DHiC 05 – Health Care for the Whole Person

Pam Nolan: When we look at social determinants of health, from my perspective, because I’m a First Nations person, it’s just common sense.

Katie Bryski: Hello and welcome to Digital Health in Canada, the Digital Health Canada podcast. My name is Katie Bryski and I am a podcaster turned digital health professional.

Shelagh Maloney: And I’m Shelagh Maloney. I’m a digital health professional turned podcaster.

Katie Bryski: Now there are many ways that we can think about health. It’s multifaceted multi sectoral, and influenced by the social determinants of health.

So what does it look like to care for the whole person? And what are different ways to be well? Today we speak with two leaders to explore how these factors shape health and wellness as individuals and communities. We are so honoured to welcome to Digital Health in Canada, Pam Nolan, Executive Director, First Nations Digital Health Ontario, and Dr. Andrew Boozary, Executive Director of the Gattuso Centre for Social Medicine at welcome both, thank you so much for being here.

Pam Nolan: Thank you, Katie and Shelagh, for having me. I hope I can be as exciting in providing information as you both seem to be by hosting this podcast.

Shelagh Maloney: One of the things, Pam, that we like to host the podcast and bring people on who are leaders in their field and who are very interesting and have interesting stories.

So, on that note, let’s get started and maybe Pam, we’ll start with you. One of the things that we really like to give people an opportunity to introduce themselves, but we found that often people have a fairly circuitous route to where they are. So, I’m wondering if you can maybe introduce yourself and tell us a little bit about FNDHO, First Nations Digital Health Ontario, and how you got to be where you are in your position.

Pam Nolan: So, over the past 40 years, I was the health director in my First Nation community, Garden River First Nation, here in Ontario. And during that time, I started to get interested in digital health, maybe in the early 90s. And there were few people, let alone First Nations, using any digital tools at that time.

As my interest grew. I found it more challenging to find any support or help from any level of government. Whether that be the federal government or the provincial government, digital health didn’t seem to be on anyone’s radar. So, with some local support through various health organizations within the City of Sault Ste.Marie, we launched our first EMR. That was in the 90s. Shortly after that, I guess because of that work, I was recruited to be a member of the Chiefs of Ontario Panorama Working Group. Everybody knows Panorama, the immunization repository, and they were looking to see how First Nations could participate with Panorama.

And as I met other health leads from across the province who were also on this working group. And as we began our discussions, it wasn’t just about immunization, it was about digital health for everything else. EMR support and sharing information with the province and, and our home and community care getting good information, especially for discharge planning.

So we put our heads together and said, you know what, nobody’s out there helping these First Nations. So let’s go to the Chiefs in Assembly, Chiefs of Ontario, and find a couple of Chiefs who think we have a great idea here. And we did. We were successful. We had the Chief from Nipissing First Nation and the Chief from Garden River First Nation support this resolution.

And they took it to Chiefs in Assembly. And the resolution called on is to support a digital organization that would support First Nations right across Ontario. And that resolution was unanimously supported by the Chiefs in Assembly. And here we are today. FNDHO was incorporated just before COVID, so in 2019.

So that’s the story, and that’s my story. Thank you.

Katie Bryski: And thank you for sharing that story with us. It’s really good to have you, and I’m excited to get into more of your work, and more of the work that FNDHO does. As we continue our introductions, though, Andrew, can I pass the mic over to you?

Dr. Andrew Boozary: Yeah, thanks, Katie. In terms of the journey, I think it’s, it’s one that’s obviously, I think, continuing to be shaped by everything that’s happening, of course, around us. I would have to say for me, so much of this as we go back to the roots or the rationale for why we’re engaged in the work, which we are, and for me as a frontline primary care doctor, really at the intersection of health inequities and social justice and health care performance around improving the quality of health care systems for people who have been marginalized.

So much, all of it really, starts with my mother. And I think so much of that from where we grew up in the early days of St. Jamestown, which is one of the most diverse square kilometers in Canada and in downtown Toronto, but as my family had some really lucky breaks, which were not as available to people that we live with in the same apartment building, on the same floor. It was really clear early that this is not about individual failures when it comes to being able to deliver on health and wellbeing, or attain the sort of health and wellbeing people want.

