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What is Global Health? Towards an Updated, Universal Definition

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By: Maria Wilson

Global Health Office Outreach Assistant

Global Health is an attractive and high profile field. We encounter global health issues on a daily basis, often without even realizing. In 2014, the West African Ebola outbreak was sensationalized in the media for months, featured heavily on every major Canadian media outlet. Several of the world’s largest charitable organizations – which you may work with, donate to, or benefit from – target global health issues. Poverty and health inequities continue to affect both our local and global communities. Students are being encouraged more and more to engage in international experiences in order to become well-rounded “global citizens.” Global health is all around us.

But what does “global health” really mean? If we asked five experts in the field to define global health, chances are each would provide a different response. Why? Because global health has grown over the years to encompass a variety of ideas and notions, including interdisciplinary cooperation, infectious and non-infectious disease, international development, social justice, food security, maternal and newborn child health, and environmental issues…and the list goes on. Global health is broad in scope, and each one of us may approach our work in slightly different way.

Academics have tried to define global health in past. Perhaps the most well-known and widely accepted definition of global health is that of Koplan et al. from 2009:

“Global health is an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide” [1].

While this definition touches on many important aspects of global health like equity, and a worldwide reach, it fails to address the “how.” We can study, research and practice global health, but what are the best ways to engage in our work? How do we find common ground?

I must admit, I don’t have the answers to these complex questions (yet), but I’m hoping that in the near future the global health community comes together to arrive at a solution. Until then, these are questions we should all be cognizant of when we approach our work in global health. Just like Koplan et al. called for the adoption of a common definition in global health in 2009, I am calling for an updated, universal definition of global health in 2016.

Why is it important to come to a consensus on what global health means? As global health continues to grow and become a part of our everyday lives, we must come together to determine a more clear purpose, and path for the future. With everyone working with a common framework in mind, towards shared goals, we will achieve the best outcomes moving forward.

Mobile Outreach Street Health – An Interview with Becky Marval

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The MOSH van, which acts as a mobile treatment centre for underserved populations in the HRM (Source: GHO Blog, 2012).

Mobile Outreach Street Health (MOSH) has provided accessible primary care services to several underserved populations in the Halifax area since 2009: those who are homeless, insecurely housed and street involved. You may recognize the MOSH van (pictured above), which travels around the community acting as a mobile treatment centre. The MOSH website provides a comprehensive overview of their relationship-based care model, as well as their weekly schedule. In order to learn more about this amazing community organization, we interviewed Becky Marval, who works as an occupational therapist (OT) with MOSH.

  1. How large is the population you serve?

The number of individuals who stayed in a homeless shelter in the Halifax Regional Municipality was 1,973 in 2011 [1]. However, not all those that MOSH serves are homeless, and MOSH does not serve the entire homeless population. According to a 2011 North End Community Health Centre program evaluation, MOSH had an average of 350-400 encounters per month [2].

  1. You work as part of an interdisciplinary team. What members are on that team, and why do you think an interdisciplinary approach is important?

The core team has two full-time nurses, along with a part-time OT (Becky), a few part-time family physicians and part-time “jack-of-all-trades” administrative support. There is also a Housing First branch at MOSH, consisting of team lead EJ Davis and four intensive case managers, with support from an OT and a mental health outreach nurse through a partnership with the Nova Scotia Health Authority.

There are lots of reasons an interdisciplinary/transdisciplinary approach is important. One would be that the folks we’re seeing have complex needs that require different perspectives as well as different personalities. Relationship-based care requires that we have many different options for people, necessitating differences in personalities and skills. We are also able to share and learn from each other because of these different approaches. A transdisciplinary team has overlap and shared responsibilities that aren’t anyone’s job in particular, like handing out food or bus tickets. We also don’t have a social worker on the team, so wherever the scope permits, we stretch our scope as long as it can be ethically stretched in order to help the people we serve in terms of resource navigation. Having an interdisciplinary team allows us to do our work in a more holistic fashion.

