Deepest Well-Trauma and Social Inequities

By Jennifer Wile

There are many facets to stories of childhood trauma, and many layers. When I was 4 years old, I developed, in rapid succession, strep throat, scarlet fever, and then rheumatic fever. My older brother started his 10 year journey of obesity. We had both been victims of violence and other abuse from my earliest memory. Then as a teenager and in my early twenties, I had multiple surgeries requiring general anesthesia for various rare but treatable physical ailments – strangely all in the same location, but caused by different factors. As an adult, I worked on the emotional effects of PTSD best helped through cognitive behavioral therapy. I discovered exercise helped my mood significantly. Even so, I did not consider the the stress of my childhood might have affected my body until I read Dr. Nadine Burke Harris’ book, The Deepest Well: Healing the Long-Term Effects of Childhood Adversity.

Trauma is no stranger to anyone: if we haven’t experienced ourselves, we know a loved one who has experienced or witnessed violence, abuse or neglect. When I read this book, I could not help but think of the children who are now separated from their parents at the borders as well as of children fleeing Syria. There are sadly many places where trauma is a fact of life, and the inner city can be one of them. It is a matter of public as well as individual health.

WHO recognizes that social conditions are important factors in health, and the all contribute to our total health. Nadine Burke Harris gives a gripping account of her exploration of the link between adverse childhood experience or (ACE) and toxic stress. She is a social innovator in public health and serves a vibrant and economically disadvantaged community, in San Francisco’s Bayview Hunters Point (BHP). She describes the challenges she faced personally and professionally when she opened the Center for Youth Wellness (CYW) as well as her attempts to have ACE and toxic stress, recognized as serious issue in children’s health, which included getting pediatricians to use screening protocols for ACE in pediatric assessments.

Burke Harris, a pediatrician with a Master’s in Public Health, writes with passion about connecting the stress of her patients with their emotional and physical well-being. When offering free pediatric care to children via her clinic, CYW, in BHP, an area that is on the extreme end of San Francisco’s social and economic inequality, Burke Harris saw clear relationships between the trauma that the community’s children experienced and their emotional and physical health. Toxic stress can, and often does, manifest itself in disease and poor health. Her examination discusses how poverty in the inner city can result in greater incidence of poor health with difficult living conditions, more exposure to violence, and untreated mental illness. While San Francisco’s median income was above $100,000 in 2016, City-Data shows that 31% of residents of Bayview Hunters Point live below the poverty line as of the last U.S. Census.

Poverty contributes to trauma, but Burke Harris reminds her audiences that trauma crosses all socio-economic boundaries. She tells us not only the stories of the children that she treated, and still treats, at the BHP Center, but also about her personal journey of trauma. Trauma does not stop in the wealthier neighborhoods. Helping overcome childhood trauma depends on your caregiver. There are engaged and nurturing caregivers in every community, just as there are neglectful caregivers in any community; however, if you live in inner city poverty, your chance of seeing violence randomly outside the home is likely. In one of Burke Harris’ case studies, a teenage boy, recovering well from childhood abuse, sees his best friend is killed on the street in front of him. Understandably, this incident is a setback for his health. The children Burke-Harris treated suffer from multiple adverse reactions, and have debilitating physical and psychological challenges ranging from asthma, obesity, failure to thrive, to stunted growth.

Although Burke-Harris’ accounts of traumatic experience can be shattering, such as the boy who stopped growing at age four when he trauma is exclusive to inner city poverty. Burke Harris reminds her audience repeatedly that toxic stress is an issue in any income bracket. Bringing this to a wider audience, Burke Harris shows us that society suffers when it ignores childhood trauma.

Thankfully, something can be done to help children (and adults) suffering from toxic stress. In fact, according to Burke Harris, part of the antidote to toxic stress is truly integrated health treatment including a combination of healthy relationships, counselling, meditation, exercise, and nutrition. The caregiver and their response to trauma play a huge role, but, sadly for those in underserved areas, so do the resources available to the child.

Though the subject matter is tough, the book and its author are inspiring, positive and passionate. This title comes as a hardcopy, eBook and is also available as an audiobook narrated by the author, which I highly recommend.

Watch Dr. Nadine Burke Harris here: https://www.youtube.com/watch?v=95ovIJ3dsNk or find her book at your local library in audio, eBook or hardcopy: Burke Harris, Nadine. (2018) The deepest well: Dealing with the long-term effects of childhood adversity. Houghton Mifflin Harcourt

 

Congratulations to Bridge for Health changemakers!