So much of this was tied to policy decisions. And so a lot of my work has really been both at frontline care delivery, about trying to address, you know, untreated diabetes, to how we manage different chronic disease, to really also the larger structural issues that discriminate against marginalized communities and drive worse health outcomes when it comes to lack of housing access.

All of the real policy considerations that have seen this come together -with health and social policy, I would argue, being health policy writ large. And so that’s what I’ve been really fortunate, from early teachings of my mom, to so many mentors and colleagues and friends that continue to help teach me and guide me in the work, as there is no shortage of challenges and these compounding crises that so many are engaged in fighting up against.

Shelagh Maloney: Thank you, Andrew. That was interesting to hear your journey and I think one of the things that you’re emphasizing is not just dealing with individuals and prescribing medicines as a primary care physician, but that real emphasis on policy, advocacy for policy change, and policy review. Are there any specific examples that you have, or something that you’re especially proud of in your work, that has made a significant difference that you would like to share with us?

Dr. Andrew Boozary: You know, it’s tough because I think with the question about proud or having pride…I mean, the challenge, I think, there’s really not much time for reflection on that, or even that kind of sense when you really feel in the work that so many are drowning in these inequities, you know. And I think you can look at these pockets of success for sure.

And I think the one that probably is just most top of mind for me is the housing initiative that we have, the social medicine housing initiative, which will be lifted up in the coming weeks. And when we look at the work, it’s a partnership with the City of Toronto, the United Way, and Fred Victor, a supportive housing agency and shelter support agency, to house 51 individuals that are actively unhoused, that have been homeless actively for quite some time.

You know, the reality that 51 housing units is not going to end a homelessness crisis where we have over 10,000 people without housing or 8 to 10 year wait period, but so much of the learning about what this means for people individually, and one, what I think is different about this, is people get permanent housing.

They have a lease just like you or me. And this is not a hospital discharge exercise. This is truly about people having housing. I hear so much from my patients about the excitement about people wanting to be able to cook their own meals. And part of this drive where there’s been a great push from the University Health Network to leverage the resources and land for affordable and deeply affordable housing, is that for many of these patients, they ended up in the emergency department because there’s nowhere else to go.

And we had some early data numbers that 234 patients made up over 15,000 ED visits, or emergency department visits, in just one year. The most recent data is over a hundred patients accounted for close to 4,500 emergency department visits and for some of them, it was just, there was nowhere else to be. There’s nowhere else to sleep, there’s nowhere else to get care or attention, with the shelter bed capacity being where it’s at. But for many it’s also that disease conditions that could have been better treated were not, and that they are having more complex chronic disease issues that we have allowed to take place through this active policy decision of accepting that thousands of people to tens of thousands of people across the country do not have housing.

And so, this was a real effort with strong guidance and learning from a lived experience advisory council, to people who’ve experienced homelessness, to community leadership that’s been pushing and advocating for access to housing for quite some time, that are starting to finally move people into place this October.

And I think that’s something where it’s been a learning, that’s been an advocacy issue, rights issue for as housing as a human right for decades. But to see it now into practice and see something concrete with the sort of health and social supports people will need to thrive, something we continue to try to draw some hope and meaning for, given how outsized this problem is across the country.

Shelagh Maloney: As you said, those 51 people absolutely changed their lives. Pam, now let’s, let’s talk to you about that in terms of specific initiatives, or have you seen the services that you provide change over time? Are there things that you’re especially pleased to have been able to put into place?

Pam Nolan: I think what I’m most pleased about is that we were able to put an organization in place that would really work towards directly working with all the First Nations across Ontario to understand their digital health needs. We, you know, so naively thought that that was the important place to start. And I think what we found out pretty quickly was that a lot of First Nations didn’t know what they didn’t know.

I know that’s kind of a cliché term, but really, when you don’t even know that there are provincial tools out there to connect to you, when you don’t even know that they exist, you’re not going to know that you’re missing anything. Right? So, going right back to the basics and working with First Nations to help them understand how digital health can improve a person’s life in their community, I think was really important, You know, something that, it was just like an “aha” moment. “Wow, you know, this is going to make a huge difference, because we are now able to get out there and let people know what’s available.”

