What is Health?&nbsp;

Health Professions Act (BC)

Act that provides the regulatory framework for the 25 regulated health professions in the province

Medicare Protection Act- Medical and Health Care Services Regulation (BC)

outlines what is covered under BC's publicly funded health insurance plan (MSP)

Hospital Insurance Act (BC)

outlines what services are included under publicly funded healthcare (MSP) for patients admitted to hospitals in British Columbia

Physiotherapy Specific Resources

Standards of Practice

Minimum standards for physical therapy practice, established by the College of Physical Therapists of British Columbia

Code of Ethical Conduct

Document published by the College of Physiotherapists of British Columbia that outlines the ethical principles

governing the conduct of members of the profession in British Columbia

Canadian Alliance of Physiotherapy Regulators

Organization that is responsible for the national physiotherapy exam (credentialing and assessment of competency on behalf of the provincial colleges)

Canadian Physiotherapy Association

Association that provides resources and learning opportunities to its members in order to enhance physiotherapy practice. Also involved in advocacy for the PT profession across the country

What is Health?

Well-being Concepts

"What is health? The ability to adapt"

"Towards a contemporary definition of health"

"Defining health by addressing individual, social, and environmental determinants: New opportunities for health care and public health"

Bircher & Kuruvilla (2014) offers a new definition of health as a "state of wellbeing emergent from conducive interactions between individuals' potentials, life's demands, and social and environmental determinants"

COVID-19 highlights Canada's care home crisis

This report, published by the Lancet, suggests that Canada’s horrible record of long term care COVID outbreaks and deaths is a consequence of the historical decision to exclude long term care from the Canada Health Act. This omission, and the resultant exclusion of long-term care facilities from the network of provincial and territorial health systems, has resulted in under-training of staff, poor pay for workers, aging facilities, over-crowding of residents and poor infection control policies.

Recovering from the COVID-19 pandemic: A focus on older adults

This article examines how the COVID pandemic has disproportionally affected the well-being of seniors in the community. Homecare agencies have been struggling to retain staff as many care aides are opting out these traditionally low paid roles when faced with the increased risk posed by the virus. This resultant decrease in home support services has resulted in lack of attention to personal care, medication adherence and nutrition. The article is presented in terms of opportunities for improvement when considering how we care for older adults.

Evaluation of an advanced-practice physiotherapist in triaging patients with lumbar spine pain: surgeon–physiotherapist level of agreement and patient satisfaction

This study by Robarts et al (2017) is a prospective cohort study of patients that were referred as outpatients to a surgical spine clinic for low back pain that compared assessments completed by an advanced practice physiotherapist with those completed by spine surgeons. They found a high level of agreement (86%) between both parties on whether surgery was indicated. Importantly, more than 70% of referred patients did not require surgical intervention and were more appropriately managed by conservative interventions such as physiotherapy.

Centers for Disease control website- concept of "well being". How is well-being defined, measured and how does it relate to public health initiatives?

Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter?

This study by McGregor, M. (2005) examined staffing levels in long term care facilities in British Columbia. At the time of the study 70% of publicly subsidized nursing homes were non-profit, while the remaining 30% were for profit facilities. . In for profit facilities this inevitably resulted in lower levels of staffing: non-profit facilities provided 0.34 more hours of direct care time per each resident day compared to for-profit facilities as well as an additional 0.23 hours of support staff/resident day.

Dying and death within the culture of long-term care facilities in Canada

In their article, Cable-Williams and Wilson argue that a palliative approach to care should be applied throughout admission and residence to long term care. They emphasize that a palliative approach should not be equated with end of life, but should be considered as a way to emphasize comfort and quality of life in a population that typically represents the oldest old, well before death is imminent.

Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review

This was another paper that compared advanced practice physiotherapy with physicians. This study looked at patients presenting to the emergency department with musculoskeletal pain. They found that, compared to physicians, advanced practice physiotherapists prescribed less pain meds and injections, prescribed fewer assisted devices and offered more advice on management strategies. The length of stay in the emergency department was much shorter for those seen by the therapists. The authors concluded that the physiotherapist's ability to triage patients was as good as that of orthopedic surgeons.

Lancet (2009) article which offers a simple and elegant alternative to the WHO definition of health

For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths

This was a retrospective cohort study looking at 623 nursing homes in Ontario from March 29 to May 20, 2020. It found that profit status (for profit versus non-profit) was not associated with the risk of a facility having a COVID outbreak but it was significantly linked to outbreak size and resident deaths with for profit facilities having worse and more deadly outbreaks. The authors pose that much of this difference is due to outdated facilities in for-profit homes.

