Primary Health Care

Capturing the essence of transitions, may you find time to reflect on what is happening in the world of Health Care. There is every reason to believe that we can “enhance” the lives of others, and the health of the planet. With advancements in technology bring us better and faster to process our worlds and our communications, we can change “ecological footprints” and we can improve quality of life, through focus on the determinants of health.

As North America transitions through the “wake-up-call” that is calling for a new global economic order, one of the primary objectives, is to embrace the Primary Health Care solutions that are represented in a “Wellness Model”. Through prevention and health promoting lifestyles, there will be less infrastructure required for hospitals, and we will need less health human resources. This is the only approach that makes any sense. There are the few who think the status quo, is adequate, but agenda, this is a mind-set that faces extinction. Let us come together as a Primary Health Care Collaborative. Please find in the content of this blog, the very solutions I speak of…inclusive of the Pages posted to the right of the page here.

As markets surge and plummet as if the “high seas”, many are hangin’ on for dear life, others feelin’ a bit sea sick. There is plenty of reason, to “stay the course” knowing there had to be rough waters in the open seas (open global markets). If one is looking for “recession proof’ investment, one should never underestimate the tide that is shifting, in health care. Truly “water” and food sources will be last ‘valued’ commodity that will continue to be the ones that are all about survival, while “health and wellness” will be desired for “thrival”.

If we look at what the “tide” is consistent of (a sea of aging boomers) many are suggesting a “tsunami” is just about ready to crash the shores…and the most negative of doomsayers, are suggesting that there will be few survivors…only the thrivers.

So are you a “thriver”…have you investing in your own health and wellness to make it through any crisis and any short-fall. Realize this, that if only the strong survive, we are seeing “epidemics”, silent of otherwise sneak up on the vulnerable …and metaphorically they are swept out to sea, if they do not have a life preserver.

What am I actually saying is. There has been the financial (credit) crisis, that was not so predicable, yet not surprising, and we have seen the tip of the iceberg as far a the ecological crisis. Even if we wanted to press on (or could possibly afford to, health wise)…the Carbon Crisis (possible peak oil…leading to greater usage of coal, rather than less) will take many out to sea. Those that cannot afford health insurance…and subjected to higher pollution, contamination of water sources and or increase infectious disease…their life savings will be lost…possibly loss of life (or at least ability to continue to work).

Increasing unemployment coupled with “hard times” from the job loss, home loss, family stability loss (through increased divorce and separation) leads to social instability…and a breakdown of the “social safety net”. If economic downturn leads to layoffs of civil servants (police, fire, EMS health care in the field (ambulances, hospitals), then we may see the sicking of the Titanic, if you catch my drift.

This is why we need for the powerful, politicians and those with capital (investors), to consider that solutions inherent in Primary Health Care. First off, primary health care is about prevention, and wellness. It curtails the sick and ailing, that may need services from the public civil services (doctors and nurses, along with those mentioned). The beautiful part about investing in wellness, is that those that become unemployed can cope…those “aging” but laid off, can find new employment, and even self-employment as a consultant in their specialty. Primary Health Care practices (and the health systems that could be practicing PHC) could do much more with less. What I mean by this is, the best solution to the shortage of doctors and nurses is plain, simple and saves massive amounts of money. Reduce the need for them, through prevention.

The wellness movement, is strong…and may even be picking up in the face of economic downturn and uncertainty. People are going, where the feel better. The are performing the self-care advocacy that is needed by going to the spa, or massgae therapy or Yoga class, because they need more than ever to de-stress. This is what I am saying that Wellness and Primary Health Care are recession proof investments. Need I say more about this? If you are not convinced, and desire a debate that will lead to you finding the best place to invest…or would like to meet one practitioner, that will help you to feel better, and “do better”, health wise and wealth wise…click here or call 519-854-2528

BE wise, BE well,

Dave, founder of Optimal Wellness and Cardiofit for the health of it

The road less travelled, but the one we should be on… these were potential titles for new works (book chapters perhaps).