  1. What types of services do you provide as an Occupational Therapist with MOSH?

The types of services I provide are pretty broad. Occupational therapy is focused on allowing individuals to perform their activities of daily living (ADLs), like helping them take care of themselves or their apartment, assisting with mobility and transport, coping with chronic disease (both physical and addictions), and helping them find work or schooling. The focus on occupation can also mean helping individuals to determine meaningful things to do with their time, and how to adapt despite various challenges.

As previously mentioned, the role has to be broad because our team doesn’t have other specialist like a social worker or recreation therapist. Another piece of this work is helping to change the environment so it meets the needs of people. This can involve anything from working toward policy changes, to education around common topics that can be troublesome for staff that are trying to help clients, to building a ramp with limited resources to improve accessibility. There are a couple recent MOSH initiatives that benefit the population in innovative ways. The first is matching people with donated bikes, helmets and locks to facilitate mobility. The other is our history project, where people are encouraged to tell their stories. This provides a bit of a diving board for people to see themselves as experts and share their wisdom.

  1. Have you partnered with Dalhousie University before? If so, in what capacity?

We have an established partnership with Dalhousie Dentistry as part of another partnership with the North End Clinic. This involves a dental clinic a few days per week where dental students come and practice under supervision. MOSH constantly has Dalhousie students from a variety of backgrounds doing work and service placements. A lot of student projects look for real life problems and situations, and MOSH can provide them with the opportunity to conduct program evaluations and literature reviews.

  1. What do you think describes an effective partnership?

Aspects that are helpful include communication and mutual regard (respect, trust and awareness of strengths and weaknesses). Things that are not helpful include territoriality, guarding/protection of resources, and only looking out for oneself. Partnerships require similar philosophies, or at least the ability to arrive at a common ground or purpose. Finally, partnerships need to make sense for the target population. With MOSH that means achieving effectiveness with limited resources.

  1. What do you find most rewarding about your work with MOSH?

I find it really rewarding when I’m surprised at how well things can work out. I shouldn’t be surprised anymore, but just when I think we’ve run out of options, it’s very rewarding to find out we have endless possibilities and options to consider! It makes me hopeful, and reminds me there’s no reason to ever give up.

All of us at the GHO would like to thank Becky for taking time out of her busy schedule to be interviewed! If you are interested in getting involved with MOSH by becoming a committed volunteer or by donating, their contact information is available online. For more information, you can also follow MOSH on Twitter.

Worlds Together: Indigenous Medicine and the Canadian Health Care System

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This is a guest blog post written by the Indigenous Health Interest Group (IHIG) at Dalhousie University.

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IHIG is an interdisciplinary group of health professions students that share a common goal of improving the health of Indigenous peoples. Please join us for a panel event at the Halifax Central Library, March 2nd, 6:30pm. For more information, follow Indigenous Health Interest Group – Dalhousie on Facebook.

Indigenous medicine encompasses a holistic worldview. This has only recently become the more progressive understanding of health in Western medicine, where health is more accurately defined as “physical, mental, social and spiritual wellbeing” rather than simply the absence of sickness.

This conception of health is nothing new to Indigenous peoples, but is unfortunately not an ideal that is realized in many Indigenous communities today. In Canada, there are striking inequities in health outcomes for Indigenous people compared to the general population, like reduced life expectancies of 5 to 10 years. This reflects the effects of history combined with the social determinants of health. This history – which continues today – includes colonization, forced displacement and environmental degradation. The social determinants of health were grimly summarized by the Royal Commission on Aboriginal Peoples, which stated that “Aboriginal people endure ill health, run-down and overcrowded housing, polluted water, inadequate schools, poverty and family breakdown at rates found more often in developing countries than in Canada”.

It is in this context that many Indigenous communities in Canada are successfully re-building, reviving or reinforcing their cultures and practices – including Indigenous medicine. This presents an opportunity to improve care for Indigenous patients, by tackling what has historically been the total exclusion of Indigenous medicine from the mainstream healthcare system. Actively facilitating blended models that offer both Indigenous and allopathic options is one way to make the healthcare system more inclusive, effective and safe.