Bridge for Health Co-operative is very pleased to announce that Larissa Chen, our newest board member and Marco Zenone, long standing youth engagement lead at Bridge for Health have both been awarded Surrey’s Top 25 under 25 Awards by the Surrey Board of Trade  on Thursday April 26th, 2018.  The two youth are soon to be graduates from Simon Fraser University (SFU), Faculty of  Health Sciences. During their time at SFU they have both demonstrated excellent leadership skills and engagement qualities during their time at the University. Bridge for Health board is very fortunate to continue working with Larissa and Marco to fulfill our mission and vision. We invite all of our members and friends to extend a very warm congratulations to both of these inspirational young people creating a better tomorrow. #25U25

Does Mental Health matter most?

By Dr. Trevor Hancock

There is an interesting common thread underlying many of my recent columns. It is the question in my title: Does mental health matter most? By which I mean, in high-income countries in the 21st century, does mental health matter more than physical health? Which in turn means, in terms of public health, does mental health promotion and the prevention of mental disorders matter more than preventing heart disease, cancer and other physical disorders?

There are many threads to my emerging argument. To begin with, the 70 year-old definition of health from the World Health Organisation is that health is a state of complete physical, mental and social wellbeing. Since social wellbeing is primarily about how we feel about and respond to our links to and relationships with others in our families and communities, it means a significant part of the definition is really about our mental wellbeing.

Add to this the relationship between the mind and the body – our state of mind affects our neuro-hormonal and immune systems, and the latter is involved in allergy, auto-immune disease, and the detection and elimination of both infection and abnormal cancer cells – and our state of mind assumes an even greater importance.

Another important issue is the changing pattern of disease and death. Globally, the World Health Organisation noted last year, “Depression is the leading cause of ill health and disability worldwide” – depression, we should note, is only one form of mental ill health. WHO also notes that there are “strong links between depression and other non-communicable disorders and diseases” and that “depression increases the risk of substance use disorders and diseases such as diabetes and heart disease”, while pointing out that “the opposite is also true . . . people with these other conditions have a higher risk of depression”.

We can also see the importance of mental health in the decline in life expectancy in the USA in each of the past 2 years, the first time this has happened in more than 60 years. But that decline is driven not by physical disorders such as heart disease and cancer but from the so-called ‘diseases of despair’; alcohol and drug use and suicide, which are largely mental and social disorders. And as I pondered in my last column, we may need to consider whether the growing concern about the state of our environment is adding to that despair.

Another factor to consider is the impact of poverty and inequality. Absolute poverty is unhealthy because people lack the basic necessities for life and health – clean water, food, shelter and so on – and we have some of that in Canada. But for the most part our problems are now those of relative poverty. Kate Pickett and Richard Wilkinson, in their book “The Spirit Level”, showed that in high-income countries, a range of health and social outcomes are not related to national income per person, but to the degree of inequality.

It seems that being lower in the ‘pecking order’ of society is harmful to health because we experience inequality as a lower sense of self-esteem and self-worth, relative powerlessness and even helplessness. All of which are mental and social experiences that, again, can translate into physical conditions.

The implication is that if we want to have a healthy population we need to pay much more attention to mental and social wellbeing than we have been doing. We need to provide more funding to research focused on understanding the root causes of mental and social health problems, and to policies and programming for preventing mental and social health problems, as we do to understanding and preventing heart disease and cancer – because we have under-invested on the mental health side.

Beyond that, we need to give at least as much attention to promoting mental and social wellbeing as we do to promoting physical wellbeing and fitness, recognizing that they are mutually beneficial. What would it take to create mentally healthy families, schools, workplaces, colleges and universities? How do we help people maintain mental wellbeing in the face of adversity, or as they age? How do we re-focus our society – including public health – to ensure mental health matters at least as much as physical health – maybe more.

© Trevor Hancock, 2018

Originally published in Times Colonist, 20 March 2018

Health Promotion Canada Mid Career award for our Founder Paola Ardiles

Welcome to 2018!

Bridge for Health co-lead & founder Paola Ardiles sets off the year in positive light as she emerges winner of Health Promotion Canada 2017 Mid-career Award!
Paola was described as a current leader in health promotion in Canada, who is destined to be a future one as well, and was hailed for a stellar track record of accomplishments in #publichealth and a strong history of progressive advancement in leadership & management roles!

We are beyond proud and inspired!

