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Changing the Future: Social Responsibilities
GUEST EDITORIAL
Changing the Future: Social Responsibilities Ward Murdock, MD, FRCSC President, Society of Obstetricians and Gynaecologists of Canada
I
t is a great honour to become the 70th President of the SOGC. I do think my appointment shows just how inclusive the Society is, because, after all, I am from a province with a population smaller than that of most cities in Canada. We have only 35 obstetrician-gynaecologists in New Brunswick. However, I hope I will be able to represent all our members, both in Canada and beyond, and I intend to be a strong advocate for women’s health in our country. Although there will be many competing priorities for our Society over the next year, I would like to touch on two areas that I feel will be of particular importance. The first of these is engagement. Our Society exists because of its members. Membership of the Society represents a commitment to quality of care: a desire to contribute your knowledge, a will to learn from others, and a social responsibility to participate in our community. I have heard from colleagues and in meetings with other organizations that it is becoming increasingly difficult to encourage young people to become involved in our professional societies. My experience has been quite the opposite. We have an active junior membership at the SOGC, and some of my best experiences have been in meeting our junior representatives as they spend a year on the SOGC Council. Our challenge is to find ways to keep these younger members engaged after they graduate from residency. Addressing topics and developing programs that are important to young professionals is one aspect of this. They face manpower issues, and job opportunities across the country have become a major concern. Although organizations such as the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada are pursuing solutions as well, junior members of our Society will look to the SOGC to take the lead. Nobody understands the situation at the ground level better than our Society. During my term, I will strive to make the needs of our next generation a priority.
One way in which we are already doing this is by including junior members as full voting members of SOGC. This will give junior members more voice and responsibility within the Society. I also hope to meet personally and frequently with our junior member representatives. Although these initiatives are a good beginning, my feeling is that the one thing most likely to result in continued participation of our junior members in the Society is encouragement from their colleagues after they graduate from residency. Veterans must take the lead in encouraging new graduates to participate in the SOGC. When I completed residency, I had no real idea what the SOGC was involved in, and I never gave much consideration to how I could contribute through the Society to improving women’s health. But when it was proposed that I become involved, my colleagues were immediately supportive; when I was first asked to serve on the Guidelines Committee, my more senior colleagues made it clear that this was something I should do. When I was asked to sit on the Council, my practice group members were supportive without question. When I was then asked to put my name forward for the presidency and asked my group colleagues for their support, they responded without question that I should proceed, even though this meant an increased workload for them when many were already struggling with work and family responsibilities. In my group of 10 obstetricians and gynaecologists, five are currently actively involved with our Society; four others are involved with provincial or local committees. The culture of our small practice group is that you can make a difference, and that it is your duty to help make the Society better and improve the quality of care that we and others provide. This is a philosophy I will emphasize at local and national levels in an attempt to increase the sense of belonging necessary for our membership and our Society to prosper. J Obstet Gynaecol Can 2013;35(9):781–783
SEPTEMBER JOGC SEPTEMBRE 2013 l 781
Guest Editorial
Secondly, I would like to discuss our work in Aboriginal women’s health. We have done, and continue to do, a great job of collaborating with First Nations, Inuit, and Métis women’s health professionals and relevant Aboriginal and non-Aboriginal organizations to advance culturally safe health and healing for Aboriginal women and their families. However, looking beyond the areas of acute need and helping to implement and advocate for long-term solutions is much more difficult. When we as Canadians look at the long-term, system-level issues we would like to solve, it is easy to become overwhelmed. It is often difficult to see how we as individual health professionals can make changes that will make a lasting difference to our First Nations, Inuit, and Métis patients. I was struggling with this until I heard a speech by Professor Michael Marmot at the Canadian Medical Association’s Annual Meeting in 2012, in which he spoke about the social determinants of health.1 Let me share some of the guiding principles that Professor Marmot applies in his roles at the World Health Organization and the European Union and within the Government of the United Kingdom. 1. Give every child the best start in life.
This is such a simple objective; however, we are nowhere near achieving this for Indigenous populations or other marginalized groups in Canada or internationally. Professor Marmot further stated: Disadvantage starts before life and accumulates throughout life; action to reduce the health inequities must start and be followed through the life of the child. Only then can the close links between early disadvantage and poor outcome throughout life be broken.1 The SOGC has been instrumental in advocating for a high standard of antenatal and perinatal care for Aboriginal people, but is this enough? Clearly it is not. It is not enough for our society to strive to provide good health care for mother and child only during the antenatal, perinatal, and postpartum periods. We must engage other groups to participate in helping with the long-term physical and mental health of the children and mothers in these communities; only then will there be a difference. 2. Enable all children, young people, and adults to maximize their capabilities and have control over their lives; create fair employment and good work for all; and ensure a healthy standard of living for all.
