HD006

Recent Immigrant Effect

Immigrant Numbers

Immigrants are healthier, younger, and better educated than the rest of Canadians to start, and have lower rates of bad habits such as smoking, drinking, etc but due to self selection, government screening, as time goes on they get less healthy, due either to the acclimatization to the Canadian environment, to the barriers to healthcare that they encounter, or to the effects of discrimination and racism

• 19.8 % of Canadian residents born elsewhere
• 6.2% arrived last 10 years
• 12.1% of Manitoba residents
• Now approx. 10,000/year (2006 – 23% increase in Manitoba compared to Canada at 4%)
• Immigrants are major source of population growth
•  80% of population growth due to immigration in 1999-2000
• Greatest # from Asia Pacific

HD127

WHO: Types of Violence

Human Security

Global and regional burden of mortality and morbidity from armed conflict

“Peace through health”

1. Youth
2. Child abuse and neglect
3. By intimate partners
4. Elderly
5. Sexual violence
6. Self-­‐directed violence / suicide
7. Collective violence
8. NOT INCLUDED: Structural violence

A philosophy calling for global responsibility to
the interests of individuals rather than the interests of the nation state or multi-­‐national corporations. 

e.g. International ban on landmines

• % of civilians increased from 5% at the turn of the century to over 90% in the 1990’s
• In the World Bank Human Development Report in 1990, the #2 cause of worldwide total DALYs (disablity adjusted life years) lost was violence.
• By 2020 researchers predict that war will be one of the top 10 causes of loss of quality of life through disability resulting from deaths, injuries, and the lack of health care, water, shelter, and sanitation associated with conflict.

“Peace through health” is an emerging discipline to study how health interventions in actual and potential war zones may contribute to peace. Often low key and unadvertised peace through health initiatives have taken many forms such as humanitarian ceasefires, the use of health expertise to restrict weapons and war strategies, and integrating individual with social healing in war zones

Eg. Sri Lanka – initiative to address mental health effects of children affected by armed conflict  (The ‘Butterfly Peace Garden” in Sri Lanka similar to the Spiral Garden in Toronto where creative art is used in healing - Social Healing)

HD092

Poverty Random Facts

Absolute Poverty Defn

Relative Poverty Defn

The Health Gradient:

At low incomes, the marginal effect of an increase in income on health is greater than at higher incomes

The Poverty Effect:

Those receiving social assistance do less well than those with similar incomes from other sources

Relative Inequality Effect:

Poorer health status occurs in areas with relatively greater inequality (greater variance) in income

Loss of social capital
Social/psychological effects of social comparisons

Area-level (ecological) effect:

Physical Env. (walkable, safe, transport etc.)

Lacking any items required to maintain long-term physical well-being. For able-bodied persons the list would include:

1. Nutritious diet
2. Shelter
3. Clothing
4. Items for personal hygiene
5. Health care
6. Transportation
7. Telephone

Measured by:

1. Deprivation Index
2. Market-Basket Measure (Statistics Canada)

Lack the resources to have the living conditions and amenities encouraged and approved in the societies to which they belong

Measured by:

1. Low Income Measure: 50% of median family income (adjusted for family size)
2. Low Income Cut-Off (LICO): Mean expenditure for a family of a given size on food, shelter and clothing plus 20%
3. Culturally-perceived poverty: home-made versus store-bought foods or clothing etc.

HD003

What should a family practitioner know specifically for:

Pregnancy
Childhood
Adolescence
Adulthood

7 Roles of FP in building a healthy community

Pregnancy – smoking rate among pregnant women

Childhood – breastfeeding attitudes, socioeconomic status, immunization rates/attitudes, Lead poisoning, Insertion of T-tubes, Mobility
Adolescence – community attitudes towards teen pregnancy, abortion, STIs, Drugs, Gangs
Adulthood – socioeconomic status, types of employment, local medical resources, smoking, gambling

1. Clinician
2. Health educator
3. Patient advocate
4. Health advocate
5. Scholar
6. Resource manager
7. Professional

HD003

Top 10 Diagnoses in Family Practice

McWhinney's 9 principles of Family Med

(Just read, don't memorize)

• Hypertension
• Complete physical
• Diabetes
• URTI
• Anxiety
• Depression
• Fever, fatique, malaise
• Back pain
• Abdominal pain
• UTI

 1. Family physicians are committed to the person rather than to a particular body of knowledge, group of diseases, or special technique → general practice
a. family physician is available for any health problem in a person of any sex or age
b. commitment has no defined end point

