The Ontario Nurses’ Association has produced an in-depth series on the importance of public health in Ontario.
Read our flagship publication, Front Lines, as well as first-hand stories on our website and social media.
Jennifer Johnston describes herself as a “glass half-full kind of gal.”
The Windsor-Essex public health nurse, who has an infectious smile (and not in a bad way) and a keen thirst for knowledge could make virtually any bystander stand up and pay close attention to her words.
In her line of work, these traits come in handy. She and her colleagues are responsible for the health and well-being of almost 400,000 people who live in the Windsor and Essex County region. And, some of her direct work involves building relationships.
Johnston – who has been an active executive member of ONA Local 8 for a few years – and her health unit develop ongoing partnerships with many organizations including municipalities, school boards, children’s aid, local immigration support services, health-care practitioners, and police. “You name it, we work with them to come up with ideas and opportunities to improve the health of people in our community.”
Public health tailors programs for health-disadvantaged groups
Public health – less well-known than its health-care sector cousins, hospitals and long-term care – promotes health, well-being, and saves lives through a community lens. While hospital care is more “downstream” in the wellness spectrum – most often accessed once someone is already sick – public health focuses “upstream” to prevent people from getting sick or injured in the first place. It’s about prevention and creating positive conditions for people to reach their full health potential.
“Health is a result of much more than access to health-care services,” Johnston emphasizes. Health and well-being are shaped largely by the conditions in which people live. Conditions can include the safety of their home and neighbourhood, access to safe and affordable healthy food, and a quality education system.
Johnston further explains that poor conditions limit opportunities and choices. Public health has an important role in improving living conditions for everyone, with a special focus on enhancing opportunities for health-disadvantaged groups. These groups can include those living on low income, new immigrants, and people who use substances like opioids or injection drugs.
Public health professionals work in collaboration with others and through a wide variety of programs and services. This includes providing direct-to-client services like home visits to families with newborns, immunizations in schools, smoking cessation programs, and services that keep food and water systems safe like restaurant inspections.
But more importantly, public health has a lead role in identifying opportunities to improve societal factors that influence health. This includes gathering and reporting on population health status, supporting and advancing healthy public policies, and so much more.
“Public health is unique because it focuses on broader health outcomes of everyone in the region, not just clients who use our services,” Johnston notes. “We explore the root causes of poor health and work to change conditions where health-disadvantaged groups can reach higher levels of health and well-being.”
While working to improve living conditions, public health recognizes that health-disadvantaged groups experience more barriers to accessing and participating in health promotion and disease prevention programs and services.
“Public health tailors programs and services to meet community needs and encourages their partners to do the same,” she explains. “A big part of my job is helping to infuse equity-driven thinking into programs and mainstream thinking with the goal of improving health outcomes.”
For example, Johnston is currently working on a community-based project in collaboration with representatives from the settlement, health, and education sectors. The goal is to reduce language barriers experienced by persons seeking local health-care services. The project team is developing strategies to help health-care service providers like hospitals use available language-based services, tools, and approaches to better communicate with their patients and improve outcomes.
Building and maintaining strong partnerships
During the 2014 municipal election, Johnston’s health unit partnered with the United Way to launch a poverty-simulation event. They hosted decision-makers, would-be politicians, health agency CEOs, the media, and others who had the power to make decisions that could positively affect their clients and community.
“The event gave participants a sense of what it’s like to have limited choices and opportunities,” Johnston explains. The experience also helped participants see how organizational systems and community-level decisions – like policies and process – can either help or hinder people. She notes that the outcomes of the event were most rewarding for her. “I cannot tell you how emotional the debrief session at the end of the event was for our participants – it gave me goosebumps.”
In fact, just a few months ago, she met up with a municipal politician who had taken part in the event. “What was meaningful to me was that it was an impactful experience for decision-makers. The politician said to me, ‘that event changed my perspective on everything.’”
As Johnston so eloquently explains, “That’s one of the most important public health roles – enhancing decision-makers’ understanding of local health issues so effective solutions can be put in place to improve people’s lives.”
Public health must be discussed more often
Yet, the innumerable benefits of a strong public health presence in communities need to be talked about much more freely – and often.
The Ford provincial government is cutting the number of public health units across the province from 35 to 10. Diluting the vital community lens which is a cornerstone of all public health units is a common concern among health-care professionals.
Fewer agencies could mean that much-needed and community-specific programs aimed at helping local health-disadvantaged groups could be at risk. In addition, a proposed $1 billion in cuts to health and social services by the Ford government is on the table, which will undoubtedly harm those already experiencing vulnerability.
“I am trying to stay optimistic that changes will present positive opportunities, but given the vast range of programs and services that the Ministry of Health requires public health units to deliver, we are already underfunded,” explains Johnston. “It is challenging to think of how to do more with less while keeping up with our local communities’ growing needs.”
And while her health unit manages more than 300 work plans each year, nothing is set in stone. If a new need comes up in the community, practitioners need to juggle their work to be able to fit it in to their already stretched resources.
Johnston chalks up managing on-the-fly changes to her colleagues. “Public health practitioners are resilient and their strengths are building relationships and identifying approaches that make communities better places to live.” It’s something that she aspires to every day.
“Public health is truly my passion and, if we are doing our job well behind the scenes, people don’t often know about it or understand its value,” she says. “We need to do a better job increasing public awareness of the vital role that public health plays in the lives of Ontarians.”
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