Hi,

If you are reading this, I would be left to wonder, which title would catch your eye and pique your curiosity the most.

To be honest I let them both stand as I think, they carry the double impact, quite nicely.

Is this about water? Our drinking water? Our safety? Our health, or our public health safety net?

Well yes, it is. In a metaphorical and philosophical way, we think of what is important are those things that are relevant to us personally. London and all of Ontario even, have had their concerns about water safety. We know that water is an “essential element” in our lives and it goes without saying. We are “nowhere” but in for some hard times without water…in for some nasty outcomes, illness for some, long term consequences for others, loss of life for the most unfortunate (often the most vulnerable who should not be so neglected).

This is an issue that falls under the philosophy of Primary Health Care. This is the road less traveled of which I speak. Few have either a complete understanding or for some, a correct understanding of what Primary Health Care theory includes. Thinking back, some may remember, the World Health Organization introduced health promotion concepts that most countries applauded. (anyone remember Alma Ata 1978 ). Canadians held their heads with pride as the Ottawa Charter of Health Promotion was released in 1986. The premise of supportive environments toward re-orienting health services, building community development from the “grass-roots” up…well we say “participaction” and other efforts get introduced, but the support (governments, health care organizations, even the “professionals”), veered back on the road of the status quo,…and we have seen the outcomes, Walkerton, SARS, Drug-resistent VRE, MRSA, C-Diff…then Listeria, beat out “politics” for the headlines. Lead in the pipes, has become a faded notion of worry.

The road less traveled, this Primary Health Care, heavy tauted as the Health Reform solution of the Romanow Report (2002),is different than what we see right now. Right now, Primary Care dominates. Primary Care, that visit to the ER, to the medical clinic, to the Chiropractor or the Massage Therapist. That represents Primary Care ( the first point of contact with the Health care system of choice). One really big issue with Primary Care. You are not the boss of your health, really, you are “in the hands” of a practitioner. This is dependent on whether you want “covered” (non-payment) care …hospital or physician, or whether you have the benefits or money to afford any other choice. This choice issue I speak of, violates principles of Primary Health Care  (which is all about social justice…equity, availability, access…and health promotion, through choice and participation that is affordable and technologically astute). Primary Health Care is all about community development, and what the public defines as health, and self-care advocacy. Primary Health Care is a Wellness Model…and targets prevention…and has built in “safety-nets’ for public health. No up-standing and compassionate community would let there be “vulnerable populations” that get neglected. Everyone’s whole purpose for living is about a legacy, that promotes the health and wellbeing, the healing and the wholeness of the family, the community, the corporations within that community, and every single individual. Again I say, Primary Health Care is about social Justice. Primary Health care is also Green…and about striving to be greener. What more could you want…not a yellow brick road, but one paved in Green.

So, You are invited to a Forum, a public forum…a Town hall meetin’ if you will, on Primary Health Care and Green Wellness Solutions.

I do trust you care enough for this community, care for our families, our children, grand-kids, and the grand-kids of our grandkids.

Think about it, but more than think about it, take action. The action you can take right now is to scheduled this date and time, on your calender or phone.

Don’t miss out on your chance to live a legacy…Primary health care is everyone’s business…everyone’s road to be on.

Stay tuned for up coming dates and “venues” you will be invited to “share in the CARE” Collaboration Always Rewards Everyone

Dave Scratch from Optimal Wellness

One stop shopping for the patient/client/consumer.
Look at Models…all around the world, inclusive of the Spa/Resorts of California, Arizona etc …i.e. Canyon  Ranch.

Build on the Principle of Primary Health Care, Community Development and the Charters (Ottawa Charter of Health Promotion)…the Charter of Rights and Freedoms for Canadians.

Health Council of Canada supports this…there are models developing that support this is a reasonable thing to do.

Sault Ste. Marie….refers to the Ottawa Charter

Build on some of the innovations already in place…expand on other issues.

Platform that this is a social justice issue.