Click to see full awards

Photo: (left to right) Trevor Hancock, Irving Rootman, Paola Ardiles, Ann Pederson at the launch of Health Promotion in Canada: New Perspectives on Theory, Practice, Policy and Research (4th edition) November 2018, Vancouver, BC.

Being part of the Canadian Co-operative movement

By Marco Zenone

As we start the new year I wanted to share some reflections of one of my highlights for 2017. This past November, I was exceptionally fortunate to be invited to represent Bridge for Health co-op at the Canada Co-operative & Mutuals National Meeting in Ottawa and be recognized as an emerging co-operative champion. We were invited to the conference for our exceptional contributions to meaningful youth engagement and emerging recognition of our innovative, process based outlook on workplace health and well-being.

The conference was an informative and engaging 4-day event, that included a parliamentary reception with several Members of Parliament. Our role in the conference was to share our story as an emerging cooperative to the conference attendees and provide a glimpse into our rationale for utilizing the cooperative model. It was a fantastic experience to share the work of Bridge for Health to the participants of the conference. I shared the story of how Bridge for Health was developed: from the idea that health is more than just healthcare. I further explained that all our work is socially minded and we collaboratively and empirically rally around common causes to promote holistic and upstream change in local, national, and international contexts. Conference participants were very impressed by how much our cooperative has accomplished in the just over a year since we were formally created.

I learned that the number of cooperatives has been increasing and that there have been sizeable investments from the private sector to support the cooperative movement in Canada. The federal government has noted that cooperatives are clearly the best type of organization to work towards the UN’s Sustainability Development Goals; and this conference had a clear focus to create an actionable strategy to obtain more concrete federal support for cooperatives.

To me, this conference solidified how innovative the Bridge for Health model is and how strong a force we can be to genuinely ignite sustainable change. Utilizing the cooperative model is innovative; however, I think we are redefining what a cooperative model can accomplish. We are adopting an approach that is focused on setting a platform for equity and well-being that can be adopted in any context and on any issue. As Bridge for Health grows and continues to inspire future members, I have no doubt we will be continued to be seen as a field leader and be recognized as true innovators.

 

 

 

Look upstream to improve mental health

By Dr. Trevor Hancock

 

A colleague once remarked that people are so busy dealing with the important that they don’t have time to deal with the critical. That applies to the healthcare system as a whole. It is so busy dealing with people who are ill or injured that it doesn’t give much priority to looking upstream and trying to stop people becoming sick in the first place.

That especially applies to the field of mental health and addictions, which has been described as the orphan of the health care system, neglected and underfunded. But in fact mental health problems are among the most common and most expensive health problems today. The Centre for Addictions and Mental Health (CAMH) in Toronto reports that “the disease burden of mental illness and addiction in Ontario is 1.5 times higher than all cancers put together”.

CAMH reports that “in any given year, 1 in 5 Canadians experiences a mental health or addiction problem” (including dementia) and that “mental illness is a leading cause of disability” and can markedly shorten life. Not surprisingly, people with mental illness have high rates of unemployment and work absence; at least half-a-million employed Canadians are off work due to a mental health problem every week. The overall societal cost of mental illness cost in Canada in 2011 was estimated in one study to be about $42 billion, with half that being health care costs.

This is why the creation of a new Ministry of Mental Health and Addictions in BC is an interesting development. Time will tell whether it proves to be an important strategy to focus attention on a long-neglected issue or whether, as some have suggested, it divides resources and attention and becomes a problem. One thing is for sure; it highlights the growing importance of mental health problems in society.

But simply managing the problems of people with mental disorders or addictions is not enough; we need to reduce the toll of mental health in our communities. This means the new Ministry needs to focus on why people develop mental health problems in the first place, how we can prevent that happening, and how we can improve the overall mental health of the population.

Happily, BC has developed quite a strong focus on the prevention of mental health problems and on mental health promotion in the past decade. Its 10-year mental health strategy, adopted in 2010 and updated in 2017, states “Research tells us that doing a better job of promoting mental wellness, preventing mental illness and harmful substance use, and intervening at the beginning of illness, especially for our children and youth is a wise investment”.

As with much else in public health, what this means in practice is that we need to look well beyond the health care system, to society as a whole. A recent report from the UK’s Faculty of Public Health suggests what needs to be done.

First, we need to focus on childhood factors, and in particular, family relationships. Infants and young children need to feel secure in their attachment to their family, which enables them to develop trust in others. Failure to do so “leads to lifelong problems in learning, behaviour, resilience, coping, and both physical and mental health”. Adverse childhood experiences such as abuse, neglect, parental substance use or mental illness compound the problems, and call for early intervention.

