Looking Ahead to the Health Promotion Learning Journey

The formal conceptualization and application of health promotion is a new endeavour for me. Apart from a limited experience in cardiac rehabilitation, I primarily have worked in the acute care setting. I have worked in inpatient medical and surgical cardiac units and am currently employed in a cardiac electrophysiology unit, where I engage with patients who are admitted to the hospital and those who come into the hospital from their respective homes for day procedures.

With over 12 years of cardiac nursing experience, I predominantly have engaged in the curative aspect of health care, in contrast to the preventative aspects of health, which is health promotion. That is not to say I have not engaged in health promotion practices. The Ottawa Charter for Health Promotion (Ottawa Charter) (WHO, 1986) details five action areas, including developing personal skills. Providing patient education aligns with the Code of Ethics for Registered Nurses (2017): registered nurses provide education to enable informed decisions regarding not only treatment but also lifestyle choices of patients/clients; registered nurses promote nursing values, which include the promotion of health and well-being. Throughout my practice, most patient education has been focused on pre- and post-procedure teaching, the role of medications, and lifestyle modifications to encourage heart health. This is achieved in conjunction with patient resources as prepared by the Heart & Stroke Foundation and patient-specific education provided by the health authority.

As I continue to enhance my learning and understanding of healthcare in Canada, I am eager to explore health through the lens of health promotion. In Canada, health promotion prioritizes the exchange of knowledge and system changes to promote equitable health and well-being, building upon a foundational framework established by the Ottawa Charter and the Geneva Charter for Wellbeing (Canadian Public Health Association, n.d.). See Figure 1 and Figure 2 for a brief outline of the actions of each of these documents. With these and other integral documents aspiring to achieve health equity and systematic change, I look forward to examining the gender bias in heart disease that exists in Canada.  

Figure 1.

The 5 Action Areas of the Ottawa Charter for Health Promotion

Note: Adapted from “Ottawa Charter for Health Promotion,” by the World Health Organization, 1986 (https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population-health/ottawa-charter-health-promotion-international-conference-on-health-promotion/charter.pdf)

Figure 2.

The 5 Action Areas of the Geneva Charter

Note: Adapted from “Geneva Charter for Well-Being,” by the World Health Organization, 2021 (https://cdn.who.int/media/docs/default-source/health-promotion/geneva-charter-4-march-2022.pdf?sfvrsn=f55dec7_21&download=true)

My knowledge of this topic is limited, but I am motivated to learn for two reasons: first, it relates to my clinical experience, and second, it investigates a feminist interest of mine: gender bias in healthcare. Of note, there is a blatant and disproportionate bias of cardiac research on women with cardiac disease, as two-thirds of research focuses on men (Heart & Stroke Foundation of Canada, n.d.). The lack of research on women with heart disease results in underdiagnosis, undertreatment, and a lack of practice guidelines (Norris et al., 2020). This gender bias intersects with the Ottawa Charter’s action of reorientating health services based on the need for increased commitment to health research along with the Population Health Promotion Model, which calls for actions on the determinants of health based on sound research and practice (Government of Canada, 2001).

Additionally, half of women who experience a heart attack will have their symptoms go unnoticed (Heart & Stroke Foundation of Canada, n.d.). This alarming statistic is an all too familiar experience I have witnessed in both the clinical setting and my personal life. As a woman and nurse who values and advocates for women’s rights and bodily autonomy, this topic is highly relevant to my professional and personal interests.

As I navigate this topic, I look forward to learning about the status of women’s heart disease in Canada while discovering the various existing barriers that prevent equitable care. I also look forward to discovering realistic options to ensure women receive equitable cardiac care. The ATLAS project (Norris et al., 2020) has already proven to be a valuable resource. The ATLAS project was created by the Canadian Women’s Heart Health Alliance to address this issue through a “critical appraisal of the currently inadequate evidence base to support female-specific clinical guidelines and recommendations for [cardiovascular disease] in Canada” (Norris et al., 2020, p. 149).

