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Welcome to HC Link's blog! Our blog will provide you with useful information on healthy community topics, news, and resources, as well as information on HC Link’s events, activities, and resources. Our bloggers include HC Link staff and consultants, as well as our partnering organizations, clients, and experts in the health promotion field.

Please note: opinions in posts are those of the author and are not necessarily the opinions of HC Link or our funder.

We look forward to engaging in thought-provoking conversation with you!

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Stephanie Massot is finishing her Master of Public Health, in the field of Health Promotion, at the University of Toronto. This summer she is a practicum student at Health Nexus and is using her experience in systems thinking, collaboration, research, and knowledge translation to develop a situational assessment of mental health services for francophone youth in Ontario and to increase equity in partnerships through the Collaborative Leadership in Practice (CLiP) project.

Working together in a Good Way

By Stephanie Massot, HC Link

Last month in partnership with Timiskaming Best Start, HC Link delivered a webinar called ‘What we are doing in a good way: A cultural competency framework model’. Working in a ‘Good Way’ means doing things in a principled, holistic way with kindness, caring, patience and, respect and is a term commonly used by many First Nations and Métis to describe a way of thinking, being and doing that is rooted in Indigenous values.i During the preparations for the webinar, the Indigenous women I worked with taught me what it looks and feels like to approach a webinar in a Good Way.

For instance, holding meetings in a Good Way meant that our conversations went at a comfortable pace and were not rushed. This usually meant that meetings took longer than the time we had planned for and as a result I started to leave an hour available after each meeting in case that time was needed for further discussion. I valued having that flexibility in my own work schedule because I learned that when there is an opportunity to circle back and work in a non-linear way, more ideas are heard and new developments can emerge.

When working with Algonquin Elder, Grandma Marilyn, I learned that she wanted to smudgeii while drumming. As she says in the Implementation Toolkit for the Indigenous Cultural-Linguistic Framework, “Be aware of the frame of mind you’re in, not having negative thoughts: the smudge and the drum are there at the start for a reason, to calm us down.” We learned that the fire code of the building where Grandma Marilyn and the other presenters were supposed to gather would not allow for smudging and so another meeting space was found and we planned for other tech checks to occur there. As well, a smudging is typically never filmed. However, Grandma Marilyn offered to have a smudging she was doing in the community be filmed before the webinar and we included that as a video during the beginning and ending ceremonies of the webinar.

Opening and ending a webinar with an Elder was a powerful experience. In the community, Grandma Marilyn usually has from sunrise to sunset to sing and drum and is not constrained by the timelines of a webinar. Grandma Marilyn and her team of helpers practiced to ensure that everyone felt comfortable for the webinar and that all attendees would be able to participate in these ceremonies for Giving Thanks. Grandma Marilyn shared her wisdom with everyone and helped us all connect to each other even though we were all virtually attending. Participants from the webinar shared how they felt more interconnected with everyone and were thankful for this experience. Captured in the image below is Elder Protocol/Etiquette that should be considered if you would like to ask an Elder from your community to join an event that you are organising.

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This handout was developed as a promotional tool highlighting key elements of the Indigenous Cultural-Linguistic Framework.
To download a copy of the Indigenous Cultural-Linguistic Framework go to http://www.timiskamingbeststart.ca/resources_en.html.


The presenters encouraged all attendees to drop in, say hi and have a coffee at the band offices of local Indigenous communities. I also learned from the team that learning and using the language of the people you are working with shows respect for the language and culture. I learned that Chi-miigwetch means “big” or extra special thanks in Ojibwe and followed the advice of one of the presenters and started to use it wherever I would consider saying thank you – in my meetings, emails and the webinar. As a settler on the traditional territory of the Haudenosaunee, the Métis, and the Mississaugas of the New Credit First Nation, I learned so much about working in a Good Way and I can’t say miigwetch enough to everyone who taught me during this webinar.

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i Chansonneuve, D. & Hache, A. (2016). Indigenous Cultural-Linguistic Framework Implementation Planning Guide. Page 3.

ii Native Women’s Centre (2008). Traditional Teachings Handbook. Page 7.

 

 

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Public Health Ethics Part 3 of 3: Applying Public Health Ethics at Your Work

By Stephanie Massot, Public Health Practicum Student at Health Nexus

This is the third blog post in a series on public health ethics. This post focuses on how to apply public health ethics to your work.

