INNOVATION IN INNOVATION IN RURAL HEALTH RURAL HEALTH

CARECARE

DR. MEL BORINSDR. MEL BORINS

Associate ProfessorAssociate ProfessorFaculty of MedicineFaculty of Medicine

University of TorontoUniversity of Torontoactive staff active staff

St. Joseph’s Health CenterSt. Joseph’s Health Centerwww.melborins.comwww.melborins.com

RURAL RISKSRURAL RISKS

• Self destructive/Risky behaviour

• Adherence/Self-Management

• Health Promoting

SELF DESTRUCTIVESELF DESTRUCTIVE

CORE BELIEFCORE BELIEF

▼▼ ▼▼

THOUGHTSTHOUGHTS

▼▼ ▼▼

FEELINGSFEELINGS

▼▼ ▼▼

BEHAVIOURBEHAVIOUR

Source: Prochaska & DiClementeSource: Prochaska & DiClementeSource: Prochaska & DiClementeSource: Prochaska & DiClemente

Stages Stages of of

changechange

Stages Stages of of

changechangeIDENTIFICATION

PROCESS OF CHANGEPROCESS OF CHANGE

• 1. AWARENESS1. AWARENESS

• 2. WILLINGNESS2. WILLINGNESS

• 3. PREPARATION/DREAMING WITH OUR 3. PREPARATION/DREAMING WITH OUR SENSESSENSES

• 4. MAKING IT HAPPEN/TAKING THE 4. MAKING IT HAPPEN/TAKING THE STEPSSTEPS

Causes of death in USA Causes of death in USA 20002000

Causes of death in USA Causes of death in USA 20002000

TobaccoTobacco 435,000435,000 1818

Diet/activityDiet/activity 400,000400,000 1717

AlcoholAlcohol 85,00085,000 4 4

Microbial agentsMicrobial agents 75,00075,000 3 3

Toxic agentsToxic agents 55,00055,000 2 2

Motor Vehicles Motor Vehicles 43,00043,000 2 2

Firearms Firearms 29,00029,000 1 1

Sexual behavior Sexual behavior 20,00020,000 <1<1

Illicit drug useIllicit drug use 17,00017,000 <1<1

TOTALTOTAL 1,159,0001,159,000 4848

TobaccoTobacco 435,000435,000 1818

Diet/activityDiet/activity 400,000400,000 1717

AlcoholAlcohol 85,00085,000 4 4

Microbial agentsMicrobial agents 75,00075,000 3 3

Toxic agentsToxic agents 55,00055,000 2 2

Motor Vehicles Motor Vehicles 43,00043,000 2 2

Firearms Firearms 29,00029,000 1 1

Sexual behavior Sexual behavior 20,00020,000 <1<1

Illicit drug useIllicit drug use 17,00017,000 <1<1

TOTALTOTAL 1,159,0001,159,000 4848

% of Total Deaths

% of Total DeathsCauseCause

Estimated Number

Estimated Number

(Mokdad et al, JAMA, 2004)(Mokdad et al, JAMA, 2004)

SELF DESTRUCTIVE SELF DESTRUCTIVE SELF DESTRUCTIVE SELF DESTRUCTIVE

• ““All of us at one time or another All of us at one time or another do things that aren’t good for do things that aren’t good for us. It might be something like us. It might be something like not wearing a seat belt or not wearing a seat belt or perhaps drinking more than we perhaps drinking more than we think we should. think we should. Are you doing Are you doing anything right now that you anything right now that you would put into this category?”would put into this category?”

• ““All of us at one time or another All of us at one time or another do things that aren’t good for do things that aren’t good for us. It might be something like us. It might be something like not wearing a seat belt or not wearing a seat belt or perhaps drinking more than we perhaps drinking more than we think we should. think we should. Are you doing Are you doing anything right now that you anything right now that you would put into this category?”would put into this category?”

NON ADHERANTNON ADHERANTNON ADHERANTNON ADHERANT

• ““Most of us forget to take our Most of us forget to take our medication or follow through medication or follow through with diet or exercise at some with diet or exercise at some point or another. point or another. What What difficulties have you had with difficulties have you had with the treatment you are the treatment you are following?”following?”

• ““Most of us forget to take our Most of us forget to take our medication or follow through medication or follow through with diet or exercise at some with diet or exercise at some point or another. point or another. What What difficulties have you had with difficulties have you had with the treatment you are the treatment you are following?”following?”

HEALTH HEALTH PROMOTIONPROMOTION

HEALTH HEALTH PROMOTIONPROMOTION

• ““What are you doing these What are you doing these days that you believe is days that you believe is contributing to your health?”contributing to your health?”

• ““What are you doing these What are you doing these days that you believe is days that you believe is contributing to your health?”contributing to your health?”

CHOOSE ONE NEW CHOOSE ONE NEW BEHAVIOURBEHAVIOUR

• Write it downWrite it down

• Concrete, measurable, baby stepConcrete, measurable, baby step

• MEANS WHEREBYMEANS WHEREBY

• Share it with someone at your tableShare it with someone at your table

PROCESS OF CHANGEPROCESS OF CHANGE

• 1. AWARENESS1. AWARENESS

• 2. WILLINGNESS2. WILLINGNESS

• 3. PREPARATION/DREAMING WITH OUR 3. PREPARATION/DREAMING WITH OUR SENSESSENSES

• 4. MAKING IT HAPPEN/TAKING THE 4. MAKING IT HAPPEN/TAKING THE STEPSSTEPS

ACCESSIBILITY IS A ACCESSIBILITY IS A CHALLENGECHALLENGE

80% of the world's inhabitants 80% of the world's inhabitants still rely chiefly on traditional still rely chiefly on traditional medicines for their primary medicines for their primary health care needshealth care needs. .

Akerele Olayiwola, Nature's Akerele Olayiwola, Nature's medicinal bounty: don't throw it medicinal bounty: don't throw it away. World Health Forum away. World Health Forum 1993;14:390-3951993;14:390-395

BRING HEALTH TO BRING HEALTH TO THE PEOPLETHE PEOPLE

• AUCTIONSAUCTIONS• FAIRSFAIRS• HOCKEY RINKSHOCKEY RINKS• SCHOOLSSCHOOLS• BINGO HALLSBINGO HALLS• PLACES OF WORSHIPPLACES OF WORSHIP

BRING HEALTH TO THE BRING HEALTH TO THE PEOPLEPEOPLE

• BPBP• GLUCOSEGLUCOSE• CHOLESTEROL CHOLESTEROL • COOKING CLASSESCOOKING CLASSES• OCCULT BLOOD TESTINGOCCULT BLOOD TESTING

• USE OF CELL PHONES IN SMOKING USE OF CELL PHONES IN SMOKING CESSATIONCESSATION

• INTERNETINTERNET

THE BASICSTHE BASICS

• CLEAN WATERCLEAN WATER• PROPER SEWAGE DISPOSALPROPER SEWAGE DISPOSAL• ENOUGH FOODENOUGH FOOD• SHELTERSHELTER