The Social Determinants of Health w/ Kristy Kerr

We may not always connect the dots, but our social environment has a massive impact on our health and wellbeing. Social Determinants of Health involve a list of things that are proven to directly influence health outcomes. They include sex, gender identity, race, the level of education of your parents and of yourself, where you live, how much money you make, and a host of other factors. We reached out to Kristy Kerr, Executive Director of the BC CDC Foundation for Public Health to ask her about the Social Determinants of Health, and their impact on our health. She talked to us about some of the great initiatives this one-of-a-kind foundation is involved in, in efforts to address these social realities.

About Kristy Kerr
Kristy Kerr is the Executive Director of the BCCDC Foundation, a registered charity,  working in partnership with the BC Centre for Disease Control, as well as other stakeholders, in order to improve public health outcomes in BC. She’s responsible for leading strategic direction, organizational development, and the consistent achievement of the mission, vision, and mandate of the BCCDC Foundation. Kristy believes that our best way forward to create a truly healthy society is to increase public health awareness  and investment, and she is leading the Foundation with these goals in mind. Passionate about health promotion, prevention, health equity, and the social determinants of health, Kristy believes we need to shift our focus to upstream actions, that is, addressing root causes of issues and emphasizing positive and holistic health. Upstream thinking will shift our current primary focus on the acute care system toward an investment in stopping problems before they need to be fixed, resulting in a reduction in the burden on our healthcare system, and thereby improving it in the 
process. 

Prior to joining the BCCDC Foundation, Kristy worked in different research management 
and grant- writing roles within the academic world. She also worked in international  development and global health, spending time in Zambia and Kenya working with local stakeholders on various community-based initiatives. Kristy has a Master’s degree in Public Health with a specialization in Health Promotion, as well as a Bachelor’s degree in Animal Biology, and an Associate’s degree in Creative Writing. 

A BCCDC Foundation Call to Action
The BCCDC Foundation needs advocates to spread the message that we all have a role
to play in population health: individual actions can have a population impact. By working together to shift how we see health and how we engage with our healthcare system, we can protect the health of our communities now and for future generations.

Are you interested in hearing more about the work of the BCCDC Foundation? Want to join our battle cry and Activate Health by becoming a health ambassador in your community?

Learn more at www.bccdcfoundation.org and join us on Twitter, Facebook, and
Instagram @BccdcFoundation. 

If you’d like to support the BCCDC Foundation’s initiatives to address COVID-19, the
overdose crisis, or other priorities, you can donate online or reach out to donate @bccdcfoundation.org

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Find Susannah Steers at www.movingspirit.ca and on social media @themovingspirit.

Find Gillian McCormick at https://physiogillian.com/ and on social media @physiogillian

Transcript

SPEAKER_02 0:05

Health is wealth, and this is where we're going to talk about it. Small conversations for a better world podcast with hosts Gillian McCormick and Susanna Steers. This podcast represents the opinions of the hosts and or their guests to the show. The content is for informational purposes only and should not be taken as medical advice nor established legal standard of care. Hello everyone, and welcome to the Small Conversations for a Better World podcast. I'm Susanna Steers.

SPEAKER_01 0:34

And I'm Gillian McCormick. Back in the summer of 2020, we noticed an Instagram campaign from the BC Centers for Disease Control Foundation. It was about the social determinants of health. The social determinants of health are economic and social conditions that influence individual and group differences in health status. And I find them fascinating. Also, uh, I have a lot of questions and feelings about these things. Like I get a bit frustrated and a bit angry because it makes it seem like a lot of things are out of our control or preordained, which is against everything that I believe about health. I believe we can work every day toward optimal health. But what if all my efforts will be thwarted by the fact of my birth? And admittedly, when I look at the list of 17 Canadian social determinants of health, all I can see is how privileged I am. I am white, able-bodied, cisgendered, born to educated parents who educated me. They had stable jobs with arguably excellent working conditions and a ton of job security. I've been educated and I have a profession with adequate, stable income and a reasonable job security. If I cannot work, I have access to unemployment, and I enjoy an incredible social network of support that I have called upon quite a few times in the last several years. I could go on, but suffice it to say that I have a bounty when it comes to the social determinants of health. And that said, I am not a paragon of health. I struggle with my own issues just like all humans. So I wanted to know what the social determinants of health actually mean. What do we have control over? How impactful are these determinants of health? And do we need to care about them as a community? How do these factors give context to the issues of the day? Those of the cries of systemic racism, the inordinate amount of deaths that we've seen in marginalized populations related to COVID-19 infections, the way women are found more often in the front lines of this global pandemic than men. Okay, so I had a lot of questions. So I reached out to the organization that created the Instagram feed that so fascinated me. And here to answer my questions today is the executive director of the BC CDC Foundation for Public Health, Christy Kerr.