I say that optimistically, because there’s a lot of work to be done for First Nation communities who are basically just using the providers in those communities, using fax machines, still. And they’re still charting on paper. There’s a long way to go. There’s a long way to go, but very pleased now that we can help them move forward.

So, we often meet with the province now, and the province who’ve invested significantly in digital health to say, you know what, somehow we were overlooked all those years. We were passed over. People think they’re working with First Nations when they work with provincially funded organizations like Aboriginal Health Access Centres, or family health teams that are funded by the province, but those aren’t the same health teams that we work with.

We work with on-the-ground health teams that are more or less funded by the federal government. So, that was a real challenge and I think I’m pleased, again, to be able to provide the provincial government with a better understanding of who First Nation health teams are, and who they are not. So, you know, you’re missing a whole group of people there that have been overlooked for years.

You know, all those investments in digital health, like I said before, First Nations were not included in those. I don’t, I don’t know why, I think it was just a misunderstanding maybe. But you have thousands of people out there who could really benefit from some investment from the provincial side in digital health.

I always say, you know, we can’t keep up until we can catch up.

Katie Bryski: That’s a really impactful way to put it. I think it’s another great example of how that work on the ground can make such an impact for people in communities. And Pam, I wonder if we can go a little bit deeper into some of the work that you do with communities.

Because I know with FNDHO, you work with communities. You really work to understand their unique context, and their priorities and their challenges, and so I’m wondering if you can walk us through that process a little bit.

Pam Nolan: So like I said, the First Nations are spread right across Ontario, so some are southern and some are very northerly.

They all have different needs. Very, very complex service models. You can’t paint them with the same brush. Not one community is the same. You know, you have to understand their political structure. Which PTO – political treaty organization – in Ontario they’re tied to. Are they getting funding from the federal government?

How is that funding arrangement? Are you hiring your own nurses? If that’s not possible, the federal nurse is coming in to provide that support, yes or no. Do you have any provincial services, provincially funded services at all? Are your services coming from a group, a collection of First Nations who band together to form maybe a different health team group that supports those First Nations?

So once you get an understanding of that kind of landscape, first of all, then you can start doing a deeper dive into asking those questions about, what does your nursing workflows look like? How do you do things right now? Where do you chart the information? Where do your clients come? Do they use virtual care services?

So, multitude of questions just to get an understanding from the community of what they’re doing. And then, once you get that good understanding, you need to really start looking at, you know, there are some requirements on the provincial side to connect to some of these resources. You have to have really good privacy and security policies.

You may have to have some IT support. What about the connectivity? What are the issues here? What do those look like? It’s not easy. But you need to take all those things into consideration, and, you know, we really, really stress that we need to start where the community is at, and if there are changes, you know, related to turnover in those communities, okay, let’s start from square one again.

Let’s just go right back to the beginning, because the person, you know, we were working with before, the nurse, is no longer there. She’s moved on, so we have to start again. I think it’s important also to note in all of the First Nations that we work in, there are no real IT support people in most of those First Nations.

Those are outsourced, maybe provided by, you know, an external service provider and that can only get into the community whenever they can get there. There’s sometimes no real connectivity or sometimes people say, “Oh, there is connectivity in the community,” but guess what? It’s only going to the nursing station.

It’s not going to the health centre. Two different places in the community, right? Or, it’s only at the band office. And, or the nursing station is sharing that with community members that stand outside their door trying to get access to the internet. So, a lot of interesting scenarios that are happening in some of these communities.

I mean, I’m not just talking about the North because there’s connectivity issues in the South too, you’re probably aware. Sometimes in, you know, different places, maybe that you were, even in the city, you wouldn’t get good connectivity.

Katie Bryski: It really strikes me, you know, I’ve talked in digital health conversations before about really thinking about the whole person and meeting the person where they’re at.

And it’s so interesting to hear it about thinking about the whole community. And meeting the community where the community is at. And Dr. Boozary, it sounds like there’s a similar, perhaps, lens in the work that you do with the social medicine centre.

Dr. Andrew Boozary: Yeah, I mean, there’s so much learning from Indigenous colleagues and elders and so much of the work that I think Pam has laid out so powerfully. You know, really, I think when we talk about the definition of social medicine, it is about trying to get at these roots of inequality, and I think it’s very alarming at times for people who think, “Well, we have a universal health care system. So we have pretty good health outcomes.”

