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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.

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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.

ethicsquote

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:

ethicstable2
* 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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Parachute Safe Kids Week: At Home, At Play and On The Road

safekidsweek

 

By Sunitha Ravi Kumar, KT Coordinator at Parachute

This year marks the 20th anniversary of Parachute Safe Kids Week, an annual campaign that aims to raise awareness about preventable injuries in children. From May 30th – June 5th, communities across Canada will host family-friendly events to provide education about the top childhood injuries At Home, At Play and On The Road.

The number of deaths among Canadian children in the past ten years due to preventable injury has decreased by 28 percent. Think about it - that’s 2,098 children. You might be surprised to learn that even with this downward trend, in Canada today a child dies every few hours from a preventable injury...that is unacceptable.

But what does a preventable injury look like? 

At Home

safekidsweek2Children live in an environment built for adults, making children vulnerable to injury. Leading causes of injuries in the home include:

• falls down stairs or off furniture
• choking, suffocation and other breathing-related incidents
• poisoning
• burns and scalds
• drowning in the bathtub or backyard pool.

Being aware of hazards around the home and taking safety measures such as using baby gates on stairs and locking away medications, can make the home a safe place for kids to learn and grow.

At Play

Physical activity is an important part of childhood. Whether playing organized sports or participating in recreational activities, there may be some risk of injury. Assessing a child’s skill level, recognizing hazards in the physical environment, wearing the proper gear, teaching and practicing ‘fair play’ techniques can all ensure that play remains a part of healthy, active living.

safekidsweek3


On the Road

Children are vulnerable road users. Did you know that transport-related incidents are the leading cause of death for Canadian children between the ages of 5-14? Between 2003 and 2012, almost half of all unintentional deaths for children 0-14 occurred on the road1. Regardless of whether children are pedestrians, cyclists or vehicle passengers, practicing and modeling safe behaviors while on the road can keep young ones and you safe on the road.

--

Taking Part is Easy

As a national charity, Parachute is dedicated to closing the gap on childhood injuries. But, we need your help. Together, we can save more kids lives.

As a parent, caregiver, teacher or community partner, you can help reduce preventable injuries in children. Start by taking part in Parachute Safe Kids Week. Be sure to explore our 2016 Safe Kids Week Resources to help you roll out Parachute Safe Kids Week in your community. Make a pledge to keep kids safe and post to your social media channels using the hashtag #SafeKids20. Or visit our website and make a donation to support ongoing programs that keep kids safe.

Have a Safe Kids Week!

The Parachute Team
parachutecanada.org/safekidsweek
@parachutecanada

1. Statistics Canada. No date. Table 102-0540 Deaths, by cause, Chapter XX: External causes of morbidity and mortality (V01 to V89), age group and sex, Canada (table). CANSIM (database). Last updated December 10, 2015. http://www5.statcan.gc.ca/cansim/a05?lang=eng&id=1020540

 

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Working towards an alcohol control strategy for Ontario that prioritizes community safety

By Kyley Alderson, HC Link - Parent Action on Drugs

Last week, I was fortunate enough to attend the forum An Alcohol Strategy for Ontario: Promoting Public Health and Community Safety put on by the Working Group for Responsible Alcohol Retailing. The purpose of the forum was to bring together a variety of stakeholders to raise public awareness about the potential social and health impacts from expanding access to alcohol (i.e. alcohol being sold in grocery stores) and build political will to adopt an evidence-informed provincial alcohol control strategy that prioritizes community safety.

The forum certainly did bring together a variety of stakeholders – and while everyone there could agree on wanting safe communities, there was definitely some interesting conversations that were had.

The honourable Dipika Damerla, Associate Minister of Health and Long-Term Care discussed how Ontario has expanded beer sales to an additional 450 locations across the province to give Ontarians more convenience and choice while still maintaining a strong commitment to social responsibility through strict controls over how the beer is sold in these new locations (i.e. restricted hours, designated section of the store, certified and trained staff). During a Q&A period, concerns were raised about how the evidence has shown us that increased access to alcohol results in higher alcohol consumption and higher harms associated with alcohol use. Concerns around enforcement were also raised, as there are very few AGCO Inspectors assigned to large geographic areas. Damerla assured participants that the government wants to get an alcohol policy right for Ontario, and that the strategy will be robust and will require a cross-government approach.

Ann Dowsett Johnston, author of Drink: The Intimate Relationship Between Women and Alcohol shared why the alcohol file is so urgent. She spoke about how despite all the known harms associated with risky drinking, it is still a conversation that no one wants to have because alcohol is entrenched in our culture. We drink to relax, we drink to celebrate, we drink to de-stress, we drink to impress (i.e. if you know your vodkas you’re hip). She was passionate about her concern for how normalized drinking is in our society, and how it is slowing down progress for a successful alcohol control strategy.

Dr. Tim Stockwell, Director of the Centre for Addiction Research of British Columbia, tackled the myth that low-risk drinking can have actual health benefits (i.e. a glass of wine a day is good for your heart). Stockwell also touched upon the dimensions of a successful alcohol policy, including: price, control system, physical availability, drinking and driving, marketing and advertisement, legal drinking age, and screening and brief intervention. Increasing the minimum price of alcohol has been shown to have the greatest impact in reducing risky alcohol consumption and its associated harms.