I am starting to feel as though public health ethics is like a good sandwich you have made yourself. If you have been following my last two blog posts in this series, you will be more familiar with your philosophical orientation and differentiating between bioethics, public health ethics, and health promotion ethics. These make up the main protein and key ingredients to a good public health ethics sandwich. If you have made a sandwich before, you are going to know what your favourite ingredients are – mine is always cheese and Dijon mustard! If it is your first time making a sandwich or you have been given new ingredients, there will be a new process and new discoveries. Guidance on making a sandwich is important. You need to know how to bring your ingredients together.

In public health ethics, frameworks have been developed to provide assistance to practitioners who are deliberating an ethical issue in different contexts. Strengths of frameworks include making values explicit and thinking through potential unintended consequences of proposed interventions, from policies to programs. The National Collaborating Centre for Healthy Public Policy (NCCHPP) has an extensive list of ethics frameworks for public health. Going back to the sandwich analogy, what you use to ‘frame’ your ingredients, from a challah bun to rye bread, will change your eating experience. For instance, Nancy Kass provides a list of questions in her framework (great summary from NCCHPP) and Andrew Tannahill focuses on a list of principles or ‘principlism’ to guide his framework.

Principlism is a ‘broad approach of identifying a set of principles to be considered and specified when facing a decision that may contain ethical issues1 and a practical tool for practitioners who are not familiar with public health ethics. Principles can be separated into substantive and procedural categories:

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I was recently reading Unison Health and Community Services’ workbook (jam-packed with tasty ingredients) for community based evidence-informed practice. What I noticed was that an ethical framework(s) was not provided, even for the evaluative learning tools. Referring to another tool such as the Community Ethics Toolkit, could support you to consider and dialogue about public health ethics.

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Just like you might not enjoy the idea of combining certain ingredients on your sandwich (pickles and peanut butter anyone?), there will be conflicts between principles that will require deliberation. Frameworks for public health ethics will need refinement, perhaps they will even need to be combined, for your context – only through practice will you find out how to best apply them. For an excellent case study check out: ‘Getting Through Together: Ethical Values for a Pandemic’. The Ministry of Health in New Zealand worked closely with Māori communities because ‘shared values give us a shared basis for decisions.’ Now how about that sandwich?

 

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1 MacDonald, M. (2015). Introduction to Public Health Ethics 3: Frameworks for Public Health Ethics. National Collaborating Centre for Healthy Public Policy. Montréal, Québec.

 

 

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Public Health Ethics Part 2 of 3: Distinguishing between different types of health-related ethics

By Stephanie Massot, Health Nexus

This is the second blog post in a series on public health ethics. This post focuses on differentiating between bioethics, public health ethics, and health promotion ethics.

Perhaps you have been entering in some Socrates-type conversations since reading ‘Public Health Ethics Part 1 of 3: Does Your Philosophical Orientation Matter?’ and now you are feeling ready for some practical ethical frameworks to work through some health-related ethical questions, such as ‘do I prioritize autonomy or community for my program?’ or ‘is my policy paternalistic?’ Just before we start driving down the road of applying ethical frameworks, we need to take a quick pit stop and make sure we are all on the same map and heading in a similar direction as far as how we define different health-related ethics.

Not only are there many definitions for public health and health promotion, but now you may feel as though you are in the weeds trying to differentiate between bioethics, public health ethics, and health promotion ethics. You may not emerge from your rabbit hole of research for days. So why might it be important to spend the time getting to know the difference between these three types of ethics?

Unearthing the origins of words or concepts helps us to appreciate their impact on the present context. For instance, the word ‘gypped’ (often spelled incorrectly as jipped) is still used by folk to refer to instances where they have felt cheated out of something because they do not know that it has a negative connation. It is derived from the word ‘gypsy’ and portrays Romani people in an offensive manner. As a student, I wish I had spent more time tracing the roots of some of my most often referenced journal articles – what was the background of the author? Did their country’s politics impact their writing? Was the methodology of the study strong? Was the sample size robust?

Through the guidance of Dr. Ross Upshur, I did get an opportunity to delve into why there are differences between bioethics, public health ethics, and health promotion ethics. What I came away with is that it really comes down to values.

