Integrated Understanding of Health in Context

When I reflect back over the past 13 weeks of learning about our health care system, how it impacts at the individual or population level, and how various factors influence a person’s access, experience and outcomes I keep having the image of a DNA helix come into my mind.

I think of the health care system as this complex and interwoven system that looks a little bit different for each person based on where they live, what their background is, and why they are seeking care.  The system is influenced and funded at the federal, provincial and local level, creating an overall image of an overlapping and integrated system that is unique to each individual any time they access care.

When explored through a single health issue, it is clear to see the various factors that can influence an experience.  For the purpose of this assignment, I am looking at Diabetes in the context of the health care system.

Definition of Health

As we have learned the WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 2025). I found the definition from Krahn et al to take that definition one step further, they say that “Health is the dynamic balance of physical, mental, social, and existential well-being in adapting to conditions of life and the environment (Krahn, 2021).  When considered in the context of diabetes it would suggest an individual can have diabetes and still be healthy.

Determinants of Health

Determinants of health can differ depending on the organizational perspective, although there is agreement that many factors influence the health of an individual.  When considered for a diabetic, there are a few that stand out.  Health Services, the ability to access and be supported in the health system for diabetic care would have significant impact, and as we will see later, impact some much more than others.  Food Security and the ability to access nutritional and diabetic friendly food choices would be important.  This relates directly to Income, the ability to afford food, but also the high costs of diabetic care.  Diabetes Canada suggests that upwards of 17% of household income can go towards diabetes care and management (Diabetes Canada, 2024).  Employment and working conditions could have impact for those who work shifts, do not have regularly scheduled eating times, or work in physically challenging conditions.  This is not an exhaustive list, there are other determinants that could have impact on an individual, however this illustrates the way an individual’s situation can impact their ability to manage a disease such as diabetes.

While not related only to diabetics, I would also like to make an observation that I have kept coming back to all term, both as we have explored health, but also as I have assisted family members in accessing and navigating the system over the past couple of months.  I feel there is a relatively unacknowledged determinant of health specific to whether an individual works in or closely knows someone who works in the healthcare system.  I have experienced firsthand the massive advantage that comes with this connection.  When you understand how the system works, have connection and direct access to both clinical and administrative leaders, know what questions to ask, and are not intimidated by the physical environment there is significant positive impact to a person’s health journey.  I have not been able to find any significant evidence on this topic upon literature review, perhaps an area for future focus and research.

Model of Health

When we look to the Institute of Medicine’s model of health, we start to see things take shape.  The idea that there is an individual at the center with all of these factors influencing the outcome is a powerful image (Institute of Medicine, 2010, as cited in Galea, 2015).

We can begin to understand how someone with diabetes might be positively or negatively impacted depending on many things in their life.  In addition to the determinants of health, there are other factors to consider.  Things like whether a person has family support, whether there are diabetic programs or resources in their community, whether their family doctor or endocrinologist is in close proximity, and what their perception of diabetes is or what are they learning about their disease from social media, friends and family or other influencing factors.  We can see how disease management can be shaped by a large number of factors for each person.

Chronic Disease Management

I explored diabetes in depth in terms of chronic disease management a couple of weeks ago.  The key thing to highlight is the growing burden diabetes represents in Ontario.  The amount of residents in Ontario with this chronic disease is growing, and this results in a massive cost to the healthcare system.  There are some good supports available in Ontario for medications, glucose monitors, eye exams and education.  There are also programs available for patients with more complex needs, although resources could be better developed and more broadly available (Province of Ontario, 2025).  One area that I did not discuss in that post, and is an important element for all chronic disease management, is prevention.  When exploring provincial and national resources, there was good information on living with and managing diabetes, but surprisingly little information or guidance on how to avoid getting diabetes in the first place.  Targeted education programs would be ideal, especially for at risk populations.

