"Here At Home"
The National Film Board is producing a web documentary about At Home/Chez Soi, the national research study on mental health, homelessness, and Housing First. I couldn't be more impressed. I hope you'll check it out to learn more about the project, and hear the stories of participants who have received housing and support, participants who have not received either, and service providers and community members from Vancouver to Moncton. There are 8 short films currently up on the interactive website, which means there will be 42 more to come over the next year - so do check back.
(all images from http://athome.nfb.ca/)
Infectious Art
Today's Google Doodle honours Keith Haring, an iconic pop/graffiti artist whose chalk drawings filled the empty black frames of advertising panels in the New York City subway.
Haring passed away in 1990 at the young age of 31 due to AIDS complications. Some of his most recognizable drawings (and some of my favourites) were often used to raise awareness of HIV/AIDS in the early days of the emerging epidemic.
Images via: http://www.media-studies.ca/articles/protest.htm http://www.tesionline.com/intl/focus.jsp?id=1593 http://www.fayeandco.com/2009/03/pa-spotlight-keith-haring/
Knowledge Translation: Generating Infectious Ideas
Where does knowledge come from? How does it become infectious? How can scientific knowledge be shared? A great video by Sustainable Learning.
h/t to @LittleBitLogan
Infectious Ideas | April 3 2012
A couple interesting public health lectures / presentations in the next two weeks (check the Infectious Ideas Calendar!):
Kate Shannon on Science vs. Moral Rhetoric: Sex Work, Policies and Public Health
Monday April 2nd, 6:00pm at UBC Robson
An overview and work-in-progress of At Home/Chez Soi: A Longitudinal Trial on Homelessness and Mental Health (the project I'm working with)
Wednesday April 11th, 12 noon at St. Paul's Hospital, Hurlburt Auditorium
"The Way I See It" Photography / Community-Based Research Project examining the impact of Housing on Health as seen through the eyes of people living with HIV and AIDS in Vancouver.
Thursday April 12th, 6:30pm at W2 Media Cafe
In the latest issue of the Canadian Medical Association Journal, a cost-effectiveness study found that treating chronic opiod dependence with diacetylmorphine instead of methadone may result in lower societal costs (primarily due to reductions in crime) and increased duration and quality of life.
And a recent study from the Centre for Research on Inner City Health in Toronto found that Ontario's new primary care models pay physicians less for caring for low-income patients. This is because Ontario's capitation system estimates payment based on each patient's age and sex. The researchers suggest the system should also compensate for each patient's health and socioeconomic status.
- Jason
Housing First (in Three Minutes)
Once upon a time, there was a homeless man named Murray.Everybody knew Murray. I mean - the shelter staff and the social workers, the nurses and the doctors, and of course, the police officers - they all knew Murray.
Murray used to drink pretty heavily, and when he did, he’d usually end up in one of the jails or one of the hospitals.
They’d let him go, but he’d come back again. And back, and back, and back again. He’s what they called at the emergency department, a frequent flyer.
Now one day, someone decided to look through the records, and when they added everything up, they found that Murray had hospital bills and jail and shelter costs of almost one hundred thousand dollars per year, for the past 10 years. That’s why they say:
"It cost us one million dollars not to do something about Murray"
So in my research, I wanted to know if there is something that we can do instead of nothing. Not just to save money for the system, but also to support people in improving their health and quality of wellbeing. To get treatment and support for mental illness and substance use. And reconnect with friends family and community.
There’s an idea called Housing First - and it’s pretty simple.
Ask someone who is homeless if they would like their own apartment to stay in, and if they say yes - get them housing immediately. Also, hook them up with a mental health team, or a case manager.
If they don’t want to see a psychiatrist, or an alcohol and drug counsellor right away, that’s okay - don’t force them to and wait until they’re ready.
But help them adjust to living in their new place, build relationships with landlords, and make sure that your mental health team has enough resources.
This is what we’re doing right now in Vancouver, in the At Home/Chez Soi study, a pilot research project in which we’re testing out Housing First. We’ve already recruited a couple hundred people who are homeless and living with a mental illness, including substance use disorders.
I mentioned frequent flyers in the emergency department earlier, and that’s specifically what I’m looking at for my thesis. I’ve linked people from the At Home Housing First program to their emergency department records at two large hospitals in Vancouver.
I’m going to look at how often people are visiting the emergency department, what they’re coming in for, and what happens to them after, and I’ll compare them to another group who are not in the Housing First program.
We think that having safe and stable housing and access to community-based mental health support will have an impact on whether people come to the emergency department or not, and see positive change in other aspects of their life.
At the end of this, we’ll have evidence about how Housing First is working in Vancouver and something to show to anyone willing to fund a mental health team, build more supportive housing or increase rent subsidies.
So when someone asks you what to do about homelessness, you can tell them that this may be part of the solution. It will cost us a bit to invest in Housing First up front, but in the long run, it might not cost as much as doing nothing.