Tax-payers want choice…they want “preferred Providers” the idea that  paternalistic notions of the past should be maintained, should be dismissed once and for all.
Citizens deserve a system that is all about them…”client-centred Care”…perhaps they do not even want to be considered or “made a patient”.
When we release from labels we can be free from the stigma…why does a person need a label, such as “Mental Health Patient”…in order to get the help they need.

Why can’t a nurse help someone, without first having another health care professional label, diagnose or prescribe.
Why do we not have nurses who can prescribe exercise, safe and effective weight management…or other natural (drug-free means of lower blood-pressure and cholesterol)
Why could there not be a centre to go to that focuses on wellness, health promotion and illness and injury prevention.

Why can there not be payment to other providers that want to provide valuable…disease preventing services and receive funding in the same ways that other providers have for years.

If there is a need, why can’t a nurse hang out a shingle and bill OHIP.
Political Power Brokerage in the hands of powerful lobbying groups inclusive of Health Care professionals, that is why.  We have many social justice issues un-addressed in this province and it is time that the power be returned to the public.

The Wellness CARE centre model.
Largely supported by volunteerism and “co-oping” from High Schools, Colleges and University.  A “Health Sciences” Stream be introduced to high schools…promote the “health care professional” streams…and educate all to speak the same language and take the same courses.
These volunteers, learn some skills, but also set up and manage telehealth systems.
Triaging is from volunteer to RPN to RN to NP then MD consult.
All professionals attached to the Centre are “share-holders” after one year of service and can buy shares that are available to a ceiling percentage.
This provides incentive to make it a successful venture.
This will provide for more “promising “options for those that may not otherwise want to continue in health care.

McGuinty’s recent initiative to open up schools…”after hours” is timely. It is time for the community to take charge of their school.  There can be many more things done at the school if support staff (custodial) are paid to keep the doors open  from 5 am till midnight. The 5 am period for the potential of exercise programs before work hours for some in the community to “pre-school” in a differing sense…before school programs for those parents who have children …who are school-aged and they themselves need to be at work ,by say 7 am (like nurses and other health care workers (not every one is “nine- to- five”.

These early hour drop-off children could be fed a healthy breakfast and have a one hour “learn about healthy living”…a focus on dental care and other hygiene issues.
Each student that helps out from that school would be credited with community service hours that add up to some sort of reward…points toward a field trip, sport camp or summer camp opportunity.

High School student programs- This could be an enhancement and educational opportunity to build onto the existing 40 community hours requirement. There could also be co-op hours for the older grades that could count toward sciences credit if biological, psychological and sociological credits could be built in. This could be an attractive “pre-requisite” program for the Health Sciences which could include Medicine, Nursing, Kinesiology/PT/OT, dietician and or social worker/psychologist.

The partnership could extent to Community College for PSW program, RPN and Collaborative BScN programs.

There could be clinical and co-op hour opportunities for those student placement at the Wellness Centre. It is also reasonable that some opportunities exist for those students of Education Careers…and Community workers as well as Social Workers.

Each individual/family would be assigned a   Wellness CARE TEAM. One that has a built in triage system. A support/advocacy volunteer/student could do their best to prioritize the needs, and make referral starting with the APN to do a Health Screening and Education Need profile, while an RPN would be assigned as “case-manager”.
At the discretion of the CARE TEAM, there may be referrals to Chiropractic, Osteopathic, Naturopathic as well as to Physicians

Collaboration

Always

Rewards

Everyone

Yes CARE is what it is all about

…and just like TEAM, Together Everyone Achieves More

The Collaborative Model for Social Integration has success built right in, as everyone likes to work with and socialize in positive settings, those settings where motivation, transformative leadership and “coaching” is part of the vision statement with true intention.

Some of the features of the Primary Health Care Collaborative Model is that natural focus to be on the inidividual and family in a very service oriented way.

