Health Care Organization, Primary Health Care and Structural Violence

Question 1

Describe health care organization in Canada.

Answer 1

It is a complex, diffuse, and decentralized arrangement of actors and services.

Question 2

True or false. There is one single national health system.

Answer 2

False. There are 15 single-payer, universal, and public systems in Canada.

Question 3

What is the Canadian Healthcare Act?

Answer 3

Canada’s federal legislation for publicly funded health care insurance

Question 4

What is the primary objective of the Canadian Healthcare Act?

Answer 4

To protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers

Question 5

What are the 5 founding principles of the Canadian Healthcare Act?

Answer 5

Public administration
Comprehensiveness (insurance plans coverage)
Universality (equity and equality)
Portability (care at home)
Accessibility (equity and equality)

Question 6

What are functions of the federal in the healthcare system?

Answer 6

Establishing standards, funding, providing health care to specific groups (first nations, inuits, members of the Canadian Forces, veterans, inmates, some refugees), etc.

Question 7

What are functions of the provinces/territories in the healthcare system?

Answer 7

All medically necessary services provided by hospitals and physicians.
“Medically necessary” is determined by provinces and territories

Question 8

What is the mission of Public Health Agency Canada?

Answer 8

Promote and protect the health of Canadians

Question 9

True or false. In Québec, the prevalence of chronic diseases is increasing faster than anywhere else.

Answer 9

True

Question 10

True or false. In Québec, 30% of patients seen in primary care have 5 or more chronic diseases (multimorbidity).

Answer 10

False. 50% of them.

Question 11

What is the RUIS?

Answer 11

Réseau Universitaire Intégré de Santé
Facilitate specialized care, medical education and research throughout the province
Favoring complementary and integration of care
Mandate to institute a culture of collaboration

Question 12

What is a CLSC?

Answer 12

Centres Locaux de Services Communautaires
Attempt at integration at a structural level
Wide range of services : routine, prevention, nursing services, rehabilitation, reintegration, public health services

Question 13

What is a GMF?

Answer 13

Family medicine groups
Group of family physicians who are responsible for a large group of patients and work in collaboration with nurses and other professionals

Question 14

What are the goals of a GMF?

Answer 14

Improve access to family MD and hours available
Improve quality patient follow-up, and continuity of care
Decrease unnecessary visits to ER

Question 15

What is the CIUSSS/CISSS?

Answer 15

Centre intégré (universitaire) de santé et de services sociaux

Question 16

What is the organizational difference between the healthcare system before and after the Bill 10 reforms?

Answer 16

In 2004, there were 18 health and social services regional agencies, in which there were 94 health and social services centres
In 2015, there were 13 integrated health and social services centres and 9 integrated university health and social services centres

Question 17

What is the goal of public health?

Answer 17

Keep people healthy
Prevent injury, illness and premature death
Combination of programs, services and policies that protect and promote the health of all Canadians

Question 18

Name implementations of public health.

Answer 18

Health promotion, protection, surveillance
Population health assessment
Disease and injury prevention
Emergency preparedness or disaster response

Question 19

What are the 5 levels of prevention? Briefly describe each of them.

Answer 19

Primordial : prevent risk factors
Primary : eliminate risk factors, prevent occurrence of disease
Secondary : detect and stop disease development before symptoms occur
Tertiary : reduce negative effects of the disease
Quaternary : identify those at risk for overmedicalization

Question 20

To what level of prevention does “interrupt the chain of causality” belong?

Answer 20

Primary

Question 21

What are the 4 pillars to prepare for emergency or plan for disaster?

Answer 21

Prevention and mitigation
Preparedness
Response (care)
Recovery

Question 22

What is social justice?

Answer 22

The fair distribution of society’s benefits and responsibilities.
Focus on eliminating the causes of inequities.

Question 23

Social justice involves which structures of a society?

Answer 23

Political, social and economic

Question 24

What is health equity?

Answer 24

The fair distribution of resources for health.
The absence of systematic disparities in health.

Question 25

What is the **difference between inequity and inequality**?

Answer 25

Inequity refers to unfair, unjust, or **morally wrong disparities**, whereas inequality refers to **unequal distribution of resources**.

Question 26

What are broad approaches for health equity?

Answer 26

Improvement of **daily living** conditions Tackling the **inequitable distribution** of resources Increasing the public’s awareness of, and health professionals’ training in the **SDoH**.

