Section 5 - Includes both lecture content and content from readings. PDF

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Week 10: The Environment: Disasters, Emergencies & Community NursingEcological Determinants of HealthEnvironmental Health Inequities Caused by climate change, pollution, resource depletion, marine degradation, population growth  Nearly 25% of global disease burden attributable to environmental...

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Week 10: The Environment: Disasters, Emergencies & Community Nursing Ecological Determinants of Health Environmental Health Inequities

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Caused by climate change, pollution, resource depletion, marine degradation, population growth Nearly 25% of global disease burden attributable to environmental risks (e.g. air/water pollution) Differences in health related to the environment by: o Geographic/geopolitical location o Social location o Developmental stage

CHN Role    

Primordial prevention o Precautionary principle Secondary prevention o Screening Tertiary prevention o Prevent further deterioration Quaternary o Avoiding over-medicalization Types of Disasters

Natural Disasters   

Unpredictable Can happen very quickly or slowly Can you think of some examples? (Online poll)

Examples  Southeast Asia tsunami 2004 – 280,931 deaths  BC Wildfires 2017 – 65,000 residents displaced, 1.2M hectares destroyed Man-Made Disasters  

Often result in mass numbers of civilian injuries and deaths Examples include bioterrorism, bombings, and technical disasters, such as nuclear disasters and oil spills o Bioterrorism: intentional use of micro-organism to cause infection or death

Examples  9-11  Lac Megantic Train Derailment  Deepwater Horizon Oil Spill Epidemics 

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Epidemics can occur when an infectious disease spreads rapidly, affecting a large number of individuals within a population, community, or region o Epidemics with high levels of morbidity and mortality often lead to economic and social disruptions Epidemics versus Pandemics

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Epidemics BECOME pandemics when infection becomes widespread across the globe Outbreaks – epidemic limited to a particular geographic area.

Examples  Alberta declares syphilis OUTBREAK – July 2019  COVID-19 2019 - ?? / SARS – 2003 o highlighted weaknesses in Canada's public health system o clinical system and clinical/public health interface o lack of surge capacity to deal with this crisis situation o timely access to laboratory results o information sharing, data ownership o Communication to the public was sometimes inconsistent, and it was not always clear who was in charge of the outbreak response. Key Activities in Public Safety and Emergency Preparedness Emergency Preparedness    

Federal legislation with respect to emergencies and emergency preparedness is found in three complementary acts: Emergencies Act o Public welfare emergencies, public order emergencies, international emergencies, state of war Emergency Preparedness Act Emergency Management Act

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Emergency management involves 1. Prevention 2. Mitigation 3. Preparation planning 4. Response 5. Recovery 6. Effective emergency management action can avoid the escalation of an event into a disaster

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Get Prepared Emergency Kits o Water and food (and a can opener) o Flashlight, radio o First Aid Kit o Cash (small bills and change) o Medication, formula, equipment

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Chapter 32: Emergency Preparedness and Disaster Nursing 

By completing a Hazard Identification Risk Assessment (HIRA), organizations can prioritize specific threats based on risk of probability and consequence or impact o Probability: likelihood of event occurring within a given time period o Impact: level to which the hazard will affect:  Humans  Physical infrastructure  Business

Emergency Preparedness

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Public health authorities use the Incident Management System as an operational framework for emergency preparedness and response planning Basic Structure includes: o Command o Operations o Planning o Logistics o Finance & administration Roles of the Public Health Agency of Canada

PHAC   

Provides leadership in promoting health, investigating and controlling disease, supporting public health infrastructure, and fostering collaboration between governments (provincial/federal) PHAC works with national and global partners including the World Health Organization, the US CDC, and the new European Centre for Disease Prevention and Control PHAC and Public Safety Canada work with the provincial and territorial governments to coordinate a unified response to any national public health emergency CHNs and Disaster

Disaster Nursing – Stages of Emergency Management 1. 2. 3. 4. 5.

Prevention Mitigation Preparedness Response Recovery

Disaster Nursing 

CHNs must learn from past disasters and develop strategies that include: o infection prevention and control in mass casualty incidents o public education o internal and external communication o building partnerships with outside agencies

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Surge capacity (ability to respond) o PUBLIC Health Triage o Sorting POPULATIONS for priority interventions

Jennings Disaster Nursing Management Model

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Jenning’s Model 

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Phase I (Pre-Disaster) o assess resources and risks o planning to achieve primary prevention (i.e. provide information to help the public prepare for a disaster) Phase II (Disaster occurs) o provide care, education, and case management to disaster victims o consider emotional, physical, psychosocial, and cultural aspects of care Phase III (Post-Disaster) o perform tertiary prevention and ensures that victims in the disaster are receiving treatment Phase IV (Positive Client/Population outcomes) o measure the overall impact of the disaster to organize the coordination of community services

