The MHST 601: Critical Foundations for Health Disciplines course from Athabasca University is meant to provide the knowledge base to understand the complexities of the Canadian Health Care system and the factors that impact the health of Canadians. Many topics were explored in depth, including the concept of health and the determinants of health, the Canada Health Act and multilevel models of health among others. This summation blog explores how many different factors are complexly interwoven to create the health landscapes of the country and various populations within it, as well as strategies for interventions to target and improve those health landscapes.

There is much to consider regarding the future of health care within Canada. Electronic medical records are one way to improve the health care provided to Canadians. There are multitude of electronic health records currently in use across the different health entities and province. With so many records, it is difficult to have timely and consistent coordination and communication of health services. Alberta Health Services is transitioning to a single electronic health record over the next several years. This is anticipated to improve patient outcomes as patients will have access to areas of their medical charts, there will be timely reporting of procedures and tests, and there will be increased communication across disciplines. This step forward comes with a hefty price tag however; the contract for this electronic medical record was awarded at $459 million dollars.

Another vulnerable population within Canada are immigrants. Within Alberta, there is an immigrant population of approximately 21% per Statistics Canada. A “healthy immigrant” effect has been observed in the literature, which is described as immigrants arriving in Canada in better health than Canadian-born individuals, but the longer that they remain in Canada the more their health declines. Access to culturally appropriate health care is a barrier to some immigrant groups, especially those that settle outside of larger metropolitan areas such as Vancouver, Montreal and Toronto. Coverage under provincial health care plans may not be immediately available for those who have newly arrived to Canada.

Several vulnerable populations exist within Canada; one of the more prominent populations are Indigenous peoples. Racism and prejudice remain in the Alberta health care system, though steps are being taken to improve the cultural sensitivity of health care provided within the province. Alberta Health Services has mandated its employees to undertake cultural sensitivity training. The Indigenous Health Program has created several resources aimed to educate the general population as well as health care providers. Through the Indigenous Health Program, Indigenous Liaison Coordinators aim to support Indigenous, Inuit and Metis people throughout the health care system. In the field of nutrition there is plenty that has been done to improve the cultural sensitivity of services and resources, yet much more is still needed.

Multilevel models of health are beneficial tools when evaluating a health topic. Multilevel models explore various determinants of health and how they impact a specific health issue. There are many models that exist in the literature, with the Social Economic Model being one used frequently. Williams and Swierad (2019) explored the Social Economic Model and identified that while it analyzed several determinants of health and their impact on a health issue, it did not provide insight on how to apply a focused intervention for that health issue. The Multisensory Multilevel Health Education Model was created by Williams and Swierad (2019) to target that gap. In this discussion, the Social Ecological Model and the Multisensory Multilevel Health Education Model were both applied to the issue of malnutrition within hospitals. The strengths and weaknesses of the Multisensory Multilevel Health Education Model were evaluated using the issue of malnutrition.

Chronic disease, including diabetes, contribute significantly to the rising costs of health care in part due to complications of those conditions. Certain populations are predisposed to the development of chronic diseases, and in particular Type 2 Diabetes. Whenever possible, it is ideal to target the prevention of chronic diseases. Nutrition plays a key role in the prevention as well as management of Type 2 Diabetes. Within Alberta, there are several programs that include dietitians such as the Alberta Healthy Living Program (via Alberta Health Services) and Primary Care Networks. In the future, for better patient care and outcomes in Alberta regarding chronic diseases, these two programs would require improved communication and coordination as currently they fall under two health care entities.

Multilevel models of health are useful to target health intervention at multiple levels which would lead to a synergistic effect (Williams and Swierad. 2019). Many multilevel models exist in the literature; perhaps the most well-known model is the Social Ecological Model. The Social Ecological Model examines components of and connections between individual, relationship, community and societal factors. A newly developed multilevel model is the Multisensory Multilevel Health Education Model, created by Williams and Swierad (2019) after identifying a need to apply a model to “how” a health intervention can be applied. The Multisensory Multilevel Health Education Model builds on the Social Ecological model by incorporating three domains: art, culture and science. Being a new model, it has not been studied extensively in the literature, however Williams and Swierad (2019) were able to deconstruct a successful health education intervention in the United States using the Multisensory Multilevel Health Education Model.

The determinants of health are quoted often in literature and policies, and include factors such as childhood experiences, education, economic status, employment and housing. These factors all play an impact on health. Within the determinants of health is the concept of equity. Equality is the equal provision of support or services regardless of starting point. Equity is providing support and services for an equal end point, taking into account the starting point or rather the individuals’ or populations’ determinants of health. The determinants of health are not causative of poor health but rather risk factors. Policy can affect health disparities as much as the determinants of health and need to be considered when evaluating the health of an area.

The current definition of health used in the literature and many public policies was created by the World Health Organization in 1946, indicating that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition is difficult to measure however and could be considered a definition of happiness and quality of life rather than overall health. The need to have a definition of health is driven by the need to measure health outcomes, particularly to evaluate program and intervention successfulness. Measures of Quality of Life, rather than health, could be an alternate outcome to evaluate as health can be a rather subjective concept.

The Canada Health Act, created in 1984, describes the universal health care system within Canada. Within the Canada Health Act, the term medical necessity is used to describe the coverage provided to Canadians, however no definition is provided for this term. There are many challenges that the Canada Health Act faces. One aspect is the need for accessibility regardless of location or population demographics. Remote locations are one area where accessibility is less than ideal. Indigenous populations and their ability to access health care are another. The Dietitians of Canada identified the need for access to a healthy and safe food supply to be incorporated into the Canada Health Act due to the impact of proper nutrition on overall health.