This is the 'elevator-pitch' version of my thesis, which I recently presented for the 3-Minute Thesis competition at UBC. I borrowed heavily from a short story popularized by Malcolm Gladwell and greatly oversimplified the ideas of Housing First, Supported and Supportive Housing, Assertive Community Treatment, and Intensive Case Management. Please check out the links to find out more!
the At Home/Chez Soi Project (1) (2)
Stories from At Home/Chez Soi in Vancouver (1) (2)
Million-Dollar Murray, by Malcolm Gladwell
- Jason
Sporting my Pink Shirt
It's Pink Shirt Day. I love its history - I love that a group of teenagers came together to support a classmate being teased for wearing pink by sporting the colour themselves. There are lots of people, teens, kids, and adults alike, who take a stand against bullying, and this warms my heart.
Because bullying is a serious issue. As previously posted here on Infectious Ideas, bullying can lead to suicide. Too many suicides happen here in Canada, and they're entirely preventable. And wearing a pink shirt is part of what's needed for preventing them - but only a part.
The Purple Letter Campaign here in BC has been working hard for awhile to specifically target homophobic bullying through province-wide policy, as has the Pride Education Network. I've attached a policy brief that I wrote for a class on this issue, which you can read to get informed about some of the structural changes that would support positive school climates. And I hope that as we wear our pink shirts today, we think about what we can do to stop bullying and support victims in our own lives - the racism, sexism, homophobia, and discrimination that we see every day. Because creating safe spaces for everyone is going to take change and action at every level, starting with ourselves.
Drug Policy-Making and Breaking
Bringing a public health perspective to drug policy-making and reform is something we're quite passionate about at Infectious Ideas. Despite the overwhelming focus on politics and ideology in this area, we advocate for policies and programs informed by scientific evidence and compassion for the health and wellbeing of individuals and communities.
With that in mind, here are a few links for anyone interested:
Tomorrow afternoon at Vancouver's Langara College, there is a screening of the documentary Raw Opium as part of Co-Dev's 11th annual World Community Film Festival. Raw Opium looks like it will have an interesting range of stories to share from across the globe, and I'm looking forward to watching it.
In Raw Opium, we meet a variety of people with different perspectives including opium growers in Southeast Asia, a UN drug enforcement officer on the border of Afghanistan and a former Indian government drug czar.
We are introduced to Portugal’s new, revolutionary policies toward its drug situation and to Vancouver’s Insite Clinic with its creative approaches to this complex issue. Assumptions about drug addiction and the War on Drugs are profoundly challenged.
There is an excellent article in Megaphone Magazine on the history of drug policy in Vancouver. It traces back to Canada's first anti-drug law - the Opium Act of 1908, which cracked down on a thriving industry in Vancouver's Chinatown - to the Four Pillars strategy of prevention, treatment, enforcement, and harm-reduction and the recent Supreme Court ruling on InSite.
The article is the first in a 3-part series on harm reduction, so look out for the next issue of Megaphone to hit the streets.
People's Health Radio has a recent radio show on drug prohibition and health, and AHA Media should have footage from a recent panel discussion on drug prohibition and alternatives to the war on drugs up on their site soon.
Lastly, the omnibus crime bill, which includes new mandatory minimum sentences for non-violent drug offences, is currently being heard by the Canadian Senate. The Candian Drug Policy Coalition is blogging from the Senate hearings, so check that out if you want to hear about all the debate.
Let us know if you hear of anything else or learn something interesting from the links above!
- Jason
Innovation
"Innovation!" they say. More innovation in health care is what we need to solve the rising costs, expanding wait-times, and the impending doom that is to come as the baby-boomers require more care. Days of meetings and discussions, and the most our premiers can come up with is a call for innovation.
Well, duh.
Clearly, things need to change. Our current fee-for-service system, where physicians are paid based on the number of patients they see rather than the quality of care provided, along with our focus on acute medicine and illness must change as demographics, technology, and population needs change. We cannot continue to operate on the same medical system that was built around physicians, communicable diseases, and hospitals. If the health care system is to be sustainable and truely make an impact, it needs to be a system that is instead built around patients, holistic care, and communities. And guess what? We already know that. And so do our premiers.
We already have lots (and I mean lots) of information and innovative ideas readily accessible and waiting for strong leadership to enact change. Restructuring compensation and salaries, actualizing scopes of practice, and capitalizing on technology are just a few examples of areas in which change has been closely studied, and in some areas, is beginning to take place (see the paper I wrote, below, on using nurse practitioners in rural settings, for example). But the health care system isn't going to change itself. And change is never easy. Which is why I was so disappointed that at their meeting to discuss the renewal of our health accord, the premiers failed to do anything more than form a health innovation group.
Isn't it time that we actually did something? I expect my leaders to show a little more leadership, which needs to be strong and vocal if we want to hold together (and maybe even improve!) universal health care as we know it. And there's nothing especially innovative about that.
