Task 1: Discussing the main health challenges faced by Canada
There are 3 tasks required in this case study assignment
Task 1: You must choose a country and provide an overview of the main health issues/challenges in the country.
You can choose to 2-3 diseases that are contemporary health issues in the chosen country. You are NOT required to describe the diseases themselves (i.e. what they are) but you need to describe the scale and the nature of the health challenges (e.g. social group that are most affected). You can also discuss how the issues are tackled by the government. Your overview should be based on sound and recent data from the World Health Organisation, as well as studies or reports published by the World Bank or Non-Governmental Organisations such as the Red Cross, Médecins Sans Frontières, etc.
Task 2 : You must discuss the health system in the chosen country (i.e. how it was created and changed).
Provide a historical account of key health events or trends in the country, and describe the evolution and constitution of its health systems. You will need to present a concise historical account, or timeline about these key events (e.g. Civil wars, droughts, outbreaks of disease etc.), how those events were dealt with and how the health system changed as a consequence. Students may also discuss examples of health policy changes/reforms or current issues within the health system. The priority in this section is to describe how and why the country’s current health system and policies are functioning as they are.
Task 3: You must predict the future health of the population in the country using relevant health indicators (e.g. you may assess the country’s performance using life expectancy, infant mortality rates, etc.).
In order to assess a country’s performance, you would need to do some trend analysis (trend over a period of time – could be 5, 10, 15 years). You should include at least two points in time (e.g. comparing 2009 and 2019) to discuss whether the health of the population has improved or not in recent years (e.g. for the last ten years). There is no need to compare with other countries (if you do, the purpose of the comparison must be related to discussing/emphasising the chosen country’s performance perhaps against similar countries in a relevant WHO region). Students can also relate their argument to current political, economic and/or social issues in the country but they need to say ‘how’ the issues are likely to affect the health system/policy (e.g. staff shortage, funding, meeting SDG targets etc.)
What do I need to do to pass? (Threshold Expectations from UIF)
In order to pass Assignment 1 you will need to:
1.Identify and describe key health issues in a country
2.Analyse policies and programmes introduced in order to tackle the health issues in the country
3.Critically assess the effectiveness of the interventions employed
How do I produce high quality work that merits a good grade?
This section of the brief will be discussed in seminars.
The lecture and seminar schedule for the first six weeks of teaching will explore broad issues directly related to informing the tasks that contribute to the case study assignment. These topics will include exploring the nature of Global Public Health, an introduction to Health Systems, measuring Health Status, The World Health Organisation, Regional and National Health Challenges and the SDGs , Health inequalities & Ideology: The “Spirit Level” Arguments and Human rights and Global Public Health.
Chronic obstructive pulmonary disease (COPD) is a chronic disorder that has a significant effect on individuals, families, and the overall healthcare system. Globally, the economic and human burden of COPD is rapidly increasing, accounting for approximately 4 percent of deaths (Gershon et al., 2019). COPD is among the top four leading causes of death and the sixth most common cause of hospitalisation among women and the fourth most common cause of hospitalization in men in Canada.
According to the (WHO) 2012 statistics, COPD was identified as the third leading cause of death in 2012 across the globe (Dang-Tan, Ismaila, Zhang, Zarotsky & Bernauer, 2015). The WHO predicts that COPD will become the leading cause of death by 2030 across the globe. Approximately 90 percent of death brought about by COPD occur in low-income nations where there are limited strategies in place to control and prevent the condition (Dang-Tan et al., 2015). The mortality due to COPD remains high in males; however, recent studies indicate an increase in mortality in females, which is attributed to trends in smoking rates among men and women in the past few decades (Dang-Tan et al., 2015). In Canada, the prevalence of the condition among individuals aged 35 years and above has increased steadily across the life span. The condition's prevalence was similar among females and males until the age group of between 60-64; past this age, the prevalence was noticed to be higher in males than in females (Dang-Tan et al., 2015).
COPD prevalence varied among provinces and territories in Canada, with some provinces recording the high prevalence of the condition than others. Nunavut recorded the highest prevalence of the disease among all Canadian jurisdictions, followed by Yukon, Nova Scotia, and the Northwest territories(Dang-Tan et al., 2015). The lowest incidence rate of COPD was recorded in Newfoundland, Labrador, and Quebec. Being the fourth leading cause of death in Canada as of 2012, the estimates propose that the projected rise in the occurrence of the condition may lead to significant strains to Canadian healthcare system.