There are a small but growing number of examples in Canada that show how Indigenous medicine can work in parallel with the mainstream healthcare system to benefit Indigenous patients. These include the multi-disciplinary teams at Anishnawbe Health Toronto Community Health Center and the research action centre Well Living House, which provide patients a more comprehensive package of culturally-based services to meet their needs.

Dr. Margaret Chan, Director-General of the World Health Organization, summarizes the opportunity well: “The two systems of traditional and Western medicine need not clash. Within the context of primary health care, they can blend together in a beneficial harmony, using the best features of each system, and compensating for certain weaknesses in each.”

For all patients, healthcare providers should be sensitive of, and responsive to, their needs and preferences. It is also important for patients to have the opportunity to decide what health services work best for them. For many Indigenous people, healthcare may include some aspect of traditional medicine or Indigenous knowledge. Having these options available – and having them respected by non-Indigenous health providers – is important for Indigenous patients’ health and health outcomes. This is especially true because many report negative experiences with the healthcare system including anxiety, stereotyping/stigmatization and racism.

The healthcare system can become more inclusive and more effective by opening the door to Indigenous healing systems, cross cultural communication and reciprocal knowledge sharing. As current students, we can be part of this movement by engaging in discussion, learning from Indigenous communities, and building our own awareness and cultural competency. Doing so will equip us to support a more inclusive healthcare system in our future roles as providers, leaders, policy makers, and gatekeepers.

Is this relevant to Nova Scotia? In a word, yes. Whether or not we are aware, willing or able, we will provide healthcare to Indigenous patients, because:

  • Indigenous people comprise about 3% of the total population of Nova Scotia today
  • There are 42 reserve locations across Nova Scotia, but nearly half of the Indigenous population in Nova Scotia live off-reserve – in cities around the Province
  • There are not enough Indigenous health practitioners to be the sole healthcare providers for Indigenous communities

 

 

 

Black History Month Matters

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By: Kalkidan Gebre
Global Health Office Outreach Assistant
 

February 2016 marks the 90th anniversary of the celebration of Black History Month. Black History Month dates back to 1926 when historian Carter G. Woodson established the second week of February to be “Negro History Week”. During this month, the Western world is challenged to contemplate on the study and celebration of the journey and achievements of its African-descended residents: a journey filled with obstacles and triumph. From denied freedom, equality, and justice to compromise, sacrifice, opportunity, and community. This history is complex as it is embedded with sadness, pain, promise, and hope. It is filled with lessons of leadership, community, and love that are still applicable to our lives today.

We asked some Dalhousie students what Black History Month means to them and why it should be celebrated on campus. This is what they had to say:

Black History Month is a beneficial period where many can gain awareness of the contributions and accomplishments of, often, unrecognized people of African ancestry. It’s a period when the younger generation can learn about a comprehensive history of Canada and abroad. For me, Black History Month is not confined to the shortest month of the year, it’s every month! I celebrate and learn about my history and culture in every aspect of my life and illustrate that pride in everything that I do.

– Mana Gebreyohannes, Masters of Social Work

Black History month means taking time to pay tribute to those who broke down barriers for me. Although every day I am conscious of and proud of my roots, black history month is like an active reminder to celebrate out loud. To bring the roots of my being to the forefront for once in a society where they often take the back seat. It is important that we celebrate Black History Month on campus because it is a way to bring people of all races together. Recognizing that we all have an important history to share and we all can play a role in celebrating how far we’ve come while also remaining aware of where we have yet to go.

– Cinera States, 3rd year Medical student

To me, Black History Month means celebrating and appreciating a history that is often extenuated. It means letting the world know that Black people have made significant contributions to society, as well as reminding the younger generations of the barriers cleared for them by those who challenged extremely unequal conditions of the past. It should be celebrated at Dalhousie because when the community is not aware of different perspectives on events in history, attitudes of racism and discrimination have room to arise in people’s opinions and thoughts. This negatively impacts students of African descent, and perpetuates situations that lead to disadvantages that people have worked so hard to eradicate over generations.

