Panel Discussion #3: Addressing the Needs of Impoverished Persons

1. Panel Discussion #3: Addressing the Needs of Impoverished Persons Ivy Cawley, Laura Chisholm, Michelle Cleary

2. Outline • What is poverty? • Statistics • Who are the vulnerable population? • Social Determinants of Health • Role of Public Health/ Community Nurse in helping impoverished people • Policies • Barriers in accessing Resources • Barriers as a Public Health/ Community Nurse with Resource accessibility • Case Study • Discussion

3. “Overcoming poverty is not a gesture of charity. It is an act of justice. It is the protection of a fundamental human right, the right to dignity and a decent life.” - Nelson Mandela

4. What is Poverty?

5. Poverty in Canada • More than 3.5 million Canadian live in poverty. (Make Poverty History Canada, 2010) • On average, one in every ten children in Canada struggles to have their basic needs met. In First Nations and Inuit communities, one in every four children grows up in poverty (Make poverty History Canada,2010). • Families who spend more then 54.7% of their income on basics needs are living below the Low Income Cut Off. (Cohen & Reutter, 2007) • 31% of all low income children are living in families with at least one parent working full time, full year. (Cohen &Reutter, 2007)

6. Who is Vulnerable to Poverty • Families led by single women • Families that are socially isolated • Families with low income living in urban and rural areas • Individuals and families affected by substance use, mental illness, human immunodeficiency virus (HIV), hepatitis C virus (HCV), disability and homelessness (Browne et al, 2010) • Aboriginal Peoples • Immigrants • Visible Minorities • Older Adults • Women and children

7. Vulnerability in Nova Scotia • In Rural communities, and three groups in particular – Aboriginal people, people with disabilities, and African Nova Scotians are the larger population living in poverty and have economic insecurity (Saulnier, 2009). • Unlike most of the rest of Canada, poverty rates in Nova Scotia are higher in rural areas than in urban centres: 17.3% compared to 15.5% in 2000 (Singh, 2004).

8. Nova Scotia • Despite attempts to transition to the ‘new economy,’ the shift away from a resource-based economy has been especially difficult in rural Nova Scotia. Outmigration from rural communities to other provinces and shifts to urban areas of the province are exacerbating the situation. Lower levels of unemployment, coupled with an ageing population and the loss of educated and skilled youth to other regions have resulted in some areas struggling to find workers.

9. Social Determinants of Health • Personal Health Practices and Coping Skills  • Healthy Child Development  • Biology and Genetic Endowment  • Health Services  • Gender  • Culture  • Income and Social Status  • Social Support Networks  • Education  • Employment/Working Conditions  • Social Environments  • Physical Environments 

10. Case Study #1 • Jane Doe: She is the oldest of 3 children to a single mother. Did not have much of a childhood, and activities included babysitting younger siblings. Jane did not keep close friends, and was embarrassed to have friends over and moved frequently. She became rebellious as a teen and her mother could not handle it, so she was put into foster care. Jane dropped out of high school in 10th grade. Jane had regular substance use of tobacco, alcohol, marijuana, pain killers and antidepressants. By the age of 16 Jane was pregnant and gave her baby up for adoption. Jane had scattered jobs, and was in frequent unstable relationships which were often abusive. By the age of 30 Jane had 2 more children. Several attempts to upgrade education which had been found to be difficult because lack of support for child care. Jane Puts her personal needs on the back burner and focuses on children. She continues to look for support in the community for family.

11. Case Study #2 • In contrast we can see Jennifer Smith. She had a happy childhood, she was one of two children. Jane enjoyed family support and had extended family involvement. Jennifer did many activities as a child such as brownies, dance, music lessons and family vacations. She had many close friends growing up and lived in the same house from birth to going away to university. Jennifer established her career by 25 and by 30 she was married. Jennifer currently has 2 children, is a member of a book club. Jennifer and her husband along with their children go out in many family outings such as skiing, soccer tournaments, hiking, and biking on weekends. Jennifer is busy at work but always juggles her time so she can take her children to their activities, and chairs the children's school parent advisory group.

12. Roles for Community Health Nurses In Helping Impoverished Persons • 1.)Monitoring • 2.)Alleviating/ Preventing • 3.)Bringing about change

13. Monitoring • Provide information to local and regional health authorities • Health profiling • Evaluating effectiveness

14. Alleviating/ Preventing • Increasing access to services. • Case advocacy

15. Bringing About Change • Empowerment • Public policy • Policy advocacy

16. Contextualizing ‘Risk’ • How do PHN’s understand, contextualize, and address risk? • How specifically do they relate and interact with families at risk in ways that promote health and alleviate potential harm?