And when you actually compare us to other OECD countries, we don’t do that well. And a lot of that is. There are major access issues where there has been tremendous research led by Indigenous researchers and organizations, showing long standing gaps in access to surgical services to medical services over many decades.

We’re seeing this with refugee newcomer populations the last 20 to 30 years, tremendous work by Black-led organizations and researchers through the pandemic, especially showing these very serious gaps in access to life saving interventions. And so much of that advocacy and work really shifted certain public health authorities to say, we’re going to collect race-based data and sociodemographic data.

It’s really the underpinnings of any social medicine work. When we look at the histories of social medicine, I think, you know, one of the telling quotes is about that really, that this medicine is about policy decisions on a grand scale. And when you look at some of the other work that’s been done around how can we better help prevent poor outcomes by the sort of partnerships.

And to me, it’s not as much about social prescribing, but the power of partnerships with various organizations, and expertise people have in terms of whar we need to be thinking about differently as health care institutions and hospital networks, where we’ve had, I would argue, more of a rigid view and this sort of, you know, unilateral perspective of where innovation moves in and out of the hospital into communities.

And really this delivery gap, and this failure to embrace the innovations, and how to better deliver health care, I think, has held us back and is another driver as to why we have far worse health outcomes than some other jurisdictions.

Shelagh Maloney: Interesting you talk about that. You know, there’s the dichotomy, and I want to talk to you about this a little bit, that you work for University Health Network, I think the biggest, largest network of hospitals in the country.

And some might think it’s innovative, it’s leading edge, it’s using all the technology. And for the University Health Network and other facilities like it across the country to establish a social medicine center, to bring somebody like you on staff, to take parts of their budget to buy and build affordable housing.

That’s a major shift. How did that come about? You gave the stats around small numbers of people using a lot of the emergency services. Was it a budgetary decision?

Dr. Andrew Boozary: I think it’s really important to reiterate your point that a lot of what we’re doing is in no way altogether new, right?

Community health centers have been pushing and driving so much of this work for decades and goes all the way back to the Hastings report. We’ve seen this in the Lalonde report in Canada, that’s now 50 years old. Again, I think that’s really important. Decades and centuries from Indigenous leadership and wisdom around how to be thinking more broadly about these notions of health.

And we have taken, in many ways, for a number of years, an acute care perspective. What does utilization look like? What is more or less utilization, good or bad? But really, I think, you know, hearing so much of Pam’s work and being able to engage with more folks across the country. What does health and well-being mean for people?

And one of the things that was great to see, the University Health Network, really step forward in this space is, the question or the challenge, are we the University Healthcare Network, or the University Health Network? There’s a fundamental difference between health and healthcare. And if you’re the health network, there is a large body of evidence and work about what actually drives and determines better health outcomes.

And so I think that was part of the push, Shelagh, around thinking of, “What is the lane in housing or housing as health care, housing as a health intervention?” What does it mean when it comes to food insecurity or partnering with public health and community health centers in rolling out vaccines that play a crucial part in terms of trying to mitigate some of the disparities?

What does it mean in accessing primary care? To addictions and harm reduction services that really pivotal in keeping people alive. So that I think is the fundamental shift. I think the data tells a really important story, but I think the big part of it is what is the narrative arc? And I think it is around, as you’ve mentioned, and of course is clear here that this is the largest academic health sciences network.

This is evidence informed treatment, these are evidence informed pathways, and we can’t see these clinical divides and silos that have been shutting people out of innovation, of life saving treatment, of progress. And more than that, I would say, it’s having lived experience advise and guide and set what more and more of the priorities are for us as the Gattuso Centre for Social Medicine.

And so that, I think, is where we’re trying to go. Of course, this is always a work in progress. There is no, I would say, finish line when we look at the outcomes we want to achieve. And given how dire many of the outcomes are, we continue to lose people every day who cannot access housing or are unable to access housing, drowning in the pathologies of poverty.

And so I think that is really where we’re trying to see some of the shift. And I think the data has been helpful to try to push those conversations, both internally and externally with our partners, but really this fundamental rethink around. What is the role of the hospital as an anchor institution, and communities that have some of the largest footprint when it comes to hiring practices, to environmental and climate change policy, to what’s available by the way of procurement, food insecurity, and housing policy.

