Models of Health

Women’s health, specifically pre, intra and postpartum care has been the area of focus for the majority of my career.  It has impacted me both personally and professionally in the city of Hamilton.  I have seen firsthand where care has excelled and where care has lacked.  For this week’s assignment I chose to look at multi-level models of health from a women’s health perspective and highlight some of the concerns around the reality pregnant women in my city are facing.

The first article I reviewed discussed multimorbidity in Canadian urban centers, acknowledging that the number of Canadians living with chronic conditions poses a significant burden on the healthcare system, as well as on individuals and their families.  The study also found that being female increased the likelihood of having multimorbidity.  Additionally there is an inverse relationship between socioeconomic factors, as the onset of multimorbidity occurs earlier among individuals in more socially deprived groups.  This would suggest that women, especially of child bearing age, and with lower socioeconomic status are at a disadvantage when it comes to health. 

When cross referenced with City of Hamilton’s Public Health Status Report, the story is the same. Being of child bearing age saw some of the highest rates of living in poverty, 14% for those aged 18-24 years.  Specific to breastfeeding, the highest rates of exclusive breastfeeding at two months, and the lowest rates of any formula use in hospital, were among caregivers with post secondary educations, incomes greater than $150,000 in a stable relationship and who identified as white, with one quarter of the population in Hamilton self identifying as belonging to a racialized group.  Rates of preterm births and low birth weights are higher among residents with lower incomes and lower education. At every turn there is evidence to suggest that being of lower economic status, of any kind, puts women and their babies at a disadvantage.

So how can a difference be made?  In their article Spheres of influence and strategic advocacy for equity in medicine, Karches et al talk about the role of the physician (although this could be expanded to the role of the care provider), outlining practical ways physicians can work within their spheres of influence to counteract disparities.  They conclude that there are many ways systemic problems such as race and class-based discrimination impact the efforts to care for patients, and that physicians should consider such advocacy an essential part of their professional duty. And that physicians can promote change in their respective institutions and communities that will enable them to improve the health of all patients.

While there is understood to be universal healthcare in Canada that allows reasonable access to medically necessary health services, decisions around funding and services made at the provincial and regional level can greatly influence access to resources.  The findings in the articles reviewed could be used to inform local public health officials, acute care centers and Women’s health care providers about the realities of health for women of child bearing age in Hamilton.  This could help them to better advocate for the allocation of resources to this population which research shows are at a higher risk and target interventions accordingly.

In Hamilton this would mean a call to all obstetricians, midwives, and family physicians to acknowledge the disadvantages their patients face, and to advocate for change at all levels to decrease this disparity.  To work with their colleagues, public health, acute care centers, and community organizations to address the challenges facing their patient population, and to acknowledge that access to care and support should look the same for all pregnant and postpartum women.

References:

1.       Multimorbidity in large Canadian urban centres: A multilevel analysis of pooled 2015–2018 cross-sectional cycles of the Canadian Community Health Survey. (2021). Journal of Multimorbidity and Comorbidity. https://doi.org/10.1177/26335565211058037

2.       Karches, K., DeCamp, M., George, M., Prochaska, M., Saunders, M., Thorsteinsdottir, B., & Dzeng, E. (2021). Spheres of influence and strategic advocacy for equity in medicine. Journal of General Internal Medicine, 36(11), 3537–3540. https://doi.org/10.1007/s11606-021-06723-1

3.       Hamilton Public Health Services. Hamilton’s Community Health Status Report. Hamilton: City of Hamilton; 2024.