17. Contextualizing ‘Risk’: Relational Approach Example: • Risk behaviour in a mother or father. Relational Approach vs. Non-relational Approach

18. Contextualizing ‘Risk’ Three central aspects: • 1.) Simultaneously working with risk and capacity • 2.) Taking a temporal view of families • 3.) Being flexible

19. Self-reflexivity (Reflection) • Ongoing process • Mindfulness • Awareness of own judgements and assumptions

20. Collaboration • Working with impoverished people • Empowerment • Non-judgement • Trust • Other disciplines, other sectors

21. Local Resources and Programs • Fluoride Rinse programs in schools • Bread being fortified with Folic Acid • Public Health Nurses providing vaccinations in the schools so it allows for accessibility. • Women’s Health Centres, accountants working their to help manage finances • Men’s Resource Centre • Collaborating with Job Resource Centre that will help individuals develop resumes, job search, interview preparation • Friendship Corner • Christmas Daddies – donations of money to buy presents for children throughout the Maritime • Adopt a family Project • Ronald MacDonald House • Kids First • Mother and Baby Drop in • Family Services • Big Brothers/ Big Sisters • Creative Wellness Program

22. Policies • Employment Insurance • Canada Child Tax Benefit • National Child Benefit • Working Income Tax Benefit • Income Assistance • Annual Monetary Supplement

23. Barriers of Impoverished People Accessing Resources • Transportation • Education Level • If living in Rural Areas • Stereotypes • Feelings like getting Lost in the System • Stereotypes • Racism • Lower Income • Living Arrangements • Working Poor • Lack of Health Insurance or Benefits • ALL of the Social Determinants of Health

24. Barriers for Nursing helping people living in poverty • Lack of understanding of poverty • Personal beliefs and attitudes towards people living in poverty that prevent us from facing the reality of poverty • Holding stereotypes towards people living in poverty • Stigmatization and racism • Fear of being judgemental and therefore failing to assess individuals, families, population and community needs properly • Cut downs in health care system • Not know resources available • Fear we don’t have knowledge to make decisions. Feelings of frustration and powerlessness regarding the plight of poor families • Lack of research about PHNs roles. • Nurses and nursing students not being exposed to poverty • Insufficient professional education related to Poverty. No experience. • Obstructive processes and policies within health and social services • Lack of proper assessment tools • Lack resources (funding, human and time) • Communication barriers between community agencies that provide services to poor families • Client non-compliance/lack of engagement/ lack of trust • Lack of public understanding of PHN role

25. Case Study • Tracy, Brian and their 4 children are living in rural Nova Scotia, one of her children has behavioural problems. They live in a small home. They have recently moved from a small town back to her home town. Tracy is unemployed and Brian works at a local store. Tracy worked at Tim Horton’s until the birth of her second child. The family does not own a car and finds it difficult to get around After high school she attended University but was unable to continue after the birth of her first child. Tracy and her family are receiving Income Assistance, and has support from her mother and father. They are settling into their new community well, and the one child in school really enjoys it and it more involved in after school activities. Other community members are very helpful.

26. Discussion • In the case study what factors can you identify that are barriers to Tracy and her family accessing health care and resources? • What Social Determinants of Health can we discuss that have impacted her family’s situation • What can we do as a Community Health Nurse that could address this situation?

27. Welfare Food Challenge World Poverty Day October 17, 2012

28. References Browne, A. J.; Doane, G. H.; Reimer, J.; MacLeod, M. L. P., & McLellan, E. (2010). Public health nursing practice with 'high priority' families: The significance of contextualizing 'risk'. Nursing Inquiry 17(1): 26-37. Canadian Revenue Agency (2012). Retrieved from: www.cra.gc.ca Carriere, G. L. (2008). Linking women to health and wellness: Street outreach takes a population health approach. International Journal of Drug Policy19:205-210:doi: 10.1016/j.drugpo.2008.03.006 Cohen, B. & Reutter, L. (2007). Development of the role of public health nurses in addressing child and family poverty: A framework for action. Journal of Advanced Nursing, 60(1): 96-107. doi: 10.1111/j.1365.2006.04154.x Government of Nova Scotia (2012). Retrieved from: http://novascotia.ca/ GuysboroughAntigonish Strait Health Authority (GASHA), 2012. retrieved: http://www.gasha.nshealth.ca/public-health.htm#our_team Make poverty History. (2010). End Poverty in Canada. Retrieved from http://www.makepovertyhistory.ca/learn/issues/end-poverty-in-canada.

29. References Reutter, L. & Kushner, K. E. (2010). ‘Health equity through action on the social determinants of health: Taking up the challenge in nursing. Nursing Inquiry, 17(3); 269-280 Reutter, L. Sword, W.; Meagher-Stewart, D. & Rideout, E. (2004). Nursing students’ beliefs about poverty and health. Journal of Advanced Nursing, 48(3): 299-309. Saulnier, C. (2009). Poverty reduction policies and programs. The causes and consequences of poverty: Understanding divisions and disparities in social and economic development in Nova Scotia. Canadian Council on Social Development. Retrieved from: http://www.ccsd.ca/Reports/NS_Report_FINAL.pdf Seccombe, K. (2002). ‘‘Beating the Odds’’ Versus ‘‘Changing the Odds’’:Poverty, Resilience, and Family Policy. In Journal of Marriage and Family. Retrieved 09/10/2012, from http://onlinelibrary.wiley.com/doi/10.1111/j.1741-3737.2002.00384.x/pdf. Welfare Food Challenge, 2012. Retrieved: http://welfarefoodchallenge.org/ The World Health Organization, 2012 retrieved from: http://www.who.int/social_determinants/en/, http://www.who.int/topics/poverty/en/