– Desiree Jones, 4th year sociology major & minor in Law

Black History Month is an opportunity for communities to learn about and honour the cultures, histories, and legacies of people of Afrikan descent. Not only should Black History Month be celebrated at Dalhousie but the legacy of people of Afrikan descent should be meaningfully reflected and integrated in academic curriculums and policies.
(Amina Abawajy, 4th year Informatics and International Development Studies major)
To me black history month is the recognition of the adversities and liberation of the African people throughout history. I believe that Black History Month symbolizes the movement to change injustices that we currently live in. Black History Month is important to acknowledge at Dalhousie so that students are aware of the substantial contributions that we have made to society. In a world that is run by white privilege, we need to continue to motivate the black people to strive for the greatest so that they may emulate their ancestor’s great work of changing society to be better.

– Vicky Atiol, 4th year Economics student

 

Celebrating Black History Month at Dalhousie is critical, because it can be used to correct many of the misrepresentations and misunderstanding of black history and culture. Black History Month encourages open dialogue and personal interactions between the many cultures found on campus. These conversations and interactions can lead to a better understanding and appreciation for the different experiences and challenges each student endures every day.

“Injustice anywhere is a threat to justice everywhere…whatever affects one directly, affects all indirectly” – Dr. Martin Luther King Jr.

For Black History focused events throughout the month on and off campus visit: https://blogs.dal.ca/globalhealth/

 

Environmental Racism – January Global Health Rounds

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Photo credit: enrichproject.org

 

The first Global Health Rounds of 2016 took place on January 20th in the Sir Charles Tupper Medical Building. Global Health Rounds is a free public lecture series, focused on highlighting and discussing the global health activities at Dalhousie, as well as contemporary global health challenges, with leaders in the field. These sessions are offered monthly and anyone is welcome (and encouraged) to attend. Speaker and location details will be posted on the Global Health Office Website, Facebook, Twitter and Instagram.

January’s Rounds, led by Dr. Ingrid Waldron, was entitled “Race, Place & Waste: Exploring the Health Effects of Environmental Racism in African Nova Scotian & Mi’kmaw Communities.” Dr. Waldron discussed the Environmental Noxiousness, Racial Inequities and Community Health – or ENRICH – Project, which aims to better understand the effects of environmental racism in African Nova Scotian and Mi’kmaw communities, and to support their struggles against it. Dr. Waldron’s talk drew a crowd of more than forty students, faculty, health professionals and community members. We hope to see just as much enthusiasm for February Global Health Rounds: Health & Wellness of African Nova Scotians. Check out (and share) the Facebook event for more information, and to indicate your interest and plans to attend.

Some of the January Global Health Rounds attendees. We had to open a second room connected by video-conference because there were so many people!

Some of the January Global Health Rounds attendees. We had to open a second room connected by video-conference because there were so many people!

 

What is Environmental Racism?

The first time I heard about environmental racism was in a 2013 article by Vice News about The Chemical Valley [1]. The Aamjiwnaang First Nations reserve near Sarnia, Ontario, home to about 850 Chippewa, sits surrounded by harmful chemical plants that produce gasoline and synthetic rubbers, among other materials. Why are these plants located next to a First Nations reserve, rather than in the midst of a middle class, primarily white neighbourhood? How do race and class shape where hazardous industries are located?

Dr. Waldron’s research in environmental racism seeks to answer these types of questions in Nova Scotia, while assessing the health impacts and working toward policy solutions. In Nova Scotia (and globally), there is a disparate location of hazardous industrial polluters in communities of colour, First Nations, in remote areas and among the working poor. The ENRICH project began with community consultations in the spring of 2012. Consultations took place in Yarmouth-Acadia First Nations, Eskasoni First Nation, Membertou First Nation, Lincolnville, and other affected communities. The concerns that were identified among these communities include (but are not limited to) fear of water and soil contamination, high rates of cancer, asthma and fetal anomalies and social nuisances such as loud noises, increased insects and mammals. Some women feel that their reproductive choices are limited, not wanting to expose a child to the aforementioned effects of environmental racism.