The Human Development Index ranks countries using a combination of indicators including life expectancy, education, and income. In 2006, Canada ranked sixth in the 782 l SEPTEMBER JOGC SEPTEMBRE 2013
world,2 but First Nations communities in Canada ranked 68th. Indeed there are significant gaps in life expectancy, education, and income.3 In Canada, life expectancy varies for First Nations, Inuit, and Métis, with average life expectancy six years below that of non-Aboriginal Canadians. The gap is narrowing, but remains significant.4 We are not alone in this: life expectancy of the world’s Indigenous communities is lower than the corresponding general population. Australia has an 11-year gap, and New Zealand has a gap similar to Canada’s.5 What are we doing currently as a Society to address the social determinants that create healthy, sustainable communities, and what can we do in the future? In June, the SOGC published a new guideline that suggests ways in which individual women’s health professionals can work to close the gaps in the social determinants of health by advocating for long-term, systemic change and empowering patients to receive better quality of care.6 With the SOGC’s support and resources, every member can be a leader and can advocate in this area. We also partner with other Aboriginal and non-Aboriginal organizations to support and empower their activities. And SOGC members help to further this work through your support and involvement. 3. Create and develop healthy and sustainable places and communities.
The health and well-being of Aboriginal women and communities in Canada is relevant to all of us. Aboriginal people are the fastest growing population in Canada, and they are increasingly moving to urban centres.7 As individual women’s health professionals we can begin by making strides to improve our capacity to provide culturally safe care to all of our patients, and especially our First Nations, Inuit, and Métis patients. In conjunction with the relevant social determinants of health, the SOGC’s guideline6 is a great resource and provides recommendations and clinical tips for beginning to advance culturally safe health and healing for Aboriginal women, their families, and their communities. The key principles can, in fact, be applied across everyone’s practice to advance the culturally safe health and healing of all patients. I am very excited about the year ahead; I hope that, with your help, I can make a difference for our practices, for ourselves, and for our patients—the women of Canada and the world. We must all remember that we have social responsibilities: to participate as members of our community, to access every resource we can to improve our quality of care, and to be cognizant of social determinants of health and what we can do to eliminate inequities.
Changing the Future: Social Responsibilities
REFERENCES 1. Marmot M. Health equity through action on the social determinants of health. CMA 145th Annual Meeting, Yellowknife, NWT, August 2012. Available at: http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Annual_ Meeting/2012/presentations/Marmot_en.pdf. Accessed June 17, 2013.
5. Anderson I, Crengle S, Kamaka ML, Chen TH, Palafox N, Jackson-Pulver L. Indigenous health in Australia, New Zealand, and the Pacific. Lancet 2006;367(9524):1775–85.
3. Aboriginal Affairs and Northern Development Canada. The Community Well-Being Index (CWB): measuring well-being in First Nations and Non-Aboriginal communities, 1981–2006.
6. Wilson D, De la Ronde S, Brascoupé S, Apale AN, Barney L, Guthrie B, et al.; Aboriginal Health Initiative Committee. Health professionals working with First Nations, Inuit, and Métis consensus guideline. SOGC Clinical Practice Guideline no. 293, June 2013. J Obstet Gynaecol Can 2013;35(Suppl 2):S1–52. Available at: http://sogc.org/guidelines/ health-professionals-working-with-first-nations-inuit-and-metisconsensus-guideline. Accessed June 17, 2013.
4. Health Canada. A statistical profile on the health of First Nations 2001/2002. Available at: http://www.hc-sc.gc.ca/fniah-spnia/pubs/aborig-autoch/ stats-profil-atlant/index-eng.php. Accessed July 8, 2013.
7. Statistics Canada. 2006 Census data. Aboriginal peoples. Available at: http://www12.statcan.gc.ca/census-recensement/ index-eng.cfm. Accessed July 8, 2013.
2. United Nations Development Programme. Human Development Report 2013. Available at: http://hdr.undp.org/en/media/ HDR2013_EN_Summary.pdf. Accessed June 17, 2013.
