Beyond Stress: How Leadership Style and Decision Making Authority Influence Health


When we talk about employment and health, the conversation usually focuses on how your health impacts your ability to find and maintain meaningful employment, or how being healthy impacts your performance at work. However, while the above is absolutely true, the opposite is true as well – employment is in fact one of the most influential determinants of health.

Some of the ways employment can impact your physical, mental, and social health include:

  • Positively influencing self-esteem
  • Providing a vital link between the individual and society
  • Enabling personal fulfilment
  • Social contact and satisfaction arising from involvement in a collective effort (Institute of Public Health in Ireland, 2005).

Not only does employment influence health directly, it also shapes many other aspects of life important for health and wellbeing, including the ability to pay rent, bills, and afford healthy food. For more info on how all of the various determinants of health influence each other, check out this great short video from the Wellesley Institute.

While employment in and of itself has been linked to health, specific aspects of your work also influence health – in addition to such obvious factors as physical hazards in the workplace or stress, the social organization of your workplace, management styles, degree of control you have, and social relationships have also all been found to influence health. Some examples of this include:

  • Little opportunity to use your skills and low decision-making authority can negatively impact health (WHO, 2003)
  • Little control over one’s work is strongly related to an increased risk of low back pain, sickness absence and cardiovascular disease (WHO, 2003). For example, a study of civil servants in the U.K. showed that individuals with low job control were nearly twice as likely to report coronary heart disease than other workers (Institute of Public Health in Ireland, 2005)
  • Receiving inadequate rewards (e.g. money, status, or self-esteem) for the effort put into work has been linked with increased cardiovascular risk (WHO, 2003).

In addition to impacting health, these factors also play a role in job satisfaction, performance, and success in your chosen field. Whatever your role at work may be, having control, being rewarded, and using your skills could positively impact all aspects of your life.

World Health Organization (2003). Social Determinants of Health: The Solid Facts.

Institute of Public Health in Ireland (2005). Health Impacts of Employment: A Review.

Assessing the Impact of a Policy or Program on the Mental Health of a Population

There are many definitions of mental health promotion that have been put forward by organizations, governments, and individuals from around the world. While all similar, there are some important differences that impact how mental health promotion is understood and practiced. One of my favourite definitions is this one: the “actions taken to maximize the mental health and wellbeing of populations by improving social, physical and economic environments; and strengthening the understanding and skills of individuals in ways that support their efforts to achieve and maintain mental health” (Victorian Government Department of Health, 2010).

The reason I’m so partial to this definition is because it highlights the fact that mental health is influenced not just by the knowledge and behaviours of the individual, but also by the environment in which he/she lives, works, and plays; what’s more, the environmental factors influencing mental health are mentioned first in the definition, implying considerable weight should be given to these factors. I find too often, emphasis is placed on what an individual can do to promote their mental health, with little acknowledgement of the structural and environmental conditions that play a significant role in one’s mental health and well-being.

This is the definition that is utilized within the Victorian Government Department of Health’s recent publication, Using policy to promote mental health. This publication is intended to provide policymakers with the skills to be able to understand and consider the social and environmental determinants of mental health when developing or reviewing policies. Some of these key determinants include social inclusion, freedom from violence and discrimination, education, income, employment, and working conditions. One of the things I appreciate most about this document is that it provides some concrete steps policymakers can take to assess the mental health promoting impact of a policy or program.

Because mental health is influenced by such a broad range of social, environmental and economic factors, a large majority of programs and policies could benefit from having their mental health promoting impact assessed. For instance, an assessment of the mental health promoting impact of the City of Vancouver’s Healthy City Strategy (which I have previously written about here) could be very useful in deciding which programs and policies to implement. I would encourage anyone involved in developing or reviewing economic, social, or environmental programs or policies to think about these programs/policies through a mental health promotion lens, and consider assessing the mental health promoting impact of their program/policy.

