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

Chandana Unnithan PhD, MbusComp, MBA, is a global expert/advisor and Professor in Public Health Informatics, Health Systems Implementation projects. She is an official delegate representing Australia to the UN in the Scientific and Technical Sub Committee (STSC), Committee on Peaceful Uses of Outer Space (COPUOS), United Nations Office of Outer Space Affairs (UNOOSA). She is also a health technology and informatics expert in the working group on Space and Global Health (WG-SGH) within the UN COPUOS, engaged in building applied projects that intersect space technologies and global health. The group is represented by members from space agencies (incl. Australia Space Agency, NASA, ESA, CSA, etc.), WHO, Public Health agencies and experts in Digital Health from various countries.
Chandana has spent multiple years in pioneering/implementing innovative technologies (IoT) for public health enhancements. She is an invited expert and advisor to companies in blockchain, remote sensing, geo-spatial applications, and health informatics (MLA, AI). As an applied scientist, Chandana is widely published across technical and high impact journals (e.g. Nature), international conference proceedings, edited books, books, research videos and webinars. She is an invited speaker for international conferences and is on multiple program committees in Australia, USA, Canada and Europe.
As a professor, Chandana continues to mentor a diverse cohort of international multi-disciplinary (graduate) students (particularly practitioners in the health sector) combining flipped classroom approaches with e-learning, using online platforms (WebCT, Blackboard, Moodle and Desire2Learn.  Her success is also reflected in the global internship programs with a conversion rate of 80% graduate students into full time career positions. She continues to lead applied research programs in partnership with universities (e.g. University of British Columbia) and health sector organisations globally.

 

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

Canada 15,000/150: Wellbeing for the seventh generation

By Dr. Trevor Hancock

This is National Aboriginal Day (June 21st) and we are just 10 days away from Canada Day. So it is a suitable time to reflect on Canada 150, or – as Inuk film-maker Alethea Arnaquq-Baril rightly pointed out in one of the recent Walrus Talks – Canada 15,000. After all, before the two ‘founding nations’ of Canada appeared on the scene back in the 16th century, the real founding nations had been here some 14,000 years.

Just as Indigenous people were not celebrating in 1992 the 500th anniversary of the ‘discovery’ of the Americas by Columbus, I can’t imagine there will be many celebrating Canada’s 150th birthday. And who can blame them? The harm inflicted on the Indigenous people of the Americas in the past 500 years has been devastating, as has been the history of the relationship between Canada and its Indigenous people since 1867, as demonstrated in the report of the Truth and Reconciliation Commission.

While we can’t undo that history – and indeed need to face it and accept it – we can create a different story for the next 150 years, and there is no better time to be thinking about this than right now. Moreover, in doing so, we can acknowledge an approach credited to Indigenous ways of thinking, namely to plan for the 7th generation. Since a generation is roughly 20 – 25 years, 7 generations takes us out about 150 years.

As a long-time planner and futurist, I am well aware of the difficulty of planning for a time horizon of 150 years, or even 50 years. Sadly, our political cycles do not reflect the reality of the seventh generation viewpoint, indeed they barely reflect the next generation. But here are some ways to think about what connects the present to the next 100 years or more, and why today’s decisions are so important for the long term.

First, consider that the buildings and infrastructure we create are with us for 50 – 100 years or more. The suburban sprawl we have created since the 1950s still shapes our way of life, our transportation systems, our energy use and our impacts on human and ecosystem health, and will do so for decades to come.

Next, recognize that a female foetus in her mother’s womb today contains within her developing ovaries the eggs that one day, some 20 years hence, will be her children. If those infants live to be 80 – our current life expectancy, although by no means predictive – then the mother of that yet-to-be-born infant carries within her the eggs that will be her elderly grandchildren some 100 years ahead.

Some of our most toxic pollutants are called persistent organic pollutants because they were designed to be persistent; unfortunately, this means that we and our descendants will carry body burdens of them throughout our lives.

The carbon dioxide we are spewing out – and that Donald Trump wants to increase – has an atmospheric lifetime of up to 200 years, according to the Intergovernmental Panel on Climate Change, and will thus continue to overheat the planet. And the species extinctions we are creating at 10 – 100 times the base rate over the past 10,000 years, are forever.