We take that one step further …in a self-less service environment, there is little movement toward conflict or pessimism. The work or practice environment is again a “naturally” nurturing environment…more partnership and empowerment focused while maintaining professional integrity and ethical frameworks.
As the very foundation, this is all built on the Principles of Community Development. It is strongly supported by volunteerism and the social mandates that are built into academic programs. High School students are required to complete 40 hours of community service. Many of the students will be looking at social service careers or in the health care sector. This will be an opportunity unlike any other to “enliven” evolving “co-op” programs and opportunities. We now have an understanding that the generations, now in high school and colleges have different outlooks on career and the way in which they will choose to live their lives. They also will be much stronger competence with information technology and how to utilize communication and social networking systems that are evolving. This is the moment of opportunity to build on Intergenerational Collaboration, and have the younger generation absorb the wisdom of the experienced seasoned professional all the while teaching many things to their older counterparts…that is to experience life enrichment and health enhancement through emerging technologies. All will live healthier, happier more social and culturally responsive lives.
There is convergence of many important issues. The “greening” of our lives can also be enhanced through learning from one another. This is a Global Scale issue…just as health care is a global issue…one that will be greatly improved on if there is both inter-generational and international collaboration.

The era of “Separate Silo’s” has come to an end. All nations will work together to solve the worlds problems. The greater integration of the systems of education, health care, social services, service clubs and faith communities will bring radical transformation in they the way we understand the term community. Beyond the context of the “Global Village”, these “cross-cultural” and multi-national initiatives will come to life on the world wide web. All approaches and solutions will be supported by on-line communities….communities that will be “alive” with students who develop and monitor web-based technology. There will also be a greater “evolution” of the “exchange-student” programs that already exist.

Eco-tourism will take on new meaning. Volunteer organizations offering health care, construction and operation of schools and teaching members in other countries ecologically responsible community development and ways of living…such so that we will see dramatic changes on this shared planet. Essentially the world will continue to get much smaller. There will be more “Shared-CARE” of the worlds most vulnerable populations. Pandemic planning will extend beyond vaccinating to bringing nutritious foods, pure water and decreased stress…all of which will bring enhanced immune function that will be the under-pinning of the new focus of global health promotion.

Re-orientation of Health Services was one of the mandates of the Ottawa Charter, as was supportive environments. It will be a re-alignment of commitment by governments around the world to work to toward those visions addressed by the World Health Organization. There will be ongoing transition from focusing on a “Sickness-Biomedical” Model of health care…to one of Wellness and Whole person health. Greater social justice will be realized, there will be greater empowerment of all health professionals, and the person, whether conceptualized as patient, client or they who are in charge of care…will be advocated for and empowered with learning.

May this be the dawning of a new era.

Prevention and Health Promotion focused, working from the foundations of Primary Health Care:

Accessibility and affordability.

Public Participation (Community Development)

Inter-sectoral, Inter-disciplinary, Inter-generational and International Collaboration

Health Promotion and Illness and injury Prevention
Affordable and appropriate Technology

It is worthwhile to build on the context of the Health Council of Canada.

Lessons from those living with Diabetes is just the beginning.

We are here with solutions for Primary Health Care, Information Technology, and Home Care. Again, the strong representation of volunteerism and expanding the scope of practice for the Primary Health Care Providers such as Nurse Practitioners, Nurse Case Managers, and Personal Support Workers, with our unique training and education is offered to governments at all levels, all nations.

The PHC Collaborative Model will, as found in this dialogue, focus on Health Promotion and Prevention. Stress reduction and integration of relaxation therapeutics will replace some of the reliance on Pharmacology, much of which has been discussed a toxic to organs, immune systems and or cognitive functioning.

Chronic Disease Management will be an empowerment model with advocacy toward self-care, while teams of professionals will work to full and expanding scopes of practice as appropriate.

CARE-co-ordinators from nursing backgrounds will aid the case management approach that will be largely facilitated in the community.

In Ontario there is a convergence of opportunity as the Premier Dalton McGuinty paves the way for greater utilization of local high schools by the community. Further this with the intent to promote and support Nurse-Led initiatives…community health that can be brought to those high schools with supportive programs to have the students of those schools contribute their mandated community hours and so many empowering ways. Many will be able to “grow into” a health professional or social service provider through such integration.

