Critical Foundations in Health Disciplines: A Strong Base to Begin With

It is hard to believe that as Canadians, we still have individuals who do not have equal access to healthcare. Health equity is something that should be a priority for every practitioner within the healthcare field. Over the last 13 weeks in the Critical Foundations in Health Disciplines course, we discovered the importance of health equity. This was done by examining material over seven units. As each unit passed, we were able to build upon the last one and develop a solid foundation of learning. Throughout our units we discovered not only the social determinants of health and how they affect the health of Canadians, but also how we can utilize a multilevel model of health to dissect healthcare access for vulnerable populations.

In the following blog I reflect on what I have learned during the semester and apply it to the access of healthcare towards vulnerable populations, specifically, lesbian, gay, bisexual and transgender (LGBT) individuals.

At the beginning of this course my thoughts and perceptions of what defined health would have included physical and mental health conditions. I would never have thought that the definition of health according to the World Health Organization, would have been from 1948 and included physical, mental and a state of social well-being (Huber, 2011). When the definition of health is examined, most people would assume that it should be something which could be accessed and obtained by all Canadians. Unfortunately, as we have learned over the past 13 weeks, health is not something that comes as easy as one may hope for within Canada.

There are many factors that affect whether or not an individual is considered healthy. The social determinants of health are a large part in what can contribute to the health of an individual. According to the Government of Canada (2020), the social determinants of health are social and economic factors that influence the health of not only an individual, but the health of a population as well. In the diagram below you can see the determinants of health and how the factors for an individual are embedded into broader aspects of society.

Source: Dahlgreen, G. and Whitehead, M. (1991). Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute for Future Studies.

When you take into account the aspects of the social determinants of health, it is important to also look at health equity. As Canadians we want our citizens to all have equal access to healthcare and overall health. However, with societal impacts and cultural “norms” there are inequalities for individuals based purely on who they are or where they are born. The health equity framework revolves around equity at the core. It is an upstream approach to address marginalization and to ensure that access to health is equitable for not only individuals but the community as a whole. According to the Canadian Mental Health Association (n.d), marginalization is deeply ingrained within a social, economic and political history. In order to obtain health equity we need to break down the disadvantages that some groups face in society. When we truly have health equity within our communities, we will see a fair access to resources and opportunities for all individuals, no matter who they are or what their economic status is (Peterson et al., 2021).

An additional layer required to be worked through, would be the groups that have structural vulnerability against them. Structural vulnerability can exist when populations are put at risk for negative health outcomes purely based on social and political hierarchies (Carruth et al., 2021). The social determinants of health and the inequity of health care affect vulnerable groups at a higher incident rate. LGBT individuals belong to a group that have a vast history of disadvantages. According to Canadian Queer History (n.d), it wasn’t until 1969 that Canada decriminalized homosexual acts and finally in the year of 1995, sexual orientation was included in the Canadian Charter of Rights and Freedoms. This short history, as well as the LGBT individuals who may never openly express their sexuality, have a large effect on the amount of research that has been effectively done in regards to health care within this group.

As laws began to change and acceptance started to rise, the emergence of LGBT individuals was recognized on national and provincial surveys. These surveys started to highlight the health disparities within the LGBT culture versus that of their heterosexual peers. The stigma and prejudice related to being LGBT alone, has likely risen the mental health problems within the vulnerable population (Fredrickson-Goldsen et al., 2014). When examining the effects of stigma and discriminatory behaviours towards LGBT individuals, there is a direct correlation of health inequities for those who are discriminated against. The individuals who identify as transgender for example, have a harder time securing housing, consistent employment, a liveable income, health care and quality education (Higgins et al., 2021). This has a negative effect on the individual and diminishes their ability to have equity within their own personal definition of health.

I always knew that LGBT youth had a higher risk for homelessness and mental health problems. Unfortunately, as some individuals “come out” to their family they are not accepted and kicked out of their home. This has a downward spiral effect for that individual. When you are not accepted and loved by those who should love you the most, you immediately develop a mistrust of people, feel unsafe around those you do not know, and create an emotional barrier to protect yourself. While I learned about the importance of the social determinants of health this semester I started to recognize the vast issue that we have for setting up not only LGBT, but also LGBT youth, for success. In the infograph below it depicts the homeless population in Toronto and shows that 20% of this population is youth and of that, 25-40% identifies as LGBT. With the LGBT being such a vast majority of the homelessness of youth, there are not always viable options where the youth feel safe enough to go to a shelter. Knowing that housing is a key factor within the social determinants of health, this begins a potential life filled with inequity.

