Health is defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 2006:1). It can also be defined as “a state
of balance, an equilibrium that an individual has established within himself and between himself and his social and physical environment” (Sartorius, 2006:662). This balance definition implies active involvement of individuals in promoting their own health obtaining a balanced state that enables them to make the most of life (Sartorius, 2006).
The increase in number of individuals living with chronic diseases around the world has led to a lot of debate on the definition of health, and the practicality or sustainability of current trends in health care (Huber, 2011; Sartorius, 2006). Common chronic diseases in Canada include hypertension, periodontal disease, osteoarthritis, ischemic heart disease, diabetes, cancer, mood and anxiety disorders (Public Health Agency of Canada [PHAC], 2020). According to PHAC (2020), 73% of individuals aged 65 years and over are living with at least one of the 10 common chronic diseases in Canada. In this population, 65.7% have hypertension, 52.0% have periodontal disease and 10.5% have mood and anxiety disorders (PHAC, 2020). Figure 1 shows the prevalence and risk factors for chronic diseases among Canadians aged 65 years and over (PHAC, 2020).
Various healthcare professionals play a role in the prevention and management of chronic diseases in Canada. In this blog, I will provide an overview of healthcare in Canada, and more specifically, the Province of Alberta, to set the context for discussing ways in which Environmental Health Professionals (EHPs) can contribute to Chronic Disease Prevention and Management (CDPM).
Figure 1
Prevalence of Chronic Diseases and Risk Factors among Canadians Aged 65+
Healthcare in Canada and Alberta
Across Canada, healthcare is currently funded both provincially and federally. The Provinces are eligible for federal cash contributions under the Canada Health Transfer (CHT), if five criteria and conditions stipulated in the Canada Health Act are met (Government of Canada, 2020). These federal amounts are combined with provincial taxes paid by citizens, to fund Provincial Healthcare systems. This model presents some challenges, which has resulted in an ongoing debate on the issue of privatizing healthcare in Canada. Whilst some Canadians are of the opinion that there should be a mix of private and public healthcare systems to provide options for Canadians and increase overall efficiency in the healthcare system, others oppose privatization (Flood & Thomas, 2016).
In the Province of Alberta, Alberta Health is the Ministry responsible for health, whilst Alberta Health Services (AHS) - a “provincewide, fully-integrated health system” founded in May 2008 by amalgamating nine Regional Health Authorities and three Agencies in Alberta - is responsible for healthcare service delivery (Alberta Health Services [AHS], 2020).
Alberta has three main primary health care models, namely Primary Care Networks (PCN), Community Health Centres and Family Care Clinics (Government of Alberta, 2020).
PCNs, the most common model involves groups of doctors working together with teams of healthcare professionals to meet primary health care needs of people (Government of Alberta, 2020). Family Care Clinics "provide individual and family-focused primary health care services to meet the needs of the community" (Government of Alberta, 2020). Community Health Centres "integrate team-based care with health promotion, social services and community programs that address social barriers to health" (Government of Alberta, 2020).
Environmental Health in Alberta - Where do EHPs Fit In?
Executive Officers/Public Health Inspectors (PHI) in Alberta are EHPs involved in delivering "support and allied health services" through AHS’ community-based Environmental Public Health Program (AHS, 2020). These services include inspecting public places such as child and adult care facilities, rental dwellings, food establishments and recreational facilities (AHS n.d.) to ensure compliance with the Public Health Act and Regulations. Other activities include investigating complaints and suspected food-borne illness incidents, educating the public on environmental health issues, and other health promotion activities.
PHIs are required to maintain active membership with the Canadian Institute of Public Health Inspectors (CIPHI), which unites, represents, and certifies Environmental Public Health Professionals in Canada (Canadian Institute of Public Health Inspectors [CIPHI], 2020). CIPHI also engages in education, Environmental Health advocacy, and ensures that all members adhere to the CIPHI Code of Ethics (CIPHI, 2020). The Code of Ethics consists of seven fundamental principles, including justice, accountability, inclusion, and evidence-informed decision-making (CIPHI, 2017). In addition, CIPHI members are required to maintain professional competencies through the Continuing Professional Competencies Program (CIPHI, 2020).