Truly WIN-WIN-WIN for all.

While it is going to be ” personal perspectives” that help quantify or rate the importance of the determinants of health, I give you a list to consider the relevance of these particular issues at this time in history.

AGE- the very youngest and the very oldest of our society are very vulnerable…for one major reason, their voice is always spoken by someone else, inclusive of that “someone else’s” agenda.

POVERTY- this is inclusive of the quality of life possible in developed countries and even more critical as we examine the lack of essential food,  clean water and often even shelter, for those identified as refugee’s.

PEACE- the daily news from many media sources is illuminating the struggles of societies and the world at large over the issue of peace and civility through-out Africa, the Middle East, Parts of Asia and South America. Even the threat of Nuclear armamant, the return of a Cold War…the fear and anxiety that prevails is a very big threat to Health in all its Domains.

HEALTH SERVICES ORIENTATION- This is a much bigger issue than is publicized or even conceptualized among lay persons and professionals alike. Maintaining a status quo, of promotion of “cure” has been “profitized” and promotes exploitation and disparity. The exploitation of the “Pink Ribbon” phenomenon, stands as one example. BIG PHARMA lobbying for research dollars on one hand while lobbying for the denial of affordable generic drugs (in particular for AIDS in Africa) stand as a Legacy…on that should be a “cloak of shame” for industry”…one that is attached to the health , well-being and quality of life of the human species. The insistence of perpetuation of power and control of Medicine practitioners over the public and all other Professions related to healthy living, Healthy Families and Healthy Communities, is also a shameful, unethical stance.

LITERACY- Without question, those that can read, comprehend and act on one’s own behave with information and knowledge of dangers, risks, threats to health…and all other components of healthy living and self-care…will always be hugely disadvantaged…and in many cases, exploited by others while much less likely to achieve optimal health, well-being or quality of life.

The GENDER equation- there are now two sides to this coin. For millenia, it has been a disadvantage to be a woman. Many nations and societies in the world continues to disadvantage women  through religious practices, denial of education, and victimization and exploitation. Enslavement, rape associated with lawlessness and/or war…is still a harsh reality for some. Social Justice mandates action toward positive change. Gender bias has been long established regarding treatment and response in health care. Research based on men, to this day, supports treatment for women for many differing conditions. The DSM-IV is a hugely flawed system, and continues to perpetuate gender-based stigmatization, stereotyping, mis-guided treatment  and empowers a huge male cohort of Powerful Professionals with control and “authority” over dis-empowered and victimized groups. Historically, Post-Traumatic Stress Disorder
On the other hand the historical “feminization” of Nursing has led to one profession being hugely dominating one gender over another, with a legacy that includes exclusion of males from the profession, and remains, as  a “discretion” of a largely female faculty. Further, there has been the perpetuation of “Nursing Theory” in which the male perspective has been absent.  The list of “who’s Who” amongst nursing theorists, will demonstrate this huge disparity and gender gap. With funding towards equality issues such as Nurse Practitioner services and/or Nurse-led-clinics, any critical examination will reveal significant emphasis on the value of womens health specialization (which is a valued social justice initiative) while at the same time…there is little evidence that “Men’s Health” is being valued or perpetuated within the domains of Nursing or evolution of nursing roles.

ENVIRONMENTS- This can be viewed under an “ecological lens” as well as one that is a “contained: environment such as the workplace, as much as it could be a “conceptual” environment, referring largely to workplace cultural environments. Workplace safety is an ongoing issue and challenge. Workplace violence and exploitation is still under “the radar” as we examine Healthy Workplaces.

On very tragic, unfortunate, yet valuable “Case Study” regarding Workplace Culture will be ever immortalized by the tragic death of Nurse Lori Dupont. Being that it was a “health care environment” makes it that more valuable to put examined under a critical lens. Harrassment, Aggression, Bullying, Horizontal Violence, exploitation, threat, extortion and defamation of character are all illuminated by one such tragic case, in which we hope many valuable lessons will be learned. This also stands as a reasonable evaluation of the previous Gender and Power issues that have also been discussed.