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                                                      Dr. Tim Stockwell (Centre for Addiction Research of British Columbia)

 alcoholforum5

                                                       Pegeen Walsh (Ontario Public Health Association)


Dr. Robert Mann, shared trends in alcohol use and problems among adolescents. In Ontario, the most stunning statistic was the decreased rate of drinking and driving among grade 11 drivers (from 46% in 1977 to 3% in 2015). Since 1977, the three major drops in drinking and driving are seen when: the legal age for drinking was increased, when graduated licensing was established (where a blood alcohol level of zero is the law), and when a blood alcohol level of zero was required in all drivers under 22. While there are many programs and initiatives working towards reducing drinking and driving (and working well!), this data does show the profound effects that policies can have. While Ontario has always been the best performing province in motor vehicle fatalities involving alcohol (meaning the lowest numbers), the new data shows that Ontario has the highest rates for drug-present fatalities. There was discussion around how a zero tolerance for drugs policy for drivers under 22 years of age needs to occur.

Dr. Lisa Simon, Associate Medical Officer of Health, spoke about equity as it relates to alcohol consumption and associated harms. While those with the highest income level report the highest alcohol consumption, those with the lowest income have 2x the harms (alcohol-attributed hospitalizations). Furthermore, low income areas tend to receive disproportionate amounts of alcohol outlets. Perhaps not surprisingly, policies that increase the minimum price for standard drinks have been shown to have the most positive impact on those with a lower socio-economic status.

One participant from the audience asked the question to a few of the presenters, what ONE POLICY should be reflected in an alcohol strategy, the answers were:

  • SES should be considered when siting alcohol outlets

  • A minimum price for standard drinks should be set at $1.65

  • Guidelines for low-risk drinking should be on all drinks

  • Reduced availability of alcohol outlets


Brenda Stankiewicz, Public Health Nurse at the Sudbury & District Health Unit spoke about 3 specific challenges in the North regarding alcohol:

  1. Much higher percentage of underage youth reporting parental permission to drink (42% vs 26% in the rest of Ontario)

  2. Transportation issues. With limited or no public transit or taxis available – there are far fewer options for getting home safely after drinking... causing more drinking and driving.

  3. Very limited enforcement. There is the prevailing attitude that if you drive home on dirt roads or long stretches of deserted highways, you will not get caught. Also, because everyone tends to know each other – there is the attitude that no one will report them. Furthermore, there is only 1 AGCO in all of Sudbury, which means – enforcing and monitoring even more alcohol outlets will be even more challenging.

There were many other great attendees who presented, asked thoughtful questions, and engaged in stimulating dialogue. All in all it was a worthwhile forum, and hopefully a stepping stone in the direction of developing an alcohol control strategy for Ontario.

Although the discussion of the forum was focused on a provincial strategy, the role for local players was highlighted. To support your efforts CAMH HPRC is offering free promotional materials to public health and health promotion professionals in Ontario who are interested in supporting low risk drinking: https://www.porticonetwork.ca/web/camh-hprc/resources/substance-use.  You can also check out the Parent Action on Drugs website for information and resources on issues that impact substance use and youth geared towards youth, parents, and professionals.

 

 

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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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Using Popular Theatre as a Facilitation Technique

By Gillian Kranias, HC Link Consultant

This is the eight blog post in a series on facilitation techniques and approaches written by HC Link staff. This post focuses on using popular theatre for warmup/centering activities and even as a learning tool.


Without being an actor or director in any way whatsoever, I have pursued a lifelong passion for using popular theatre activities in community learning, community development and social change settings. These activities all value equity and inclusion, as well as a holism that engages creativity, non-verbal communications and full body awareness in our analysis, learning and organizing efforts.

Some techniques take a significant amount of time and are difficult to explain in writing. For this blog post, I am sharing few warmup/centering activities and the technique of image theatre, which can take anywhere from 5-90 minutes.

For more reading on popular theatre and theatre of the oppressed, try these titles:

Practical Books

Games for Actors and Non-Actors
By Augusto Boal. (New York: Routledge, 1992)

Educating for a Change
By Rick Arnold, Bev Burke, Carl James, D'Arcy Martin, Barb Thomas
(Toronto: Doris Marshal Institute for Education and Action & Between the Lines, 1991)

Essays

Playing Boal: Theatre, Therapy, Activism
Edited by Mady Schutzman and Jan Cohen-Cruz (London: Routledge, 1994)


In the right group, your courage to do things differently will pay off in surprising ways!


Centering Activities (5 minutes)

Source Augusto Boal’s book: Games for Actors and Non Actors

DSC 0507There are hundreds of theatre and improv games that can help “center” members of a group together, build listening skills, and exercise people’s timing in response. Here are two fun ones that I learned from Augusto Boal’s book. To choose games appropriately for your group, consider the lightness or seriousness of the gathering, how well people know each other already, as well as physical ability and language differences among group members.