Victorian Government Department of Health (2010). Using policy to promote mental health. Melbourne, Victoria, Australia.

Masthead photo courtesy of Pink Sherbert Photography from Flickr

Bridging the Gap between Research and Action

Go to any academic journal and pull up a random scientific article. Can you understand it? Chances are you will probably not understand all of it. Even if you do understand all of it (yes, even including the statistical analysis section), do you understand how this relates to the dozens, hundreds, or even thousands of other articles done on the same subject? And equally as important, do you have the time to sift through stacks of articles to make an informed decision on a program, policy or service you are considering implementing in either your private or professional life? Herein lies the value of knowledge translation. Knowledge translation is the process of taking research and translating it into something practitioners, professionals, policy-makers and the general public can understand and use.

While this type of undertaking doesn’t happen enough in Canada (e.g. with professionals being given the time and resources to review research and translate it into understandable language), a good example of structures being put in place to support such KT activity is the National Collaborating Centres (NCC) for Public Health. These Centres aim to translate academic evidence and develop resources that can be used by public health practitioners and policy-makers to address a number of public health topics, including infectious diseases, health inequities, environmental health, and healthy public policy.

Living up to their name, the Centres also collaborate with one another on a number of special projects, including a structural profile of public health systems and functions across Canada. A particularly interesting project that has recently commenced within the National Collaborating Centre for Determinants of Health looks at how the social determinants of health and health equity can be integrated into population health status reporting, and in turn how such reports can result in effective health equity policies, and improved health equity in Canada.

While research and practice are equally as important and in many ways dependent on one another to fuel their respective activities, the importance of having systems in place that allow for critical and independent translation between the two is crucial to ensuring valid and reliable research is driving quality, evidence-based practice and policy.

The Launch of Vancouver’s Healthy City Strategy

This past Friday, I had the opportunity to attend the City of Vancouver’s Healthy People, Healthy City conference. The conference marked the launch of the Healthy City Strategy, which complements the City’s other two strategies – the Greenest City Action Plan, and the Vancouver Economic Action Strategy. Together, these three strategies attempt to address the social, ecological and economic needs of Vancouver. The Healthy City Strategy is comprised of three components – healthy people: taking care of the basics; healthy communities: promoting inclusion, belonging and connectedness; and healthy environments: ensuring livability now and into the future. Within each of these components, a number of ‘building blocks’ needed to achieve a healthy city are identified.

A highlight of the conference was the keynote address by The Globe and Mail public health reporter André Picard. Reflecting on what it takes to create a healthy city, Mr. Picard spoke of the importance of addressing the social determinants of health (for example, income and housing), as well as creating healthier environments through the creation of healthy public spaces, as a foundation of a healthy city. The focus on the social and environmental determinants of health speak to a good wealth of research suggesting that medical care accounts for only about 10% of one’s health. Some of Mr. Picard’s suggestions for creating a healthy city included investing in good public transit, public spaces, greenery, and local farming; developing public institutions in the downtown core; creating mixed-used neighbourhoods and roads; and de-uglifying the city by taking cars out of the equation as much as possible – a key facet in all of these suggestions is the ability to bring people together.

Throughout the morning, a total of 9 lighting-stroke quick presentations (no exaggeration – each presentation was three minutes long) described some of the ways in which the City  was already working towards some of the building blocks identified in the strategy. For example, Bill Briscall spoke of the ways RainCity Housing was creating opportunities for healthier housing, and Miguel Testa and Steven Dang spoke about CitizenU, an innovative initiative that engages young people as leaders in addressing racism, discrimination, and bullying. The afternoon panel echoed some of the key points made by Mr. Picard in the keynote address, with a focus on decreasing health inequities in our more vulnerable populations and creating healthier public spaces and opportunities for increased social connections (something addressed in length in this recently released Vancouver Foundation report).

