Centre for Population Health Promotion Research

“…respect for oneself, understanding and compassion for others, and a sense of responsibility for the world, its citizens and its future.”

I love this quote because to me, empathy really does encompass the self, others, and society as a whole. It is not about one over the others. The quote reflects what the Roots of Empathy program is about. In the book, Mary Gordon describes the program that is delivered through the school system – Roots of Empathy lessons are centred around a baby brought into the classroom over multiple sessions as the baby grows.

I do have a certain degree of empathy, but I wonder if it could have been more developed had I been enrolled in the Roots of Empathy program as a kid and learned to be more accepting of myself and of others. Unfortunately, I was not raised in an accepting environment at home or at school. It definitely has its effects, but I am hopeful that as an adult, I will do what I can to become more empathic.

I like puppies.  Puppies are fun. They are good for your health.  Getting a puppy is up there with exercise and meditation. Evidence shows puppies provide social support, stress relief and health benefits (Evenson, 2005).  You don’t have to pick up after a personal trainer; but, puppies yield more health benefits than people. Puppies can improve your mood. Men with AIDS were less likely to be depressed if they had a pet. Puppies keep secrets, cuddle and reduce loneliness. Elderly folks report less loneliness when visited by dogs. Puppies provide companionship and promote exercise.  Puppies are also a “mate magnet”.  This helps to reduce stress because people who like puppies are nicer.  Puppies can also control your blood pressure. Stockbrokers who got pets had lower blood pressure.  Doing a hard task is less stressful if you are accompanied by a puppy.  Owning a puppy isn’t for everyone (just nice people).

Adapted from Evenson RJ, Simon RW. Clarifying the Relationship Between Parenthood and Depression. Journal of Health and Social Behavior. December 2005.

October is Health Literacy Month. It is a call for action to improve health literacy.

In Canada, 60% of adults have low levels of health literacy (Canadian Council on Learning, 2008). Sadly, that’s a lot of people.

The most common suggestion for improving health literacy is to communicate health information in plain language. Yet, plain language is the minimum when it comes to health literacy. What other actions can improve health literacy? It helps to think of health literacy as involving: 1) a flow of information; and 2) a set of skills.

Health literacy involves a flow of information from a source (for example, a pamphlet or a doctor) to a recipient (for example, a patient). Plain language, like many other health literacy interventions, focuses on modifying characteristics of the source. While these are important, interventions that focus on the recipient in terms of skills are far fewer. Every recipient possesses a set of health literacy skills (which may change over time). We can and should increase health literacy skills in individuals as well.

These skills should be transferable across contexts. That means that my skills in finding, understanding, evaluating, and communicating health information can be used whether I’m looking for information on diabetes on the Internet, reading a pamphlet on nutrition handed out to me at a health fair, or telling my doctor about my latest health problem.

People generally learn these skills by trial and error, by following an example, or they never learn them. Wouldn’t it be great to have planned efforts to teach health literacy skills? There are several logical points of entry for teaching health literacy skills. One point of entry is the school system. Teach transferable health literacy skills so students have the capacity to acquire health knowledge in the future as adults, when they are no longer required to attend classes to learn. Other points of entry are adult basic education classes (e.g., for those who didn’t finish high school) and ESL (English as Second Language) classes. (For everyone else – adults who finished high school and who aren’t immigrants – the likelihood of a health literacy class being offered or open to them is probably slim. For this latter group, the more likely point of entry is the source of information. Characteristics of the source can be modified, such as using plain language and training health professionals about health literacy.)

Teaching transferable health literacy skills empowers people and helps them develop self-efficacy to be an active part of the exchange of health information. Plain language is the minimum. Empowerment is the guiding principle. Understanding is the goal. Better health is the outcome.

Reference:

Canadian Council on Learning (2008). Health Literacy in Canada: A Healthy Understanding. Ottawa, Ontario: Canadian Council on Learning.

Today I was referred to a video on literacy uploaded by the BC Government on YouTube.

Before you might think “oh no, another boring government video” (I admit I did), I found myself actually liking the video:

• It contains a single, yet clear, message – to build literacy, start kids on something they love to read, even if it is a comic book. From a social marketing perspective, a simple and clear message is better than multiple, complex messages.
• The plot is simple. The kid in the video tries to read something (War and Peace) and is frustrated by it. Kids chucks War and Peace to the side. Enter the comic book. Kid lights up.
• The video uses a simple creative strategy to emphasize its message. While the kid tries to read War and Peace, the video is in black and white, but as soon as the comic book is introduced, the video changes to colour.