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Public health ethics only became a distinct area in the late 1990s. Prior to this time, Bioethics (considered synonymous with health care ethics) was considered an acceptable theoretical base for ethical issues faced by public health practitioners. Why as members of a public health network (mentioned in Part 1 of this blog series) would it matter what base you are using to discern ethical issues in your field? This table will help you distinguish between different types of health-related ethics:

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* Reference: MacDonald, M. (2014). Introduction to Public Health Ethics: Background. Montréal, Québec: National Collaborating Centre for Healthy Public Policy.
** Carter, S., Cribb, A. & Allegrante, J. (2012). How to think about health promotion ethics. Public Health Reviews, 34(1), 1-24.


Check out this short public service announcement on obesity and use each of the different ethical approaches above to see what you perceive as an issue or non-issue. Which of the three health-related ethics comes closest to serving as the basis for the video you just watched? If you are thinking health care ethics, than we are heading in the same direction.

A campaign by the Covenant House called ‘why can’t street kids just get a life?’ takes a more public health ethics approach because it informs the general population in a public spaces, such as the subway, and includes values such as social justice and solidarity in the questions being asked. How could this campaign be changed if a health promotion ethics lens were applied in its creation? It is important to understand the ethical approach that you and your organization take, because whether you know it or not, your approach drives everything you do (e.g. policies, programs, marketing messages), much like your philosophical orientation. ‘Ethical Dilemmas in Health Promotion Practice’ can help you dive deeper into analyzing issues you may be observing in your work.

Although ethical questions such as ‘what is a good society?’ or ‘what should health promotion contribute to a good society?’ can seem daunting, engaging in ethical reflexivity to question our own assumptions can help us to uncover unintended consequences from well-intended health practices. Stay tuned for practical ethical frameworks to apply to your work in health!

 

 

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Public Health Ethics Part 1 of 3: Does Your Philosophical Orientation Matter?

 

By Stephanie Massot, Public Health Practicum Student at Health Nexus

This is the first blog post in a series on public health ethics. This post focuses on the importance of understanding your/your organization’s philosophical orientation.


One of my first year-long courses during my undergraduate degree in Health Education at the University of Victoria was Philosophy 100. I know I spent many hours poring over the writings of well-known philosophers but what seems to have stayed with me are disordered images of Waking Life, a film that captures a range of philosophical issues, and an overall feeling that philosophy was a ‘nice to know’ but not a ‘need to have’.

Fast forward 11 years later to the final academic term of my Master of Public Health at the University of Toronto and I am creating a course in Public Health Ethics, which has strong roots in philosophy. Since I worked in the nonprofit sector, I know that many decisions have ethical implications, such as resource allocation or selecting which organizations to collaborate with. You have an impact on the public health system if you or your organization puts any energy towards keeping people healthy and preventing injury, disease and premature death. For many of us this occurs by taking action on the living conditions that affect our community members. As members of a public health network, having an understanding of public health ethics and tools available will result in better decisions and improvements in the health and satisfaction of the people we serve.

Now how to take on ethical decisions in public health?

Whenever you have to make decisions, whether you are aware or not (typically therein lies the problem) you always come from a particular philosophical orientation. Since you may not be cognizant of your philosophical orientation, as a public health practitioner it is important to develop reflexivity and understanding of your orientation because if tough, moral decisions occur in your public health work (which they will) and especially if the decisions have to be made quickly, you want to be aware of where you and your colleagues stand.

Population and Public Health Ethics: Cases from research, policy, and practice is a useful resource for familiarizing yourself with philosophies that are particularly influential in the public health arena and to use case studies to expand your understanding. A quick summary is below and you can ask yourself, ‘in Canada, our governmental system is most aligned with which philosophy? Our neighbours down south?’

ethicsblogimage

 

The answer for Canada is liberalism and for the United States it is libertarianism. Although these philosophical orientations sound similar, libertarianism is about having individual freedom through as little government involvement as possible whereas liberalism is basically about having individual freedom guaranteed by governments (see bolded text in the above chart). The context of your work (country, specific organization) should always be a consideration when you are thinking about ethics because context will influence your decisions.

I may not be able to quote you passages from Socrates and Plato, but I will aim to create a space for discussion where colleagues can co-inquire about values, assumptions and concepts that build a foundation for equitable decision-making and of course, ask more questions.

 

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