My journey through MHST 601, Critical Foundations in Health Disciplines has deepened my understanding of a range of concepts, issues and trends which are central to the health and wellbeing of the Canadian population. I have gained greater breadth and depth of health considerations impacting marginalized groups, individuals with chronic disease and indigenous peoples for example. This paper will highlight key learning from this course by integrating knowledge from the 13 units of study. Based on my current practice in mental health and my research interests, I chose to focus my course learning on the intersection of mental health, older adults, and population aging, which is a common thread throughout my blog posts and curated resources.
At the outset of the course, the Canada Health Act (CHA) was examined and critiqued for its outdated approach to public healthcare. The CHA is in desperate need of reform to sustain the pressures of the growing and aging population. According to the 2021 Census, people aged 85 and older are one of the fastest-growing age groups. By 2046, the population who are aged 85 and older could triple to almost 2.5 million people (Statistic Canada, 2022). As evidenced by my research, modernization must be a priority to accommodate this shift in population (Flood & Thomas, 2016). With respect to geriatric mental health, there are a myriad of compelling arguments calling for change. Some examples for modernization include re-defining what is meant by medically necessary/required services, broadening access to mental health care, extending coverage to allied health disciplines and emphasizing community health and wellness programs for older adults. Expanding access to quality mental health services and psychological support is critical in addressing the current mental health crisis, particularly in the older adult population (Health Canada, 2023). Older adults require increased funding to access mobility equipment, adaptive devices and technology, affordable day programs and mental health supports, virtual care, accessible transportation, as well as increased opportunities for community engagement. Unfortunately, the Canadian healthcare system is ill-prepared to deal with the aging population where older adults live meaningful and purposeful lives while aging with dignity (Health Canada, 2023).
What followed in our course learning was a deep dive into the definition of health, the key determinants of health and exploring various models of health. I was drawn to a definition from the French philosopher and physician, Georges Canguilhem’s and his conceptualization of health. The article, “What is health? The ability to adapt”, acknowledges the interconnectedness of health and one’s physical, psychological, and social environment. Canguilhem posited that human health cannot be separated from the health of the environment (The Lancet, 2009). To this end, Canguilhem offered a modest and practical definition of health, which is the ability to adapt to one’s environment. He believed that health should be defined by the person, not the doctor. Emphasis is placed on the individual to be self-determined in their health care choices, with the physician supporting this adaption. I found this view to be liberating and person-centred and acknowledges the complex determinants of health in a specific landscape (The Lancet, 2009).
As we moved through the course, focus was placed on the social determinants of health, which provided context to a vast number of health concerns. According to the World Health Organization (WHO), the social determinants of health (SDH) are defined as “the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life” (World Health Organization [WHO], n.d.). Common examples of SDH include income, social support, early childhood development, food insecurity, education, employment, social inclusion and non-discrimination, housing and gender (WHO, n.d.). These examples can influence health equity in positive or negative ways. Carter et al., (2023) explain, at the individual level, SDH account for 80% of the factors affecting health outcomes. This is a striking statistic that highlights the importance of understanding the totality of an individual in their environment.
In the article titled “Taking action on the social determinants of health in clinical practice: a framework for health professionals”, the authors discuss how clinicians can better understand and address causes of poor health. This article was packed with concrete actions for addressing inequities which go beyond the traditional medical model of identifying risk factors (Andermann & Clear, 2016). For example, depression and anxiety in older adults is often underrecognized and undertreated (WHO, 2023). Therefore, when working with an older adult, a physician could seek to understand hidden social issues by asking about their social history, available support networks, financial limitations, food insecurity, abuse etc. which can help identify social challenges and clinical red flags (Andermann & Clear, 2016). Physicians and allied health professionals can reduce barriers for hard-to-reach older adults by acting as a referral source and supporting community connections. Health care services could be provided for instance, outside of a medical clinic and take place in neighbourhood schools, community centres or religious organizations to increase accessibility. Health care professionals can be valuable advocates for social issues to improve equity-oriented care (Andermann & Clear, 2016).