SEPTEMBER JOGC SEPTEMBRE 2013 l 783
Changing the Future: Social Responsibilities Ward Murdock, MD, FRCSC President, Society of Obstetricians and Gynaecologists of Canada
I
t is a great honour to become the 70th President of the SOGC. I do think my appointment shows just how inclusive the Society is, because, after all, I am from a province with a population smaller than that of most cities in Canada. We have only 35 obstetrician-gynaecologists in New Brunswick. However, I hope I will be able to represent all our members, both in Canada and beyond, and I intend to be a strong advocate for women’s health in our country. Although there will be many competing priorities for our Society over the next year, I would like to touch on two areas that I feel will be of particular importance. The first of these is engagement. Our Society exists because of its members. Membership of the Society represents a commitment to quality of care: a desire to contribute your knowledge, a will to learn from others, and a social responsibility to participate in our community. I have heard from colleagues and in meetings with other organizations that it is becoming increasingly difficult to encourage young people to become involved in our professional societies. My experience has been quite the opposite. We have an active junior membership at the SOGC, and some of my best experiences have been in meeting our junior representatives as they spend a year on the SOGC Council. Our challenge is to find ways to keep these younger members engaged after they graduate from residency. Addressing topics and developing programs that are important to young professionals is one aspect of this. They face manpower issues, and job opportunities across the country have become a major concern. Although organizations such as the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada are pursuing solutions as well, junior members of our Society will look to the SOGC to take the lead. Nobody understands the situation at the ground level better than our Society. During my term, I will strive to make the needs of our next generation a priority.
One way in which we are already doing this is by including junior members as full voting members of SOGC. This will give junior members more voice and responsibility within the Society. I also hope to meet personally and frequently with our junior member representatives. Although these initiatives are a good beginning, my feeling is that the one thing most likely to result in continued participation of our junior members in the Society is encouragement from their colleagues after they graduate from residency. Veterans must take the lead in encouraging new graduates to participate in the SOGC. When I completed residency, I had no real idea what the SOGC was involved in, and I never gave much consideration to how I could contribute through the Society to improving women’s health. But when it was proposed that I become involved, my colleagues were immediately supportive; when I was first asked to serve on the Guidelines Committee, my more senior colleagues made it clear that this was something I should do. When I was asked to sit on the Council, my practice group members were supportive without question. When I was then asked to put my name forward for the presidency and asked my group colleagues for their support, they responded without question that I should proceed, even though this meant an increased workload for them when many were already struggling with work and family responsibilities. In my group of 10 obstetricians and gynaecologists, five are currently actively involved with our Society; four others are involved with provincial or local committees. The culture of our small practice group is that you can make a difference, and that it is your duty to help make the Society better and improve the quality of care that we and others provide. This is a philosophy I will emphasize at local and national levels in an attempt to increase the sense of belonging necessary for our membership and our Society to prosper. J Obstet Gynaecol Can 2013;35(9):781–783
SEPTEMBER JOGC SEPTEMBRE 2013 l 781
Guest Editorial
Secondly, I would like to discuss our work in Aboriginal women’s health. We have done, and continue to do, a great job of collaborating with First Nations, Inuit, and Métis women’s health professionals and relevant Aboriginal and non-Aboriginal organizations to advance culturally safe health and healing for Aboriginal women and their families. However, looking beyond the areas of acute need and helping to implement and advocate for long-term solutions is much more difficult. When we as Canadians look at the long-term, system-level issues we would like to solve, it is easy to become overwhelmed. It is often difficult to see how we as individual health professionals can make changes that will make a lasting difference to our First Nations, Inuit, and Métis patients. I was struggling with this until I heard a speech by Professor Michael Marmot at the Canadian Medical Association’s Annual Meeting in 2012, in which he spoke about the social determinants of health.1 Let me share some of the guiding principles that Professor Marmot applies in his roles at the World Health Organization and the European Union and within the Government of the United Kingdom. 1. Give every child the best start in life.
This is such a simple objective; however, we are nowhere near achieving this for Indigenous populations or other marginalized groups in Canada or internationally. Professor Marmot further stated: Disadvantage starts before life and accumulates throughout life; action to reduce the health inequities must start and be followed through the life of the child. Only then can the close links between early disadvantage and poor outcome throughout life be broken.1 The SOGC has been instrumental in advocating for a high standard of antenatal and perinatal care for Aboriginal people, but is this enough? Clearly it is not. It is not enough for our society to strive to provide good health care for mother and child only during the antenatal, perinatal, and postpartum periods. We must engage other groups to participate in helping with the long-term physical and mental health of the children and mothers in these communities; only then will there be a difference. 2. Enable all children, young people, and adults to maximize their capabilities and have control over their lives; create fair employment and good work for all; and ensure a healthy standard of living for all.
