Exploring health promotion practitioners’ experiences of moral distress in Canada and Australia

Abstract

This article introduces moral distress - the experience of painful feelings due to institutional constraints on personal moral action - as a significant issue for the international health promotion workforce. Our exploratory study of practitioners' experiences of health promotion in Australia and Canada during 2009-2010 indicated that practitioners who work in upstream policy- and systems-level health promotion are affected by experiences of moral distress. Health promotion practitioners at all levels of the health promotion continuum also described themselves as being engaged in a minority practice within a larger dominant system that does not always value health promotion. We argue that health promotion practitioners are vulnerable to moral distress due to the values-driven and political nature of the practice, the emphasis on systems change and the inherent complexity and diversity of the practice. This vulnerability to moral distress poses significant challenges to both workers and organisations and the communities they seek to benefit. We propose that further research should be undertaken to fully identify the causes and symptoms of moral distress in health promotion. Extensive existing research on moral distress in nursing provides ample resources to conduct such research.

A Brief Foray into Social Inclusion- what does it mean for professional health practice?

“…While our general health, mental health and overall wellbeing is very much socially determined, all levels of government appear increasingly focussed on individual risks and lifestyle factors (Lin & Fawkes, 2007). Indeed, this dilemma and its associated tension have since been identified as a primary source of moral distress for health professionals (Sunderland, Harris, Johnstone, Del Fabbro, & Kendall, 2014). Is it really surprising, despite the significant investment, good work and good practice that has been identified, in particular, in partnership with the community sector to improve Indigenous health, education and employment outcomes in Australia, that ten years on we are still looking to make significant inroads against the targets identified to Close the Gap (in disadvantage) without corresponding structural reforms?…”

“She’ll be right, mate!”: do Australians take their health for granted?

“…20 Employment status, education level, income and location (state and postcode) were also all selfreported. 2,12,[21][22][23] To control for the effect of health professional perspectives, an item was included to ask if people had worked in the health system in the previous 10 years.…”

“…1 This approach has relied on actively seeking to increase awareness for health and promote healthy choices through social marketing campaigns. 1,2 Health consciousness is described as 'the degree to which an individual is conscious of his or her own health'. 3 Health-related motivation plays a primary role in determining individuals' engagement in specific health behaviours.…”

Expanding the breadth of Medicare: learning from Australia

“…These similarities of history (majority), language and national wealth, and the similar Medicare arrangements mean that the health systems in the two countries are closer in structure than any other pairing for both Canada and Australia and have often led to the two nations being part of: comparative studies of aspects of system performance (Morgan et al, 2006;Clement et al, 2009;Tempier et al, 2009;Coleman et al, 2011;Sunderland et al, 2015); system organisational arrangements (Philippon and Braithwaite, 2008;Elson, 2009;Suchowersky et al, 2012); contracting and accountability for Indigenous health care (Lavoie, 2004;Lavoie et al, 2010;Dwyer et al, 2011;Tenbensel et al, 2014); as well as a number of whole system comparative publications (Duckett, 1983;Crichton, 1995;Crichton, 1998;Duckett, 2015). Australia and Canada were two of the original five nations included in the Commonwealth Fund's International Health Policy survey, the others being New Zealand, the United Kingdom and the United States (Donelan et al, 1999;Schoen et al, 2000), and Australia remains one of the 11 countries in the contemporary surveys (Osborn et al, 2016).…”