I have merely started progressing through the ATLAS project’s publications and learning about the social determinants of health impact on heart disease in women (Jaffer et al., 2020). Figure 3 shows the role of intersectionality and highlights the effects of some of the social determinants of health. I look forward to learning about the unique effects of intersectionality and the social determinants of health and to what extent they differ in women compared to their male counterparts.

Figure 3.

The Intersectionality of Heart Disease in Women

Note: From “The Canadian Women’s Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women—Chapter 2: Scope of the Problem,” by S. Jaffer, H. J. A. Foulds, M. Parry, C. A. Gonsalves, C. Pacheco, M.-A. Clavel, K. A. Mullen, C. Y. Y. Yip, S. L. Mulvagh, and C. M. Norris, 2020, CJC Open, 2(3), 145-150 (https://doi.org/10.1016/j.cjco.2020.02.004)

Lastly, I am cautiously optimistic that adequate research is being conducted four years after the ATLAS project was first created. Before sourcing the ATLAS project, I had located appropriate research, but nothing as comprehensive as noted in the ATLAS project. I anticipate learning about the relevant recommendations to improve women’s cardiac care in Canada while understanding and recognizing the changes that must occur at various societal levels to ensure equitable care. I am also keen to discover community-level approaches as a preventative measure against heart disease beyond the recommendations of a healthy diet and exercise. I understand most women are aware of these recommendations, but I recognize that people often do not seek to change or modify their behaviours unless a tangible risk threatens them. Is one behavioural change model more relevant for women with cardiac disease than another?

As my entire professional career has encircled cardiac nursing, I look forward to venturing down a new avenue of healthcare: health promotion. I look forward to discovering the distinct circumstances that uniquely impact heart disease in Canadian women while recognizing the societal barriers and changes that need to be made to ensure that all women not only receive equitable cardiac care, but also mitigate the risk of developing heart disease in the first place.  

Reference

Canadian Nurses Association. (2017). Code of ethics for Registered Nurses (2017 Ed.). https://cna.informz.ca/cna/data/images/Code_of_Ethics_2017_Edition_Secure_Interactive.pdf

Canadian Public Health Association. (n.d.). Health Promotion Canada. https://www.cpha.ca/health-promotion-canada#:~:text=Health%20promotion%20is%20the%20process,structural%20interventions%2C%20policy%20and%20research

Government of Canada. (2001). Population Health Promotion: An Integrated Model of Population Health and Health Promotion. https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health-promotion-integrated-model-population-health-health-promotion/developing-population-health-promotion-model.html

Heart & Stroke Foundation of Canada. (n.d.). What we don’t know is hurting women. https://www.heartandstroke.ca/women

Jaffer, S., Foulds, H. J. A., Parry, M., Gonsalves, C. A., Pacheco, C., Clavel, M.-A., Mullen, K. A., Yip, C. Y. Y., Mulvagh, S. L., & Norris, C. M. (2020). The Canadian Women’s Heart Health Alliance ATLAS on the epidemiology, diagnosis, and management of cardiovascular Disease in women-Chapter 2: Scope of the problem. CJC Open, 3(1), 1–11. https://doi.org/10.1016/j.cjco.2020.10.009

Norris, C. M., Yip, C. Y. Y., Nerenberg, K. A., Jaffer, S., Grewal, J., Levinsson, A. L. E., & Mulvagh, S. L. (2020). Introducing the Canadian Women’s Heart Health Alliance ATLAS on the epidemiology, diagnosis, and management of cardiovascular diseases in women. CJC Open, 2(3), 145–150. https://doi.org/10.1016/j.cjco.2020.02.004

World Health Organization. (2021). Geneva charter for well-being. https://cdn.who.int/media/docs/default-source/health-promotion/geneva-charter-4-march-2022.pdf?sfvrsn=f55dec7_21&download=true

World Health Organization. (1986). Ottawa charter for health promotion, 1986 (No. WHO/EURO: 1986-4044-43803-61677). World Health Organization. Regional Office for Europe.  https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population-health/ottawa-charter-health-promotion-international-conference-on-health-promotion/charter.pdf