Social Justice and Social Determinants of Health Affect all of nursing and nursing culture

1. What is Social
Justice?
“SOCIAL JUSTICE IS A MATTER OF LIFE AND DEATH. IT AFFECTS THE WAY
PEOPLE LIVE, THEIR CONSEQUENT CHANCE OF ILLNESS, AND THEIR RISK OF
PREMATURE DEATH”
“We watch in wonder as life expectancy and good health continue to
increase in parts of the world and in alarm as they fail to improve in
others”

2. What kind of learner are
you?

3. Stories
 I will use some of my experiences working as a RN
in direct care, research, education, administration,
policy, research, in the north, and, often an outsider,
working in different situations, as someone with a
lot of privilege.
 You are a part of the story.

4. Social Justice Unit
Concepts:
 Marginalization
 Oppression
 Health Disparities
 Health Determinants
 Advocacy
 Political and Social Activism
 Population Health
 Social Justice

5. Canadian Nurses Association
 Foundation of the Code
 Nursing ethics is concerned with how broad
societal issues affect health and well-being. This
means that nurses endeavour to maintain an
awareness of aspects of social justice that affect the
social determinants of health and well-being and to
advocate for improvements.

9. ᒥᐢᑕᑎᒼ mistatim [NA]
 horse
 a spotted horse, i.e.: a pinto, masinâsowatim (na); a
stud or male horse, nâpestim (na); a young horse, i.e.:
usually refers to a yearling, oskastim (na); a harness
horse or a work horse, otâpahâkan (na); s/he has
horses or dogs, otemiw (vai); an untamed horse,
pikwatastim (na) (Northern Cree); an untamed horse,
pakwatastim (na) (Plains Cree); it is a good or nice
horse or dog, takahkatim (na); a white horse or white
dog, wapâstim (na); a saddle horse, tehtapîwatim (na)

10. “What we see, we do not
see.”
 Archie Weenie

11. We Don’t See Things As They
Are, We See Them As We Are
“It has been well said that we do not see things as they are, but
as we are ourselves. Every man looks through the eyes of his
prejudices, of his preconceived notions. Hence, it is the most
difficult thing in the world to broaden a man so that he will
realize truth as other men see it.”
Anaïs Nin

12. Perspectives are very
important
When a person looks
out at the world, he sees
it filtered through a
screen of his words, and
this process is as
invisible to him as water
is to a fish.

13. Invisible Backpack
“All of us carry an invisible ‘backpack’ of our culture, experiences,
beliefs, values and morals. Whenever we encounter another
person, our backpack is present with us and influences how we
interact with our patients and their families”.
Scott Harrison
Invisible Knapsack Peggy McIntosh

14. What is Culture?
 Behaviour is what you do…
 Culture is how you do it…

15. Everything is about CULTURE!
 Everybody knows about it
 Everybody does it
 Nobody talks about it
 Kathleen Bartholomew, RN, MN

16. Why are some people
healthy and others not?

17. What are the most important
factors affecting the health of individuals?
 Whether people are healthy or not, is determined by
their circumstances and environment.
 Income and social status
 Education
 Physical environment
 Social support networks
 Genetics
 Health services
 Gender

18. Greg…. You work with “those”
people?!
 HIV +
 LGBTQ2S+
 People who use injection drugs – addicts?
 Indigenous People
 And who will you work with?
 _______________________________________________?

19. There’s always a reason why
a person becomes who they are.

20. My life sucks because….

21. Determinants of Disease? Or
health?
Both the etiologic agents directly responsible for disease
and other factors that facilitate exposure, multiplication,
and spread in the population
=agent, host, and environmental factors
https://quizlet.com/ Has Flashcards!