So that’s really the hope and the push. And I think, again, I continue to learn so much in this role – now coming into five years in the coming months. It was a pressure cooker through COVID of where, you know, it made the work in many ways more important than ever. But what I try to draw some hope from, is that it illuminated the social determinants of health in a way that was not breaking through to people.

And my only hope in this work is that those lives that we lost, the lives we lost before the pandemic, the lives that we continue to lose, are not in vain and that we are actually serious about prevention, and that we are serious about social medicine as a society.

Katie Bryski: That distinction between health and health care is really powerful.

And Pam, I’d be interested to hear your perspective on this, as I know FNDHO also is involved in the Indigenous Digital Health Ecosystem, which is an integrated suite of platforms that don’t just address health, but also domains like education and housing. What is your perspective and your experience in terms of social determinants, health, and health care?

Pam Nolan: I think when we look at social determinants of health, from my perspective, because I’m a First Nations person, , it’s just common sense. There’s no, there’s no, you know, other way to look at it. We were always in our teachings, if the individual is healthy, then the family is healthy, extended family is healthy, the community is healthy. It just keeps building from there.

So, when we were asked, or when we were asked to become part of the IDHE, the work around identifying digital tools to capture determinants of health, really, related information and material from First Nations, from that perspective of a healthy person.

And it, it just made sense. It was just something that, yeah, why didn’t this happen years ago, or, you know, I say this not, not in a bad way. But I remember in my work as health director in the early days, we had all the services under one roof, basically for health. So mental health and addictions was under one roof, home and community care, patient transportation, maternal/child health.

Because my community was 1,500 people, you know, on reserve, and we had one health center, it wasn’t an odd concept for me to integrate that health care. So that comes very naturally to me. As I started to reach out back in the 90s to my colleagues in the city, I really got to see how the health care system outside of my community was really fragmented.

Home and community care was like, up on the hill and the public health unit was way over here ,and the other services across, you know, mental health and addiction, were like, two miles away from those other buildings. And it’s like, wow, they could really learn something from First Nation health care.

And that was way back when. So I think people are really starting to see the benefits of trying to make sure that information on a person is available no matter who that health information comes from, but that’s available so that we could start taking care of the needs of the whole person. And the IDHE project is even going beyond that.

We’re not only talking about those, you know, health things, we’re also talking about Jordan’s Principle, the information from that, the information from education, the information from housing. All of those pieces that if they, you know, had using digital tools in a First Nation community to start collecting, you know, the person would be the client for all of those different purposes, right?

And thinking about this maybe as a digital case manager, that’s how I always think about the IDHE project. So it was a case manager, care manager, that had the capacity digitally, all that information would come into one system. You know, there’d be all kinds of permissions and rights and consent and all those things taken care of in the background.

But, wouldn’t that be wonderful for this case manager to be able to say, for this client? “You know what? There’s an issue here around housing that I think somebody, you know, the housing people need to really start addressing.” And, or, when the housing person was, you know, doing their housing, they’ve noticed that one of the children could benefit from some sort of special needs device or something, and maybe, you know, that case manager, through the digital case manager, would be able to notify Jordan’s Principle.

So it’d be really, the way that I think that the IDHE project is going, is really incorporating how First Nations really think about determinants of health. And using digital tools to make sure that we’re using all that information that’s available out there right now in a good way to support that client, because that’s what it’s all about, at the end of the day.

In all the diagrams that we do, we put that little client in the middle, that little person in the middle, and, I see that little person there. And that’s what drives me to do what I do today, just to make sure that person has the best care possible and, you know, their needs are met in the best way possible.

Shelagh Maloney: One of the things that you both talked about is information. And data, and you know, Andrew, you talked about evidence based and using the data to drive these policy changes and make people aware of some of the issues. And Pam, you talked about, you know, your digital case manager having all the information about the whole person together in one spot.

You also talked about power of partnerships. Both of you talked about the acute care sector, the community, and all the people involved coming together. I want to tie that up a little bit. Maybe Andrew, we’ll start with you, around how has digital health impacted the work that you do in some of the things that you’re doing around your social medicine initiatives?