COPD is a multi-environmental disorder with numerous risk influences linked to its advance. The lifestyle and health risk factors linked with the condition include body mass index and smoking (Osman, Ziegler, Gibson, Mahmood & Moraros, 2017). In developed nations, including Canada, more than 73 percent of the cases of COPD are brought about by smoking (Osman et al., 2017). In Canada, 18 percent of the residents are smokers; hence, approximately six million individuals are at risk of contracting COPD in Canada (Osman et al., 2017). Approximately 50 percent of the Canadian population is obese or overweight, with the percentage increasing with age (Osman et al., 2017). 24 percent of the Canadian population aged above 40 years are underweight. Overweight and obese and underweight individuals have an increased threat of developing COPD.
Task 2: Understanding the evolution and structure of Canada's healthcare system
Demographic risk influences of developing COPD includes sex, racial organ, age, and immigrant status. Recently, the incidence of COPD has increased in women, attributed to various behavioral influences, for instance, increased smoking and gender bias in the diagnosis of the condition(Gershon et al., 2019). An increase in age is also associated with a high risk of developing the disease mainly due to the pathophysiological changes in lung structure witnessed in old age. There is a disparity in racial and cultural origin in the prevalence of COPD, although the link is often brought about by underlying risk factor, including socioeconomic status. Low socioeconomic status is linked with the prevalence of COPD (Collaborative, 2012). Besides, low education is also associated with deteriorating functions of the lung and increased severity and prevalence of COPD.
Different care plans have been derived by the Canadian government to help deal with the condition. For instance, to contain the gap between the care needed and provided, the INSPIRED COPD outreach program was developed in nova scotia in the year 2010 (Vestbo et al., 2013). The program is a community based holistic approach to dealing with COPD care beyond admissions in the hospitals (Khan, Dickens, Adab & Jordan, 2017). The programs promote patient and family-centered care and support across care transition for individuals dealing with COPD (Vestbo et al., 2013). The program has improved positive health outcomes at lower costs while still enhancing patient and family experience.
The healthcare system in Canada is publicly funded with reforms that have been made over the past four decades and continues to change with changes in the field of medicine and throughout the society (Marchildon, 2013). Therefore, the Canadian healthcare system continues to change as the Canadian population and situation change, in addition to changes in the healthcare sector (Valle, 2016). The healthcare system is based on a universal coverage for all medically essential healthcare services offered based on the needs and not the capacity to pay (Marchildon, 2013).
The Canadian constitution has the mandate to set out the authorities of the federal, provincial, and territorial administrations. The constitution ACT 1867 outlines that the provincial government was mandated with the responsibility of establishing, maintain, and managing hospitals, healthcare facilities, and other health-related institutions while the federal government was mandated with the authority over marine healthcare services and quarantine (Marchildon, 2013). The federal administration was offered the mandate to levy and borrow as well as spend the finances as long as it did not have any implications of the powers given to the provincial governments (Marchildon, 2013). From the year 1867 to 1919, the department of agriculture carried out federal health services before the creation of the department of health (Marchildon, 2013). With time the mandates presented to the two levels of governments have changed (Marchildon, 2013).
Task 3: Predicting future health indicators for Canada
Prior to world war 2, the Canadian healthcare system was majorly confidentially delivered and funded. The Saskatchewan province presented a provincial universals heathcare care plan in 1947 (Marchildon, 2013). Consequently, British Columbia and Alberta implemented the healthcare plans in 1950 following its success in Saskatchewan. In 1957 the federal government of Canada approved hospital cover and diagnostic Act that was to compensate or share the cost of half of the expenses for stated hospital and diagnostic facilities offered at the provincial and territorial levels (Marchildon, 2013). In 1961 all the provincial and territorial governments had agreed to offer publicly sponsored inpatient diagnostic and hospital facilities. Saskatchewan introduced the provincial medical coverage plan to offer doctor services to all its constituents, which was later followed by other provinces and territories (Marchildon, 2013). In 2000 critical reorganizations in primary care, pharmaceutical administration, health equipment, infrastructure health data, and communication technology were made as an agreement between the federal, provincial, and territorial governments (Marchildon, 2013).
Since the start of public funding in the Canadian healthcare system, the service delivery has changed significantly from dependence on hospitals and doctors to other care transfer, mainly in primary health care centers, clinics, and community health centers and home care (Marchildon, 2013). These changes have ensured efficiency in the delivery of health services.
