The Association of Registered Nurses of BC

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The Upstream Approach to Healthcare

A passerby sees a body floating down a river, and calls 911. Firemen arrive and haul the body out, paramedics start resuscitation and the victim is rushed to the ER where the hospital PR director proudly announces that the highest quality care is being delivered to deal with the situation. By contrast, health promotion would focus upstream to figure out what is causing people to fall into the water, and correct it. Health promotion aims to prevent disease by modifying the social determinants of health or 'upstream' factors.

University of Ottawa. (n.d) Health Promotion.
According to the Public Health Agency of Canada, "Population health is an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups."

A population health approach shifts the idea of health from the 'absence of disease', to a positive concept, of complete physical, mental, and social well-being. Rather than conceptualizing health as a state, the population health approach views health as a resource, and focuses on the interrelated social, environmental and economic conditions that influence health and well-being throughout the life course. A population health approach also emphasizes factors that fall outside the health care system (known as social determinants of health), and the various sectors that affect health and well-being.

Adopting an upstream approach addresses the "causes of the causes." It recognizes the many factors that influence health outside of one's lifestyle and behaviour, and tackles the structural, political, economic, and social contributors to health and well-being. Through this perspective, empowerment and capacity building are key in improving and maintaining the health and well-being of individuals and communities.

Due to the complexity and interrelatedness of factors that affect health and well-being, improving population health and wellness requires inter-sectoral collaboration and upstream approaches (approaches to address the structural determinants of health). A key approach to improving the health and well-being of a population is through health promotion. Drawing upon the Ottawa Charter for Health Promotion, five key action areas include: building healthy public policy, creating supportive environments (all physical and social environments), strengthening community actions (empowering and increasing ownership and control of one's endeavours), developing personal skills (health education and life skills), and reorienting health services.

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The health issues of B.C. are becoming more complex, and greater health inequities are being recognized. There has been progress within B.C. in addressing health and well-being through a population health approach. For example, the Tripartite First Nations Health Plan has brought together partners from several sectors to increase health equity of aboriginal peoples by addressing the social determinants of health, and health authorities across the province have developed their own population health approach strategy.

While progress has been made, investment in curative health care services continue to dominate. In general, the health system within the province, and across Canada was built around emergency hospital treatment. However, as the health issues have become more complex (increased chronic diseases) and demographics have changed over the years, it has not adapted to meet current needs. In order to continue to build healthy communities across B.C, there must be a shift in the way individuals view health. Addressing the health and well-being of British Columbians through a population health approach requires continued investment, support, collaboration and leadership between government, non-for-profit organizations, as well as private business.

ARNBC is interested in pursuing various issues under this policy area, including end-of-life care (and physician-assisted death), preventive, rural and environmental health, harm reduction and health promotion. The association is committed to working with all RNs, NPs, and stakeholders across sectors in creating thriving individuals and communities across the province.





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