The strategy put forward by the City of Vancouver is ambitious, and serves as a comprehensive conceptual framework for the City. Mr. Picard offered some good advice moving forward: be bold with the strategy, but remember to have goals and timetable, as well as to prioritize (“if everything is a priority, then nothing is a priority”). I look forward to seeing how the plan is put into action, and how it (in the words of Mayor Gregor) will accelerate and deliver.

Photo courtesy of JamesZ_Flickr

Play Dates, Imaginary Friends, and Getting Lost in the Woods: The Diversity of Play

Glimpses of summer these past few weeks spawned a conversation with my husband (and Daily Gumboot Editor-in-Chief John Horn) recently about our childhoods – what did we do in the summers? How did we play? Which one of us was more likely to run away into the surrounding woods and get lost? (I’m sure you can guess the answer to that one!). We discovered that although there were some similarities to our play, the different environments that we grew up in very much influenced the type of play we engaged in. For instance, John grew up in a rural environment, and I grew up in a semi-urban (okay, fine, suburban) neighbourhood. Not surprisingly, John spent more time freely exploring the wooded areas around his house, while I spent more time in backyards and a (now that I think back to it) fairly sketchy vacant lot up the street. Another difference we discussed was who we played with – because there weren’t a lot of other kids around, John spend a lot of time playing with his sister, or with his imaginary friend named Sparky*, while I played with a larger group of kids from the neighbourhood and school.

An article recently published in the BC Council for Families magazine, Family Connections, explored this concept of play across environments and cultures, and found that environments and cultures do indeed have a very large influence on play. These findings touched on some of the key differences John and I had explored – for example, one large factor that can lead to differences in play include whether there are other play partners around (neighbours, cousins, siblings, friends), and how safe it is to run freely around the neighbourhood.

Some interesting cultural differences were also explored within the article. For example, in Western society, it is emphasized that parents should devote time to play with their children, while in other cultures, the extended family plays a much larger role in playing with children than the parents. The idea of having structured play (e.g. sitting down to finish an art activity, like making a bracelet or using toys with numbers/letters) vs. free play (e.g. children engaging in pretend play, like playing kitchen) is also something that varies across – and within – cultures.

With the even-diversifying cultural landscape we find ourselves living within, these different approaches to play can lead to some interesting learnings, creativity and flexibility – but hey, isn’t that what play should be all about anyway?

*John may or may not have had an imaginary friend named Sparky.

What Makes for a Happy Country?

Recently, the very first World Happiness Report was launched by the United Nations, and Canada faired pretty darn well. After Denmark, Norway, Finland, and the Netherlands (all Northern European countries, of note), Canada ranked a respectable fifth. The least happy countries are all in Sub-Saharan Africa (Togo, Benin, Central African Republic, Sierra Leone). The report speaks to two broad measurements of happiness: the ups and downs of daily emotions, and an individual’s overall evaluation of life.

So what makes a country happy? Some of the criteria is fairly obvious – for example, wealthier countries ranked higher that poorer countries – while some criteria is a bit more surprising. Take, for instance, the role that political freedom and an absence of corruption play – together, these two factors, along with having strong social networks, play a greater role in well-being than income. In fact, while basic living standards were found to be essential for happiness, after the baseline was met happiness was found to vary more with quality of human relationships than income. Additional factors impacting happiness, at an individual level, included mental and physical health, job security, and stable families.

Not only does this information provide us all with some tips about where we might consider relocating, or changes we might consider making in our personal lives, it also offers important information about the society in which we live. As discussed within the report, such information can signify underlying crises or hidden strengths, and can often suggest the need for change. Such findings can also help countries to develop healthy public policies and practices. For example, based on the findings in the report, policy goals should include high employment and high-quality work; a strong community with high levels of trust and respect, which government can influence through inclusive participatory policies; improved physical and mental health; support of family life; and a decent education for all. With the attention paid over the last few years to the financial status of countries around the world, a report that focuses on happiness provides a refreshing lens through which to view true wealth.

