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Health and Healing: Community as Partner

Improving a Community’s Quality of Life: The Jane and Finch Locale

The nursing profession revolves around the nursing process, which provides a gradual facilitation of not only of individual health but also that of communities. All the elements of the nursing process, which includes the assessment of needs, planning, interventions, and implementation, are equally important. However, it is imperative to engage in the precise assessment of a community’s healthcare needs, which ultimately helps community health nurses (CHNs) accomplish their mission in responding to those needs in a timely and effective fashion (Thorne, 2009). This paper presents an assessment of the Jane-Finch community’s healthcare needs, geopolitical boundaries, as well as the socioeconomic and environmental factors that have impacted health of this neighborhood. This paper also highlights one priority issue affecting this community, as well as the determinants of health that cause inequity, and what CHNs can do to resolve the issue.

The Jane-Finch locale is situated at the north-west end of the city of Toronto and spreads over a 21 Km2 area. The total population as documented by Statistics Canada, 2008 is 80,150, making this a densely populated region, with 3817 persons per Km2. Through a windshield survey and personal experience living in the vicinity of this neighborhood, I was able to get a better picture of the neighborhood and a good understanding of its community’s needs. I have noticed that most of the people in this neighborhood are immigrants, mostly of South Asian extraction, with lesser concentrations of individuals of South American, Eastern and West African, and the Middle Eastern descent. The town houses, semi-detached houses, and other buildings are between 50 and 60 years-old; most of them with leaks in their seals, broken doors and ripped screen windows. Some of the buildings are even infested by cockroaches and bedbugs, as I later discovered. Garbage bins piled up on the back of the buildings, which provide hibernating places for disease spreading insects and rodents. All these factors converge to create poor housing conditions that pose a grave threat to the health of the community. The neighborhood has very few parks and playgrounds to provide children and their parents with a recreational area dedicated to the promotion of physical activities, which are essential to a positive environment for community health. Moreover, safety issues, such as street shootings restrict the community members from involving them in other healthy outdoor activities (Cecil-Karb & Grogan-Kyler, 2009). According to Statistics Canada, (2008) the majority of the residents of this neighborhood are low-income families, a fact that can also be observed from most people’s street clothing and the run-down nature of grocery and convenience stores in this area. The fast food and traditional neighborhood restaurants provide tasty, but greasy food selections, which can lead to other health problems, such as high cholesterol, heart disease, and other health problems relating to diet (Dean & Wilson, 2010). Socio-economic factors, such as the relative poverty of the families living in this neighborhood can also be considered a threat to the community’s health. People living in poverty might not be able to afford living in healthier and safer neighborhood, apart from not having access to supplemental healthcare. Poverty, which can be observed in this neighborhood, may lead a person to social isolation, which ultimately makes a person more vulnerable to mental and physical health problems (Sicchia & Maclean, 2006).

As a community health nursing student, I found myself placed at an elementary school in the heart of this neighborhood. The school represents a broad picture of multiculturalism, which is evident from the 25 different languages one hears in hallways. Students from across the globe give a unique appearance to the school, most of them are Canadian by birth, their ancestry is linked to approximately 37 other countries (Toronto District School Board, 2012). The school has a total of 361 students registered for the year 2012, of which 178 are female and 183 male. Their age ranges from four to eleven years of age. In examining the demographics of this community critically, it is evident that the children in this community have come from very different ethnic and cultural backgrounds, each group speaking a distinct language; however, the commonality among them based on the determinants of health is the family income, which is below the average family income of Canadians as a whole (Statistics Canada, 2008). Children are the future of our society, linked to their parents until they approach a certain age. They might suffer as much as their parents, if the family cannot afford to live in a reasonably clean and safer environment.

In order to assess Jane-Finch community’s healthcare needs, I have applied both of contact and non-contact approaches, including the parent and teacher surveys, interviews with community members, the community health nurse, personal observations, and a library search for relevant nursing literature. An upstream approach has been used to explore the neighborhood’s environmental, socio-economical, and other related factors affecting the community’s health, which together provide a broad picture of the healthcare problems and needs of this community (Cohen & Reutter, 2007). The contact assessment methods including interview and survey represent peoples’ problems from their own perspective, which provides a better picture of their healthcare needs (Running, Martin, & Woodward Tolle, 2007).

The data collected from Statistics Canada (2008) reveal that over 61% of the population in this neighborhood consists of immigrants, and 57.4% of this population cannot speak either of the official languages. Most of the population falls under relative poverty when compared with other neighborhoods, with an annual family income of $ 40,376. The “short questionnaire” survey conducted for the assessment of the community’s healthcare needs discloses that “safety” is a major issue in this community with respect to health. An overview of the data gathered has shifted my understanding of this neighborhood. The most important determinants of health -education and income- are correlated with each other. People in this neighborhood are missing Canadian professional education that ultimately prevents them from competing in the job market (Stats Canada, 2008). Not being able to find a reasonable job and not being able to speak the official languages, provides a barrier and poses a threat to the income and ultimately, the health of the community. As majority of this neighborhood consists of immigrants, it has been reported that immigrants have experienced a decline in their health in the first few years of their stay in Canada (Dean & Wilson, 2010).