Canada has witnessed an increase in life expectancy and a decline in mortality rate since 1980. The mortality rate of the Canadian population has declined by approximately 43 percent between 1980 and 2005 (Nemis-White, MacKillop & Montague, 2012). A small number of Canadians dwell in the immense rural regions of the country. A significant number of new immigrants live the Canadian cities, while some of the Aboriginal residents dwell in the rural reserves or the poorer cities' neighborhoods (Nemis-White et al., 2013). The Canadian healthcare system should consider four factors when servicing the population, demographic aging, remote and rural communities, cultural diversity due to high immigration rates and unique rights due to the historical marginalization of the indigenous communities (Nemis-White et al., 2013).
The Canadian population is among the healthiest across the globe. Currently, the country population has a life expectancy of approximately 82.30 years, which is higher in comparison to other developed nations (Nemis-White et al., 2013). The Country has a small proposition of the elderly population than most of the western Europe nations. The senior population is made up of 14 percent of the country population and is projected to increase up to 24 percent by 2030 (Nemis-White et al., 2013). The country performs well in terms of population health indicators; however, significant disparities are realized mainly emanating form of socioeconomic status, aboriginal identity, geography, and gender (Verma, Petersen, Samis, Akunov & Graham, 2014). The indigenous population has a lower life expectancy, records a higher infant mortality rate, and have limited health and home care services compared to the rest of the population (Marchildon, 2013). The universal healthcare system, therefore, needs to feature in the social determinants of health to ensure health equality in the country’s population.
COPD in Canada
Canada has a positive economic performance; however, the country’s healthcare cost has grown significantly at a rate that surpasses the government's revenue growth, which raises concerns on the future financial sustainability of the healthcare system in the county (Nemis-White et al., 2013). Due to the rise in the aging population, the finding of the public healthcare may experience challenges in the future as the emphasis has shifted from promotion, protection, and prevention to containing the cost of treatment (Allin, Veillard, Wang & Grignon, 2015). Chronic diseases are the greatest healthcare challenge that has contributed to increased plans and programs that meant to prevent diseases (Marchildon, 2013).
Canada has 13 healthcare system that is controlled by the provinces and territories as provided by the constitution. Hence healthcare innovations take place at the regional level (Marchildon, 2013). The country faces the challenge is to develop mechanisms and channels that healthcare stakeholders require to share the innovations across the different regions (Nemis-White et al., 2013). Therebefore there is the need for collaboration between the provinces and territories to share proven and promising technologies to help in healthcare improvement across the nation.
Allin, S., Veillard, J., Wang, L., and Grignon, M., 2015. How can health system efficiency be improved in Canada?. Healthcare Policy, 11(1), p.33.
Collaborative, O.C., 2012. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework. Ontario health technology assessment series, 12(2), p.1.
Dang-Tan, T., Ismaila, A., Zhang, S., Zarotsky, V., and Bernauer, M., 2015. Clinical, humanistic, and economic burden of chronic obstructive pulmonary disease (COPD) in Canada: a systematic review. BMC research notes, 8(1), p.464.
Gershon, A.S., Mecredy, G.C., Aaron, S.D., Camp, P.G., Tu, K., Hernandez, P. and To, T., 2019. Development of quality indicators for chronic obstructive pulmonary disease (COPD): a modified RAND appropriateness method. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 3(1), pp.30-38.
Khan, A., Dickens, A.P., Adab, P., and Jordan, R.E., 2017. Self-management behavior and support among primary care COPD patients: a cross-sectional analysis of data from the Birmingham Chronic Obstructive Pulmonary Disease Cohort. NPJ primary care respiratory medicine, 27(1), p.46.
Marchildon, G.P., 2013. Health systems in transition: Canada (No. 1). University of Toronto Press.
Nemis-White, J., MacKillop, J., and Montague, T., 2012. Canada's future healthcare: can it be better? Will it be better?. HealthcarePapers, 12(2), pp.51-9.
Osman, S., Ziegler, C., Gibson, R., Mahmood, R., and Moraros, J., 2017. The association between risk factors and chronic obstructive pulmonary disease in Canada: A cross-sectional study using the 2014 Canadian community health survey. International journal of preventive medicine, 8.
Valle, V.M., 2016. An Assessment of Canada’s Healthcare System Weighing Achievements and Challenges. Norteamérica, 11(2), pp.193-218.
Verma, J., Petersen, S., Samis, S., Akunov, N., and Graham, J., 2014. Healthcare priorities in Canada: A backgrounder. Canadian Foundation for Healthcare Improvement.
Vestbo, J., Hurd, S.S., Agustí, A.G., Jones, P.W., Vogelmeier, C., Anzueto, A., Barnes, P.J., Fabbri, L.M., Martinez, F.J., Nishimura, M. and Stockley, R.A., 2013. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American journal of respiratory and critical care medicine, 187(4), pp.347-365.
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