2. The family physician seeks to understand the context of the illness
a. c.f. in hospitals, the focus is on the foreground → much of the context of hospital is removed/obscured → limited picture of illness

3. The family physician sees every contact with his patients as an opportunity for prevention or health education
a. a physician sees each patient ~4 times/yr → opportunities for prevention/education

4. The family physician views his or her practice as a “population at risk.”
a. family physician must think in terms of both single patient & population groups

5. The family physician sees himself or herself as part of a community-wide network of supportive and healthcare agencies → ↑approachability

6. Ideally, family physicians should share the same habitat as their patients → ↑knowledge, ↑approachability
a. ↑awareness of patients’ home environment → quicker assessment of problems
b. ↑visible presence within the community

7. The family physician sees patients in their homes → ↑accessibility, ↑knowledge of patient

8. The family physician attaches importance to the subjective aspects of medicine → empathy

9. The family physician is a manager of resources

HD009 - Skipped making cards, very long but take a brief read through (actually do it)

HD065

Diseases and Conditions More Prevalent

in Men in Canada (7)

Diseases and Conditions More Prevalent in Women in Canada (9)

Diseases and Conditions More Severe, Serious or Presenting Differently in Men / Women

1. Ischemic heart disease
2. Cancer (overall)
3. Injuries
4. Suicide
5. Emphysema/chronic bronchitis
6. Cirrhosis of liver
7. AIDS

1. Hypertension
2. Arthritis
3. Osteoporosis
4. Alzheimer disease
5. Multiple sclerosis
6. Breast cancer
7. Migraine
8. Depression (diagnosed)
9. Asthma

Women:
Domestic violence injuries
HIV/AIDS
Heart disease

Men: 
Multiple sclerosis
Depression

HD065

Gender Differences In Life Expectancy at Birth

Mortality Rates by gender

Depression Treatment trends

Females 83.0 years, Males 78.4 years (Canada 2006)
Gap is NARROWING - Even more in High Income quartiles

• Male mortality is 1.5x female:
• All cancer: 1.4
• Lung cancer: 1.7 - but gap is closing in (females up, males down)
• Heart disease: 1.8
• Liver disease: 2.2
• M.V.A.: 2.6
• Suicide: 3.3
• Alzheimer’s: 0.7
• #1 cause of death in Aborginals is injury/poisoning/suicide

Women have more cases of depression, but they are on a decline in the proportion receiving treatment

HD065

Percent of Population Reporting Disabilities (by Gender)

Teen Smoking Rates (by Gender)

Body Weight by Gender

Activity Levles

Health Care Use

 Self-rated health

Males: 13.4%
Females: 15.2%

Females used to smoke more than males, but these rates are dropping and are almost equal now (ie gap closed)

Females more likely to be Normal Weight/Underweight

Males more likely to be overweight/obese class I

About equal above that

Men > Women, both going up but gap is staying equal

Physician Visits: Women > Men even when we remove Repo

Hospitalizations: Men > Women

Worse rated for Women

HD069

 Aboriginal Women's Health

HD116 - not worth Q carding - led by Dr. Kraut so make sure to read it

HD095
Independent Living (IL) principles:

All bad, everything is worse, but look through the slides again - Read JYYS

1. PWD must have access to appropriate
      Housing
      Transportation
      Healthcare
      Employment
      Education
      Political process
2. PWD determine what is “appropriate” by owning the process of deciding needs/supports rather than being assessed externally and told what their needs are

“What is the role of a person with a disability in his/her own care?”

Rehab Model: Patients or Clients (Passive)
IL Model: Consumers (Active)

What is the role of a service provider?

Rehab Model: Professional, “Prescriber”, Manager of Tx Plan, Diagnostician, Gatekeeper to Services

IL Model: Peer, Consultant, Role Model, Advocate, Mentor

What is the experience of disability?

Rehab Model: A “Problem”, A “Malfunction”, An “Impairment”, A Biologically Based Condition, A Problem Located within the Person

IL Model: Barriers (environmental, social architectural, employment, educational) take away opportunities

What is the ‘solution’ to the problem of disability?

Rehab Model: Intervention by medical professionals, Services based on external evaluations, Complete treatment, Psychological adjustment to disability, Improve motivation, Maximum ADL

IL Model: Self-help, “Consumer” control, Remove barriers,
Remove disincentives, Self direction, Social/Economic productivity, Full citizenship