Palliative care has been lacking for decades in long term care.

This is another article that advocates for a palliative approach for residents of long-term care. However, the author highlights a key barrier to providing quality palliative care: staffing levels. In a hospice, the typical staffing ratio of nurse to patient is 1:4 which is vastly different than the 1:30 ratio typical of long-term care. The author also highlights the fact that, although the demographics of long-term care have shifted in recent decades, with patients entering long term care at a much older age and much closer to end of life, the staffing models have not changed accordingly

Bradley et al. (2018) article providing another contemporary definition of health recognizes that disease and disability can and often do co-exist with wellness. This in direct opposition to the WHO definition which includes the complete absence of disease

COVID-19 in long-term care homes in Ontario and British Columbia

This study by Lui, M. et al. (2020) compared COVID mortality rates among long term care residents in British Columbia versus Ontario (2.3% of residents, versus 0.6%, respectively). Other differences were noted which may have explained some of this difference in mortality. For example, Ontario has a much higher proportion of LTC beds being in shared room and a much lower rate of annual inspections.

The Joint Clinic: Managing excess demand for hip and knee osteoarthritis referrals using a new physiotherapy-led outpatient service

This study looked at the effectiveness of sending patients with hip and knee osteoarthritis to a Joint Clinic, where they would be assessed by a nurse and a physiotherapist, instead of referring all patients directly to an orthopedic surgeon. After assessment by the nurse and physio, patients were provided with an individualized care plan which might include things like exercises and pain management strategies. Surgical referral was provided in cases where the nurse and physio felt the case was severe enough to warrant surgical intervention.

Social Determinants of Health

Social determinants of health: The Canadian facts. 2nd Edition

Raphael, D. et al. (2020) examines 17 different social determinants of health and their impact on the health of Canadians, looks at what Canada is doing to address them and suggests opportunities for improvement

Health inequalities data tool

Government of Canada's publicly available data tool on health outcomes and health determinants, which can be viewed through a range or social and economic indicators

Key health inequalities in Canada: A national portrait. Executive Summary

Report published by Public Health Agency of Canada (2018) which provides a summary of the types and magnitudes of health inequalities across Canada

Priority health equity indicators for British Columbia: Selected indicators report

Provincial Health Services Authority (PHSA)-

provides data for 16 health equity indicators across selected geographic, demographic and socio-economic dimensions in BC

Health inequalities of British Columbia- discussion paper

Paper by the Health Officers Council of BC (2008) which uses

BC data to describe the existing health inequities in the province and suggests policy options that offer opportunities to address those inequities

Healthy futures for BC families. Policy recommendations for improving the health of British Columbians

Publication by the BC Healthy Living Alliance (2009) which

highlights policy options aimed at tackling the underlying social determinants of health and health inequities.

BC’s guiding framework for public health March 2017 update

Guiding document by the Ministry of Health (2017) which outlines resources and strategies in place to address key public health challenges. Includes seven overarching goals, each with specific targets and measurable indicators

Multilevel models of health

Toward an experimental ecology of human development

Original ecological systems model proposed by Bronfenbrenner (1977) which includes four nested structures/levels influencing human behaviour (microsystem, mesosystem, exosystem and macrosystem). The classical model is based on child/human development and education.

Bronfenbrenner's Ecological Systems Theory

This article published on Simply Psychology in 2020 by Guy-Evans, O. is an easy to read overview of Bronfenbrenner's original model including its applications in modern times

An Ecological Perspective on Health Promotion Programs

Article published by McLeroy, K. et al (1988) which proposes a model for health promotion based on the work by Bronfenbrenner. This model posits that human behaviour is determined by intrapersonal factors, interpersonal factors, institutional factors, community factors and public policy

The social ecology of health: Leverage points and linkages

This article by....provides a review of Bronfenbrenner's theory with examples of how these concepts have been found to influence health and how health professionals can use the model in practice

Grzywacz, J.G. & Fuqua, J. (2000). The social ecology of health: Leverage points and linkages. Behavioral Medicine, 26(3), 101-114. https://doi.org/10.1080/08964280009595758

COPD in Canada

Government of Canada data blog (2018) with percentages of patients diagnosed with COPD at various age groups and prevalence estimates for each province/territory

Incidence, comorbidity, case fatality, and readmission of hospitalized stroke patients in Canada

This article by Johansen et al. (2006) examines the incidence of acute stroke for different age groups and provides a comparison of length of stay, fatality rate and rate of repeat admissions for strokes across the different groups

Report summary: Tracking heart disease and stroke in Canada in 2009

This report, by Dai, S. et al. (2009) provides a picture of the rates and prevalence of stroke and heart disease in Canada. The data was a result of a collaboration with CIHI (Canadian Insitute of Health Information), the Heart and Stroke Foundation of Canada, Statistics Canada and the Canadian Stroke Network.