SPEAKER_02 3:13

Christy Kerr is the executive director of the BC CDC Foundation. She believes that our best way forward to create a truly healthy society is to increase public health awareness and investment. And she's leading the foundation with these goals in mind. Passionate about health promotion, prevention, health equity, and the social determinants of health. Christy believes we need to shift our focus to upstream actions. Now, Christy, we know that this year has been quite busy for the CDC, and we assume that the foundation is not exempt from that. So we are so grateful that you could take time with us today. Welcome to the podcast.

SPEAKER_00 3:52

Thank you so much. I'm really excited to be here. I love talking about these things, and I'm just so excited that you want to talk about them too.

SPEAKER_01 4:03

So, Christine, our inaugural episode uh back in that was released in January of 2020. Wow, January of this year, we interviewed Dr. David Patrick, who at the time was the executive lead of the BC CDC. And when we look back on this episode, we were so innocent and naive, weren't we, Sue? No kidding. I've literally kicked myself for not focusing more on the reasons why having a CDC is so important and how it impacts the daily lives of all Canadians and, you know, globally. Even though we spoke of it, we still didn't really get it, you know, hindsight and all of that. When we interviewed him, it was the fall of 2019, and a global pandemic was on the mind of almost no one. Now it is really clear what the CDC is for and how they impact us every day. So what is the CDC Foundation for pelvic or public health? Can you tell us about that? I'm gonna say that one more time. What is the CDC Foundation for Public Health? Tell us about that.

SPEAKER_00 5:14

Okay, happy to. So the BCCDC Foundation for Public Health is a registered charity, and we work in partnership with the BC Center for Disease Control, which you just described, the very important role of as our provincial uh government public health uh agency in the province. We work with the BC Center for Disease Control and other stakeholders to improve public health outcomes in BC. And we lead public health initiatives and we fund evidence-based projects and research. We also raise awareness and shine a light on the importance of public health and the need for public health investment, which I think is uh pretty clear to the world over right now with what we're going through with COVID-19. We are independent organization from the BCCDC, but we work very closely as partners with basically the same goal of improving public health. And we're we're a pretty small organization, but I feel that we're having a very big impact on public health by bringing initiatives that matter to communities.

SPEAKER_02 6:17

On the website associated with the foundation, I found references to activate health. And I want to read something that I found there. It says, individual actions can have a population impact by working together to shift how we see health and how we engage with our healthcare system. We can protect the health of our communities now and for future generations. This is our battle cry. And I have to say, Jillian and I are 100% behind this message. The whole idea of the Small Conversations for a Better World podcast was that those small conversations that are seemingly insignificant are the things that allow us to change the tide, to change someone's mind, and to change behavior. And I'm thinking maybe we're on a similar mission here. Can you tell us a little more about Activate Health and what's going on right now?

SPEAKER_00 7:10

Yeah, definitely. Well, I I think we are on a similar mission here. Um Activate Health is a uh it's it's it's a campaign. It's a small campaign that we launched in the summer of 2019, well before, like you said earlier, that uh we were even thinking about uh a global pandemic or what might be facing us. And it it really comes from my kind of belief and and desire to shift the way that we think about health and really shift that conversation. I think it really needs to start with a conversation and and raising awareness around that. And and I mean, right now, I little did we know when we launched this campaign that we would have such an obvious example of it in COVID-19, but really it's you know, our individual individual actions can have that population level impact. And I believe that by focusing on population health, and I I know we're gonna get into what that means in the social determinants because I know that you're you're very interested in that, but I I do believe that if we start to think about population health, that we will ultimately be able to shift the our sort of lens of health and kind of move more upstream. And in doing so, we will also remove the burden on our healthcare system. And we can get more into that. I can explain what I mean by that. But activate health is really still quite a small campaign, but we're starting to see uh and you you two are a perfect example. It you know, it's it's starting to speak to people, and and I'm uh I'm I personally I'm really jazzed by it.

SPEAKER_02 8:47

I love it. Well, I would love to know what what in your background, what drew you to this, and and what makes you the perfect candidate right now? I mean, you're you're taking the helm of an organization that's doing some really important work. How did you get here?

SPEAKER_00 9:04

Well, it's probably too long of a story to actually get into all the details, but uh and I I don't know that I'm the perfect person to be running this organization, but I do think that I am in a good position to be running this organization. Uh, and I have been doing so for a number of years. Uh, we only actually have become quite public-facing in the last couple of years, but uh there's a lot of work behind the scenes that went into getting us to where we are now. And my background is uh I have a science degree and then I have a master's in public health, and my specialization is health promotion, uh, which really has a uh sort of equity at it at its core. And so I was actually working at the BCCDC in a in a different, in a more academic position, and uh the foundation was sort of just starting to to get off the ground, and I was hired as the first employee to basically figure, figure it out, go build this thing. Yeah. Um so and then just my own sort of uh experience. I spent time working in Zambia and Kenya as well, uh doing uh international development, but really focusing at the local capacity building level, and doing that work was just extremely eye-opening for me. And I started to really get a better sense of what health actually means and the importance of um, like I said, you know, focusing on population level. And that's not to say, that's not at the expense of individual health. Of course, that's very important, but I think shifting the tide and in creating healthy societies is really uh sort of how I see where we're going to move forward and into a healthier future.