For more information check out these two great articles:
http://www.hilltimes.com/policy-briefing/2012/02/06/are-canada’s-premiers-serious-about-innovation-in-public-health-care/29467#.TzGFHO8v06g.twitter
http://www.theglobeandmail.com/life/health/new-health/andre-picard/politician...
Resolutions
The new year is upon us, and with January comes a myriad of articles, news stories, and advice on how to stick with your 2012 resolutions. You only have to browse the magazines at the check out or spend a few minutes on the internet before you're inundated with ways to lose weight, eat healthier, get fit, and have a better sex life - our resolutions, it seems, revolve around improving health, presumably because it will not only prolong our life but help us feel better about ourselves, fit in amongst our peers, and be happy.
But it's not so easy, is it?
Health behaviour scientists have been studying and theorizing about healthy behaviours for a while now; they have lots of ideas about how to promote healthy behaviours as a means of preventing disease. Everything that articles tell you about how it's easier to get yourself out for a jog if you have a friend waiting, to stock your kitchen with only healthy foods, or to keep a food or fitness journal comes from these theories. There are thousands upon thousands of tips and tricks to keep us motivated to take care of our health, even beyond fitness, such as how to quit smoking or remembering our annual cancer screenings.
And yet clear differences remain between populations that engage in these health promotion behaviours and those who don't. These differences can be tracked and studied, and they tell us a lot. What they mostly tell us is that choice is an extremely complex term, and that choosing whether or not to engage in a health promoting behaviour (or, likely, any behaviour) is influenced by several factors, many of which are out of an individual's realm of control.
An interesting article by Dorgelo, Pos, Vevoordeldonk & Jansen is available here. In this article, the authors provide this visual diagram of the ASE model of individual behaviour differences by de Vries that I think does a nice job of demonstrating this complexity. Even from these few variables represented, it's easy to see how so many of them are not easily influenced by an individual person. Instead, they require societal-level interventions for changes in behaviour to occur.
Let's take a new year's resolution to walk 30 minutes a day as an example to break this down. On a large scale, socially walking daily is highly accepted. But it may not be highly accepted as a priority if someone is expected to be in their office for 12 hours a day, or if they spend time amongst people that do not put any value in fitness (hard to fathom here in Vancouver, I know). An individual also has to believe that s/he is capable of walking 30 minutes a day. All of this to only arrive at intention. But beyond that there may exist several societal-level barriers beyond issues of finding childcare, taking time from work, or owning running shoes which may be more individual-level barriers. What if the streets aren't safe to walk along? What if it is too cold to be outside? Are there sidewalks at all?
We can begin to see how one seemingly simple action becomes increasingly complex. The challenge, then, is to create health interventions that benefit all members of our community; that begin to remove barriers to health, especially for those who are less likely to have benefitted from previous interventions. It is no longer enough to tell people to take care of themselves - health promotion must begin to look at how laws, policies, and programs can promote behaviours that currently hide behind socially created barriers. How's that for a resolution?
We look forward to hearing your resolutions not only for your own health, but for the health of your family, neighbours, and community. How can we reach these goals together? I hope that 2012 is filled with many more infectious ideas.
Happy New Year!
- Claire
Primary Health Care Renewal and Community Health Centres
Although the papers attached below are more from almost a year ago, they are about a topic that I am still very interested in: Primary Health Care Renewal and Community Health Centres.
Community Health Centres (CHCs) are a model for organizing and delivering primary health care services, with a focus on health promotion, prevention, and community development.
There are a couple aspects of CHCs that I think are great:
- CHCs have an interdisciplinary team that works together from the same facility. A typical team may include family physicians, nurses (or nurse practitioners), a pharmacist, a dietician or nutritionist, a mental health professional, a dentist, and a social worker or counsellor.
- CHCs are non-profit or government sponsored organizations that are governed by a board of local residents and clients.
- Physicians who work in CHCs are usually paid on a per-hour basis (salaried) as opposed a fee-for-service basis (fee-for-service arguably encourages doctors to see as many patients as possible and offer as many services as possible. Alternative payment schemes may encourage more comprehensive care, a focus on prevention, and facilitate collaboration with other health professsionals)
- CHCs create a space for community programs, such as REACH Community Health Centre in Vancouver, which provides programs and services through its multicultural family centre.
I think that CHCs offer a way to provide better chronic care, health promotion and preventive services, and improve access to health care for underserved populations.
The ~5 page paper attached below discusses some of the policy objectives and developments in primary health care renewal, describes what CHCs are and outlines some of the barriers or facilitators that may impede or encourage their implementation.
There is also a 2-page brief attached that surveys remuneration (payment models) for primary health care physicians, including alternatives to the fee-for-service model.
For more info, I'd suggest checking out the Canadian Alliance of Community Health Centre Associations and the Association of Ontario Health Centres. And, feel free to comment on my ideas or suggest your favourite solution for primary health care renewal!
- Jason
Policy Paper: Primary Health Care Renewal and the Community Health Centre
Policy Brief: Remuneration of Primary Health Care Physicians
