Examining Stroke Using Various Concepts I have Learned
- Danielle
- Jul 28, 2019
- 7 min read
Updated: Jul 28, 2019
As I near the end of my first course in the Master of Health Studies degree at Athabasca University, this post will examine all of the concepts I have learned about. One of the common health themes I have focused on many times throughout this course is stroke, which is what I will use to illustrate all of the concepts I have learned throughout this course.
In 1948 the World Health Organization defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (Huber, 2011, p.235). At the start of this course we examined this age-old definition of health and pointed out several issues with this definition including the word "complete", as how can complete health be defined and is it even attainable? Perhaps an updated definition such as “the ability to adapt and to self-manage, in the face of social, physical and emotional challenges” (Jambroes et al, 2015, p.412) would be more appropriate, as this definition moves away from the notion of having complete health and aims for people to be considered healthy if their chronic disease is managed/they are coping well with their disease. When we look at someone who has suffered from a stroke they will always have this history on their medical chart. In many cases, patients who have suffered a stroke will have lasting effects - for example it has been found that 50% of those greater than or equal to 65 years old will have reduced mobility (CDC, 2017). As per the National Institute of Neurological Disorders and Stroke (2019), they state that "the goals of rehabilitation [is] to help survivors become as independent as possible and to attain the best possible quality of life. Even though rehabilitation does not "cure" the effects of stroke in that it does not reverse brain damage, rehabilitation can substantially help people achieve the best possible long-term outcome." This statement highlights just one of the many issues of the WHO's definition of health and illustrates how perhaps changing the definition to include attaining the best health possible for each individual person would be of benefit.
We then moved on to look at determinants of health, more specifically social determinants of health which include both the social and economic items that impact one's health (Canadian Public Health Association, 2019). According to the BC Healthy Living Alliance (2009), "access to income, affordable housing, healthy food, education, early childhood development, and recreational opportunities influence our ability to make healthy choices and ultimately the state of our physical and mental health as well as life expectancy…“social determinants” or “health inequities” must be addressed due to their significant impact on health." Again, when we look at the stroke population we can see how these determinants of health can impact both likelihood of having stroke and ability to recover from stroke. These determinants of health became quite apparent when looking at models of health.
Looking into spheres of influence or models of health we see how "A multilevel approach to population health is predicated on the understanding that exposures at many levels of organization work together to produce health outcomes" (Galea, 2015). In an earlier blog post I delved into the ecological model and stroke risk factors, in particular there are five different levels: 1. intrapersonal/individual, 2. interpersonal, 3. institutional/organizational, 4. community, and 5. public policy. Using the ecological model we can see that there are several layers at play in affecting ones likelihood of suffering from a stroke, therefore many different aspects must be targeted in order to help reduce the likelihood of someone suffering from a stroke. "It is important to note that the more factors you can target within a health program or strategy, the more likely it is to be successful in achieving positive outcomes (Rural Health Information Hub, 2019)." For example, the individual factors that affect the risk of stroke can be modifiable and include diet, physical activity, smoking/tobacco and alcohol, all of which can be controlled by an individual and directly affect their risk of stroke. The cornerstone of these factors is that the individual must have knowledge of these factors, as well as the correct attitude in order to be able to reduce their risk of stroke (National Stroke Association, 2019).
Examining chronic disease prevention and management allowed me to learn about the Federal Government of Canada's strategic plan to prevent chronic disease. Some of their objectives are to reduce obesity and reduce diabetes rates, both of which can impact an individuals chance of stroke (Federal Government of Canada, 2013). It is through learning about chronic disease prevention and management that I found that stroke is more prevalent in women. With statistics such as 59% of deaths due to stroke being in women and 2/3 of stroke research focusing on men, I knew this was an area I wanted to educate myself in further (Heart and Stroke Foundation of Canada, 2019). On the Heart and Stroke Foundation of Canada (2018) website it says, "women continue to be under-researched, under-diagnosed, under-treated, under-supported and under-aware of their risks. As a result, they’re over-dying." As a result, the Heart and Stroke Foundation has implemented a social media campaign #TimeToSeeRed in order to raise awareness and change the course of history with women and stroke. They have key initiatives such as doubling the monetary funding for stroke research in women specifically and to help increase support for women who have had the misfortune of suffering from stroke (Heart and Stroke Foundation of Canada, 2019). It will be interesting to see the data that the Canadian Chronic Disease Surveillance System collects over the upcoming years to see how the work the Heart and Stroke Foundation translates to reduced number of strokes in women.
Vulnerable populations was the next theme we examined and can be defined as, "the economically disadvantaged, racial and ethnic minorities, the uninsured, low-income children, the elderly, the homeless, those with human immunodeficiency virus (HIV), and those with other chronic health conditions, including severe mental illness2…The vulnerability of these individuals is enhanced by race, ethnicity, age, sex, and factors such as income, insurance coverage…and absence of a usual source of care" (American Journal of Managed Care, 2006). When looking at vulnerable populations I looked into Indigenous people and their risk of stroke and found that Indigenous people are twice as likely to die from stroke than non-Indigenous people. Part of this discrepancy stems from Indigenous people being at a greater risk of having certain risk factors for stroke: hypertension, diabetes, smoking and childhood obesity (Heart and Stroke Foundation of Canada, 2019). Again, the Heart and Stroke Foundation of Canada is helping to work towards closing this gap and therefore affording Indigenous people a higher quality of life. Now couple being Indigenous and being female and you have an extremely vulnerable population, in fact "First Nations, Metis and Inuit women are at greater risk of stroke and twice as likely to die from it when compared to non-Indigenous women" (Heart and Stroke Foundation of Canada, 2018).