Vulnerable Populations

Diabetes impacts indigenous people at a rate of 17.2% for individuals living on reserve and 12.7% for individuals living off reserve.  This is significantly higher than the overall national average of 9.6%.  Additionally, Indigenous peoples are diagnosed with diabetes at a younger age, have more severe symptoms when diagnosed, face higher rates of complications, and experience poorer treatment outcomes overall.  This higher rate can be attributed to a number of factors which negatively impact indigenous people, including fragmented health-care, poor chronic disease management, high health-care staff turnover in indigenous communities, and chronic underfunding of health services.  Additionally, there is often a lack of culturally appropriate care given western medicine rarely incorporates traditional indigenous healings or medicine (Diabetes Canada, 2025).

The Future of Healthcare

When looking at the future of health care, I focused my readings on virtual care.  I do think there is opportunity for virtual care when it comes to Diabetic care.  It would give access to specialists virtually that otherwise would be difficult or impossible, in the case of those living in remote areas or who have challenges with transportation.  Care elements such as education and nutritional supports could be easily delivered in a virtual model.

The other way to look at the future of healthcare is a call to address disparity and make change.  As we have explored above, diabetes is a disease that negatively impacts some more than others.  It has huge impact in terms of volume and culturally appropriate care for the indigenous population.  There are also financial implication which would disadvantage some of the most vulnerable patients.  While there are some great programs and support opportunities in Ontario, more could be done.  Hopefully the future of healthcare involves technological advances and new therapies, and gives opportunity to meet more patients where they live.  But hopefully it also involves continuing to minimize inequities across the entire province.

My Role in Healthcare Delivery

As an administrator in the acute health care system, my role is to help to ensure access to care for all individuals with the community, and in my case the region for a number of programs.  My role is to understand the system, and to also understand the inequity or disparity that exists within that system and help to influence and support programming that will help to minimize or eliminate those inequities.  When I think back to our first couple of week, and of my professional identity, I still connect most closely with being a Registered Nurse.  The Registered Nurse Association of Ontario’s mission “We are the professional body representing registered nurses, nurse practitioners and nursing students in Ontario.  We advocate for healthy public policy, promote excellence in nursing practice and power nurses to actively influence and shape decisions that affect the profession and the public we serve” (RNAO, 2025).  A pretty good summary and alignment between professional identity and responsibility as a RN, and a hospital administrator.

Also, as stated above, there is also a level of responsibility that comes with working in the healthcare system.  While I have direct access to clinicians and administrative staff, it is important not to take advantage of this access.  Or perhaps if considered form another perspective, it is my job to ensure every person accessing the system is able to be connected with the right care provider, tests, and appointments in a timely fashion.

By exploring a single health issue in the context of a system, from various perspectives of influence, we can see the ways a single individual would be impacted, supported or disadvantaged.  We can clearly see how the system and those accessing it are integrated and interwoven.  It is a complex system that does not look the same for each person or for each health issue. 

References

World Health Organization. (n.d.). Constitution of the World Health Organization. https://www.who.int/about/governance/constitution

Krahn, G. L., Robinson, A., Murray, A., & Havercamp, S. M. (2021). It’s time to reconsider how we define health: Perspective from disability and chronic condition. Disability and Health Journal, 14(4). https://doi.org/10.1016/j.dhjo.2021.101129

Diabetes Canada. (n.d.). Diabetes in Ontario. https://www.diabetes.ca/research-(1)/advocacy-reports/national-and-provincial-backgrounders/diabetes-in-ontario

Institute of Medicine. (2010). Promoting cardiovascular health in the developing world: A critical challenge to achieve global health. https://www.iom.edu/Reports/2010/Promoting-Cardiovascular-Health-in-the-Developing-World-A-Critical-Challenge-to-Achieve-Global-Health.aspx

Diabetes Canada. (n.d.). Indigenous communities and diabetes. https://www.diabetes.ca/resources/tools---resources/indigenous-communities-and-diabetes

Government of Ontario. (2025, January 23). Preventing and living with diabetes. https://www.ontario.ca/page/preventing-and-living-diabetes

Registered Nurses' Association of Ontario. (n.d.). About us. https://rnao.ca/about