In discussing models of health, I chose to focus on the Biopsychosocial (BPS) model of health, as it is well positioned to support a holistic framework to inform the diagnosis and treatment of various psychiatric illnesses. The BPS model is a holistic approach that acknowledges key determinants of health and the complex integration of biological, psychological, and social factors in the assessment, prevention, and treatment of diseases (Havelka et al., 2009). Philosophically, it is a way of interpreting how suffering, disease and illness are affected by multiple “organizational” levels from molecular to societal. At a practical level, it looks to the patient to understand subjective experiences, leading to an informed diagnosis centered around empathic and compassionate interactions (Borrell-Carrio et al., 2004).
To illustrate the BPS model, the journal article ‘Being well and wellbeing: better understanding of patient priorities in primary care’, describes a New Zealand study which discusses the downfall of the biomedical model and offers a biopsychosocial focus of healthcare. The patient-centered approach seeks to understand the patient as a whole-person which informs treatment goals in the context of wellness and wellbeing. Corin (2019) explains, “as we get older and have to face the reality of illness, disease and death, doctors are not well equipped to consider what wellbeing is for our patients. The experience and meaning of illness and suffering is widely variable” (p.90). It is imperative for doctors to understand a patient’s personhood by asking questions like ‘what does a good day look like for you?’ or ‘what does quality of life mean for you?’ or ‘what are you living for?’. This can help identify patient priorities beyond health status to get at what wellbeing means for patients. As someone who practices holistic, strengths-based approaches, I was enlightened to read the authors’ findings and suggestions for improving the patient-practitioner relationship in the context of better health outcomes.
To wrap up my learning on mental health and older adults, my research on vulnerable populations centered around mental heath within Indigenous communities with specific focus on the role of Indigenous Elders. “Elders are those identified by the community as possessing qualities such as leadership, wisdom, compassion, community devotion, and dedication to personal healing. Experiencing a connection with Elders can allow individuals to assert or reclaim cultural identity and counter the marginalization experienced by many Indigenous people in health care settings” (Tu et al., 2019, results).
Intergenerational relationships within indigenous communities play a significant role in transmitting knowledge, values and practices, which builds identity and strengthens mental health. Indigenous Elders have the capacity to foster intergenerational solidarity which promotes positive attitudes and behaviours and improves self-esteem and resilience (Viscogliosi et al., 2022). This mutually beneficial relationship between Elders and younger generations has a positive impact on the mental health outcomes of indigenous communities. The role of Elders should be considered when developing and implementing mental health and wellness programs to improve holistic approaches to care (Viscogliosi et al., 2022).
Our final unit of study encouraged out-of-the box thinking to identify a future trend within the Canadian health sector. I explored age-friendly communities and the intergenerational housing model. With a growing older-adult population, significant consideration needs to be given to supporting individuals in inclusive communities which help them thrive. Housing is an important social determinant of health and impacts many aspects of an individuals’ overall health status (Suleman & Bhatia, 2021). Unfortunately, as people age, they are more likely to live alone and are at risk of certain health concerns. An intergenerational housing model can address loneliness faced by older-adults and have profound positive impacts on younger generations.
Unlike many existing homogeneous housing models, which separate older adults into 55+ communities, assisted-living buildings and long-term care facilities, intergenerational housing deliberately brings mixed age groups together where there is interaction among and connection between the groups (Sudo, 2021). Communal spaces and programs are thoughtfully designed to bring mixed age groups together through face-to-face interactions to promote social engagement. An example of intergenerational living is a “university-based retirement community” (Jacobs, 2021). Well-appointed senior apartments with on-site medical care are located nearby or on a college campus. The level of engagement between retirees and students varies with some universities requiring annual educational hours.