The message communicated by the video made me think about my childhood and how true the video’s message really is. In primary school, I did not particularly enjoy the story books that the teacher read to the class and found myself daydreaming instead. Because of this, I only borrowed books for silent reading in class (because I had to, not because I wanted to). Of course, I only borrowed story books because that’s all I thought existed. Until I discovered non-fiction books for learning science, etc. That’s when I started borrowing books like crazy, thinking that in one summer I could learn everything there was to learn in the world! (I don’t think this anymore!)

As an adult, I still prefer non-fiction over fiction but I’ve also discovered the kinds of fiction and authors that I do like. It is about discovering what you love to read rather than following a formula (read this, not that).

I have sometimes wondered how many adults have actually read War and Peace when they weren’t required to do so for an English class. The length of the book is daunting, but I’d like to give it a try someday…

What books did you enjoy as a kid? What about now?

I am pleased to find out that Canada’s Economic Action Plan (CEAP) also includes an environmental and social purpose, i.e., a healthy environment.

As part of CEAP, the ecoENERGY Innovation Initiative (ecoEII) will “support energy technology innovation to produce and use energy in a more clean and efficient way” by providing $97 million over two years for research, development, and demonstration projects that advance Canadian leadership in clean energy technologies. Those who are interested may submit a Letter of Expression of Interest to address one of five priority areas: Energy Efficiency; Clean Electricity and Renewables; Bioenergy; Electrification of Transportation; and Unconventional Oil and Gas.

I am pleased about this opportunity because it reflects two important principles for society:

• EcoEII provides an opportunity rather than a punishment such as fines. Fines seem to have a place in this imperfect world but are collected after the fact – the deed and damage are already done.
• The ecoEII links economic goals with environmental and social goals, which are all connected. The approach reflects a long-term vision of sustainability rather than a short-term priority of profits. A short-term focus on profits tends to erode the ‘supply chain’ in terms of the human capital and the resources that support production (and thereby profits).

I don’t think ecoEII will be a magic bullet for our economy, environment, and society. But I do believe that it’s a step in the right direction. Every action counts.

The concept of the ‘social determinants of health’ continues to make its way into popular media – it’s on YouTube! On August 5, 2011, thecanadianfacts.org uploaded a video that explains that our health is primarily affected by our living conditions, not medical treatments or lifestyle choices.

This is not the first YouTube video on the social determinants of health. However, the effort continues the commitment to share knowledge with the general public. It is not special knowledge that should be exclusive to public health workers. The reality is that public health workers on their own can’t improve people’s health (nor should public health workers do it on their own).

While the video introduces the social determinants of health, details can be found in the free report The Social Determinants of Health: The Canadian Facts. I won’t go into the facts here, but I will emphasize six actions that anyone (i.e., including public health workers) can take to improve health for all:

• Ask your elected representative in government: what is being done to address these issues?
• Support candidates of political parties that are receptive to the social determinants of health concept.
• Raise these issues with agencies, organizations, and institutions whose mandates include promoting health and preventing illness.
• Ask public health units, disease associations (e.g., Heart and Stroke Foundation, etc.), and health care organizations (e.g., hospitals, professional associations): what is being done to educate Canadians about the social determinants of health and promote public policy action?
• Join and/or support organizations that work to strengthen the social determinants of health.
• Spread the word – share the video, share the report, talk about it with people you know (e.g., family, friends, co-workers, classmates, etc.).

We all want better living conditions and good health. How will you help spread the word and improve health for all?

Health Nexus and 3M Canada are calling for nominations for the 3M Health Leadership Award that “recognizes an outstanding community leader that has had an impact on the health of their community by addressing at least one of the social determinants of health.” This is a great opportunity to recognize inspiring individuals who have done much to improve the health of their community.

Please ensure that you read the Eligibility Criteria before you nominate someone, e.g., the individual is affiliated with an organization that is outside of the formal health care field, etc.

The deadline for nominations is September 15, 2011.

Some people would answer ‘no’ but I hope that ‘doing good’ does become a social movement.

The concept of doing good is not new. In Ancient Greece, Aesop said “No act of kindness, no matter how small, is ever wasted.” Nor is the idea passé. With the internet and increasing use of social media, people are now able to more easily and widely share their experiences and inspire others to do good as well. People are getting tired of hearing bad news.

In the U.K., Action for Happiness is “a movement of people committed to building a happier society. We want to see a fundamentally different way of life where people care less about what they can get for themselves and more about the happiness of others.” Their comprehensive website blends science and humanity to encourage people to create a happier society for all. Doing things for others is identified as one of 10 keys to happier living.

