When we think of health we generally think of physical health and the ability to do the things we enjoy. However, the World Health Organization has a much broader accepted view of what heath is, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” (WHO, 2022, para 1). How do we get to a point where everyone has an equal ability to enjoy health?
Health promotion is certainly a component to ensuring health for all. The Ottawa Charter provides us with five areas to focus on. Build health public policy, create supportive environments, strengthen community action, develop personal skills, and reorient health services (WHO, 1986). During this course I expect to find that while the Charter has been around for a long time now (getting closer to forty years!) there is still much work to be done. Many at risk groups have not had the same attention focused on reducing their inequalities as others and that needs to change. We pride ourselves in Canada as having a strong healthcare system but is it really as strong and as comprehensive as we think?
As a health professional with an imaging background, the health promotion issue that always speaks the most to me is breast cancer screening. Breast cancer is a leading cause of death in Canadian women and as many as one in eight are diagnosed with breast cancer during their lifetime (Ferdous et al., 2019). While we do have a breast cancer screening program in Ontario called the Ontario Breast Screening Program (OBSP), which allows for women aged 50-74 to be screened for breast cancer every other year without the need for a doctor’s referral (Cancer Care Ontario, n.d.), the OBSP program still has room for improvement when it comes to focusing on the needs of Indigenous women in our province.
Death from breast cancer has stabilized over recent years despite an increase in the number of breast cancers each year, but that is not true for all Canadian women (Mazereeuw et al., 2017; Withrow et al., 2017). Indigenous women are diagnosed at a later stage of breast cancer and are two times more likely to have another comorbidity identified at diagnosis than their peers (Sheppard et al., 2010). The health promotion problem identified is unequal access to breast cancer screening for Indigenous women in Ontario. The opportunity for improvement is to work to create supportive environments and strengthen community action while develop personal skills within the Indigenous communities to increase Indigenous women’s participation in breast cancer screening. Increased, earlier screening should reduce death from breast cancer, bringing Indigenous women’s rates in line with their non-Indigenous peers. Education focused on the needs of this group will be key, as will working with Indigenous leaders to learn what practices will align with Indigenous care.
It is time to pay attention to the inequalities that still exist in Canada that reduce the ability for all to experience health. We have a long way to go to be the truly great and healthy whole nation we can be. It is time we focused on our most at risk members, the Indigenous population.
References
Cancer Care Ontario. (n.d.). Ontario Breast Screening Program (OBSP). https://www.cancercareontario.ca/en/cancer-care-ontario/programs/screening-programs/ontario-breast-obsp
Ferdous, M., Goopsy, S., Yang, H., Rumana, N., Abedin, T., & Turin, T. (2019). Barriers to Breast Cancer Screening Among Immigrant Populations in Canada. Journal of Immigrant and Minority Health (22). 410-420. https://doi.org/10.1007/s10903-019-00916-3
Mazereeuw, M., Yurkiewich, A., Jamal, S., Cawley, C., Jones, C., & Marrett, L. (2017). Cancer risk factors and screening in First Nations in Ontario. Health Promotion and Chronic Disease Prevention in Canada. 37(6). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650013/
Sheppard, A., Chiarelli, A., Marrett, L., Mirea, L., Nishri, E. D., Trudeau, M., & Aboriginal Breast Cancer Study Group. (2010). Detection of Later Stage Breast Cancer in First Nations Women in Ontario, Canada. Canadian Journal of Public Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973584/
Withrow, D., Pole, J., Nishri, E. D., Tjepkema, M., & Marrett, L. (2017). Cancer Survival Disparities Between First Nation and Non-Aboriginal Adults in Canada: Follow-up of the 1991 Census Mortality Cohort. Cancer Epidemiology, Biomarkers & Prevention. (26). 145-151. https://cebp.aacrjournals.org/content/26/1/145
World Health Organizaiton. (2022). Constitution. https://www.who.int/about/governance/constitution
World Health Organization. (1986). Ottawa charter for health promotion, 1986 (No. WHO/EURO: 1986-4044-43803-61677). https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population-health/ottawa-charter-health-promotion-international-conference-on-health-promotion/charter.pdf
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