In addition to good parenting, the school environment is also important: “The school ethos, mental wellbeing of teachers, relationships with peers and prevalence of bullying all matter”. And as young people transition from school to college or work – “a time of upheaval and uncertainty” – strong relationships with caring friends and adults are important, while loneliness is a problem. This continues into adultood, where stable relationships and mentally healthy workplaces are important, while unemployment increases the risk of anxiety or depression by 4 to 10 times.

Good mental health benefits us all, but clearly is a much bigger issue than the new Ministry can address on its own. It will need to engage the whole of government and the wider society – schools, workplaces and communities – in creating a mentally healthy society. In my next column, I will discuss in more depth how this can be done.

© Trevor Hancock, 2017

Originally Published in Times Colonist

Dr. Chandana Unnithan

Dr Chandana Unnithan is a recognised professional in Health informatics, Project Management and Business IT, from Australia. She is an interdisciplinary Professor in two public universities, with cross appointments in business, information systems and public health faculties. She is best known for her applied innovative, socio-technical approaches in change management and transformation. In Australia, she has partnered with public hospitals, IT companies (Intel/IBM), consulting practices (Deloitte), implementing innovative technologies in emergency departments of hospitals. She has also spent considerable time with the Information Communication Technology sector (ICT), managing projects in multinationals (IBM) to undertaking management consulting for smart city initiatives using IoT.

Currently associated with “Space and Global Health”​, an expert group (within the United Nations Committee on Peaceful Uses of Outer Space (UN COPUOS), chaired by Public Health Agency, Canada – engaged in building interdisciplinary and applied projects with global partnerships. She has implemented the global ‘Trello’ platform for experts to work together virtually in this project. Chandana is also a panel member of IoT/wearable technologies on the Grace Hopper Women in Computing Series.

She has not only coordinated and managed an international workforce, but also managed projects and addressed the needs of a diverse (multi-ethnic, international) workforce. Conversely, she has run successful internship programs, developed/taught a range of courses within masters programs using innovative online courses/programs (using Blackboard, WebCT, D2L etc) and is on the PhD supervision panel, academic boards and faculty boards of Universities.

She continues to challenge her horizons with innovation and a vision for tomorrow.

Education:

PhD in Health Informatics (Information Systems Management), Victoria University, Australia

Masters in Business Computing (e-business research), School of Business Information Technology, Faculty of Business, RMIT University, Melbourne, Australia

MBA, Graduate School of Business, RMIT University, Melbourne Australia

Professional Memberships:

Canada’s Health Informatics Association –   COACH

Expert Focus Group – Space and Global Health (Scientific and Technical Subcommittee (STSC) of the United Nations Committee for the Peaceful Uses of Outer Space (UN COPUOS) http://at6fui.weebly.com/dr-chandana-unnithan.html

Project Management Institute (PMI.org) [Global]

International Fellow, Centre for Advancement of Global Health (CAGH), India.

Australian Collaborative Education Network –   ACEN

 

Crhistinne Gonçalves PhD

Crhistinne Gonçalves

Faculty of Medicine, UFMS – Federal University of Mato Grosso do Sul, BRAZIL

Biography

Crhistinne is a public health researcher, practitioner and policy expert. She has experience in the area of Collective Health, with emphasis on public management, in the following themes: Health Promotion, Social Determinants of Health, Social Participation, Management and Health Planning, Public Policies, Evaluation of Health Services, Telehealth and Health of Indigenous Populations, Tuberculosis, Incarcerated Population.

During 2013-2016, Crhistinne was teaching as Professor of the Higher Teaching Department of Medical Course, UFGD – Federal University of Grande Dourados, Community Health disciplines and was Coordinator of the Specialization Course in Public Health of UFGD 2014-2016. This experience supported significant approach of   Health of Indigenous populations and researches of tuberculosis in prisions.

Nowadays, she is a Professor of Faculty of Medicine -UFMS- Federal University of Mato Grosso do Sul, Internship Collective Health discipline. It is an experience to engage students in different contexts in municipalities far away from urban centers.

Education

  • Dentistry, Federal University of Mato Grosso do Sul
  • PHd, Public Health Faculty, University of São Paulo
  • MHSc, Local Development, Dom Bosco Catholic University
  • Diploma, Investment for Health: Integrating Health in All Policies, University of Padova & WHO European Office for Investment in Health & Development