Wednesday, December 15, 2010

Good Health is related to poverty and education

Yes, we know that good health depends upon education, and social advantage. I have written about the differences between death and a good death. Sometimes it is a function of rural vs. urban issues, as in my post about a 'good death'.

I remember sitting in my Foundations of Palliative Care Course with a young nurse. She stated that everyone has equal opportunities for good health care. I managed not to argue with her. I'd seen too many situations as a Meals on Wheels volunteer: poor nutrition, addictions, lack of information about medications. I've seen self-neglect, when a senior gives up all hope and sinks into a morass of depression, drinking, drugs. In a case of elder abuse, he allowed a neighbour to grow weed in his basement, until a cop, volunteering for Meals, found it and all hell broke loose.
10:30 a.m. on Wednesday

Yes, chronic diseases, many preventable, are a function of eating well, refraining from smoking, getting exercise, keeping your weight in control, socializing, keeping in control of cholesterol levels, keeping medications under control, keeping alcohol in moderation.

 It is also a function of Primary Health Care Professionals understanding their jobs and knowing the difference between respecting privacy, and stepping up in the best interests of a client.

Unfortunately, those with social/emotional issues, alienated from adult children, alone, in debt, these are the people who end up in depression. I know, having been in serious depression after my parents died, that you cannot look after yourself in this situation. It takes caring, committed, educated friends to look after you. Not people who will bring you alcohol and cigarettes.

It is as simple as health care workers respecting that self-neglect is as bad as elder abuse. Health care workers who listen to a senior and allow them to sit in their filth since the senior refuses to go to hospital. At this point, they are beyond making sense.

Arguing with a CCAC outsourced worker (I think it was a physiotherapist) who refused to call an ambulance when the client greeted us not wearing pants, with diarrhea, and having consumed much of his pill pack, despite the day being young. The senior, fuzzy with beer, spilled on his bedroom floor, at 10:30 in the morning.

I think it is up to the care staff to be better trained. I believe that interventions would have prevented this man from getting dehydrated and ending up in hospital. The pain meds, for a broken arm a year previous, were renewed by a doctor 200km away, sight unseen, the man was addicted. It must have been easier for the doctor to simply say yes, without even speaking to the patient.

Social determinants of health are a function of health care workers who are impotent, and unable to respond to clients, due to a misunderstanding of FIPPA and PHIPA. (FIPPA is an act cited by many health care workers when choosing not to divulge health care concerns. I have written about this before. The medical profession doesn't get it. PHIPA precludes FIPPA when it is a safety issue.) There comes a time when intervention is the only response. Why should a client, in this day and age, seen by a doctor, to die from renal failure. This same senior who has had gangrene, due to diabetes, and had a foot amputated, and the other leg amputated from the knee.
  •  Canadians with the lowest incomes are more likely to suffer from chronic conditions (diabetes, arthritis and heart disease)
  • Live with a disability
  • Be hospitalized for a variety of health problems
  • Have many mental health issues and to die earlier
  • Twice as likely to use health care services as those with the highest incomes. 
  • In 2010 the estimated health care expenditure in Canada is $192 billion. An estimated 20% of that cost may be attributable to income disparities. 

Stepping It Up: Moving the Focus from Health Care in Canada to a Healthier Canada

Good health is not simply a matter of diet and exercise,” says John G. Abbott, CEO of the Health Council of Canada. These things matter, but research shows that other factors such as our income, employment, home and work environment, and social relationships have a stronger impact, on our health and well-being.”

The report Stepping It Up: Moving the Focus from Health Care in Canada to a Healthier Canada indicates that health disparities play a significant role in health system costs. It states that ongoing spending on acute care and programs encouraging a healthy lifestyle is not enough to improve the overall health of Canadians, particularly those who live in or close to poverty.

 Stepping It Up: Moving the Focus from Health Care in Canada to a Healthier Canada

 Announcement | Fact Sheet


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