But perhaps the new BC government – more attuned as it is to environmental sustainability and social justice – could use the opportunity afforded by Canada 15,000/150 to initiate a conversation – in partnership with Indigenous people in particular – about our long-term responsibilities and our duty to future generations.

Fundamentally, it is unethical for us to consume the resources and harm the natural systems that our descendants will depend upon for their own wellbeing; this is the ethical principle of intergenerational justice. Arguably, it is also unethical for us to appropriate ecosystems and resources that other species require for their own survival; the Earth is not ‘ours’ alone, we share it with many other species, many of which we depend upon for our own survival.

So – much as we are doing here in Victoria with our ‘Conversations for a One Planet Region’ – as we mark Canada 15,000/150, lets think about the next 150 years, the next seven generations, and how we ensure a more healthy just and sustainable life for them.

© Trevor Hancock, 2017

Originally published in Times Colonist June 18, 2017

 

Paola Ardiles, Bridge for Health Founder wins Social Trailblazer Award

Simon Fraser University News

SFU health sciences lecturer Paola Ardiles is honoured by the Surrey Board of Trade for social trailblazing with a Women in Business award.

PEOPLE

Health sciences lecturer honoured as social trailblazer

March 09, 2017

SFU health sciences lecturer Paola Ardiles has been honoured with a 2017 Surrey Board of Trade Women in Business award for her role as a community “social trailblazer.”

The annual awards recognize the work of Surrey’s businesswomen and their contributions to the community. Ardiles is cited for contributing to myriad public health areas including mental health promotion, health literacy, cultural competency, immigrant and refugee health and women’s mental health.

Ardiles provides mentorship and supervision for students interested in the public health field. She recently co-designed the new Health Change Lab at SFU Surrey, in partnership with SFU’s Radius Social Innovation Lab, Beedie School of Business.

The Health Change Lab launched as an experiential program to help students co-design innovative and entrepreneurial solutions to complex social/health problems in partnership with City of Surrey, Fraser Health Authority and various community partners.

Such partnerships ensured that students were working with mentors and coalitions to support priority areas identified by the Surrey community, such as food security, active transportation for seniors, mental health and substance use issues.

This past week her fourth-year students participated in the Surrey arm of Metro Vancouver’s Homeless count and saw first-hand the impact of homelessness and poverty.

“I’m incredibly honoured to receive this award, and will continue to work with our students and community partners towards solutions to our most urgent public health issues,” says Ardiles, who shared the award with her two co-nominees, Jen Temple of the Trademark Group and Alice Sundberg of Surrey’s Poverty Reduction Coalition.

Paola Ardiles and Surrey Board of Trade speaker and SFU alumna Margaret Trudeau

Ardiles has placed a particular focus on youth engagement and leadership development over the last few years. In 2015, she launched a social media campaign for youth and with youth to answer the questions of why and how to best engage youth in global health policy development.

Ardiles joined SFU’s Faculty of Health Sciences in 2013 to design and teach a new curriculum on health promotion in the Canadian context for the Master of Public Health program. The same year, she founded Bridge for Health (B4H), a local and global network focusing on social innovation to promote health and wellbeing.

Since forming the network, Ardiles has worked to engage students, academics, professionals and organizations to share their talents, ideas and solutions in the B4H creative space. She also created an advisory group of global research and policy experts, whose initial report instigated the creation of a youth symposium at the World Health Organization’s international conference in Shanghai last fall.

For the past eight years, she has been a board member of the Public Health Association of BC and is past president of the non-for-profit organization, which advocates for healthy public policies. Her collaborative efforts led to the first public dialogue between the business sector and B.C.’s public health community, the first of its kind in Canada.

The idea of using sustainable business practices as a force for good health led her to enrol in SFU’s part-time MBA program in Surrey to study the concept. That led to the recent launch of the Bridge for Health Cooperative, to support businesses to design healthy social and physical environments in the workplace.

In 2016, Bridge for Health piloted its Well-being at Work Innovation Labs in Surrey with some local businesses as part of a Surrey Board of Trade event. The co-op will be implementing the labs in Brazil in May 2017.

