and culture (“Social Ecological Model”, 2011).
Connecting the SDOH and Risk Factors for Diabetes
Diabetes Canada (2018) lists the risk factors for diabetes, which I have stated below:
“Having a family member with the disease;
Being of Aboriginal, Hispanic, South Asian, Asian or African descent;
Having health complications associated with diabetes, such as: High blood pressure; High cholesterol level; Polycystic ovary syndrome; Acanthosis nigricans; Obstructive sleep apnea; Psychiatric disorders, schizophrenia, depression, bipolar disease
Having given birth to a baby that weighed more than 9 pounds at birth or having had gestational diabetes (disease during pregnancy);
Having been prescribed a glucocorticoid medication; and
Being overweight” (Diabetes Canada, 2018).
Given these risk factors one can definitely see how they fall under one or more SDOH.
The World Health Organization (WHO) describes that these SDOH are, “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power, and resources at the global, national and local levels and are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries” (WHO, 2018).
The Indigenous Population
A vulnerable group that has experienced health inequities that I have looked at closely would be Canada’s Indigenous population, which is identified above as having risk factors for diabetes. An article by Cameron, Plazas, Salas, Bearskin and Hungler (2014) explains that a vulnerable population refers to, “those individuals who experience a heavier burden of disease and suffering than other population groups” (Cameron, Plazas, Salas, Bearskin & Hungler, 2014).
So how is the Indigenous population considered a vulnerable group for diabetes? The Ontario Ministry of Health and Long-Term Care (OMHLTC) states that the Aboriginal population are diagnosed with diabetes at a younger age compared to the non-aboriginal population, and female Aboriginals experience higher rates of gestational diabetes then non-aboriginal females. Additionally, complications of diabetes are more frequently seen among the Aboriginal population in comparison to the non-Aboriginal population (“Aboriginal Diabetes Program Funding Information for Applicants”, 2013). The Public Health Agency of Canada (PHAC) depicts the prevalence of self-reported diabetes among the Aboriginal and Non-Aboriginal populations of Canada in the table below:
Table 2: Prevalence of self-reported diabetes among First Nations, Inuit, and Metis individuals ages 12 years and older, Canada, 2006, 2008-2010, 2009-2010
Source: “Diabetes in Canada”. (2011). Public Health Agency of Canada, Diabetes in Canada. Retrieved from www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/pdf/facts-figures-faits-chiffres-eng.pdf
The Social Ecological Model
Diabetes Canada (2018), found that the rates of diabetes are 3 to 5 times higher in First Nations, due to barriers to care (“Diabetes Statistics in Canada”. 2018). In fact, 39% of First Nation adults indicate that they have less access to health services compared to the rest of the Canadian population (“The Health of Indigenous People in Canada, 2017). Furthermore, The National Collaborating Center for Aboriginal Health (2013) indicates that, “Colonialism and resulting economic, social and cultural marginalization has had a huge impact on the health of the Indigenous people (“An Overview of Aboriginal Health in Canada, 2013).
A multi-level model that can be used to evaluate the factors that influence diabetes in the Indigenous population is the Social Ecological Model (SEM). This model is a “theory-based framework for understanding the multifaceted and interactive effects of personal and environmental factors that determine behaviours, and for identifying behavioural and organizational leverage points and intermediaries for health promotion within organizations (“Model 1: What are the Social Ecological Mode”, 2004). This model consists of five hierarchical levels which include the: individual level, interpersonal level, community level, organizational level as well as the policy/enabling environmental level (“Model 1: What are the Social Ecological Mode”, 2004) and is depicted in figure 1 below.
Source: “Social Ecological Model”. (2011). Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion. Retrieved from http://www.cdc.gov/cancer/crccp/sem.htm.
Diabetes Prevention and Management for the Indigenous Population
There are several programs that aim to address the prevalence of diabetes in the Indigenous population. They include:
Aboriginal Diabetes Initiative
The Aboriginal Diabetes Initiative (ADI) is a program that, “focuses on increasing awareness of diabetes among First Nations, Inuit and Metis in order to reduce the prevalence and incidence of diabetes in these high-risk communities… The ADI supports over 600 programs for Aboriginal people living with diabetes in Canada” (Diabetes Canada, 2018).
Ontario’s Aboriginal Diabetes Strategy
The Ontario’s Aboriginal Diabetes Strategy is a, “long-term approach to diabetes prevention, care, treatment, education, research and coordination, developed by the Government of Ontario in Collaboration with Ontario Aboriginal organizations and independent First Nations” (Diabetes Education Program, 2018).
Southern Ontario Aboriginal Diabetes Initiative
The Southern Ontario Aboriginal Diabetes Initiative has programs and services that focus on health promotion, disease prevention and diabetes management using both Aboriginal and western approaches such as: traditional medicine, teachers and healers (“Diabetes: Strategies and Prevention”, 2012).