Community involvement in the process of assessment plays a major role in exploring the needs, plans, and forms an implementation to ensure positive outcomes. In order to ensure community participation in the assessment process, nurses need to have cultural competence in their practice. Developing a trusting relationship has also been helpful in community involvement for the assessment of their needs (Running et al., 2007). To have community involvement in the assessment process, I applied a participatory approach to this process, making sure that I considered community members as my working partners and empowered them to identify their own needs. Cultural competence also played a role in becoming closer to the community, and listening patiently helped me explore their healthcare needs from their perspective. An inability to apply any of these rules could hinder the assessment process and could also harm the community’s trust of researchers (Running et al., 2007).

Age, ethnicity, and previous assumptions also have an impact on the process of assessment. While this community has a rich mix of multiculturalism, unfortunately the generalization of crime in this community has earned the neighborhood a notorious reputation across the city. However, as a student nurse becoming involved in the corridor of this neighborhood and speaking the same language gave me and my clients a level of comfort for exploring their needs. No matter what the previous assumptions may be, to transform and strengthen a community, it is important to get involved and understand the community’s social and cultural norms, before conducting an assessment of their needs (Zeidler, 2011).

I was surprised to discover from the data collected from the parents’ and teachers’ surveys that 82% of the participating population considered “safety” as their major health issue. The key stakeholders of the neighborhood were contacted, such as the parents of the children going to the school, the local police, public health nurse, and the vice principal. It was an eye opening moment for me, when I came to know that the average crime rate at two different levels was 16.30% against people and 27.16% against property for every 1000 people in the neighborhood (Statistics Canada, 2008). The vice principal of the school said that last year they had a lockout when two teenagers were shot dead right in front of the school. On October 11, 2012, another homicide in the heart of this neighborhood took place that scared the community after the death of a 24 year-old man (personal communication, October 25, 2012). Eight residents from the community who were randomly selected and interviewed also indicated “safety” as their main concern. According to them, street shootings, robbery, and other violence had affected their health; they cannot leave their homes after sunset to go out for walk when they have free time on their hands (personal communication, October 26, 2012).

In relation to the significance of the identified issue, “safety”, it is very important to explore the impacts of safety on the community’s health. Street shootings, violence, and sex assaults have scared the denizens of this neighborhood. Violation of public security leads to many other problems, such as restricting their physical and social activities, and an increased use of motorized vehicles even in the early evenings. People spend more time indoors, as well as they are scared of being injured as bystanders or as victims of robberies. It is evident that the majority of the population living in this neighborhood is immigrants from across the globe (Statistics Canada, 2008). Dean and Wilson (2010) described that the immigrants have shown a decline in their health after their arrival in Canada. In a discussion with the community health nurse, she mentioned that this community has significantly high cholesterol levels and diabetes; which is the result of a sedentary life style (personal communication, October 26, 2012).

Safety and health problems are proportional to each other. Researchers have found that safety is linked to the increasing obesity in children, because parents perceive that it is not safe outside, ultimately restricting physical outdoor activity. They also say that parents would let their children play indoor video games and watch more Television shows, which leads them to a more sedentary lifestyle. Looking at the social determinants of health especially “income,” the majority of the neighborhood falls under low-income. They cannot afford to buy sophisticated exercising equipment for indoor use; also they may not be able to afford the luxury of joining a fitness club. The only thing that they depend on is the walking outdoors for regular exercise, which is not possible in that neighborhood (Cecil-Karb & Grogan-Kyler, 2009). Unsafe conditions force them to stay in their homes and they adopt sedentary lifestyles, which is the precursor for other complications, such as diabetes, high cholesterol, and heart problems. In relation to primary healthcare, the low family income also creates barriers in accessing primary healthcare; because they cannot afford to pay for medication. They loose their potential health, get sicker everyday by ending up in an acute care setting, increasing the burden on the healthcare system (Cecil-Karb & Grogan-Kyler, 2009).

The upstream approach helps CHNs to identify those major socio-economical and environmental issues that affect human health. So, it is better to address those issues than dealing with the problem itself. As safety has been recognized as the root cause for many health problems in this community; this reveals the importance of providing a safer environment to the people of this neighborhood. Safer environment would help the residents of this community to promote their health and improve their quality of life. Healthy community would help reduce pressure on our healthcare system by reducing their visits to the primary care and the emergency department (Cohen & Reutter, 2007).