22. 12 Determinants of Health
(Population Health Approach)
 Income and Social
Status
 Biological and genetic
endowment
 Culture
 Education and
Literacy
 Employment and
working conditions
 Gender
 Healthy child development
 Health services
 Physical environments
 Personal health practices
and coping skills
 Social support networks
 Social environments
22
(Public Health, 2016)

23. Determinants of Health
 Determinants of health are those
factors considered to determine
health status of individuals, groups,
communities or populations.
 They are the conditions for health.
23

24. Determinants of Health
# 1: Income and Social Status
 “Social gradient” of health:
 Higher income  better housing, nutrition,
education, life choices, psychosocial well-being
 Social status affects health by determining the
degree of control people have over life
circumstances, and therefore their capacity to
take action
24
(Public Health, 2016)

25. What does privilege have to
do with health?
PRIVILEGE
HTTPS://WWW.YOUTUBE.COM/WATCH?V=HD5F8GUNUGQ

26. Recognizing my Privilege.
 Firstly, to be an effective ally I need to recognize the privileges I may
(unknowingly) be benefitting from.
 As a true ally I am aware of my privilege and I am willing to speak up
about it without taking attention away from those who are marginalized.
 As a true ally this can only be decided by those who I am working with,
that is, it is not up to me at all.
 Really, I am aligning myself with others, it is an action, and an act of
doing something, and not something to be turned on or off when it is
convenient.

27. To For With
 How do we build Trust?

28. Determinants of health
#2: Biology and Genetic Endowment
 Physiological make-up is an important health
determinant
#3: Culture & ethnicity
 Cultural norms shape health-promoting (or
damaging) behaviors
 Biases create stereotypes influencing physical and
mental well-being
 Discrimination prevents equitable access to other
health determinants
 Ethnicity increases risk for certain illnesses
(Public Health, 2016)
28

29. Determinants of Health
#4: Education and Literacy
 Knowledge and skills for problem solving,
employment, health care
 Increases opportunities for income and
security
#5: Employment and Working
Conditions
 Meaningful employment, economic stability,
and a healthy work environment >> good
health
(Public Health, 2016)
29

31. Determinants of Health
#6: Gender – LGBTQ2S+
 Risk for particular psychosocial and physical
conditions
#7: Healthy Child Development
 Prenatal and early childhood experiences have a
major impact on health outcomes
#8: Health Services
 Availability/accessibility of primary, secondary and
tertiary prevention services (interventions)
(Public Health, 2016)
31

32. Determinants of Health
#9: Physical Environment
 Air, water quality, housing, community safety
#10: Personal Health Practices and
Coping Skills
 Need environments that promote healthy
choices, teach healthy behaviors
 Coping skills key to maintaining health
(Public Health, 2016)
32

33. Precautionary Drinking Water Advisories (PDWA)
and Emergency Boil Water Orders (EBWO)
 Currently in Effect for Waterworks that are Regulated by the Water
Security Agency or Saskatchewan Ministry of Environment Fri, 18
Oct 2019 15:01:18 CDT
 NOTICE: While Water Security Agency and Saskatchewan Ministry
of Environment (Environment) make every effort to post and
remove listings of Precautionary Drinking Water Advisories
(PDWA)and Emergency Boil Water Orders (EBWO) in a timely
manner, from time to time circumstances may arise that prevent
timely revisions to this website. In the event consumers require
additional information regarding application of a PDWA or EBWO,
they are advised to contact their water supplier, the Water Security
Agency, or Environment as outlined on the site-specific PDWA or
EBWO(see: http://www.saskh2o.ca/pdwa_ebwo.asp ). If questions
arise after hours regarding a PDWA or EBWO, a Water Security
Agency or Environment Environmental Project Officer may be
reached by calling 1-844-536-9494.
 http://www.saskh20.ca/reports/GOC/EnvActive.pdf (25 Pages)

34. Do you Trust
your Water?

35. Determinants of Health
#11: Social Support Networks
 Family, friends, and communities
important in dealing with stressful
situations
 Psychosocial, economic, educational and
physical resources for health within social
support network
(Public Health, 2016)
35

36. Determinants of Health
# 12: Social Environments
 Values and norms of society that affect
health of individuals and communities
 Status of women & children
 Equity & diversity versus discrimination and
inequity
 Individual and community safety
(Public Health, 2016)
36

39. Equality Equity Reality Justice

40. Imbalance Creates Illness
 Holistic approach to address issues and factors
that impact illness targeting not just the disease,
but also the social determinants of health and
economic circumstances.
 It is recognized that the whole family (broadly
defined) is as impacted by disease and needs
healing just as the individual who is ‘sick’ requires
care, treatment and support.
 Harmony – things that go well together.