Yesterday, I learned that our local paper the Vancouver Sun is asking people to let them know about ‘positive stories’ online that they could feature.

This morning, I saw an ad on the side of the bus for People for Good.ca. I was delighted to learn that things were happening here in Canada too. The goal of People for Good is “to make the world a better place, one good deed at a time.” Their website features videos of five Canadians who documented their experiences with doing one good deed per day for seven days, as well as an area where you can submit your own ideas for doing good.

These three examples are only the tip of the iceberg. People do good all the time, sometimes in a systematic or planned manner and sometimes not.

From a population and public health perspective, doing good can help build a sense of community and social capital. At a personal level, while it’s nice to get warm fuzzy feelings by reading about what other people have done, it’s much better do some good yourself and be part of a social movement.

There’s always room in this world for more good.

Like many things in life, there is probably no one, simple answer to this question. But at least people are trying to answer it.

One way is to use regulation to get major chain restaurants to provide calorie information on their menus. New York City did this in 2008. A study on the outcome of the New York regulation showed that 15% of customers in 2009 reported using the calorie information and purchased 106 fewer kilocalories than customers who did not see or use the calorie information (Dumanovsky et al., 2011). Fifteen per cent of customers might seem like a small proportion but it is still sizeable, especially if some of these are repeat customers. For example, three meals a week at the same restaurant could net a 300-calorie reduction. That’s about half an hour of running to burn those calories! The question is how to get as many of the remaining 85% of customers as possible to see or use the calorie information to reduce their calorie intake.

While providing calorie information to customers helps them make personal decisions, another strategy is to actually improve the nutritional content of the food itself. McDonald’s just announced their “Commitments to Offer Improved Nutrition Choices” plan. One of the three goals is to expand and improve nutritionally-balanced menu choices. By 2015, McDonald’s will reduce sodium an average of 15% overall and by 2020 it will “reduce added sugars, saturated fat and calories through varied portion sizes, reformulations and innovations.” Improving the nutritional content of food items puts less onus on the consumer to make a conscious decision. Sometimes, you just want those fries! But at least the fries will soon have less salt. “Soon” is relative though. McDonald’s self-set deadlines are still 4 years and 9 years away. Hopefully, McDonald’s actions will inspire other restaurant chains and even independent restaurants to do the same and in a shorter time frame.

The above two examples are from the U.S. What’s happening in Canada? Here in Vancouver city, there are no regulations. Any calorie information would be provided by restaurants on a voluntary basis (from a business perspective, this could give these restaurants a competitive advantage). The BC provincial government is exploring the idea of menu nutrition labelling for foods served in restaurants and food service establishments. In Ontario, Bill 90 (a private member’s bill to get food establishments to provide calorie information) had its first and, so far, only reading in the Legislative Assembly in June 2010. There is some obvious interest in Canada to follow in the footsteps of New York City. I’m sure there are other examples in Canada that I haven’t heard about.

Restaurants comprise only part of the food industry. There are a lot of processed foods sold in stores. Food manufacturers could also improve the nutritional content of their manufactured food. In the absence of regulation, this would most likely be driven by consumer demand.

What works well to reduce people’s calorie intake remains to be seen. It will most likely be a combination of strategies that aim to change individual behaviour and to change the surrounding environment so that healthier choices don’t necessarily have to be conscious choices.

Reference:

Dumanovsky et al. (2011). Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: Cross sectional customer surveys. BMJ 343:d4464.

Addendum (August 10, 2011)
Update: The BC provincial government is partnering with the BC restaurant industry to introduce the Informed Dining program to provide restaurant customers with the nutrition information they need to make healthier choices.

I just read an hilarious article on how a guy survived 7 days without social media. Remember the days before Facebook and Twitter?

The article reminds me that social media has changed how we interact, including about health. Now we can ask family and friends, and even strangers, questions about health. We can get answers on how to cope or learn about a range of experiences that doctors are not privy to. Social media is another way for people to connect and share.

Social media can also be used by health organizations to provide information to the general public. For example, Health Canada uses Twitter to provide information about product recalls and safety information.

Being in the field of population and public health, the next question that arose in my head was: How can social media be used to reduce health inequities and improve population health? Upstream changes in policy and in social and economic conditions are needed rather than a focus on changing individual behaviour. It means targeting an audience of policy-makers and others who have the power to change social and economic conditions (and those who support them). It also means communicating an underlying or explicit message of equity and engagement (to work towards common goals) regardless of audience.

A lot of the dialogue on social media and health seems to relate to health care. It’s time to shift some of that dialogue to prevention.