Dr. Andrew Boozary: Firstly, I think Pam’s example of the digital case manager is so inspiring. I think that is really where we would want to go. You know, I think where the system needs to go, in terms of the kind of community health worker case manager approach where technology is helping enable both the practitioner and the patient or client. And I think how can that continue to be, technology uses a tool to mitigate disparities, as opposed to, widen some of the inequities.

And I think if there’s real active thinking and implementation of how technology and digital tools are leveraged to actually bridge those disparities, I think there’s a lot of promise in that. And a lot of the time, it’s from folks that I’ve worked with who are far more versed in the digital health space than myself.

And in listening to Pam’s expertise, I mean, really, I think it’s about, how do you incorporate or better integrate the human element that technology and digital tools allow to take place, whether that’s in a patient interaction, whether that’s in the sort of follow up, or as Pam mentioned, identifying what the needs are under one roof or out in community, whether that’s from various obstructions to accessing care, or obstacles to accessing care, to housing policy.

That’s to me where a lot of this work is really exciting. And I think there are so many leading examples, like under Pam’s leadership. So I think that’s something where we are not fully in the digital health space at the Gattuso Centre for Social Medicine. We obviously see the real importance of this, given where all of these conversations are going, and our real drive in it is how can we help partner with digital health experts in bridging and prioritizing patient populations that have historically been an afterthought, if anything, about some of these innovations.

And then we’re all supposed to feign some sort of surprise as to why the inequities are only widening. Again, it was very stark during the early days of COVID and there was huge and pivotal community leadership to try to bridge those disparities throughout neighborhoods, and really understanding that postal codes, really are a proxy for poverty and for the social determinants of health. It’s not something that’s inherent in the geography. And I mean, I think Pam’s wisdom on how obvious and central the thinking around the social determinants of health is…you know, I really don’t like the term social determinants of health and we use it all the time.

I find it very academic, and in some ways this sense that these things are, are predetermined, or that these things are looked at as deterministic, or there’s some sort of law. I mean, these are human choices vis a vis policy. And it’s something that, you know, is so obvious to us, even as children.

And I’ll close with the story around talking about where I grew up in St. Jamestown. We were right across the street from Rosedale. So folks are not from Toronto, Rosedale is just like beautiful, affluent, leafy. It’s often referred to as “leafy Rosedale,” because there’s just so much green space. And less than a block across the street is St. Jamestown, where there is a bunch of high apartment buildings, a lot of social housing, Toronto Community Housing.

But a total paucity of green space. And there’s been really important research from colleagues looking at the fact that access to green space is a really good predictor of whether people will develop diabetes or not, because you can go in nature, you can walk. And when you’re a kid looking out across the balcony, you think it’s like a different universe.

You think it’s like Narnia. And you realize that the opportunities to live a healthy life are no way equal, and this has nothing to do with geography, because you could throw your stuffed toy across the balcony into Rosedale. And I think that played out, you know, through COVID where we saw three, four differences across of COVID rates by one block.

We continue to see the same rates around cardiovascular disease, diabetes, cancer rates. And so I think these are things that we feel, and know what the social determinants of health are as children. But where we’ve kind of resigned to some belief that there’s this hold that the policies can have, or this failure as individuals for not being quote unquote “healthy enough.”

And that’s what I hope these conversations can help push against. And it’s always so inspiring to see the work that’s happening in the digital health space led by Pam and others to really try to push back on those notions in really pragmatic and concrete ways.

Pam Nolan: He just nailed it. When you look at the determinants of health, like social determinants of health, or some people have dropped social and they just start using determinants of health now, and for me, I think it’s finding the right people to talk to that can make this change.

Finding the right people at the federal government, or the provincial government. All I’ve been hearing for years and years and years, really, is reasons about why we can’t do something, right? Oh, there’s a policy reason, or there’s this act that doesn’t permit that, or there’s always an excuse for why you can’t do something.

So, I’m pushing people, when I go to these meetings or when I get the opportunity, I say, “You know what, quit telling me why we can’t. I’m tired of hearing that. I’ve been hearing that for 40 years now as health director and nothing has changed. Tell me how we can.” There’s got to be a way, whether it means that we have to go and lobby some, minister, or get on some committee, or change some wording in some act, or add some wording to maybe PHIPA, or modernize some of these old standards, or whatever it might be, tell us how we can do it, because we’re prepared as First Nation communities, as a First Nation organization to start doing the work now, the real work.

