The healthcare system is a complex web of diverse fields and professionals woven together by each individual patient and their needs. To study the Canadian healthcare system, we need to understand not only what pieces are in the web but also what the needs of the remarkably diverse population are to ensure each patient is given equitable care. In this course we have explored the healthcare system in a unique manor. We started at the very core of health by examining how we choose to define health, what factors affect a person's health, and what tools we can use to analyze health, and the healthcare systems. Once our understanding of the basics of healthcare was determined we began to explore specific issues in healthcare using the tools discovered and discussed in previous blog posts. In this final post we will bring together all the concepts we learned about health and the healthcare system and apply them to my field of interest which is oncology research. We will also compare the healthcare system applied to oncology research versus that applied to the marginalized groups we had discussed in previous posts.
I currently work as an oncology clinical research coordinator; I work on phase three trials therefore most of the trials I work on are efficacy trials rather than safety testing trials. Working in phase three trials also means that most of my patients have later stage diagnosis and have been jumping around the healthcare system for a while. I work in a hospital downtown Montreal and so I have worked with many different patients all with incredibly unique backgrounds, I have had indigenous patients come from up north, Immigrants from all over the world, first generation Canadians and Canadians whose families have lived here for as long as they can remember. Each one of these patients have different stories of how they got to where they are today, their diagnosis story and their experience in the healthcare system. However different their stories may be, it is still quite easy to see certain health determinants expressing their effects on the population. For example, many my mutations trial patients are of Asian descent, upon noticing this I did some research and discovered that EGFR mutations are much more prevalent in eastern Asian populations (Zhou, 2011). Another example of health determinents in my field is that I see many patients of low-income households and especially male patients. In Canada 12% of the population over 12 smokes, most of these smokers are males, and 1 in 5 Canadians who come from a low-income home are regular smokers (McDonald, 2018). I see this socioeconomic determinant of health in action every day in my field, and it truly has opened my eyes to this issue that is not addressed enough. We are taught from an early age that smoking is bad, and it should be avoided, however we are not taught the deeper issue leading people to turn to smoking. Being able to apply health determinants to my work has given me a deeper understanding of my patients and their needs, as now I can connect with them and provide more personalized care that serves their needs.
We have discussed in a previous post the pandemic and its effects on people with opioid use disorders using the social-ecological model of health. This model allowed us to see the deep rooted issues and vulnerabilities that the pandemic has exploited among this population. Using this multi-level model of health on my field of work uncovers a parallel between the effects the pandemic had on people with opioid use disorders and its effect on existing as well as newly diagnosed cancer patients. Initially after the onset of the COVID-19 pandemic there was an overall reduction in cancer diagnosis, mostly asymptomatic cancers that would have normally been detected in a routine physical examination (Drescher, 2022). Initial reports following the pandemic predicted that the delays it caused in cancer treatment and diagnosis would lead to a 2% increase in cancer related deaths in Canada (Malagón, 2022), this percentage assumed that treatments would return to pre-pandemic capacity in 2021. Similarly to people with opioid disorders in recovery, cancer patients in treatment were overlooked during the pandemic and had to put their care on hold to meet the needs of COVID-19 patients and to abide by new protocols being made daily.
Another marginalized group in Canada that is often overlooked especially in the healthcare system is the indigenous community. As we have explored in the last blog post, the anti-indigenous bias among healthcare professionals in Canada is very present and it is impacting the care that is provided to the members of this community. In a study conducted in Alberta most of the healthcare professionals admitted to anti-indigenous bias, and that they do prefer to treat white patients rather than indigenous patients (Roach, 2022). This bias is extremely dangerous as it will impact the quality of care that these patients will receive. When examining this bias as a healthcare professional working with oncology patients, I know that treatment is a time sensitive matter, and an early diagnosis is the patient's best chance at being cancer free again. If indigenous patients are not being taken seriously by their physicians and their concerns are being overlooked, they are automatically put at a disadvantage as the window for an early diagnosis can be quickly missed. The injustice being experienced by indeginouse members of our community, especially in the healthcare setting is disturbing and should have no place in the healthcare system.
As stated in one of my first blog posts the healthcare system is a very unique and complex system that is comprised of many moving and growing parts, and the people it is created to serve are even more complex and unique. Over the duration of this course, we have used many tools to try to understand healthcare and the broken parts and gaps within it that need to be addressed and repaired to not only grow our system but to improve it for those that it has neglected and overlooked in the past. As a clinical research coordinator, I have the privilege of working with many great healthcare professionals as well as many amazing patients and get to see first-hand the importance and the positive impact providing patient focused care can have on someone treatment. I look forward to to the day where it is a fact that every Canadian regardless of race, gender or socio-economic status is getting the best possible care and we have a healthier Canada.
Drescher CW, Bograd AJ, Chang SC, Weerasinghe RK, Vita A, Bell RB. Cancer case trends following the onset of the COVID-19 pandemic: A community-based observational study with extended follow-up. Cancer. 2022 Apr 1;128(7):1475-1482. doi: 10.1002/cncr.34067. Epub 2021 Dec 17. PMID: 34919267.
Malagón T, Yong JHE, Tope P, Miller WH Jr, Franco EL; McGill Task Force on the Impact of COVID-19 on Cancer Control and Care. Predicted long-term impact of COVID-19 pandemic-related care delays on cancer mortality in Canada. Int J Cancer. 2022 Apr 15;150(8):1244-1254. doi: 10.1002/ijc.33884. Epub 2021 Dec 3. PMID: 34843106; PMCID: PMC9015510.
McDonald, H. (2018, June 26). This is a health fact sheet about smoking among Canadians aged 12 and older. the results shown are based on data from the Canadian Community Health Survey. Smoking, 2017. Retrieved April 2, 2023, from https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54974-eng.htm#shr-pg0
Phillips-Beck, W., Eni, R., Lavoie, J. G., Avery Kinew, K., Kyoon Achan, G., & Katz, A. (2020). Confronting Racism within the Canadian Healthcare System: Systemic Exclusion of First Nations from Quality and Consistent Care. International Journal of Environmental Research and Public Health, 17(22), 8343. https://doi.org/10.3390/ijerph17228343
Roach P, Ruzycki SM, Hernandez S, et al Prevalence and characteristics of anti-Indigenous bias among Albertan physicians: a cross-sectional survey and framework analysis BMJ Open 2023;13:e063178. doi: 10.1136/bmjopen-2022-063178
Zhou W, Christiani DC. East meets West: ethnic differences in epidemiology and clinical behaviors of lung cancer between East Asians and Caucasians. Chin J Cancer. 2011 May;30(5):287-92. doi: 10.5732/cjc.011.10106. PMID: 21527061; PMCID: PMC4013393.
