Critique of a Community-Based Population Health Intervention in a First Nations Community: Public Health and Medical Anthropology Perspectives

Author: Selim M. Khan

Abstract

Launched as a community-based partnership endeavour, the Sandy Lake Health and Diabetes Project (SLHDP) aimed to prevent diabetes in a First Nations community (FNC) in Northern Ontario. With active engagement of the key stakeholders, SLHDP conducted a series of studies that explored public health needs, priorities, and the contexts. These led to the adoption of a variety of culturally appropriate health interventions, addressing several health determinants such as health education, physical environments, nutrition, personal health practices, health services, and FNC culture. SLHDP built reciprocal capacity for both the community stakeholders and academic partners, thus evolved as a model of population health intervention. The school components are being scaled-up in other parts of FNCs in Canada. This paper presents a critique from public health and medical anthropology perspectives and draws evidence-based recommendations on how such programs can do better.

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A Healthcare Lesson: Comparing Chaoulli v. Quebec (2005) and Cambie Surgery Centre v. British Columbia (2016)

Publicly insured healthcare in Canada, also known as Medicare, is currently being reviewed in a judicial case in the Supreme Court of British Columbia. The lawsuit filed by Cambie Surgery Centre is calling for allowing “medically necessary services” – those covered by public insurance – to be privately insured in order to improve access to care. Health services researchers, policy makers and citizens alike, are worried of the outcome of this 8-month provincial trial, as it is suggested that an outcome in favour of Cambie’s position would lead to a complete overhaul of Canada’s public healthcare system. In the midst of heated debates, we tend to forget that just over a decade ago, a similar legal battle challenging the extent of public insurance in Canada occurred in the province of Quebec. How are these two cases similar or different? What are the implications of each? What are lessons that can be learnt?

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Call for Bloggers

The RISS-IJHS is currently looking for students and researchers interested in contributing original content to the IJHS Blog. The ideal candidate should be able to produce monthly articles that are equally informative and stimulating, and will generate conversation among the health science community.

Blog posts must be:

  • Written in either French or English;
  • Between 300-800 words (although word count is flexible depending on the subject matter);
  • Written in accessible language to reach a wider audience.

Topics/ideas include, but are not limited to:

  • Developing and creating article series (e.g. healthcare financing in Canada – a retrospective, etc.);
  • Commenting on recent study releases, other academic journals and blogs (e.g. OECD, WHO, UNICEF and MSF);
  • Commenting on current news and events;
  • Interacting with readers by launching poll surveys, asking questions about issues, collecting opinion pieces, etc.

How to apply:

If this interests you, please send a brief summary of who you are (your motivation for doing this, writing/blogging /website experience, links to any current blogs you may have) along with a sample blog post to editor@riss-ijhs.ca.

We look forward to hearing from you!

Choice in childbirth: VBAC

Childbirth is a ubiquitous experience among mothers. Birth can occur in many ways, from medication-free natural labour, to cesarean section. Mothers in Canada can, for the most part, choose how they want to deliver. However, women with a prior cesarean section have a more difficult choice to make. They can choose to have a repeat cesarean section, or to attempt a vaginal birth after cesarean – a VBAC. How do women make this decision, and how can healthcare providers support them?

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Coffee Does Not Cause Cancer, but Hot Drinks Might

Coffee drinkers can sip a little easier now that the World Health Organization has downgraded coffee’s cancer risk. Due to inadequate evidence and inconsistent findings, consumers no longer need to worry about their morning cup of Joe. In fact, drinking coffee may actually protect consumers from several chronic diseases.

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Obesity Begins in the Womb

If you were asked “how much weight should a woman gain during pregnancy?” you might posit a guess around 15 or 20 pounds. In reality, it’s not that simple. The amount depends on her pre-pregnancy body mass index (BMI). As such, in 2009, The Institute of Medicine (IOM) released gestational weight gain recommendations for each BMI category (Table 1). These recommendations were published to promote adequate foetal growth and reduce the risk of adverse pregnancy outcomes (Rasmussen & Yaktine, 2013). Total recommended weight gain during pregnancy ranges from 28-40 pounds for underweight women and 11-20 pounds for obese women (Rasmussen & Yaktine, 2013). However, many women are not meeting these guidelines and 58% of Canadian women are surpassing them (Ferraro et al., 2012). Currently, obesity is recognized as a global public health concern with no signs of slowing down (NCD Risk Factor Collaboration, 2016). Is gestational weight gain a contributing factor?

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Ins and outs of cancer screening

 

It’s estimated that approximately 2 in 5 Canadians will develop cancer during their lifetime, and that 1 in 4 will die from the disease1. Cancer affects or touches almost everyone in this country in some way, and a lot of research has gone into preventing and treating the disease. The overall 5-year survival rate for all cancers in Canada was 63% for 2006-20081. It’s well known that cancers that are caught early have a higher chance of successful treatment and survival. One of the ways that we can diagnose these early-stage cancers is through screening.

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MCR-1: The consequence of antibiotic misuse and evolving resistance

According to a recent paper published the Lancet, a superbug gene that confers resistance to colistin, an antibiotic used to treat Gram-negative bacterial infections when all other drugs fail, has been discovered in China (Liu et al., 2016; TheStar, 2016). The gene in question, called MCR-1, was found in E.coli in samples from meat, hospital patients, and livestock in southeastern China. Given that China is among the countries with the highest colistin use in agriculture, resistance to the drug may have originated in that part of the world; however, new reports show that the gene is not restricted to China as the following countries have similarly discovered MCR-1 in bacterial DNA: Algeria, Canada, Denmark, England, France, Laos, Portugal, Thailand, The Netherlands, and Wales (TheStar, 2016). Some of the bacterial DNA analyzed and found positive for the MCR-1 gene was derived from specimens archived before 2015; therefore, dissemination of the gene has outpaced discovery, and the issue at hand may already be an international crisis.

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The Zika Virus: A Global Public Health Emergency

In May 2015, the Zika virus infiltrated Brazil (Higgs, 2016). Since then, autochthonous transmission of the virus has been confirmed in 19 other countries in the Americas (Hennessey, 2016). By October 2015, almost 4,000 cases of microcephaly were identified; a sharp increase from the previous year, in which fewer than 150 cases were diagnosed in all of 2014 (Dyer, 2016b). Although a causal link between the Zika virus and microcephaly has not yet been established, the circumstantial evidence is alarmingly suggestive (Torjesen, 2016). With no vaccine or treatment available, concern over the spread and effects of the disease is rapidly increasing.

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