At the end of our course we looked at future directions in health care. An important aspect of stroke management is adherence to medications, which can be facilitated through medication reconciliation at hospitals. "Medication reconciliation is a formal process in which healthcare providers work together with patients, families and care providers to ensure accurate and comprehensive medication information is communicated consistently across transitions of care." (ISMP, 2019). This process allows one to ensure the patient is on the correct "cocktail" of medications for stroke prevention or post-stroke, as well as can help highlight any compliance issues the patient may be having. The concept of medication reconciliation on admission and discharge is a project driven by Accreditation Canada and ISMP Canada, with the end goal of medication reconciliation across all healthcare sites. Currently in Lower Mainland British Columbia the implementation of these processes are underway and the benefits are easily seen, it will be amazing to see the achievement of all sites obtaining medication reconciliation on admission and discharge and how this will positively impact patient care. This also highlights the importance of provincial and federal governments, as well as organizations, working together to obtain a greater result for the general Canadian population.
The video below explains medication reconciliation.
As can be seen, there are several facets to stroke and many different levels that need to be examined in order to help achieve the best healthcare and health outcomes for Canadians. Before I started this course I had not heard the terms health determinants, spheres of influence or vulnerable populations. Working with other disciplines throughout this course has allowed me to see many different perspectives and better understand the complexities of problems faced by the Canadian healthcare system. It is not as simple as making sure a patient is on the correct medication regime to reduce their risk of stroke, there truly are an immeasurable number of
factors at play.
References
Accreditation Canada. (2012). Medication reconciliation in Canada: raising the bar. Retrieved from: https://www.ismp-canada.org/download/MedRec/20121101MedRecCanadaENG.pdf
BC Healthy Living Alliance (September, 2019). Healthy Futures for BC Families Policy Recommendations for Improving the Health of British Columbians. Retrieved from https://www.bchealthyliving.ca/wp-
Canadian Public Health Association. (2019). What are social determinants of health. Retrieved
Centers for Disease Control and Prevention. (2017 Sept 26). Stroke facts. Retrieved from: https://www.cdc.gov/stroke/facts.htm
Galea, S. (2015 May 31). The determination of health across the life course and across levels of influence. Retrieved from: https://www.bu.edu/sph/2015/05/31/the-determination-of-health-across-the-life-course-and-across-levels-of-influence-2/
Government of Canada. (2019). The Canadian chronic disease surveillance system – an overview. Retrieved from: https://www.canada.ca/en/public-health/services/publications/canadian-chronic-disease-surveillance-system-factsheet.html
Government of Canada. (2013 Apr). Preventing chronic disease strategic plan 2013-2016. Retrieved from: http://publications.gc.ca/site/archivee-archived.html?url=http://publications.gc.ca/collections/collection_2014/aspc-phac/HP35-39-2013-eng.pdf
Heart and Stroke Foundation of Canada. (2019). Helping to close the gap in Indigenous health. Retrieved from: https://www.heartandstroke.ca/what-we-do/our-impact/helping-to-close-the-gap-in-indigenous-health
Heart and Stroke Foundation of Canada. (2018 Apr 25). It’s time to transform women’s heart and brain health. Retrieved from: https://www.heartandstroke.ca/women/improve-womens-heart-and-brain-health
Heart and Stroke Foundation of Canada. (2019). What we do. Retrieved form: https://www.heartandstroke.ca/what-we-do/media-centre/stroke-report
Heart and Stroke Foundation of Canada. (2019). Women and stroke. Retrieved from: https://www.heartandstroke.ca/stroke/what-is-stroke/types-of-stroke/women-and-stroke
Huber, M. (2011, July 30). Health, how Should we Define it. Retrieved from:
Institute for Safe Medication Practices Canada. (2019). Medication reconciliation MedRec. Retrieved from: https://www.ismp-canada.org/medrec/
Jambroes,M, Nederland,T, Kaljouw, M, van Vliet, K, Essink-Bot, ML, Ruwaard, D. (2015, Dec 24).
Implications of Health as ‘the Ability to Adapt and Self-Manage’ for Public Health Policy: a Qualitative Study. Retrieved from:
National Institute of Neurological Disorders and Stroke. (2019 May 19). Post stroke rehabilitation fact sheet. Retrieved from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Post-Stroke-Rehabilitation-Fact-Sheet
Rural Health Information Hub. (2019). Health promotion and disease prevention theories and models. Retrieved from: https://www.ruralhealthinfo.org/toolkits/health-promotion/2/theories-and-models
The American Journal of Managed Care. (2006 Nov 1). Vulnerable populations – what are they. https://www.ajmc.com/journals/supplement/2006/2006-11-vol12-n13suppl/nov06-2390ps348-s352
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