Summary      

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Ecological determinants of health (air, water, soil, energy, materials) are not experienced equally by all populations CHNs have a role in interdisciplinary collaboration to foster stewardship of these limited resources to protect and promote people’s health Natural and man-made disasters can have global impact on mortality and morbidity Prevention, mitigation, preparedness, response and recovery are key stages in emergency preparedness PHAC provides leadership in HP and protection efforts, in PH infrastructure and provincial, national and international collaboration to respond to PH emergencies CHNs make use of Jennings Disaster Management Model to respond to disasters BEFORE, DURING, and AFTER a disaster Week 11: Maternal-Child Health…Global Health

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Maternal health care refers to health and services provided to women of childbearing age from menarche and include preconception care, pregnancy, childbirth and the postpartum period

Why does it matter?  Maternal and infant health are markers of the overall health of a nation as well as an indicator of the impact of the social determinants of health…more on this in the next section (Global Health) In 2017, approximately 295 000 women globally died in pregnancy and childbirth (WHO 2019) In 2018, approximately 5.3 million children under the age of 5 years died (WHO, 2019) Deaths from causes that are largely preventable. (van Daalen and Dosani quoted in Stamler et al., 2015 pg. 306) How is it Measured 

Multiple epidemiological measures o Mortality / Death o Preterm birth o Small / Large for gestational age o Each measure provides a different view of maternal-child health

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Maternal Mortality ratio: no of deaths during a given period per 100K live births during the same period Maternal Mortality rate: Number of maternal deaths in a given period per 100K women of reproductive age during the same period Maternal death: while pregnant or within 42 days of termination of pregnancy, expressed per 100K deliveries Preterm birth: infant born with less than 37 weeks gestation SGA birth: infant who falls in the 90th percentile at birth Neonatal death: infant who dies 0-27 days after birth Post-neonatal death: infant who dies 28-364 days after birth Total infant death: infant who dies 0-364 days after birth

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Maternal Health Context: Model of Care  

Biomedical view of birth in Canada has predominated, particularly in last half of 20th Century o For women at high risk of poor outcomes, this can be appropriate For women at low risk, a woman-centered physiologic approach may be more appropriate and preferred

Maternal Health Context: Mothering “Becoming a mother is often exalted and envisioned as a beautiful state that all women should embrace. The reality for many women in Canada is that mothering can be profoundly different from this. The discussions that society, communities, families and individuals have about mothering can help and hinder the health of women and their families…. There are contradictory messages that can set up unrealistic and unfair disconnects” (pg.315) Mothering is influenced by the views of society about its worth Maternal Health Issues:  Birth in Indigenous Communities  Teen mothers  Breastfeeding  Smoking in pregnancy INDIGENOUS BIRTH  First Nations, Metis and Inuit women who live on-reserve must evacuate at 36 weeks and deliver in hospital

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To a people whose community is central to their identity, this is disempowering Government provision of support person to evacuate with them helps, but can disrupt the family further Indigenous women are discriminated against at birth in hospital This speaks to the need for a supportive, culturally safe environment

BREASTFEEDING  Protective effects for Mum – Cancer osteoporosis; cost-effective and portable  Protective effects for Babe – Lower obesity risk later in life; infection prevention  Recommended by all leading health authorities  Exclusive for the first 6 months  To two years and beyond once foods are introduced at 6 months  Rates - suboptimal  Initiatives: Baby Friendly Hospital Initiative International Code for Marketing Breast milk Substitutes UNICEF - http://www.unicef.org/nutrition/index_24824.html TEENAGE MOTHERS  SDOH at play – more likely to be from low income families, have no partner, have experienced abuse, be from Indigenous families or Western provinces  Health impacts: Mom – depression, cannabis/tobacco use, decreased opportunities; Child: increased risk of juvenile delinquency, violence/neglect, school dropout SMOKING IN PREGNANCY  Crucial to stop/decrease in pregnancy  Even if can’t quit, health benefits of BF and smoking outweigh health risks of not BF  SDOH: younger, lower SES, no post-secondary education  CHNs: health education: smoke free home; family members should receive smoking cessation help; delay smoking before BF Newborn-Child Health: Indicators INDICATORS OF CHILD WELL-BEING  Material Well-being o Monetary deprivation; Material deprivation  Health and Safety o Health at birth; Preventive health services (immunization rate); Childhood mortality  Education o Participation; Achievement  Behaviours and Risks o Health behaviours; Risk behaviours; Exposure to violence  Housing and Environment o Housing; Environmental safety Infant-Child Health: Issues 

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Infant nutrition o Exclusive BF first 6 months o BF continued for up to 2 yrs or longer recommended Nutrition 6-24 months o Breast milk and complementary foods, iron rich, no unpasteurized milk Preschool age o Canada’s Food Guide / Indigenous version ‘Eating Well with CFG-First Nations, Inuit and Metis’ o Age group does not get recommended fat intake, potassium or fibre

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o Children from poorer households more likely to experience food insecurity Physical activity o Important to establish physical activity early in life; sedentary lifestyle predisposes to lower cognitive and psychosocial development o Canadian 24-Hour Movement Guidelines Injury prevention o Childhood injury related to physical activity a main reason for emergency department visits o Immigrant children more likely to sustain unintentional injuries o Limited data available – Canadian Hospitals Injury Reporting and Prevention Program – surveillance system in place to quantify extent of unintentional injuries, inform intervention development