Contributing to CDPM in Alberta
AHS applies an Expanded Chronic Care Model (shown in Figure 2) to chronic disease prevention and management in Alberta (AHS, 2016). The provincial Chronic Disease Prevention (CDP) team within Healthy Living, Population, Public and Indigenous Health (PPIH) is responsible for reducing the risk for chronic diseases (AHS, 2020). The CDP Team developed the AHS Chronic Disease Prevention Action Plan 2015–2018: Adult Population (18+ Years) (The Action Plan) to reduce the burden of chronic disease on both Albertans and the healthcare system, by focusing primarily on behavioural risk factors such as nutrition, physical activity and stress in adult populations (18+ years), social determinants of health and gaps and priorities in chronic disease prevention (AHS, 2016; AHS, 2020).
In response to a key gap, lack of coordination and leadership, identified during the development of The Action Plan, the Chronic Disease Prevention Coordinating Committee (CDPCC) was created to provide a mechanism to take a comprehensive, integrated, effective and efficient approach to chronic disease prevention in Alberta (AHS, 2017). The AHS model emphasizes the vital need for meaningful collaboration and effective communication between healthcare professionals, including EHPs, in CDPM.
Figure 2
Expanded Chronic Care Model
Source: Chronic Conditions & Diseases Prevention & Management Strategic Document (albertahealthservices.ca)
The Role of EHPs
Environmental Health practice involves promoting well-being and preventing human disease and injury associated with biological, physical, and chemical hazards (National Environmental Health Association [NEHA], n.d.). EHPs contribute to CDPM through various programs, including food safety, safe drinking water, safe housing, and safe built environment programs (AHS n.d.).
Determinants of health are “the broad range of personal, social, economic and environmental factors that determine individual and population health” (Government of Canada, 2020). These factors, which include work conditions, physical environments and access to health services (Government of Canada, 2020) impact CDPM efforts within populations. By applying minimum regulatory standards in all program areas, EHPs protect and promote the health of populations, regardless of socio-economic status, race and gender, and support CDPM efforts by reducing inequities. Through safe housing and social care programs (AHS, 2020), for example, EHPs protect vulnerable populations, including children, seniors, persons or colour, indigenous people and people experiencing homelessness, by ensuring that basic amenities are provided, and hazardous materials that could result in chronic diseases such as cancer are eliminated from built environments.
The AHS Expanded Chronic Care Model includes a focus on building healthy public policy (AHS, 2016). Through advocacy efforts on environmental and public health issues undertaken by organizations like CIPHI (CIPHI, n.d.), EHPs contribute to the development of policies that support CDPM activities. By advocating for safe built environments, for example, EHPs promote environments that positively influence behaviors, promote physical activity and enhance access to resources that reduce risk factors for chronic diseases (Office of Disease Prevention and Health Promotion [ODPHP], 2020).
As frontline workers who typically interact with the community and engage in educational activities, EHPs contribute to the prevention of chronic diseases by providing education on air quality, water quality, hazards such as radon, and other hazards that could cause cancer and long-term damage to respiratory and cardio-vascular systems (ODPHP, 2020). In this role, EHPs can also serve as a conduit for disseminating other vital information on chronic diseases.
Conclusion
EHPs contribute to Chronic Disease Prevention and Management through the delivery of various programs. They form an integral part of CDPM strategies, and have skill sets, expertise and strengths that can be harnessed for non-traditional roles in CDPM. To be effective in their role, EHPs must uphold the profession by operating ethically, maintaining a professional identity, and contributing to the elimination of systemic racism in the Canadian healthcare system.
References
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Alberta Health Services. (2020). Chronic Disease Prevention.
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Alberta Health Services. (2017, July). Chronic Disease Prevention Coordinating Committee
Alberta Health Services Chronic Disease Prevention Team. (2016). AHS Chronic Disease
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