A Summary of What I Have Learned: My Experience with MHST601

This blog will summarize my experience of the MHST601 course through Athabasca University. Given the title: ‘Foundations of Health Systems in Canada’, my expectation was that this course would provide me with a detailed perspective on the health care system and allow me to learn relevant facts from an expert on the subject matter so that I may gain a greater understanding of the politics and rationale behind decisions that have shaped the Canadian healthcare system into what it is today. Rather than being held by the hand and led through a maze of information however, I was instead gently pointed in a general direction and encouraged to seek multiple answers to each question to enable me to cultivate my own, well informed perspective that might contribute something new or unique to the topics covered. This method allowed the central themes of the course content to deliver a more meaningful and lasting impact, while forcing me to challenge my initial biases and think more critically. Through struggling to do just that, I was able to better understand the rationale behind my own feelings toward the topics covered. In some cases, this strengthened my position; in others, it changed it completely. Ultimately, however, I found that having a broader perspective from all sides can often turn a seemingly clear and serene stream into a ferocious, muddy river where indisputably ‘right’ answers may no longer exist.

Unconscious bias was an illuminating concept that was woven into units throughout the course. This is defined as “unconscious feelings we have towards other people…influencing our judgement of [them]” (Pratt, 2016). Such biases may be positive or negative, but either way they create an unfair playing field that undermines hard work and merit and can exacerbate social divisions. Although they may be impossible to eliminate, the effects of unconscious bias can be mitigated by developing a deeper understanding of the common types and remaining vigilant to their potential influence (Pratt, 2016). Consciously assessing topics from uncomfortable or unnatural perspectives will also help combat the effects of unconscious bias. Neglecting to address issues from all angles limits one’s ability for intellectual growth and stifles innovation -in addition to worsening social inequities.

Beyond investigating topics from all angles, this course taught me the value in assessing problems across multiple levels. This approach is integral to understanding and improving health related challenges (Galea, 2015) but is also applicable to any complex situation one may wish to modify. Models in this category require digging deeper than the obvious surface variables to factors that contribute to underlying determinants. Applying this line of thought to the epidemic of obesity, a multilevel model would demonstrate that eating less and exercising more is not necessarily an adequate prescription for reversing this trend (Ball, 2015). Affecting real change requires addressing the attitudes instilled in the individual, the social network, the environment in which they live or work, the available resources, food and time to prepare meals, and geographical constraints as well as any governing laws and regulations (Riggs, 2018). The more factors that can be manipulated in favour of the desired modification, the greater the chance of success in achieving that outcome. Furthermore, if the individual is not given the proper tools, knowledge and resources to succeed, their desire to change may be rendered irrelevant, no matter how motivated (Backholer et al., 2014). For example, observing sports drinks marketed towards athletes may lead dieters to associate their consumption with health, neglecting to account for the high caloric load and associated effect on their energy balance. Lack of understanding of the mechanism that makes these drinks beneficial (replenishment of calories and restoration of electrolyte balance after extended strenuous activity) undermines the initiative of the health-conscious individual.

Units covering indigenous and other vulnerable populations enlightened me to the true impact that social determinants of health can have on the well-being of an individual or population. Elements such as racism (Paikin & Talaga, 2017), geographical isolation, and the cultural disconnect between providers and patients can inhibit optimal outcomes (Deakin University, 2014). When social determinants are not adequately addressed, they undermine the integrity of the universality and accessibility tenets of the Canada Health Act (Minister of Justice, 2017). More than that, they may negate any benefit of the healthcare system by preventing its resources from being used effectively. For example: if a patient visits a doctor for an infection that is easily treatable with prescription antibiotics, but is then unable to afford the drug, they will not get any better, and they have effectively wasted their time and the time and resources of the staff. In fact, in this scenario the patient will likely get much worse, causing greater suffering, inconvenience and stress, not to mention a second, potentially more costly visit to the doctor (or hospital admission) who may no longer be able to produce such an easily defined solution once the condition has advanced. This limitation led Frankish (2017) to claim that the social determinants of health are “much more important in terms of the health of the population than the healthcare system” (Frankish, Kershaw, Shoveller, Evans, & McLeod, 2017). This is to say that the healthcare system is less equipped to heal illness than a socially supported individual is to prevent it or live with restrictions it may impose upon them. This point emphasizes a flaw with the current spending model for Canadian healthcare: pouring financial resources into downstream treatment at the expense of upstream prevention causes the budget to snowball, without a corresponding improvement to the overall population health (Frankish et al., 2017).