SPEAKER_02 10:46

Is there a personal connection for you that kind of drives your desire to do this work?

SPEAKER_00 10:52

Uh I there are a few personal connections. I mean, for me, when I went into public health and I discovered health promotion as as a as a discipline or as a field, it just resonated with me. I just went, oh, this is it. This is the what I'm supposed to be doing. And I actually, again, it's a long story, but I chose that path as opposed to medicine. Um, and and now looking back, I just think, well, that yes, I'm so glad that I did that. Uh I also, one of the one of the areas that we work in, so so right now, COVID-19, of course, is taking up a significant amount of our time. We uh we were one of the first charities in Canada actually to launch a uh fundraising initiative, fundraising and communications, actually. I took a two-pronged approach, but this was back in January. Um, but one of the really other important areas that we're working on is the overdose crisis, and so we're really working at the intersection of two public health emergencies right now. And the overdose crisis does have a personal uh connection for me. I did I've lost somebody to overdose, and uh I just it's it's solvable. We have the solutions, and it's just very important to me that I have whatever role it is, whether it's a small role in in solving that, but that is just uh uh extremely important to me. So that's a really specific example, but I just I just I think we can do better.

SPEAKER_02 12:17

Yeah, yeah, those things that drive us. Is there something specific that you would like to achieve as the executive director of the foundation?

SPEAKER_00 12:29

That's a really good question. I my team is uh they encourage me so much to celebrate successes. I I get so focused and do more, grow more, take on more, all these things. And uh I think I've so I've been thinking a lot lately about what you know, what is the future of this organization? And and we have, I mean, it's strange to say, but because of our role in public health, we've actually had a lot of success around uh fundraising and um people uh you know, the knowledge translate translation work that we're doing around COVID-19. And so it seems a little bit weird to say that, because of course we're all experiencing this terrible time with the global pandemic, but my organization is actually doing well and we're doing really, really good work coming out of that.

SPEAKER_01 13:22

You know, from the public-facing side, like I feel like the CDC and and by extension, the Foundation for Public Health have blown the doors off this thing. Like you've been incredibly successful at giving knowledge to the public, showing them where to go every day, talking to them about how to protect themselves and their loved ones. Like I think it's been incredible right from the start.

SPEAKER_02 13:48

And counteracting misinformation as well.

SPEAKER_00 13:52

Yeah, we actually just well, maybe you saw we had two blog posts in our uh last newsletter and then just posted this week about misinformation because it's it's it's contributing in a really, really, really negative way to uh to to what's happening with COVID-19. And I think that the BCCBC Foundation is in such a unique position because we we sort of straddle or bridge the academic world and the public world. And I think that we're able to sort of cross-pollinate in in unique ways, and I think it's an incredible opportunity for us to fill a role that supports um public health awareness and investment, and then perhaps as we grow, we're still pretty small, but as we grow, I would really like to help kind of guide the health of our province moving forward.

SPEAKER_02 14:38

Oh, I love that. We need a guide. So you talked about COVID, COVID, COVID. Has the pandemic really impacted what's going on at the Foundation for Public Health?

SPEAKER_00 14:53

It really, it really has. I mean, we like I said, we, you know, back actually we started talking about it in December. My team started asking me, what do you think this is gonna turn into something? I don't think I naively said, I think so, or I'm pretty sure, but you know, probably like SARS. Little did I know, uh, nothing really like that. And so we so we very quickly launched, uh, like I said, a two-pronged approach and uh our emergency response fund, and then doing our communications work, really trying to help uh create digestible resources for everyone. There's so much information out there, like you said, a lot of it's miss or disinformation, and uh a lot of it's just technical and it's hard to navigate. And so I just really wanted to uh use my public health knowledge to be able to try to help in that way. And we have raised to date um over$400,000 since February, and we were able since February. Since February, yes. We our donors and our partners have just like been absolutely incredible and completely stepped up. Uh, new donors, people who had never even heard of us, are supporting us, and it's just been absolutely incredible and and and heartwarming in so many ways. We've had kids donate to us. We had a, I think it was a three dollar donation from a young boy, I think he was, and the message was I might be mixing up my stories here, but the message was um that he wanted to give back so that he could keep his grandparents safe from COVID. Did you cry? You know what? I did. Yeah. Yeah, I'm about to. So yeah, so it's really it's it's I mean, it don't get me wrong, it's been very busy. But we for the first time in my career, we were able to raise enough money within a couple of months to fund a significant pandemic response project. And that rapid real-time kind of work is is is rare, to be quite frank. And it just felt so good to be able to say, we've here, we've we're giving you money to do to do this. And the uh the COVID-19 Speak Survey, which uh was uh in May, I'm not sure if you recall that, but we were able to fund that work and some subsequent work that's coming out of that. And that work is really what's helping our public health leaders, Dr. Bonnie Henry, her team, uh Dr. Rayl Gustafson is who's the head of the BCCDC. Uh it's really helping them guide their decisions and and know sort of what information is important and you know the restrictions, all the things that we're seeing. So it's been it's been incredible.