A Community health nurse can partner with the community and play an important role at many levels to address the safety issue, such as 1) individual level, 2) community level, and 3) organizational level. Asking concerned community individuals to keep a look out for violence or street crime and encourage them to report it by calling 911. However, these individuals should be instructed not to intervene, because things can get worse and they can be victimized. At the community level, there is a need for an initiative to reduce the crime rates in the neighborhood by asking the victims’ direct family members, such as the parents to address those committing these vicious crimes through Tele-media and Print media; asking them to stop violence in the community, in hopes of some sort of remorse and impact on the criminals within the neighborhood. At the community level, community health nurses can form groups amongst families in the community, and ask them to get involved in physical activities together, such as evening walks in groups, which can strengthen the community members and reduce violence. At the third level, which is influencing the government sector to perform their role in providing a safe environment to the community, this includes the involvement of the local police department, local councilors, the mayor, and social workers. Local police can be asked to increase their patrol in the neighborhood especially, parks and side streets to make those streets safer. The city mayor and councilors are the policy makers; they can be asked to increase funding towards the neighborhood to provide easily accessible community centers for those in need of any kind of support. Also, improving the street lights system in the community to promote a brighter neighborhood can create a safer environment for residents (Cecil-Karb & Grogan-Kyler, 2009).

Community healthcare nursing has a rich history of improving communities’ health, which was started at the Crimean Warfield by Florence Nightingale. She presented the idea of creating healthy environments to improve the quality of life (Parker, 2006). In the industrialized world, the scope of practice for CHNs has become even broader. These nurses look at the socio-economical and environmental factors that affect human health and attempt to uproot those problems. There is a need for CHNs to be non-judgmental and open to cultural and religious beliefs, so they can develop therapeutic relationship to explore community needs from a community’s perspective. The accurate assessment of the community is very important for positive outcomes and this would also help building healthier communities (Zeidler, 2011).

References

Cecil-Karb, R., & Grogan-Kaylo, A. (2009). Childhood body mass index in community context: Neighborhood safety, television viewing, and growth trajectories of BMI. National Association of Workers, 34(3), 169-177. Retrieved October 31, 2012, from http://web. ebscohost.com. ezproxy .library.yorku.ca/ehost/pdfviewer/pdfviewer?sid=176a51bb-19f3-4aaf-84e4-42da6dd99269% 40sessionmgr104&vid=4&hid=119

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.1365-2648.2006.04154.x

Dean, J., & Wilson, K. (2010). ‘‘My health has improved because I always have everything I need here.’’: A qualitative exploration of health improvement and decline among immigrants. Social Science and Medicine, 70, 1219-1228. doi:10.1016/j.socscimed .2010.01.009

Parker, M. E. (2006). Nursing Theories and Nursing Practice. Philedelphia, PA: F.A. Davis Company

Running, A., Martin, K., & Woodward Tolle, L. (2007). An innovative model for conducting a participatory community health assessment. Journal of Community Health Nursing, 24(4), 203–213. Retrieved October 31, 2012, from http://web.ebscohost.com.ezproxy. library.yorku. ca/ehost/pdfviewer/pdfv iewer ?sid=176a51bb-19f3-4aaf-84e4-42da6dd99 269%40se ssionmgr104&vid=10&hid=119

Statistics Canada. (2008). Jane-Finch Priority area profile. City of Toronto, ON. Retrieved  October 30, 2012, from http://www.toronto.ca/demographics/pdf/priority2006/area_ janefinch_full.pdf

Sicchia, S., & Maclean, H. (2006). Globalization, poverty and women’s health: Mapping the connections. Canadian Journal of Public Health, 97(1), 69-71. Retrieved October 30, 2012, from http://search. proquest.com.ezproxy.library.yorku.ca/docview/231995121

Thorne, S. (2009). Theoretical foundations of nursing practice. In P. Potter & A. Perry (Eds.), Canadian fundamentals of nursing (pp. 294-311). Toronto, ON: Elsevier Canada

Zeidler, D. (2011). Building a relationship: Perspectives from one first nations community. Canadian Journal of Speech-Language Pathology and Audiology, 35(2), 136-143. Retrieved October 29, 2012, from http://web.ebscohost.com.ezproxy.library.yorku. ca/ehost/pdfviewer/ pdfviewer?vid=17&hid =119&sid=176a51bb-19f3-4aaf-84e4-42da6dd99269%40ses sionmgr104

 

These articles have been written by Nasir Ahmad BSc. (HONS) Nursing, a graduate from York University Toronto, Ontario, Canada. The writer of these articles authorize Peace In-Home Health Care Services Inc to use these articles on their website as an additional resource for their clients. However, any unauthorized copying or distribution of these articles will be dealt strictly by the laws of the state. Please contact author for any queries at 416-648-2717 or email: 23.ahmad@gmail.com