POWER, OPPRESSION, COMPETITION, DISCRIMINATION, EXPLOITATION- All closely related and collectively is a reality for many. These influences will cross-over collectively or as separate issues for many other determinants of health. A civil and just society will examine theses issues for the deterents to health and quality of life for the masses, in which they represent. The sheer complexity and interactions with so man other consideration, is beyond the scope of this summary provided here.

There are many who see the future as a bleak one. I would like to remain optimistic, while struggling with “knowing too much”. I would not necessarily understand the challenges ahead in simply being a health care professional. I would have to say the notion that I am also in the “business” of life coaching, fitness and weight management, that leads me to learning opportunities where I get to see trends and life-ways for many individuals. Currently the mere ‘busy’-ness of life has people apathetic to the realities all around them, and they often cannot move in any direction as this “inertia” has left them, frozen, neither are they open, or interested in change.

The convergence of this ‘apathetic’ position, partly due to discouragement and message of “you are not valued”, that came with early stages of amalgamation and downsizing was “seared” into the consciousness of every nurse that can reflect the message of the then Premier of Ontario, Mike Harris, when he publicly disclosed thoughts and feelings that “nurses should take a 20% pay cut”. Imagine if someone suggested that for you, and your profession. I know I am one who teaches that we should move past issues…to not look on the past, but toward a positive and preferred future…while I also am a “historian”, valuing the lessons of the past. The “seeds of bitterness and resentment” were sown quite heavily during the 1990’s, most nurses who “lived” through these times…again reflect on “their past reality” with much resentment, …feelings of powerlessness and progression toward burn-out, care-giver stress…musculo- skeletal health and emotional health…deeply compromised…was the new reality. Much of this persists today. Nurses are the most “un-well” workforce. Sad legacy for the “care-givers”…the front-line and backbone of our beloved Medicare.
Dr. Heather Lanschinger, Judith Shamian, Linda O’brien-Pallas and their many colleagues can be credited with illuminating the many issues associated with work-place cultures and the sheer demand of the job.

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There are multiple dimensions to the aspects of “convergence”. We are passing through an era, never seen before, never experienced by the Health Care system…or the recipient of care…the patient. There is a HUGE retirement wave…corresponding with a HUGE wave of “new recruits”, with higher education acquirement…younger and many unmarried, newly married and very much ready to transition soon after employment to “serial maternity leaves”. The aging population looms…with the baby-boomer demographic soon to demand more from our “over-taxed”, over-burdened Health Care system. The “Peak” years for this very long drawn out retirement wave is 2010-2011. This is still 3-4 years of “progressive deepening” of the crisis that already exits.

The time is now..to act..not to study or plan. There is a major solution to be enacted NOW, the fear is that there will be “too little-too late” on the policies and government actions to decrease the impact. There has been significant increases to enrollment, Illuminating another crisis within the crisis. The shortage of qualified instructors and professors of nursing…and a HUGE shortage of “Quality” clinical placements for this ever increasing co-hort of students.

As a consumer of health care…as a citizen of this province (there will be increasing competition from other provinces to compound the draw/drain from the U.S. and now a dozen other developed countries. English speaking countries such as Australia, the United Kingdom, Ireland…are campaigning heavily to entice our Degree Prepared Graduates. New- Grad initiatives are a start.

As an instructor for these upcoming graduates, and as a father of a Nursing student, I know the initiatives well. I am deeply attached on a very emotional level, what the future holds for my own daughter. As a demonstrated, dedicated advocate for students over the past 4 years, through two different faculty, I am envisioning a future…one that is beyond my retirement. I have now been affiliated (practicing or teaching for nearly a dozen different Hospitals Long Term Care Centre and agencies where nurses and Nurse Practitioners are being utilized. I have a very broad perspective. Having worked in the U.S. also advantages me in knowing what is “good” applications for us in Canada and what would be undesirable.

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