SPEAKER_01 17:48

So this Instagram campaign in the summer that got me all up in arms, let's dig into that a little bit. So when I saw it, I thought a couple of things. And one was that it was really good in a social media sense. It was super engaging, gorgeous photos. So kudos on the social media front.

unknown 18:07

Thank you.

SPEAKER_01 18:08

What was your goal with that campaign and and how was it received?

SPEAKER_00 18:13

So the goal with that, we actually did uh so one of the other things that I I think we started this last year. I don't know, time is just a bit of a blur right now, but I really wanted to start a series where we talked about public health concepts. I think this, you know, public health is very broad and very nebulous, and a lot of people don't really understand what it is or what we do, and really it touches everything. So I wanted to start to break down some of the concepts. Um, and so we started a series called Decoding Public Health, and we just started talking about like the social determinants of health as one, health equity, um prevention, health promotion, just really trying to raise awareness about sort of those high-level concepts. What does all that mean? Why do we care? Why should we care? Why should you care? Those sorts of things. And so I really appreciate that you that you came across that and that you liked it. And uh that is thanks uh to my team. I mean, I have we're we're small, there's only four of us. We're we're doing a I think we're putting out a lot more than we're than people realize we're our actual capacity. Um but that's thanks to my team. I have a really, really dedicated team, and uh and so that social media, the the pictures, all of that is thanks to my team.

SPEAKER_01 19:30

Well, good teams are they have good leaders.

SPEAKER_00 19:33

Awesome.

SPEAKER_01 19:34

So keep that in mind. So what are the Canadian social determinants of health?

SPEAKER_00 19:42

Well, I think like you said at the beginning, um, there's a lot of them.

SPEAKER_01 19:47

Yeah, I can't I came up with well, first it was like 14 and then 15, and like the latest count I looked at was 17. So it's growing. I don't think we need to list them, but like pick out a few that are like we don't have to list them all. How about that?

SPEAKER_00 20:01

No, and I wouldn't probably be able to list them all by rote because like you said, the list is growing. I think when I when I first started learning of about this, the list was was shorter. Um, but you know, some of the some of the key ones that I think your listeners would probably be familiar with. Um, income, education, racism. Uh you know, a lot of talk about systemic racism lately, which is fantastic. We need to be talking about it. We need to do more than talk about it. Uh, gender is one as well. Um and so, really what they are are sort of the system structures and the forces that are working around us, where we live, work, play, have our social connections, where we grow older, really all the non-medical uh or non-biological factors that shape us, and these play a significant role in our health outcomes.

SPEAKER_01 20:55

How were they identified as determinants? Like, talk to me about like the evidence, I suppose.

SPEAKER_03 21:02

Hmm.

SPEAKER_01 21:03

Um if you can.

SPEAKER_00 21:05

I I will do my best. Uh I I I mean, honestly, I believe the connections between living conditions and health go back a long way. I wouldn't be able to tell you sort of who the founding fathers, for lack of a better word, uh are. They probably were fathers at that time. I'm sure they were fathers. I'm sure they were men. Uh back to the 1800s. But uh so I think the really the current kind of focus and where the evidence really started to grow is in the early 2000s. And in 2005, the World Health Organization formed a commission. Uh, I think it was called the Commission on Social Determinants, and that was led by Sir Michael, Sir Michael Marrat. And he's a leader in this work and has been for many decades, I think. Um so it it's really recent. Yes, I and it's so it's old and new, I guess, in a sense. They I think we knew that this made sense. It makes sense, right? That living conditions would make would uh connect with with health and health outcomes. But I'm not sure that it was really sort of formalized or research really started until uh within the last 20 years. And now I'm certainly not an expert on the history of all of this, so um sure there's experts out there who could give you a better historical account than I. Uh, but uh there has been and continues to be much research into the impacts, and like like you said, the list has expanded. Right. We've getting kind of more knowledge and understanding of how the world around us really, really shapes us.