The awards luncheon feature speaker, Margaret Trudeau, an SFU outstanding alumni award recipient, praised the work of all the award nominees.

© Simon Fraser University

Healthy Corner Stores-well, why not?

By Dr. Trevor Hancock

A couple of weeks ago I spoke at a conference in the US on adolescent health. One of my fellow speakers spoke with energy and passion about the need for young people to eat a more healthy diet. But it was a very American speech, rooted in an ethos of personal choices and individual responsibility. While noting that our food is laced with fructose and high levels of sugar and fat (oddly, I don’t recall her mentioning salt or lack of dietary fibre) she did not suggest that we should be regulating the food industry that provides this unhealthy diet.

I pointed this out rather firmly, suggesting that we should. Repeating Nancy Milio’s famous phrase, I said we need to make the healthy choice the easy choice. But all too often we make the unhealthy choice easy – and then wonder why people make unhealthy choices. Unsurprisingly, this suggestion was not met with much enthusiasm. Nor was another questioner who wondered how people in low-income communities, faced with ‘food deserts’, could make healthy choices when all they had were corner stores and fast-food restaurants. The speaker suggested they should create community gardens.

I have nothing against community gardens, indeed I welcome them for all sorts of good reasons; at their best they strengthen community relationships, provide exercise, green havens and links to nature, even vegetables and fruit – and they might save some people some money. But I don’t see them as a viable solution for people who live in low-income food deserts.

Instead I suggest another approach: The Healthy Corner Store. This approach was pioneered in 2004 by the Food Trust, a Philadelphia-based non-profit, in partnership with the Philadelphia Department of Public Health. The Food Trust noted that in low-income communities, where supermarkets are often lacking, “families depend on corner stores for food purchases. The choices at these stores are often limited to packaged food and very little, if any, fresh produce.”

So they set out to change that, working with local stores and their communities. The Philadelphia network now involves more than 600 corner stores. A 2014 evaluation of the Philadelphia initiative found that it resulted in “healthier choices, healthier businesses and healthier communities” and the network has now gone national.

This approach is now underway in Canada, with an initiative launched by the Toronto Food Policy Council in 2014 and by the Food Policy Lab and others in Newfoundland in 2015. The Toronto initiative began by mapping areas of the city where there was lack of access to healthy food and where low income populations live.

They selected a pilot convenience store in a high-rise complex in East Scarborough whose owners were keen to sell healthier and more affordable food. Working with the local community, including the youth, they identified local healthy food preferences and worked to strengthen relationships between the community and the store owners. Then they worked with the owners to improve their business planning, including purchasing, marketing and signage.

The product will be a ‘how to’ toolkit they hope to take to some of the other 2,000 convenience stores across the city. The intent is to boost sales and profits in the store, which makes it an attractive option for other stores to adopt, although it is too soon to tell how much this will change people’s diets.

The Newfoundland project is based on the recognition that “Newfoundland and Labrador has the most corner stores per capita, as well as the highest proportion of corner stores in rural areas, of all of the provinces or territories in Canada”, according to the Food First NL website. In rural communities, they note, these stores are also important community hubs, which means these stores can help strengthen community as well as improve healthy food choices. As in Toronto, they have started with a pilot store from which they are learning, but then plan to expand across the province.

Of course, changing our food culture takes a long time, especially in competition with the powerful marketing of fast food and junk food. But this seems like a worthwhile effort that could readily be adopted in BC, both in big cities such as Vancouver and in small, rural communities.

© Trevor Hancock, 2017

Originally published in Times Colonist Feb 27, 2017

Photograph by Claudio Vasquez

 

Paola Ardiles Gamboa PhD, Founder & President of Board

Paola Ardiles Gamboa PhD is a public health champion, educator and social entrepreneur. Her work is rooted in community engaged scholarship, participatory practice and social innovation.

As a practitioner scholar, she has published and contributed to work ranging from health equity issues to system approaches towards wellbeing in higher ed. In 2012, Paola was awarded Dr. Nancy Hall Public Policy Leadership Award of Distinction, for her local, provincial and national work to advance mental health in Canada.