Dr. Waldron noted that environmental racism is an intersectional issue. Low income white communities also experience environmental racism, but their issues are often addressed more quickly. When there are multiple factors impacting the lack of power to be protected and heard (race, place and class) due to a history of forced displacement, social marginalization and destruction of culture and language, environmental racism worsens. Despite pushback from these communities who are affected by landfills and dangerous industries, there is a common response: in order to have grounds to remove them, there must be concrete, scientific proof that they are causing harm. The burden of this proof often falls on the communities, but it should be shifted to those responsible for environmental racism.

Bill 111

Communities experiencing the health and social impacts of environmental racism shouldn’t have to wait for 100% proof and validity to have their issues addressed. Dr. Waldron’s work, in collaboration with MLA Lenore Zann, culminated in presenting Bill 111, An Act to Address Environmental Racism, in the Nova Scotia Legislature.

In 2015, Bill 111 made it to second reading, but did not pass. Dr. Waldron is not discouraged, as the bill has introduced to the issue of environmental racism to many who were otherwise unaware. Bill 111 was featured in The Huffington Post, The Chronicle Herald, and is now on the record as being debated in the Nova Scotia Legislature [2]. She plans on introducing the bill again in the near future.

Future Directions

Dr. Waldron’s current work includes working with a dedicated team to develop an all-applicable Environmental Bill of Rights, stating that everyone has the right to clean air and clean water; the right to live, work, learn and play in healthy and sustainable places, among other standard rights that those impacted by environmental racism are not always afforded.

The Global Health Office would like to thank Dr. Waldron for her eye-opening talk about environmental racism, a pressing local and global health issue. To learn more about the ENRICH Project, you can visit their website [3].

Local Partnerships: Dartmouth North Community Food Centre in Focus

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Have you ever heard the saying “think global, act local?” This phrase was first used in the context of environmental challenges, however, it is becoming more and more relevant to the field of Global Health. Global health focuses on achieving health equity for all people, worldwide. Global health issues transcend national borders, and often impact those in our own communities. Therefore, we can begin to combat global issues by addressing them on a local scale.

The Dalhousie Global Health Office partners with a number of organizations in both Halifax and Saint John to provide a Local Global Health Elective program to first and second year medical students. The Local Global Health Elective is a half-year elective, which complements family medicine placements with community and social service organizations. This elective helps students develop a broad understanding of the health of socially marginalized groups in their own communities, and the services available to address their needs. The Dalhousie Global Health Office is also exploring building service learning opportunities to be launched in fall 2016. Stay tuned for more information about our exciting new Service Learning opportunities with UGME the coming months!

One of our newest partner organizations is the Dartmouth North Community Food Centre (CFC), a project of the Dartmouth Family Centre. The Dartmouth Family Centre is located in North Dartmouth, an under-served and high needs area: 13.5% of the population in this area is aged 65+, 31% of households are single-parents families, and 6.4% of the population are immigrants, a number that is expected to grow in coming years. The Dartmouth North CFC aims to increase the number of new entry points for families with young children, providing the community with a gathering space while expanding food access and skill-building opportunities. Community members come together to grow, cook, share and advocate for good food, through a variety of programs including a food distribution initiative, community kitchens and community gardens. You can learn more about how the Dartmouth North Family Centre combats local global health issues on their Website, Facebook or Twitter.

To learn more about our Local Global Health Elective opportunities, as well as our other offerings, check out our Website. As always, for information on our upcoming events, please check out our Facebook, Twitter or Instagram.

 

 

 

Nova Scotia, Canada and the Syrian Refugee Crisis: A Brief Overview

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Map showing the 36 communities in Canada where there are existing Resettlement Assistance Program service provider organizations. (Source: Citizenship and Immigration Canada, December 29, 2015).

Map showing the 36 communities in Canada where there are existing Resettlement Assistance Program service provider organizations. (Source: Citizenship and Immigration Canada, December 29, 2015).