Intergenerational models of living exist across Europe, Japan and Singapore, all with the goal of moving away from age segregated living to more integrated spaces which address age-friendly communities. Canada should be part of this trend as our aging population grows to minimize the possible impact of social, economic and digital exclusion (Fang et al., 2023).
References
Andermann, A., & CLEAR Collaboration (2016). Taking action on the social determinants of health in clinical practice: a framework for health professionals. CMAJ : Canadian Medical Association journal, 188(17-18), E474–E483. https://doi.org/10.1503/cmaj.160177
Carter, B. J., Jafry, M. Z., Siddiqi, A. D., Rogova, A., Liaw, W., & Reitzel, L. R. (2023). Incorporation of Social Determinants of health into Health Care Practice: A strategy to address health disparities. Reference Module in Biomedical Sciences. https://www.sciencedirect.com/topics/medicine-and-dentistry/social-determinants-of-health
Corin, A. (2019, June 14). Being well and wellbeing: better understanding of patient priorities in primary care. Journal of Primary Health Care 11, 89-95.
Fang, M. L., Sixsmith, J., Hamilton-Pryde, A., Rogowsky, R., Scrutton, P., Pengelly, R., Woolrych, R., & Creaney, R. (2023). Co-creating inclusive spaces and places: Towards an intergenerational and age-friendly living ecosystem. Frontiers in public health, 10, 996520. https://doi.org/10.3389/fpubh.2022.996520
Flood, C. M. & Thomas, B. P. (2016). Modernizing the Canada Health Act. Ottawa Faculty of Law Working Paper No. 2017-08. https://ssrn.com/abstract=2907029
Havelka, M., Lucanin, J. D., & Lucanin, D. (2009). Biopsychosocial model--the integrated approach to health and disease. Collegium antropologicum, 33(1), 303–310. https://pubmed.ncbi.nlm.nih.gov/19408642/
Health Canada. (2023, March 9). Letter to provinces and territories on the importance of upholding the Canada Health Act. https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act/letter-provinces-territories-importance-upholding.html
Jacobs, K. (2021, September 2). Don’t mind the gap in intergenerational housing. The New York Times. https://www.nytimes.com/2021/09/02/style/housing-elderly-intergenerational-living.html
Statistics Canada. (2022, April 27). A portrait of Canada’s growing population aged 85 and older from the 2021 Census. https://www12.statcan.gc.ca/census-recensement/2021/as-sa/98-200-X/2021004/98-200-X2021004-eng.cfm
Sudo, C. (2021, May 31). How intergenerational living is shaping new senior housing models post-pandemic. Senior Housing News. https://seniorhousingnews.com/2021/05/31/how-intergenerational-living-is-shaping-new-senior-housing-models-post-pandemic/
Suleman, R., & Bhatia, F. (2021). Intergenerational housing as a model for improving older-adult health. BC Medical Journal, 63(4), 171-173. https://bcmj.org/articles/intergenerational-housing-model-improving-older-adult-health
The Lancet (2009, March 7). What is health? The ability to adapt, 373(9666), 781. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60456-6/fulltext#figures
Tu, D., Hadjipavlou, G., Dehoney, J., Price, E. R., Dusdal, C., Browne, A. J., & Varcoe, C. (2019). Partnering with Indigenous Elders in primary care improves mental health outcomes of inner-city Indigenous patients: Prospective cohort study. Canadian Family Physician Medecin de famille canadien, 65(4), 274–281. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467659/
Viscogliosi, C., Asselin, H., Trottier, L., D’Amours, M., & Levasseur, M. (2022). Association between intergenerational solidarity involving elders and mental health of Indigenous people living off reserve. BioMed Central Public Health, 22(1), 1–7. https://doi.org/10.1186/s12889-022-12887-6
World Health Organization. (2023, October 20). Mental health of older adults.
World Health Organization. (n.d.). Social determinants of health: Overview. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
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