The Human Development Index ranks countries using a combination of indicators including life expectancy, education, and income. In 2006, Canada ranked sixth in the 782 l SEPTEMBER JOGC SEPTEMBRE 2013
world,2 but First Nations communities in Canada ranked 68th. Indeed there are significant gaps in life expectancy, education, and income.3 In Canada, life expectancy varies for First Nations, Inuit, and Métis, with average life expectancy six years below that of non-Aboriginal Canadians. The gap is narrowing, but remains significant.4 We are not alone in this: life expectancy of the world’s Indigenous communities is lower than the corresponding general population. Australia has an 11-year gap, and New Zealand has a gap similar to Canada’s.5 What are we doing currently as a Society to address the social determinants that create healthy, sustainable communities, and what can we do in the future? In June, the SOGC published a new guideline that suggests ways in which individual women’s health professionals can work to close the gaps in the social determinants of health by advocating for long-term, systemic change and empowering patients to receive better quality of care.6 With the SOGC’s support and resources, every member can be a leader and can advocate in this area. We also partner with other Aboriginal and non-Aboriginal organizations to support and empower their activities. And SOGC members help to further this work through your support and involvement. 3. Create and develop healthy and sustainable places and communities.
The health and well-being of Aboriginal women and communities in Canada is relevant to all of us. Aboriginal people are the fastest growing population in Canada, and they are increasingly moving to urban centres.7 As individual women’s health professionals we can begin by making strides to improve our capacity to provide culturally safe care to all of our patients, and especially our First Nations, Inuit, and Métis patients. In conjunction with the relevant social determinants of health, the SOGC’s guideline6 is a great resource and provides recommendations and clinical tips for beginning to advance culturally safe health and healing for Aboriginal women, their families, and their communities. The key principles can, in fact, be applied across everyone’s practice to advance the culturally safe health and healing of all patients. I am very excited about the year ahead; I hope that, with your help, I can make a difference for our practices, for ourselves, and for our patients—the women of Canada and the world. We must all remember that we have social responsibilities: to participate as members of our community, to access every resource we can to improve our quality of care, and to be cognizant of social determinants of health and what we can do to eliminate inequities.
Changing the Future: Social Responsibilities
REFERENCES 1. Marmot M. Health equity through action on the social determinants of health. CMA 145th Annual Meeting, Yellowknife, NWT, August 2012. Available at: http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Annual_ Meeting/2012/presentations/Marmot_en.pdf. Accessed June 17, 2013.
5. Anderson I, Crengle S, Kamaka ML, Chen TH, Palafox N, Jackson-Pulver L. Indigenous health in Australia, New Zealand, and the Pacific. Lancet 2006;367(9524):1775–85.
3. Aboriginal Affairs and Northern Development Canada. The Community Well-Being Index (CWB): measuring well-being in First Nations and Non-Aboriginal communities, 1981–2006.
6. Wilson D, De la Ronde S, Brascoupé S, Apale AN, Barney L, Guthrie B, et al.; Aboriginal Health Initiative Committee. Health professionals working with First Nations, Inuit, and Métis consensus guideline. SOGC Clinical Practice Guideline no. 293, June 2013. J Obstet Gynaecol Can 2013;35(Suppl 2):S1–52. Available at: http://sogc.org/guidelines/ health-professionals-working-with-first-nations-inuit-and-metisconsensus-guideline. Accessed June 17, 2013.
4. Health Canada. A statistical profile on the health of First Nations 2001/2002. Available at: http://www.hc-sc.gc.ca/fniah-spnia/pubs/aborig-autoch/ stats-profil-atlant/index-eng.php. Accessed July 8, 2013.
7. Statistics Canada. 2006 Census data. Aboriginal peoples. Available at: http://www12.statcan.gc.ca/census-recensement/ index-eng.cfm. Accessed July 8, 2013.
2. United Nations Development Programme. Human Development Report 2013. Available at: http://hdr.undp.org/en/media/ HDR2013_EN_Summary.pdf. Accessed June 17, 2013.
SEPTEMBER JOGC SEPTEMBRE 2013 l 783