 

In 2013, 24,049 refugees made Canada their home through government assistance (GARs), private sponsorship (PSRs) and asylum-seeking [1]. A refugee is someone who been forced to flee their home country due to circumstances such as persecution, war or violence [2]. Worldwide, 60 million people have been displaced from their homes, and over half are children. In 2014, 53% of refugees worldwide came from just three countries: Somalia, Afghanistan, and Syria [3].

Since the outbreak of civil war in Syria began in 2011, millions have been displaced from their homes. Presently, 4.3 million Syrians are refugees, and 6.6 million more are displaced within Syria. Most of these refugees remain in Middle Eastern countries such as Turkey, Lebanon, Jordan and Iraq [4]. The Syrian Refugee Crisis prompted the Liberal government to make a pledge: to welcome 25,000 Syrian refugees as permanent Canadian residents before the end of December 2015. This deadline has since been pushed to February 29, 2016. Canada is partnering with the United Nations Refugee Agency to identify Syrian refugees in Jordan and Lebanon who are interested in coming to Canada. Security and health screening processes include an interview with visa officers, identity and document verification (both before and upon arrival), and health screening [5].

A total of 6,300 Syrian refugees have arrived in Canada since November 4, 2015, and another 5,307 refugee applications have been finalized. These figures are based on data from January 3, 2016. 85 communities across Canada (not including Quebec – their refugee program is run in-province) are currently preparing to welcome privately-sponsored Syrian refugees [6].

Once refugees arrive, they will be provided with immediate, essential services and long-term settlement support to ease their transition and integration into Canadian society. Support for GARs is provided by the Government of Canada, covering items such as clothing, food, temporary shelter and basic household needs. Social supports include assistance with finding permanent housing, employment and community orientation. Support seeks to align with provincial and territorial social assistance rates. Refugees resettling in Quebec receive similar support, but this is provided by the province. PSRs are provided with care, lodging, settlement assistance and social support by sponsors, who normally commit to 12 months of support, or until the refugee becomes self-sufficient (whichever comes first) [5].

Here in Nova Scotia, community donations have also been welcomed. On the first day of the Bayers Lake drop-off centre in Halifax, 1,500 bags of clothing, 200 pieces of furniture, 40 baby strollers and many children’s toys, toiletries and linens were donated. The centre is located at the former Rona location in the Bayers Lake Business Park, if you are in the Halifax area and interested in making an item donation such as winter outerwear, new toiletries, baby supplies, toys, school supplies and gift cards for groceries [7]. Many communities, both large and small, have begun refugee sponsorship and support groups. The Immigrant Services Association of Nova Scotia (ISANS) estimates that 500-700 Syrian refugees could be arriving in Nova Scotia in the coming months, though no concrete figures have been provided [8]. The ISANS website has a compilation of wonderfully laid out information about welcoming Syrian refugees in Nova Scotia, and what you can do to help, if you have further interest [9].

Many false claims have caused some in Canada (and in other countries) to be wary of accepting Syrian refugees. Thankfully, people worldwide have taken to the internet to debunk some of the myths around refugees, notably in the United States [10], the UK [11] and in Canada [12].  Additionally, ISANS has compiled a list of debunked myths for Nova Scotians [13] . We hope that you will take the time to read them if you are feeling skeptical, and to recognize that soon enough, at least 25,000 Syrian refugees, as well as other refugees worldwide, will be permanent residents of Canada. We should be treating them as such, by welcoming them into our diverse, nurturing, prosperous and peaceful country, with arms open wide.

The Canadian Council for Refugees applauds the warmth and hospitality provided by countless Canadians; however, they identify several key challenges that must be tackled in 2016 to ensure Canada’s refugee response is effective. Firstly, continuing support to Syrian refugees, while expanding immediate concern to refugees from all regions. This includes shortening processing times for resettled refugees from all countries, which has been shown to be possible through the recent effort with Syrian refugees. The Council also encourages Canadians to not stop their efforts at 25,000, specifically encouraging the government to support 25,000 refugees, with PSRs going over and above this number. Finally, equitable treatment for refugees, such as full coverage under the Interim Federal Health Program, is recommended [14].