Focus on heart failure: Adressing a silent epidemic

This 2015 web-page, by the University of Ottawa's Heart Institute provides a look at the healthcare costs of heart failure, the prevalence of heart failure in Canada and new initiatives for heart failure management

Comorbidities and mortality associated with hospitalized heart failure in Canada

2012 article by Dai, S. et al. looks at the overall healthcare system burden of heart failure in acute care centres. It looks at mortality rates, length of stay data and presents the most common co-morbidities seen in patients diagnosed with heart failure

Model core program paper: Healthy living

This paper, by the Ministry of Health (2007) outlines three “lifestyle factors” (preventing smoking/smoking cessation, healthy diet, and physical activity) as being the biggest priorities for the government to address in order to reduce the risk of chronic disease across the province. For each of these factors the paper then outlines strategies that the government has identified targeting various levels of health and partnerships with businesses and community organizations

Well-being after stroke in Canadian seniors

This study by Clark, P. et al (2002) examined data collected as part of the Canadian Study on Health and Aging to compare the health, function and well being of seniors living in the community who had experienced a stroke with those who had not had a stroke

Evidence review: Chronic disease

This is a review by the Ministry of Health (2010) is a compilation of the evidence supporting primary prevention and early detection methods in various chronic conditions, including stroke, heart disease and COPD.

Chronic Diseases

Vulnerable Populations- Indigenous

Creating conditions for Canadian aboriginal health equity: The promise of healthy public policy

This review by Richmond, C.A. and Cook, C. (2016) examines the historical context of colonialization and implications of the Indian Act in producing the social inequalities and health effects seen in modern day Canada. The report provides data on key health issues faced by indigenous communities and compares rates of illness/disease among indigenous individuals with national averages.

Insiders' insight: Discrimination against Indigenous peoples through the eyes of health care professionals

This qualitative study by Wylie, L. & McConkey, S. (2019) examines the views of health care workers in southern Ontario in terms of their perspectives on challenges that indigenous patients and families have with accessing health services. The paper notes widespread discrimination and stereotyping (often not consciously) against indigenous populations by health care workers, as well as an overall un-welcoming environment as being barriers to accessing care.

The state of knowledge of Aboriginal health: A review of Aboriginal public health in Canada

This is a fairly comprehensive document by the National Collaborating Centre for Aboriginal Health (2012) that outlines available data and statistics regarding aboriginal health and relates these issues to social determinants of health. It also provides a summary of current programs and initiatives being implemented by the different levels of government to deal with these issues.

In plain sight: Addressing Indigenous specific racism and discrimination in BC health care

This is the report written by independent reviewer Turpel-Lafond, M. A. (2020) which investigated systemic racism against indigenous persons within the BC health care system, following accusations of a "Price is Right" game occurring amongst health care workers at a BC emergency department. Although the report did not substantiate the existence of such a game (where healthcare workers guessed at an individual's blood alcohol level), it did significant evidence for pervasive racism and discriminatory behaviour.

A review of Aboriginal infant mortality rates in Canada

This systematic review by Smylie, J. et al (2010) examined available literature on infant mortality rates among aboriginal populations in Canada, which the authors state is a good indicator statistic for the overall health of a population. According to this review, the overall infant mortality rate in Canada is 5.1 for every 1000 live births. The rate among Indigenous populations was difficult to definitely state due to large gaps in data but was estimated to be 1.7 to 4 times the Canadian average

Residential schools and the effects on Indigenous health and well-being-- A scoping review

This systematic review by Wilk, P., Maltby, A., & Cook, M. (2017) examines the impact of residential school attendance on health and well being of survivors and their children and grandchildren. The impacts of residential schools are seen to be generational, with the children of attendees demonstrating poorer health and mental health outcomes compared to children of indigenous people who did not attend residential schools