Question 27

True or false. **Social determinants of health are underlying causes of poor health**.

Answer 27

True

Question 28

True or false. To improve health, one needs to think at an individual level.

Answer 28

False. One needs to think at a **community-population level**.

Question 29

What can we encourage for **better health at a community level**? (2 examples)

Answer 29

Advocate for **social prescribing** Referral to community-based **support groups**

Question 30

True or false. Physicians, nurses and other healthcare providers can serve as **effective health advocates and valuable resources for the community**, not just for their clinic or hospital.

Answer 30

True

Question 31

Define **leadership** in the field of public health.

Answer 31

The ability of to influence, motivate, and enable others to contribute towards the effectiveness and success of their community and/or the organization in which they work. They inspire people to craft and achieve a vision and goals. Leaders provide mentoring, coaching and recognition. They encourage **empowerment**, allowing others to lead

Question 32

What are the **general competencies of leadership**?

Answer 32

**S**ystem transformation **A**chieve results **L**ead self **E**ngage others **D**evelop coalition

Question 33

What are the **levels of care**? What **types of care** do each of them provide?

Answer 33

**Primary care** : early detection, routine, health promotion and prevention **Secondary care** : in a hospital, care provided by specialists **Tertiary care** : complex care/pathologies, teaching hospitals **Quaternary care** : experimental treatments and procedures

Question 34

What are the **5 primary health care principles**?

Answer 34

Accessibility Public participation Health promotion Appropriate technology Intersectoral collaboration

Question 35

Describe **Accessibility (PHC Principle)**.

Answer 35

Access to promotive, preventive, curative, rehabilitative, supportive/palliative care

Question 36

Describe **Public Participation (PHC Principle)**.

Answer 36

People are invited to participate in making decisions about the health needs of their own community. This requires to be **flexible, responsive, and have a respect for diversity** including alternative approaches to address those needs.

Question 37

True or false. Health promotion focuses on the individual behaviour only.

Answer 37

False. It goes beyond the focus on individual behaviour towards a wide range of social and environmental interventions.

Question 38

Describe **Intersectoral Collaboration (PHC Principle)**.

Answer 38

Health and well-being are linked to **economic and social policies**. Providers from **accross health sectors** (local, national).

Question 39

What are the **3 levels of PHC interventions**?

Answer 39

**Upstream** (very broad approach, working with higher forces) **Midstream** (more in the field, implementing in institutions) **Downstream** (more specific, promoting access to care)

Question 40

What are the **8 elements of PHC** (WHO)?

Answer 40

Education on health problems and prevention Promotion of food supply and nutrition Adequate supply of safe water and basic sanitation Maternal and child care Provision of essential drugs Immunization against major infectious diseases Prevention and control of locally endemic diseases Appropriate treatment of common disease and injuries

Question 41

What are the 3 main things to consider for health promotion according to the **Population Health Promotion Model**?

Answer 41

On what should we take action? How should we take action? With whom should we act?

Question 42

What is **structural violence**?

Answer 42

**Social structures that stop individuals, groups and societies from reaching their full potential** (i.e. economic, political, legal, religious, cultural) Think about how they affect the education and healthcare systems

Question 43

What is **anti-racism**?

Answer 43

**The active effort to eliminate all forms of racism** including individual, institutional, structural, and systemic racism.

Question 44

What is **anti-oppression**?

Answer 44

Actions that challenge social, historical, and existing intersectional inequities and injustices within systems and institutions that privilege groups to dominate over others.

Question 45

True or false. The **Indian Act**'s aim is to foster respect for the Indigenous People.

Answer 45

FALSE. The aim is to assimilate and eradicate them >:(

Question 46

How can we ensure **cultural safety**?

Answer 46

Considering the **historical and social contexts** as well as **structural and interpersonal power imbalances** that shape health and health care services. Progress towards achieving **health equity**.

Question 47

What is **cultural humility**?

Answer 47

**Being open** to the cultures of other individuals and communities.

Question 48

What is the difference between **reflection and reflexivity**?

Answer 48

Reflection is used to examine our interpretations of a situation. Reflexivity is the ability to understand and question our own context.

Question 49

What are the **6 critical indigenous determinants of health**?

Answer 49

Balance Life control Education Material resources Social resources Environmental and cultural connections