Perhaps the most enduring impact this course will have on my future will be my vastly improved digital skills and comfort with exploring new digital programs. Building an e-portfolio had to be the most intimidating portion of this experience for me. Entering the class with limited digital skills, I had no concept even of the fact that I had the ability to produce a personalized website. More than this, the concept of a digital content curation tool was something that I would not have identified as useful, even if I had known that such products exist. Now, I have active accounts through Mendeley, Pocket, Pearltrees and Google Keep, and somehow find a unique purpose for each of them! While I still find Twitter to be an overwhelming mass of hashtags and irrelevant information, I do have an appreciation for its usefulness as a mass communication and content sharing resource and can admit that I now use it regularly to stay current on trending news items. Social media in general as a professional tool is another notion that I strongly opposed at the outset of this course, but for which I can now envision multiple worthy concepts within the patient scheduling and resource sharing realm of medical imaging programs (Bola & Liszewski, 2017).

In conclusion, I registered for this Master’s class because I was looking for a challenge that would allow me to branch off in the health care system and expand my expertise beyond the confines of the medical imaging field. I had hoped to gain a broader perspective of healthcare in Canada. While I am comfortable in stating that this course did fulfill that expectation, I feel that my greatest accomplishment was not necessarily my comprehension of the course content. Instead, I feel that I was able to change the way that I approach problems. Also, through hours spent searching for and reading over scholarly journal articles, I have greatly improved my efficiency in this skill. The many news articles presented to me by my instructor and peers (along with their insightful commentary) have led me to change the way I consume news media; causing me to look beyond the headline and critically reflect on how the topic might affect me or a subject about which I am passionate. This shift in perspective will offer me greater insight into every aspect of my life and spark more lively dialogue in everyday conversation. In relation to health care, discussions revolving around indigenous and vulnerable populations and the social determinants that segregate them from the privileged majority have granted me greater empathy toward their struggles and made me less certain in prescribing blanket solutions to their issues. I believe this to be a significant accomplishment because only through developing a greater understanding of and respect for our most marginalized citizens will the true spirit of the Canada Health Act ideal be realized. Society has a long way to go, but thanks to this course, I feel like I am now a little bit closer.

Resources

Backholer, K., Beauchamp, A., Ball, K., Turrell, G., Martin, J., Woods, J., & Peeters, A. (2014). A Framework for Evaluating the Impact of Obesity Prevention Strategies on Socioeconomic Inequalities in Weight. American Journal of Public Health, 104(10), e43. https://doi.org/10.2105/AJPH.2014.302066

Ball, K. (2015). Traversing myths and mountains: addressing socioeconomic inequities in the promotion of nutrition and physical activity behaviours. The International Journal of Behavioral Nutrition and Physical Activity, 12, 142. https://doi.org/10.1186/s12966-015-0303-4

Bola, R., & Liszewski, B. (2017). Knowledge Translation in 140 Characters or Less: #ProfessionalDevelopment #Collaboration #Patientengagement. Journal of Medical Imaging and Radiation Sciences, 48(3), 221–225. https://doi.org/10.1016/J.JMIR.2017.06.003

Deakin University. (2014). Faculty analysis of distributed medical education in Northern Canadian Aboriginal communities. Rural and Remote Health. Retrieved from https://www.rrh.org.au/journal/article/2664

Esther Riggs. (2018, January 7). Bronfenbrenner’s Theory and Ecological Mapping [Video file]. Retrieved from https://www.youtube.com/watch?v=nULPGD0N6WM&t=52s

Frankish, J., Kershaw, P., Shoveller, J., Evans, R. & McLeod, C. [UBC Medicine – Educational Media]. (2017, January 13). The Social Determinants of Health [Video file]. Retrieved from https://www.youtube.com/watch?v=nTqknri15fQ

Galea, S. (2015). The Determination of Health Across the Life Course and Across Levels of Influence. Retrieved July 20, 2019, from Boston University School of Public Health Dean’s Note website: https://www.bu.edu/sph/2015/05/31/the-determination-of-health-across-the-life-course-and-across-levels-of-influence-2/

Minister of Justice. (2017). Canada Health Act. Retrieved from https://laws-lois.justice.gc.ca/PDF/C-6.pdf

Paikin, S., & Talaga, T. (2017). Transcript: Racism and Death in Thunder Bay | Dec 13, 2017 | TVO.org. Retrieved from https://www.tvo.org/transcript/2473638/racism-and-death-in-thunder-bay

Pratt, S. (2016). 9 Types of Bias and the Shocking Ways They Affect Your Recruiting Efforts. Retrieved July 24, 2019, from Social Talent website: https://www.socialtalent.com/blog/recruitment/9-types-of-bias