SPEAKER_01 22:44

Really shapes us. So just if you're listening, and you know, we've talked about income and education and you know, some of those things, but also housing is on this list. Geography is on this list, where you geographically live impacts your health. Think about that. Um immigration. Are you an immigrant? Food security, early childhood development. Like, do you get tingles when you hear this list? Because I really do. Like this is uh ah, it's a big deal. But what I want to know is, does a physician think it's a big deal? Like, do they pay attention to social determinants of health?

SPEAKER_00 23:24

Hmm, I mean, that's that's an excellent question. And I guess my answer would be, I sure hope so. Um I, you know, I'm not a physician, and so I I can't speak fully to uh how a physician uh incorporates some of this into their into their work or into their practice, but I think that they definitely should care about all the determinants. Um the biological and medical ones, of course, factor in as well. But the social factors are such a significant contributor to health outcomes. Um, so a doctor with uh dedication to their patients should be able to work within a system that allows them to focus on the bigger picture. I'm afraid that's not quite how our system operates, though, and I think that that's that that's a challenge, and I imagine it's probably a challenge and a frustration for many doctors.

SPEAKER_01 24:14

Okay, so I I think we need to pick apart that statement. A doctor who cares about their patients, and they all do. What did you say? It was like they should have the ability to treat their patients within a social system, and that's not how our system works. Can you say more about that?

SPEAKER_00 24:33

So the way I see it is well, there's a few different things. I don't think that we necessarily have a health care system. I think we have a sick care system, and we focus very much on um uh, you know, I mean, we're I should preface this by saying we're very lucky in Canada to have a good system. None of what I am saying here is meant to go against any of that. We have resources to care for people, uh, and that's that's of course very important, and um, you know, but it's it's it's vital. However, in our healthcare system, we think about the sick, we think about the injured, the vulnerable, and we don't tend to create or foster a system where we think about creating health and positive health, and it doesn't tend to be very holistic. And so what I think we need to really think about in you know our health system is that we try to focus on health and social support and protection and security, and really it's about aiming for well-being kind of across all parameters of life. And I don't believe in our current system that doctors have the capacity to be able to do that. And now we are starting to move towards primary care, which is a really good step forward, and it is important. I think that we can create sort of more holistic system in that sense, but it is still about solving things after they've happened. And and I guess my view, if that makes sense, my my view is just really trying to focus upstream and let's address the root causes, let's focus on prevention, let's do the things that we can do. We can't do everything, we can't stop everything. That's you know, that would be completely um impossible, but we can do a lot more to stop more things from happening, uh, preventing injury and illness, and really focusing on health promotion to keep people healthy as opposed to having to sort of um treat and repair once problems have already started.

SPEAKER_02 26:43

I was just thinking as you were speaking, Christy, uh, we spoke in our first season early in 2020 to a physician here in North Vancouver, Dr. Didisha Haloenko, and she actually described some of the difficulties that you mentioned. Um, in she's trying to do more of a women's health practice and uh you know sort of feels a little hamstrung sometimes in that she can't she can't do some of the things that she would like to do to promote wellness um as opposed to um dealing just with the sick, just exactly the way you describe it. So I think sometimes the physicians are as frustrated as the rest of us.

SPEAKER_00 27:25

Right. I I can imagine, I can imagine so. I think that you know their hands are tied in a lot of ways based on just sort of how the system works and uh they're very important part of that system. And you know, I know some I work with some amazing uh doctors, and I just I think that we I think that that we can do a lot more, and that if we can sort of renavigate our system a little bit and give doctors sort of some more breathing room in a sense to do more that that they would be able to do more.

SPEAKER_01 28:01

So that begs the question, what do you think that would take to give the doctors more breathing room?

SPEAKER_00 28:09

Currently, right now, or typically, less than 5% of our healthcare funding goes to public health prevention, health promotion, uh, which really underlies the importance of having a proactive and well-funded approach to public health. We're seeing that, of course, right now with COVID-19 and is demonstrating that for us. Um and the way I see it is that if if 95% of our funding in our healthcare system in BC is going into acute care, if we just flipped some of that around and we put more emphasis and more investment into prevention and health promotion working upstream, then I strongly believe that we actually wouldn't need as much for acute care because we would be relieving the burden on the healthcare system naturally by making this shift.

SPEAKER_02 29:02

So what would that mean? Um I'm thinking about somebody listening who who might not have won the social determinants of health lottery. Is there anything we can do as individuals if if we're not sitting in the the luxury of of privilege? Um is there anything under our control or the ways that we can look after health even if we haven't won the lottery?