Getting our daily dose of “Vitamin G”

Last September, over 200 participants took part in a unique forum in Vancouver to discuss nature and health – more specifically, the impact of spending time in nature on health, and the contribution of parks and protected areas to healthy communities. The forum sought to share knowledge, foster linkages between diverse sectors, and to identify best practices, strategies, and tools.

One of the things discussed by presenters and attendees was how people intuitively know that being in nature, simply put, makes them feel good. Whether getting a dose of ‘Vitamin Green’ helps to relieve stress, lift the spirit, or provide a bit of perspective on life, getting out into nature seems to contribute to enhanced wellbeing. While everyone intuitively understands this, our reductionist North American tendencies have had us questioning how and in what ways nature has this effect on health for the past decade or so. Well, good news for those of you scientific folk out there (you know who you are!) – the quantitative evidence supports a nature-health link. Our intuitive selves have been right all along! As discussed by keynote speaker Dr. Frances Kuo, research has linked healthy urban ecosystems to stronger, safer neighbourhoods, lower crime, reduced AD/HD symptoms, and reduced aggression, with benefits still being found even when income and other factors that could explain a nature-health link are taken into account. Additional quantitative evidence exists at the physiological level as well, with benefits having been measured objectively through such indicators as blood pressure and immune system functioning. For a comprehensive review of the literature, check out this National Recreation and Park Association report written by Dr. Kuo.

So now the evidence is there to prove what we kinda knew all along. What’s next? Well, at an individual level, we can all get outside more. If you’re like the bulk of urbanites, you may not be close to mountains, lakes, and forests (although a shocking number of us here in B.C. actually are – not to rub it in, Toronto). Forum presenters actually addressed this, and made it clear that nature can be found anywhere – a nearby park or stream by your house, a patch of trees outside your work – and even the smallest exposure to nature has been found to be beneficial.  In addition, urban planners and health professionals have been starting to act based on this ever-growing body of evidence. For example, some physicians are now prescribing time in nature to their patients.

Getting past the urban/nature divide may take some work ... but it can be done

It’s clear that to address this at a population level, an interdisciplinary approach is needed, with health professionals, urban planners, and environmental specialists being just a few of the disciplines who need to be at the table to ensure that all Canadians have access to diverse and regular sources of nature. If this forum is any indication, these various disciplines are ready and willing to come together to focus on this in creative and holistic ways.



Fans, food and flummox: The Vancouver Canadians Experience

Last Saturday night, I had the pleasure of attending a Vancouver Canadians game with a group of family and friends. Having spent the last year focused on learning the basic rules of soccer so that I could muster my way through a Vancouver Whitecaps game without completely embarrassing myself, I’m flummoxed and somewhat hesitant to admit that I somehow lost all of my knowledge of baseball. After receiving a crash course (and braving the incredulous response I received from my husband, who asked more than a few times, ‘you’re joking, right?’), I was able to sit back, enjoy the game, and, more importantly, critically analyze some of the key differences and similarities between Vancouver’s sports teams. In no particular order:

1. The fans

The ever-enthusiastic Whitecaps fan base

One of the key things that struck me was the difference in tone, atmosphere, and make-up of the fans. The Canadians game was definitely more family-friendly – a claim I can confidently make after astutely observing the large number of families in attendance. That, plus the fact that I left the game without hearing one swear word or having any beer spilled on me – two things one can always count on at any given Whitecaps game. What’s more, I didn’t notice a lot of folks on their cell phones or wearing business suits, which tend to be frequent sites at Canucks games.  I chock this difference up to – not surprisingly – the low cost of tickets and marketing efforts geared towards families.

2. The food

Sadly, the food is one similarity that I wish was different. It tends to be overpriced, unhealthy fare no matter what the venue or sport. While fans justify overindulgence with the explanation that, “you gotta have [insert unhealthy food option here] when at a [insert sport here] game!”, for those of us who care about what we put into our bodies or where our food comes from, having some healthier options would definitely be appreciated.