We want to see that change. We want to make that change. So, determinants of Health, to me, is only going to be successful if we all understand what we’re talking about. Determinants of health might mean something completely different to you. It might mean something completely different to somebody at the Ministry of Health or, we all have to get on the same page so we all have to see the same vision.

For example, you can talk to me about determinants of health today, and I’m passionate about determinants of health. That’s how I grew up, that’s how I lived, that’s kind of what I believe in, right? That’s ingrained in me, it just wasn’t a term that I looked up in a book and, you know, so I tried to figure out what that meant.

It can be a really powerful thing if we all look at it in the same way and say, this is what determinants of health means. And if we all work towards that, oh my goodness, we’re going to be able to change lives. We’re going to be able to change the future. But if it’s just words on a paper, we’re going to be back here again in another 20, 30 years saying, “Oh, what’s determinants of health mean to you?”

Shelagh Maloney: That’s a great. Ending and a great comment, like last word, Pam, in terms of, let’s just understand it, and let’s just do it, and let’s all work together toward that same vision. Thank you so much to both you and Andrew for speaking with us today on this program. Very, very important topic and congratulations and thank you for all the work that you do in this space.

[Musical interlude]

Shelagh Maloney: Wow, what a great conversation. People that are making such a difference in the world. It was just, what are your, what are your key takeaways?

Katie Bryski: I think both our guests really challenged us to think about what we mean when we say “determinants of health,” right? Like I think both in terms of looking at the social determinants of health as not being deterministic and also that need to articulate a common vision of what we mean when we say, determinants of health. Because it made me wonder if sometimes when we look at these inequities and disparities in health outcomes, if just saying, you know, “social determinants of health” can sometimes be a bit of a way to elide the policy choices, and the choices that collectively many of us have made that have contributed to these inequities and these disparities.

And so I think it makes for a more complex situation. But it also, if, if they are choices that we have made through policy or otherwise, they’re choices that we can change. And I think that that’s very empowering. How about you, Shelagh?

Shelagh Maloney: You know, my favourite line in the whole podcast came from Pam, and she said, “You know, it’s just common sense.”

Somebody who is healthy is somebody who is safe, who has food to eat and a house to live in. It’s almost this artificial health versus healthcare. But the thing that I liked best about this is just hearing about the initiatives that we have. And in particular, what, you know, Dr. Boozary was saying about organizations like the University Health Network, who are really making an effort and have strong voices and can influence this policy direction.

And taking cues from the Indigenous communities and taking lessons from the communities, and talking about the power of partnerships in making these changes and, you know, the power of working with people with lived experience. And making sure that they are driving the change. And so that was a really, I like, “It’s just common sense. And we just need to do it.”

Katie Bryski: You know, something else I really appreciated was Pam’s description of in every diagram, no matter how complex these health systems get, and they can be incredibly complex, especially looking to Indigenous health, in the center, there’s always the person. That’s why we do the work that we do.

And it kind of reminds me of the conversation that we had in our last episode with Tracey MacArthur and Victoria Lee, of knowing yourself and knowing your purpose, and knowing why you do what you do. And I just see that so clearly in both of our guests today. They know why they do the work they do.

They know why they’re here. And I think that that’s a good reminder for all of us, to really think about what is it that drives us, you know, what gets me out of bed on a Monday morning to bounce into work.

Shelagh Maloney: Well, and you know, and patient centered care has been a term that we’ve been using for a long time.

And I think, you know, people like Pam and Andrew are living and breathing, and truly are committed and believing this patient centered care. It’s not a term. It’s not a phrase that we use. It’s purposely thinking about, this is the person about whom we care, and who are we are going to ensure are healthy and not just has access to health care resources.

And so, yeah, it really drives home the meaning of patient centered care.

Katie Bryski: I mean, I think we could talk about this for another hour, at least. But as we come to a close, listeners, we’d like to thank you so much for joining us today. If you are looking for more Digital Health content before our next episode, remember that Digital Health Canada members can register for Webinar Wednesdays on the Digital Health Canada website.

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