41. Physical Mental Emotional
Spiritual Health
My perspective is that each of these four parts can be treated as
its own body.
Each requires its own form of sustenance and exercise to be
healthy

42. Individual Health
 Unus pro omnibus, omnes pro uno
 Un pour tous, tous pour un
 "One for all, all for one“
 Public Health vs Personal decisions
 Vaccines

44. Bronze rule
 Do unto others as they have done unto you

45. Silver
 What you do not want done to yourself, do not
do to others

46. Gold
 Do unto others as you would have them do unto
you.

48. THE PLATINUM RULE
Do Unto Others as They
Want done Unto Them
TREAT OTHERS
HOW THEY WANT TO BE
TREATED

50. Advocacy
 Advocacy refers to the act of supporting or
recommending a cause or course of action,
undertaken on behalf of persons or issues. It relates to
the need to improve systems and societal structures to
create greater equity and better health for all. Nurses
endeavour, individually and collectively, to advocate
for and work toward eliminating social inequities.

51. CNA CODE OF ETHICS -
Advocacy
 ADVOCATE: actively supporting a right and good
cause; supporting others in speaking for themselves or
speaking on behalf of those who cannot speak for
themselves
 Advocacy involves engaging others, exercising voice
and mobilizing evidence to influence policy and
practice. It means speaking out against inequity and
inequality. It involves participating directly and
indirectly in political processes and acknowledges the
important roles of evidence, power and politics in
advancing policy options.

52. CNA CODE OF ETHICS -
Advocacy
 Nurses should endeavour as much as possible,
individually and collectively, to advocate for and work
toward eliminating social inequities by:
 iii. In collaboration with other health-care team members
and professional organizations, advocating for changes
to unethical health and social policies, legislation and
regulations.

53. Restoring Balance through Harm
Reduction
 North American culture looks at problems of
substance abuse as individual problems rather than
looking at the larger societal picture.
 In individualistic societies we blame the individuals,
often missing the larger patterns and forces at work.
 Most social ills are seen as the result of actions by
people who are “bad”.
 The individualistic perspective frequently narrows
the ethical discussions to consideration of individual
rights rather that collective goals and
responsibilities.
 We are far too focused on individual behaviour to
see the larger context that encourages people to act
ethically.

54. “Our preference would be that no one would engage in the risk and
harm that goes with drug use, but we know there has to be help and
support for those already addicted,” said Regina Police Service
spokesperson Elizabeth Popowich.
The province said in a written statement that it’s not currently
considering supervised consumption sites, but it is monitoring them in
other places and will review evidence and research as it becomes
available.
Harm Reduction & Substance Use
Harm-reduction advocates call for safe
injection sites in Regina

55. Harm Reduction Nurses Association
(HRNA)
Position Statement - Safer Injection
HRNA BELIEVE THAT SAFER INJECTION INCLUDES THREE
COMPONENTS:
1. How you inject
2. Where you inject
3. What you inject
 Safer injection reduces the risk of complications (including soft
tissue infections, venous injury, endo-carditis, sepsis), prevents
blood-borne diseases and overdose-related death, and improves
health.
http://www.hrna-aiirm.ca/wp-content/uploads/2018/01/hrna-aiirm_infosheet_saferinjection_en_180116.pdf

57. Speak with one voice vs
Many voices
 Coordination is always the best.
 Largest voice for the biggest ears
 Divide and conquer? Divided we fall
 Can’t we just all get along? If not, what can we agree
on?

58. Types of Advocacy
 Self-advocacy, personal advocate
 Group advocacy.
 Peer advocacy.
 Citizen advocacy.
 Professional advocacy.
 Non-instructed advocacy.

59. Advocacy
 Not always about solving a problem
 It is about change, or sparking the
conversation
“Make them smart before you make them mad”

60. Who should advocate for
whom/which group when?
And when do we stop…
What will stop you from being an advocate?
When is it time to let ‘the other’ advocate for themselves?

61. Risk and Rewards
 We often face a risk acting, and we also face a
risk when we do not act.

62. What can be done to
improve the health of
individuals/groups in y/our
community?

63. & DonT be arfaid
to
kame mit sakes
Ask questions, listen,
and then ask more
questions.

64. Contact information
Greg Riehl RN BScN MA
Indigenous Nursing Student Advisor
Saskatchewan Polytechnic Indigenous Nursing
Saskatchewan Polytechnic
Regina Campus
Email: greg.riehl@saskpolytech.ca