SPEAKER_00 29:28

I I believe so. I mean that's it's that's uh that's a complicated question. There's not an easy or simple answer to that, but uh that's a cop-out. I won't say that. Um I totally understand where you're coming from. And I think it's it's difficult because none of this is, you know, there's no one answer. It's a very complex, complicated system. We have to consider uh biology and genetics, uh early childhood development. These are very important factors as well. And so are personal choices, behaviors, and lifestyle. That's all important. So when we're talking about the social determinants, we're not saying we have to shift entirely to only focusing on that. It's really the looking at the big picture, and all of these are pieces of that pie of that big picture.

SPEAKER_02 30:18

Okay, so let's talk about the big picture because I think when we're talking about our health, we can become really focused and and perhaps bogged down, just focusing on our own health. Do you think that we as individuals need to maybe reach past that to consider the group at large?

SPEAKER_00 30:39

I I believe so, and that is where this sort of activate health concept was kind of born from. And I really think that not every single person can do something specifically to change the healthcare system, but I think that we need to start with the conversations. We need to start sort of with provoking thought and then leading to um generative conversation about what that means and using our own voices, using our vote where we can to really try to uh put an emphasis on public health and population health, and of course, not at the expense of individual health. I too have had some challenges and I and I uh I get it, it's important. We need a good acute care system. But I do think that the starting place for us, because it's it's not easy, it's not gonna happen overnight, but I think that the starting place is exactly what what the three of us are doing right now. We're having a really what I think is a really important conversation, and it's it's sort of raising the starting to raise awareness about this and getting people talking about it, getting people thinking about it, and just thinking about, hmm, I wonder if you know we could prevent uh this X or or Y. There, you know, there are a lot of preventable illnesses that we still have a very high disease burden of. Um and you mentioned actually uh David Patrick earlier, and so uh David and I have been working together for for many years now, and one of the projects that we are actually working on is a research project uh with David, and he is leading some work that is has started to show a correlation between antibiotic use in infancy and asthma in adulthood. And so I think we also need to start putting the investments into uh research like that to understand what are the tools and the things that we can do to prevent certain things.

SPEAKER_01 32:47

Yeah, that would be a fascinating study. I would love to know the results of that. Do you guys have anything cooking over there at the foundation for helping movers and shakers to help get this well care system off the ground? Um I'm thinking of like, I don't know, like a grant or uh, you know, for okay, for instance, for a pelvic health physiotherapist who might like to educate teens about their bodies and how they work to help them promote pelvic health across their lifetimes. Maybe that person won would like to apply for a grant to get a little help getting their program off the ground. Is there anything like that at the foundation?

SPEAKER_00 33:34

There there isn't at this point, um, but it's it's interesting that you bring that up because actually last year, so before we sort of got sidelined, so the world got sidelined by COVID-19, we were having starting to have some conversations about some of the work or some of the initiatives that we might want to take on as the foundation. And because the interesting thing about the about us is that we we fund public health, but we also do public health. And so we were really interested in um some youth programming and sort of coming at that. Like, how can we set uh people up for the healthiest life that they that they can have? So we don't have anything like that right now, but that really is a capacity uh uh thing for us. And I would just say stay tuned as we grow because you know, all of this starting this conversation isn't for me as far as I want to go. I would love to be able to start to offer more public health initiatives uh from the foundation. We did last year we ran an anti-stigma campaign uh around the overdose crisis and really trying to raise awareness about stigma and why it is uh well, it's costing lives, quite frankly. Um, so work like that is really important to me. So I love I love that you're bringing this up. I wish I could I wish I could say yes. We have that's all right.

SPEAKER_01 35:04

We're uh we're planting seeds as you are.

SPEAKER_02 35:09

Christy, from your perspective, uh what are the things that are most impactful in changing the story of our health outcomes?

SPEAKER_00 35:18

So that's a good question too. I mean, I so my my background, my passion really is health promotion. And like I said, the core of that really is equity. So I think that to truly shift our health, our health landscape, we need to focus on addressing health inequities and we need to take a social justice lens to our work.

SPEAKER_02 35:45

Well, you've said before, and even just today, um, that upstream thinking will shift our current primary focus on the acute care system toward an investment in stopping problems before they need to be fixed, resulting in a reduction in the burden on our healthcare system and thereby improving it in the process. So let's talk about upstream actions. What are those?

SPEAKER_00 36:10

So upstream actions, and I realize it's it's a little bit jargony, um, but it what it really means is addressing the root causes, root causes of issues and focusing on things before they become a problem. So uh let's see, a good example for me, and and I think you mentioned housing earlier, so this is one of my sort of passion areas because uh I also um on a board of another nonprofit called McLaren Housing Society, and we provide housing for people uh living with HIV AIDS uh who are at risk of homelessness or experiencing homelessness. So um housing for me is kind of a passion as well. And uh example of an upstream action would be the housing first model. And what that really means is uh providing housing to somebody before uh, you know, they have you know, telling them uh, you know, you have to get your substance use under control, or you have to have a job, or you have to have all of that, and then we'll provide housing. Housing first means that you give somebody housing and it it's it's um not connected to sort of whether they use substances or have a job or anything like that. And evidence really shows that that improves health outcomes. And we have this expectation that people need to be healthy and do everything right before we will do something to help them. And to me, that's just completely backwards. You know, in Vancouver, well, not just in Vancouver, but we have a major homeless problem that we need to address, and and I believe that we can address it. And I think that that's uh you know, pretty clear and understandable example example of an upstream action that we could take.