The 519. (n.d.). Retrieved April 3, 2022, from https://www.the519.org/education-training/lgbtq2s-youth-homelessness-in-canada/in-canada

Examining the inequity within the LGBT group further, it can be noted that there is a higher rate of certain cancers, higher incidence of alcohol, drug and tobacco use, reproductive issues, and some specific mental health concerns (Fish & Karban, 2015). Prior to this course I would not have made the connection between the social determinants of health and accessing healthcare and the disparities of this vulnerable group. A lot of issues stem from knowledge on how to provide care or treatment for LGBT. When undergraduate medical education was surveyed in the United States of America, the average number of hours over the four years that LGBT education was taught was five and 11 schools had zero LGBT curriculum at all (Cooper et al., n.d.). When a healthcare provider does not know the questions to ask, or how to treat concerns of the patient, the mistrust of the system happens again. By creating this mistrust LGBT individuals often will delay searching out care (Schreiber et al., 2021). The future of health for LGBT individuals is something that I hope will continue to grow as more exposure and acceptance happens throughout the country. It was not long ago that pride parades were something that was hidden underground, kept away from mainstream society and seen as illegal activity. As the inclusion of LGBT education for healthcare providers increases, I do feel that we will see a shift in trust and more healthcare needs will be met. Utilization of the upstream approach of the health equity framework will continue to help create policies, laws and standards of education that will help promote health equity for this vulnerable group.

References

Canada, P. H. A. of. (2020, October 7). Government of Canada. Social determinants of health and health inequalities - Canada.ca. Retrieved April 2, 2022, from https://www.canada.ca/en/public-health/services/health-promotion/population- health/what-determines-health.html

Carruth, L., Martinez, C., Smith, L., Donato, K., Piñones-Rivera, C., & Quesada, J. (2021). Structural vulnerability: Migration and health in social context. BMJ Global Health 6 :e005109. doi:10.1136/ bmjgh-2021-005109

Cooper, M. B., Chacko, M., Professor, Christner, J., & Dean. (n.d.). Incorporating LGBT health in an undergraduate medical education curriculum through the construct of Social Determinants of Health. MedEdPORTAL. Retrieved April 2, 2022, from https://www.mededportal.org/doi/full/10.15766/mep_2374-8265.10781

Dahlgreen, G. and Whitehead, M. (1991). Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute for Future Studies.

Fish, J., & Karban, K. (Eds.). (2015). Lesbian, gay, bisexual and trans health inequalities: International perspectives in social work. Policy Press.

Fredrickson-Goldsen, K. I., Simoni, J. M., Kim, H-J., Lehavot, K., Walters, K. L., Yang, J., Hoy-Ellis, C. P., & Muraco, A. (2014). The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. American Journal of Orthopsychiatry, 84(6), 653-663. http://dx.doi.org/10.1037/ort0000030

Higgins, R., Hansen, B., Jackson, B.E., Shaw, A., & Lachowsky, N., J. (2021). At-a-glance- Programs and interventions promoting health equity in LGBTQ2+ populations in Canada through action on social determinants of health. Health Promotion and Chronic Disease Prevention in Canada, 41(12), 431-435. https://doi.org/10.24095/hpcdp.41.12.04

Huber, M. (2011). Health: How should we define it? British Medical Journal, 343,(7817), 235-237. https://doi.org/10.1136/bmj.d4163 (link http://www.jstor.org/stable/23051314)

Peterson, A., Charles, V., Yeung, D., & Coyle, K. (2021). The health equity framework: A science- and justice-based model for public health researchers and practitioners. Health Promotion Practice, 22(6), 741–746. https://doi.org/10.1177/1524839920950730

Queer history timeline. QueerEvents.ca. (n.d.). Retrieved April 2, 2022, from https://www.queerevents.ca/queer-history/canadian-history-timeline

Schreiber, M., Ahmad, T., Scott, M., Imrie, K., & Razack, S. (2021). The case for a Canadian standard for 2SLGBTQIA+ medication education. Canadian Medical Association Journal CMAJ, 193(16) E562-E565. DOI: https://doi.org/10.1503/cmaj.202642

The 519. (n.d.). Retrieved April 3, 2022, from https://www.the519.org/education-training/lgbtq2s- youth-homelessness-in-canada/in-canada