In 2013, Paola founded Bridge for Health, a local & global network focused on citizen and youth engagement to promote health & wellbeing. Bridge for Health became an incubator for social innovation and was established as a co-op association, receiving the 2017 Coast Capital Savings Venture Award for Social Impact for its efforts to advance wellbeing in the workplace.

Since 2013, Paola has been teaching and mentoring at Simon Fraser University. She has developed new undergraduate and graduate experiential courses in Health Promotion & Social Innovation. In 2016, in collaboration with academic & community partners, Paola co-designed the new Health Change Lab, an experiential program to help students identify community health challenges in the city of Surrey and design innovative & entrepreneurial solutions. She received the 2017 Surrey Board of Trade-Women in Business, Social Trailblazer award.

Paola has 15 + years of leadership and facilitation experience, plus a passion for creating and leading innovative, collaborative and multi-sectoral initiatives. She received the inaugural 2017 Health Promotion Canada’s Mid Career national award and was recognized as one of TD Bank’s 10 most influential Hispanic Canadians.

Paola serves as the immediate Past President of the Public Health Association of British Columbia, a non-for-profit organization.

Bilingual: Spanish/English, advanced French

 

 

Rebecca Zappelli BASc MHM, Founding member

Rebecca Zappelli

Rebecca Zappelli

Rebecca has 10 years of experience working in the health sector in health policy and health promotion roles for government, community and research organizations in Australia, the United Kingdom and Canada. Her skills in management, policy development, implementation, health promotion programming, research and community engagement have seen her contribute to a number of successful health programs and policy initiatives in Australia, Canada, the United Kingdom and Vietnam.

Whether it’s been backpacking across Egypt, volunteering in Peru, living in a Ger in Mongolia or travelling in an overland truck across East Africa, Rebecca has cultivated a passion for developing relationships that contribute to community development and global partnership. This passion has led her to work with Bridge for Health’s co-founders and network members to lead the cooperatives global engagement agenda, building its international network towards co-producing socially innovative solutions to complex health issues.

In addition to being a founding member and Bridge for Health’s International Partnerships Lead, Rebecca is the Director of Operations at the Centre for Applied Research in Mental Health and Addiction (CARMHA) at Simon Fraser University. It is in this role that Rebecca is responsible for managing CARMHA’s resources, developing and managing organizational and program budgets, supporting the planning and organization of research projects and the execution of research operations.

Rebecca has also held senior policy roles within the Western Australian (WA) government, including working for the WA Mental Health Commission: a government agency charged with state-wide mental health reform. Whilst at the WA Mental Health Commission, Rebecca was a part of the project team working with State and Federal governments to plan for the delivery of a comprehensive youth early psychosis service across WA. She also project managed a number of youth mental health initiatives and co-developed the ‘WA Mental Health Prevention and Anti-Stigma Framework 2011-13’ to guide the state governments strategic investment in the area.

Rebecca’s expertise in health have seen her present at a number of national and international conferences on health related topics such as; youth engagement, social marketing, collective impact, sexual and mental health and social inclusion.

Rebecca has completed a Masters in Health Management from the University of New South Wales and also has a Bachelor’s Degree in Applied Science (Health Promotion) Deakin University. Rebecca is also a member of a number of professional groups in public health and health promotion.

 

Natasha Moore, Co-founder

Natasha has over 10 years experience in the technology, health supports and market research sectors. Her work spans project management, community engagement, research and evaluation in Australia and Canada.

A growing interest in disrupters in the health and wellbeing space led to a connection with Bridge for Health’s co-founders and the opportunity to play a key role in the creation of the cooperatives business structure. 

Natasha is a founding member and co-Chair of Bridge for Health, as well as Research Analyst for Wellbeing at UBC. At UBC Natasha provides strategic and evaluation support for programs and projects that focus on wellbeing of community members. 

In the technology space Natasha contributed to the development Tyze Personal Networks, a care coordination platform. With a focus on research, community engagement and product management Natasha played a key role engaging users, developing resources and making strategic product improvements.

Natasha has a Bachelor of Social Science (RMIT University, Australia) and Graduate Certificate in International Management (Capilano University, Canada).