SPEAKER_02 37:55

Absolutely, and we see it on the streets and we see it here in Vancouver every day.

SPEAKER_01 38:00

So then, Christy, what about prevention? What does prevention look like? That's a biggie. Um, okay, okay. I envision education. Like, I feel like you prevent things by helping people understand how to do that. It is a biggie, isn't it? Like, what how do you do that? What about vaccinations? That's probably under prevention to a certain point.

SPEAKER_00 38:28

Vaccination would be a very well-known example of prevention. Um, yeah. And you know, we can see with uh vaccine hesitancy how that actually impacts things. There's been measles outbreaks in the last uh couple of years, and um so vaccination is is very, very important part of prevention. Um, but there's also, I mean, the the project that I was just talking about with uh Dr. Patrick, if the evidence does show that antibiotic use in infancy contributes to asthma rates, then there's a way that we can um create a prevention program that would be probably uh directed a lot at physicians and not prescribing. Um so that's one example. Uh well, I mean, a really great example right now, I guess, is if we look at COVID-19, every all of the sort of preventative health measures that we are taking, let's say masks, for example, which is one of our one of our layers of protection, um, is prevention that we are trying to prevent spread of the virus. And so there's a lot of different, I guess, layers or levels of prevention that we could talk about.

SPEAKER_01 39:38

These also they overlap with one another. Like health promotion is preventing things, you know, health a certain sigh from going on in a in a human. Um, it just looks like there's a lot of, I just had the idea, there's a lot of these are concepts and there's a lot of overlap in how those how a certain action might play out.

SPEAKER_00 39:59

And there is a lot of overlap. Yeah, we're sort of there they're not uh concepts that work or function in isolation, they're interconnected. There's you know intersections across all of them, and and we need to use the different tactics that are most appropriate and applicable to specific situations. And uh with COVID-19, of course, we're trying to prevent spread, we're trying to protect people. Uh, but then when people are sick, of course, we're trying to treat them and save lives. So that sort of runs kind of the the whole spectrum of why we need we need all of it. And um another example, another good example, we we talk about, we actually had a guest blog post written by one of our BCCBC experts around injury prevention. And I I don't know that people think a lot about you know that road safety is public health. You know, uh reducing speeds, that's prevention. And I can speak to that from a very personal perspective. I was in a bad car crash uh a number of years ago, and uh it was because somebody was speeding. And if we had more sort of emphasis on prevention, and in you know, that is one specific example, then maybe that wouldn't have happened to me.

SPEAKER_01 41:16

A hundred percent. And I can tell you that there is data definitely linking severity of you know injuries within a motor vehicle accident to speed of vehicle at the time um the accident occurred. If there are lower speeds, there are lesser injuries. And I know that that seems like like a a bit of a duh, but good research is often like a clinical duh. It's like, well, of course. You've said that health is created outside the healthcare system. Tell us more about that.

SPEAKER_00 41:51

So I guess the way that I am thinking when I say that is that the healthcare system is a system. Health is not a system. So while we, of course, need access to good care and services, that's very important. Our health is not created within that system, it's created elsewhere. Uh, the healthcare system takes care of us when we're sick or we're injured, but it isn't really structured in a way that it takes care of our health and wellness. And so the way I see it is that health is a resource, the healthcare system is a resource, but they aren't the same resource. So creating good positive health isn't actually tied to our current healthcare system. That system is a safety net and it's a very important one, but our health is really shaped by the world around us. So everything that I've mentioned or talked about or we've talked about uh at the foundation, social determinants, equity, social justice, this is where I believe that our focus should be, and this is where I think that the true positive health actually lives.

SPEAKER_02 42:54

Christy, how can people, the public organizations that might be interested, how can they contribute to the foundation for public health? How can we help you?