Incorporating the Indigenous Populations’ Concept of Health
Although one program (The Southern Ontario Aboriginal Diabetes Initiative) introduces traditional medicine, teachers and healers for disease prevention and management of diabetes for the Aboriginal population, there is still a need for understanding and incorporation of the Indigenous populations’ concept of health and healing as they are integrated in their culture and can aid in treatment and improvement of health outcomes. The Indigenous population uses the medicine wheel (depicted in figure 2 below) as it symbolizes, "the interconnection of all life, the various cycles of nature, and how life represents a circular journey (“The Health of the Indigenous People in Canada”, 2017). Some concepts of health and healing for this population include: the use of sweetgrass, tobacco, cedar and sage; healing circles; purification lodges; medicine dances; pipe ceremonies and potlach's (“The Health of the Indigenous People in Canada”, 2017).
Figure 2: The Medicine Wheel
Source: “The Health of Indigenous Peoples in Canada”. (2017). University of Ottawa. Retrieved from www.med.uottawa.ca/SIM/data/Vul_Indigenous_e.htm
Click the link below for more detail on these concepts: www.med.uottawa.ca/SIM/data/Vul_Indigenous_e.htm#medicines
Conclusion
Throughout this analysis, we have explored some of the determining factors that increase the risk of developing diabetes, a chronic in Canada with increased prevalence in the Indigenous population. The lack of availability to health services is one of the many health inequities experienced by this population and is a current and emerging health issue that needs to be understood and addressed (“Ontario’s Population Determinants of Health, 2014). With a better understanding of the social determinants of health that impact this population along with the levels of influence on health and their concept of health and wellness, healthcare policies and programs can be tailored towards this populations specific health needs in order to reduce their incidence of diabetes.
References:
[3D4Medical]. (2017, April 29). What is Diabetes? [Video File]. Retrieved from https://www.youtube.com/watch?v=_hAKAF5Ex1s
“Aboriginal Diabetes Program Funding Information for Applicants”. (2013). Ontario Ministry of Health and Long Term Care. Retrieved from https://www.nslijhs.com/Aboriginal-Diabetes-Program-Funding-Information-for-Applicants
“An Overview of Aboriginal Health In Canada”. (2013). National Collaborating Centre for Aboriginal Health. Retrieved from https://www.ccnsa-nccah.ca/docs/context/FS-OverviewAbororiginalHealth-EN.pdf
Cameron, B.L., Plazas, M., Salas, A.S., Bearskin, L.B., & Hungler. K. (2014). Understanding Inequities in Access to Health Care Services for Aboriginal People: A Call for Nursing Action. Advances in Nursing Science, 37(3), E1-E16. Retrieved from https://cloudfront.ualberta.ca/-/media/nursing/about/docs/understandinginequalities.pdf
“Chapter 1- The Burden of Diabetes in Canada”. (2011). Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/chronic-diseases/reports-publications/diabetes/diabetes-canada-facts-figures-a-public-health-perspective/chapter-1.html
Kresser. C. (2015, November 3). What is Health? Retrieved from https://chriskresser.com/what-is-health/
“Complete”. (2018). Merriam-Webster. Retrieved from https://www.merriam-webster.com/dictionary/complete
“Diabetes”. (2017). Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/chronic-diseases/diabetes.html
“Diabetes Education Program”. (2018). Government of Ontario. Retrieved from https://www.ontario.ca/page/diabetes-education-program
“Diabetes in Canada”. (2011). Public Health Agency of Canada, Diabetes in Canada. Retrieved from www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/pdf/facts-figures-faits-chiffres-eng.pdf
“Diabetes Statistics in Canada”. (2018). Diabetes Canada. Retrieved from www.diabetes.ca/how-you-can-help/advocate/why-federal-leadership-is-essential/diabetes-statistics-in-canada
“Diabetes: Strategies and Prevention”. (2012). Ontario Ministry of Health and Long term Care. Retrieved from http://health.gov.on.ca/en/common/ministry/publications/reports/diabetes/diabetes.aspx#impact
“Model 1: What are the Social Ecological Model (SEM), Communication for Development (C4D)?”. (2004). Unicef. Retrieved from https://www.unicef.org/cbsc/files/MNCH_Guide_Module_1.docx
“Ontario’s Population Determinants of Health”. (2014). Public Health Ontario. Retrieved from http://www.publichealthontario.ca/en/DataAndAnalytics/Maps/Pages/Social-Determinants-of-Health.aspx
“Social Ecological Model”. (2011). Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion. Retrieved from http://www.cdc.gov/cancer/crccp/sem.htm.
“The Health of Indigenous Peoples in Canada”. (2017). University of Ottawa. Retrieved from www.med.uottawa.ca/SIM/data/Vul_Indigenous_e.htm
“Types of Diabetes”. (2018). Diabetes Canada. Retrieved http://www.diabetes.ca/about-diabetes/types-of-diabetes
“What Determines Health”. (2011). Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
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