Maria Powell is an Internal Medicine Resident (R1) at the University of Calgary who graduated from medical school at Memorial University of Newfoundland in 2017
Admittedly, my social histories used to consist of the same three questions: Do you smoke? Do you drink alcohol? Do you use recreational drugs? I would occasionally ask if the patient worked outside the home, or what they did for income, but the question rarely came up when reviewing consults with resident and staff physicians so I did not routinely ask about it. One thing I am sure of: I never asked whether or not the patient had a home.
During my first two years of medical school, I had lectures on the social determinants of health, and I thought I understood their importance. Yet, it was not until I did a “Health of the Homeless” elective in downtown Toronto that I truly appreciated the impact of the social determinants of health. ...continue reading →
Li (Danny) Liang is a second year medical student at the University of Toronto with a BEng degree and a deep interest in the intersection of urban design and health
Growing up in Toronto's suburbs, I slowly began to realize what was wrong with how much of the city is designed. Most of the neighborhoods outside of the downtown core are clearly designed for cars, instead of pedestrians and cyclists. Most neighborhoods in the suburbs, composed of a sea single detached houses with small oases of high-rises sprinkled in, are not very walkable nor bike-friendly. Getting from point A to point B by walking becomes a huge odyssey: it often took at least half an hour to walk to the nearest library, movie theatre, grocery store or community centre. The way the city is designed is also unfair from a social justice perspective, as most of the people living in the Toronto Community Housing apartments I lived in could not afford to drive. The overall low population density of Toronto's suburbs means that there is not enough ridership to justify building rapid transit to the clusters of high-rises in the suburbs that are drowned by single-family detached houses. ...continue reading →
Bonnie Larson is Family Physician at Calgary Urban Project Society (CUPS) Health Centre
Recently I called the emergency department from my outreach clinic in an urban shelter. Near the end of the day, the nurse mentioned that one of the clients staying there, a young aboriginal woman I will call Ms. Rain, was supposed to follow up on an abnormal lab result from a few days earlier. As I looked the patient up on the ancient clinic laptop, I thought about the promise I had made to my daughter that morning to try to be home by suppertime. I willed the computer to load the results a little faster so I could get home to my family.
Although physicians generally recognize that social determinants influence the health of their patients, many are unsure how they can intervene. Dr. Anne Andermann, Associate Professor in the Department of Family Medicine at McGill University in Montreal and founding director of the CLEAR Collaboration, discusses how physicians and allied health care workers can address social determinants in their day-to-day practice. She wrote a review article (subscription required) published in the CMAJ.
Meghna Rajaprakash is a medical student at the University of Toronto (class of 2016)
The recent Truth and Reconciliation Commission (TRC) report (2015) called upon medical schools “to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices.” As I read the details of the report, it resonated greatly with my experience of a gap in my formal education and the drastic need I felt when I worked with Indigenous patients during my clinical experiences.
My early exposure to Aboriginal health issues was during my graduate work on prenatal alcohol exposure, when I learned of Indigenous children who were separated from biological mothers, placed in multiple foster placements, and who suffered from poor physical and mental health. ...continue reading →
Canada’s Health Ministers met in Vancouver this week. All indications are that their talks were a lot about health care and funding, and very little about health itself. After all, let’s face it, our ‘health’ ministries are really ministries of illness care, there to manage a (very expensive) illness care system. And that system is there mainly to pick up the pieces once we become sick or injured or ‘unwell’ – not so much diseased as ‘dis-eased’.
Now don’t get me wrong, when the time comes when I need it, I would like a good illness care system there to look after me and – hopefully – restore me to pretty good health. And when I am too frail to manage, I hope it will be there to care for me with kindness and compassion. But wouldn’t it be better if I didn’t need it – or didn’t need it very much? ...continue reading →
Canada’s health ministers will meet in Vancouver on January 20, 2016. It is good to know we have a federal government that will engage with the provinces on health care. Let’s hope they will engage on health, not just health care.
Forty years ago, the Trudeau government of the day produced the fabled Lalonde report. It became the first government in modern times to acknowledge that further improvements in the health of the population would not come primarily from more health care. ...continue reading →
“I have stage 4 lung cancer. I’m dying and this is where I will spend my last days.”
I listened as a vulnerable, palliative, homeless man told our team about his life in a homeless shelter in Toronto. I watched him and thought of my great aunt who passed away from cancer, surrounded by her loved ones, housed, safe and comfortable. I was left feeling ashamed - how could we allow people to pass in such circumstances? ...continue reading →
The federal election seems to be focusing largely on issues such as the economy and security. If health is mentioned at all, it is in the context of health care.
But health care is a determinant of our health; it is not the main one. While our genetic inheritance also plays an important part, much of our health comes from the environmental, social, economic, cultural and political conditions we create as communities and as a society.
In our system, the federal government does not provide health care or manage a health-care system, aside from special situations such as for aboriginal people and the armed forces. But many other areas of policy for which the federal government does have full or at least partial jurisdiction do influence the health of Canadians. ...continue reading →
More than 800 000 Canadians access food banks each month, and no province or territory is unaffected by food insecurity. As citizens of one of the wealthiest countries in the world, Canadians should not have to struggle to put healthy meals on their families’ tables — families living on minimum wage should not have to go into debt to benefit from a nutritious diet. We tend to concern ourselves with these issues during traditional “giving” holidays, particularly Thanksgiving and Christmas. As a result, donations to food banks hit a lull during the summer, which unfortunately coincides with increased demand due to children no longer being enrolled in school-based meal programs. We need to be concerned year-round. ...continue reading →