 

 

 

“Name & Motion”

* Engages group members to listen, observe, and move

* Requires only limited “theatrical risk-taking”

* Generates lots of smiles and breaks down inhibitions

Instructions:

- Have everyone stand up in a circle. As the facilitator, explain and demonstrate how this introduction game works:

- Each individual, when they are willing, takes one step towards the center of the circle and makes a motion (preferably large) while calling out their first name. Everyone else must then together repeat the person’s “name and motion” two times (like an echo response).

- Allow time for each person to introduce their “name and motion” and be welcomed by the group through their “name and motion”.

“Pass the Clap”

* Engages group members to listen, observe, and move

* Focuses group members attention to one collaborative challenge

* Encourages a lighthearted approach to mistakes

Instructions:

- Seated or standing in a circle, the facilitator claps in the direction of someone next to them. This person is asked to pass the clap to the next person in the circle, and so on the clap will pass from person to person around the circle.

- Do this a few times around, so that the clap passes around the circle and past the facilitator several times. Then, while the clap is passing on the opposite side of the circle, the facilitator can begin a second (and later a third) clap that will travel in its own timing around the circle (so several claps will be circling at once).

- The facilitator can keep passing the clap through the circle for a while, and then eventually gather the claps (by not passing them past the facilitator) to close the activity.

- Variation: It is also possible to shift from sending the clap around the circle, and send it instead to someone across the circle.

 

Personal Style Reflection - What animal am I most like in a group? (5 – 20 minutes)

Typecasting by others can heighten conflict. Allowing each individual in a group to share their uniqueness and offer insight into the qualities of their “animal” creates an appreciative and collaborative dynamic. I learned and used this activity from colleagues at the Self Help Resource Centre.

* Engages group members to reflect on what they bring personally to the group

* Uses metaphor to convey complex ideas in a non-restrictive way

* Provokes laughter – being lighthearted about the strengths and challenges of our unique personalities

Instructions:

- Post pictures, or a list, of 6-8 different types of animals.

- Ask people to reflect on which animal they most behave like, when working in a group setting.

- Invite each participant to share which animal they identified with most, and why.

- With larger groups, the same question can be explored more dramatically/playfully by asking people to act out their animal, find others acting like them, and then sit together in their animal group to create a list of what they see as the significant qualities of their animal in groups.

 

Image theatre (10 - 90 minutes)

(Source: Headlines Theatre, Vancouver & Mixed Company, Toronto)

Image theatre is a wonderful technique! It is less intimidating than roleplay, and can be used on its own or as a warm-up activity before roleplaying. This technique is also known within popular education groups as “human sculptures”.

* Engages group members in holistic thinking and analysis, and learning

* Works equally well for multi-lingual groups

* Helps groups analyze patterns within shared issues or experiences

* Great for experiential learners

Instructions:

- Begin with people’s experience. In small groups, on a given theme, share stories or jump right into identifying patterns or key elements of a problem. Ask the group to create a frozen image (no words) to convey their perspectives. For example: How does inclusive leadership work? Or What keeps you [parent] from getting more involved in your child’s school?

- Each group takes turns “exhibiting” and “viewing” the sculpture of other groups. Encourage people to explore all sides of the sculpture by touring around it. If the image includes people playing specific roles, after the sculpture has been viewed, the facilitator can point to the people one at a time and ask each of them to say a few words about “what is your character thinking/feeling?”

- Another variation is to ask people to return to their groups and develop a series of 3-5 images – evolving from the first – that bring about a positive change. When these image series are being shared, the facilitator claps her/his hands to signal the group to change from one image to the next.

Augusto Boal’s book: Games for Actors and Non Actors has an entire chapter on different image theatre techniques and describes dozens and dozens of such games.

SPOTLIGHT –Organizations are using popular theatre as a learning tool!

Popular theater uses theatre as a tool for social transformation. It typically involves the “audience” as participants and invites groups to explore attitudes and social problems and imagine a range of potential solutions.

Reflet Salveo, an organization that promotes access of Francophones to quality health services in French, used the popular theater approach as a learning tool within a workshop context. They hired actors from a French language community theater group (Les Indisciplinés de Toronto) to role play and demonstrate a series of possible scenarios in the context of hiring people with various disabilities. They allowed for audience feedback and found this was a great tool to generate discussion amongst participants.

 

Companies in Ontario who work with communities and are using theater as a tool for positive change:

Mixed company theatre uses forum theatre (an interactive approach that involves the audience in developing real-time strategies for dealing with social and personal issues) to educate, engage and empower audiences in schools, communities and workplaces.
Website: http://www.mixedcompanytheatre.com/

Sheatre uses issue-based theatre to find solutions to social problems. Artists and community members work collaboratively to express and explore a wide variety of issues that are important to their community.
Website: http://sheatre.com/

In Forma Theatre aims to engage community members in meaningful dialogue through participatory theatre.
Website: http://www.iftheatre.org/

Branchout Theatre believes in the use of popular theatre as a branch towards social change by connecting and empowering individuals and communities to communicate and transform the world around them.
Website: https://sites.google.com/site/branchouttheatreworkshops/home

 

 

 

 

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