SPEAKER_00 43:08

I'm so glad you asked that. Um so the BCCDC Foundation for Public Health puts evidence into action on some of BC's most pressing health public health issues, like we're seeing today. But we can't do it alone. We really we need help. We need um we need support, and really, you know, that can be a donation, uh, which would be phenomenal. And we have our two main campaigns right now: our COVID-19 emergency response fund, which really goes to uh supporting very uh important research and activities to help us get through this global pandemic. And our other core campaign is um uh addressing the overdose crisis through a program called Compassionate Inclusion and Engagement. And what that is, is a program where we provide grants and funding to peers. So people with lived or living experience of substance use to form harm reduction services, overdose prevention services, and anti-stigma work in local communities. So it's a very grassroots campaign. And the peers are the experts in this work. And so we're really trying to support peers across the province. And so those are kind of our two main campaigns right now. We do a lot of other work, but that's kind of where the you know the important work is for me right now. Considering our capacity, we do have to focus, and these are the two key priorities for us. So if someone wants to contribute with a donation, that's wonderful. If someone wants to engage with us on social media, that's wonderful. Sign up for our newsletter, share our content. We obviously can't have events right now, or well, we could virtually if we wanted to do that, but attend events when we can't or when we're able to do that again. There's lots of ways to get involved. And I think the activate health campaign is really that kind of battle cry to engage uh individuals and the public in taking some of this on themselves and becoming health ambassadors in their own community. And um, the decoding public health series that I talked about, you know, read it, share it, think about it, all of that. And uh, you know, we're we're here. The core of our work is people. I have this vision of the healthy human, creating a system, a society where we have, we strive to have the healthy human. And maybe that sounds a little bit idealistic, but uh I think it's achievable. And so, you know, we're here. We're here for people, we're passionate, and we're committed to our work to improve public health.

SPEAKER_02 45:44

Christy, before we we let you go, um, you alluded to directions that you'd like to take the province related to health. Uh, can you give us a sneak peek about the kind of direction you want to move in?

SPEAKER_00 45:56

I think it's, I mean, it it's gonna be a lot of work. It's a it's a long road, but I think we're starting. We're starting here. We're starting with conversations like this and talking about the social determinants and uh health promotion. And we really need to start really digging into health inequities. And I think that that is gonna be a really, really important part of shifting um our health system and how we view health. And, you know, we're seeing with COVID-19, of course, the importance of public health awareness, public health investment, and public health leadership with Dr. Bonnie Henry at the helm of leading the province uh through this pandemic and doing a phenomenal job as far as I'm concerned. Uh, we're really, I think the public are really uh starting to understand the importance of this. And so what that ultimately, I believe, is going to mean is shifting the sort of the allocation of investment and in funding in our health care system so that we invest in and prioritize prevention and health promotion and really, really focusing on addressing health inequities. And again, this is not at the expense of the acute care system. I think we will enhance the acute care system by doing this work and by shifting and flipping some of uh some of the ways that we do health in our province around.

SPEAKER_02 47:22

All right. That's that's an amazing goal, and I I look forward to the days when we get there. Not that we ever arrive, but you know what I mean. We're we're reaching the point in the show now where we ask a question of all our guests, and I have to admit, I'm particularly excited to hear your answer today, Christy. According to you, what is health?

SPEAKER_00 47:49

So this is a fascinating and difficult question, but let me let me just try and sort of uh articulate my view on what health is. So I think the way we view health currently as a society is very black and white. You're sick or you're not sick. This is gonna sound maybe like a bit of a goofy way to describe it, but I see it as more of a rainbow, uh, like a broad spectrum that encompasses all the factors and all the prerequisites, um, you know, shelter, food, uh safety, you know, all of those things uh that we need, and none of those things live in isolation. So I also see health, I tend to look at it more on a population level, because if we can do all the things that I've talked about and that we that we're talking about right now, and again, recognizing none of this is easy, it's all very complex, uh, I think we will create a healthier, healthier society, and that means that we as individuals will also have better health and better health outcomes. So, health to me is situated very much in the context of our environment, of where we live, work, and play, as I mentioned before. I see it as a holistic concept and an absolute fundamental human right.

SPEAKER_02 49:09

I love this. I just took a nice deep breath into all of that.

SPEAKER_01 49:16

Yeah, exactly. Christy, thank you so much for coming on the show today and answering all of our questions, my questions about the social determinants of health, the ways that we can all improve our health fortune and the future of the crucial organization of the Foundation for Public Health.

SPEAKER_00 49:37

Oh, thank you. Thank you so much for having me. I, like I said, I love talking about this. Anytime you want to talk about it, happy to dig into it. And um, I just really, I really appreciate being welcomed onto your show today.

SPEAKER_01 49:50

Oh, it's definitely our pleasure. That is all for today's small conversation. We hope that you enjoyed it as much as we did. We will provide links to the BC CDC Foundation in the show notes, um, including their social media, their website, uh whatever platforms we can find.

SPEAKER_02 50:11

And we'll be here next time.

SPEAKER_01 50:13

And we'll have the coffee on. If you liked what you heard, we encourage you to head on over to iTunes and leave us a five star review. Better yet, subscribe and leave a review. That really helps to make it easier for others to find us to help broaden this small conversation.