Reproductive Health Promotion Reproductive rights: legal rights established 1968 by UN and adopted to varying degrees in different countries (1) Reproductive health for women and men (i.e. all people) (2) Reproductive decision-making (3) Equality and equity for people to make informed choices free from gender discrimination (4) Sexual and reproductive security free from sexual violence, coercion and with the right to privacy Reproductive justice = ties reproductive rights to determinants of health --complete physical, mental, spiritual, political, economic, social wellbeing of women and girls --will be achieved when women and girls have economic, social and political power and resources to make healthy decisions Maternal and Child Health: Summary • • •

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Maternal-child health is key for governments, globally CHNs play a role to promote health in this group due to their close involvement with young families, many of whom are vulnerable CHNs can advocate for evidence-informed policies that promote health by addressing underlying social determinants, rather than just mitigating or preventing illness or injury CHNs have an ethical obligation to advocate for culturally safe care for these groups, that needs to be targeted appropriately Women and children around the world deserve the same quality and timely care that is received in Western countries

Global Health What is Global Health What is Global Health? How is it different from International Health, or Public Health? (pg. 591 Table 33.1 differences)

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Global health: ‘Deals with issues that directly affect the health of all people in the world, including those that transcend national boundaries’ International health: ‘Deals with health issues of resource constrained countries rather than one’s own country of residence or citizenship’ Public health: ‘Deals with issues that shape population health of a community or entire country and within the geographic boundary of that country’

5 Components that differentiate these: 1. Geographical scope 2. Level of collaboration and cooperation 3. Focus on individuals/populations 4. Access to health 5. Areas of expertise

Why Does Global Health Matter?  

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In Canada, 1 in 5 Canadians are international migrants o By 2031 this will be 1 in 4 Canadians CHNs need a more global understanding of the cultural values and traditions held by our communities

Global Health   

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Globalization Disease Burden Communicable Diseases o New/emerging infections o Non-Communicable Diseases Canadian context Globalization: ”a constellation of processes by which nations, businesses, and people are becoming more connected and interdependent via increased economic integration, communication exchange, and cultural diffusion” (Labonte & Torgerson, 2005, p.158). Good: Because it advances technology, science, communications and cross-national working Not so good: because it creates disparities in terms of access to societal resources and opportunities (e.g. reliance on products coming in from one country means a shortage can significantly impact a community, and ultimately their health – e.g. EpiPens for children with peanut allergies

Disease Burden  measured in terms of years of life lost (YLL) or Disability-Adjusted Life Years (DALYs)  In global health we recognize there is a collective susceptibility to disease that crosses national borders  Disease burden increases where there is a lack of access to health care Communicable Diseases:  rates are decreaseing overall, but HIV and TB persist (and the latter is preventable); new and emerging infections are making their presence felt (e.g. Zika, MERS, SARS, COVID-19)  We need to understand the pathophysiology of these diseases  We need early detection  We need robust global surveillance! Non-communicable Diseases  Worldwide those with the biggest mortality = CVD, CA, respiratory disease, diabetes  In LMICs there is a shift in burden from communicable to non-communicable diseases as the economies improve Canadian Context  We are rated as the 8th best place to live worldwide  BUT we lag behind other countries in terms of equitable prosperity  An increasing amount of burden is being experienced due to the opioid crisis MNCH and Global Health   

Maternal Newborn and Child Health (MNCH) is a key marker of a country’s overall health MNCH indicates the influence of social determinants of health o This shows clearly how well a country’s government is looking after its population in general Maternal newborn and child health is inextricably linked to global health

Ten Facts About Maternal Health (WHO, 2019) 1. 2. 3. 4. 5. 6.

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More than 800 women die every day due to complications during pregnancy and childbirth There are five main causes More than 135 million women give birth per year About 16 million girls aged between 15 & 19 give birth each year Maternal health mirrors the gap between rich and poor Most maternal deaths can be prevented

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Many women do not see a skilled health professional often enough during pregnancy About 22 million abortions continue to be performed unsafely each year Reducing the maternal mortality ratio has been slow Lack of skilled care is the main obstacle to better health for mothers

See URL for more details on each of these: https://www.who.int/features/factfiles/maternal_health/maternal_health_facts/en/ 1. 800+ women die DAILY: second leading cause of death after HIV/AIDS in women of reproductive age 2. Five main causes of maternal mortality: -severe bleeding, infections, unsafe abortion, hypertensive disorders (pre-eclampsia and eclampsia), and medical complications like cardiac disease, diabetes, or HIV/AIDS complicating or complicated by pregnancy. 3. 135M women give birth each year: High morbidity – 20M experience morbidities (fever, anaemia, fistula, incontinence, infertility, depression) – ostracization happens 4. 16M girls 15-19 give birth each year:...