3. Advertising and corporate sponsorship

Advertising at the Nat - No space left unspoken for

While advertising and corporate sponsorship are of course prevalent across all sports organizations, I found there was quite a difference in advertising methods, dependant on opportunities for promotion within the structure and coverage of the game. Given the continual flow of soccer, with few breaks other than half-time, advertising is done through marketing materials, clothing and gear. With a large Bell logo on the front of our jerseys that we wear to every game, we the fans advertise on our team’s behalf. On the contrary, with the frequent commercial breaks and high viewership of Canucks games, most advertising is done through commercials. In the most hilarious of advertising efforts, the Canadians squeeze it in where they can: between innings. A Smart car driven around the field between second and third inning? That will do!

So there it is – a few observations from a casual fan, slowly learning about the fascinating world of Vancouver sports.

The Good Earth

CLJ Reviews The Good Earth by Pearl S. Buck

What We Read

The Good Earth was published in 1931 and won the Pulitzer Prize in 1932. Generally regarded as a classic, I chose the book for two reasons: 1.) It’s my mom’s favourite book and I promised her we would read it for Book Club, and 2.) Yann Martel – out of all the books he could have recommended to us in his letter to the CLJ – recommended this one (which of course led to numerous claims of “I told you so!” by my mother). Turns out, it really was a great book suggestion. The Good Earth tells the story of a simple, farm family living in pre-revolutionary China who encounter many trials and tribulations throughout the course of the protagonist, Wang Lung’s, life. Facing not just drought, pestilence, and floods, Wang Lung must learn to grapple with conflict within his family, and his own feelings of lust, greed and entitlement.

What We Did (and How We Did It)

One of the major themes within the novel is the importance of being connected to the Earth – when Wang Lung leaves his land, hurt and despair seem to follow closely behind. Within the novel, the cultural belief that various Gods are responsible for the fortunes or misfortunes of the family is also evident. Tying these two themes together, the activity asked CLJ members to spend some time planting seeds of their choices into small pots. They were then asked to take on the persona of a character in the novel and pray to the Gods for their seeds to grow and flourish –with the best depiction of character and plea to the Gods, our newest CLJ member Alison Atkinson took home the trophy.

What We Thought

The group talked a lot about the relevance and appropriateness of a privileged American woman telling this story from the perspective of a Chinese peasant. Given the year of publication and popularity of the novel in America (and around the world), we also talked a lot about this book’s probable impact on how many Americans viewed China, as this book was arguably one of the earliest and most realistic depictions of Chinese life that many Americans would have been exposed to. The underlying themes of greed, the social order, and the treatment of women were also explored. Most members of the CLJ thoroughly enjoyed the book – or at the very least, appreciated the opportunity to read a thought-provoking piece of literature they otherwise would not have read.

As told by Michelle Burtnyk-Horn

Community on the Juan de Fuca Trail

47 kilometers of West Coast awesomeness!

Last week, John and I went on an adventure in the wilderness. After weeks of accumulating supplies, preparing menus, going on test hikes, and becoming far too acquainted with the staff at MEC, we set out on the Juan De Fuca Trail on Vancouver Island’s West Coast. Mentally – and somewhat physically – prepared for the 47 km, 5 day hike, what follows is a daily synopsis of the ups and downs (literally and metaphorically), our observations about community we found on the trail, and some stories and anecdotes that are just, well, funny.

Bear Beach looks good early in the morning.

Day 1: China Beach to Bear Beach

Filled with excitement and anxious to get started, we threw on our packs and headed towards the trail from the China Beach parking lot … only to be stopped in our tracks by a number of minor, let’s say, incidents. Incident #1: John realizing his water bladder, attached to his backpack, is empty … which subsequently made sense when we noticed that the back seat of the car was soaked. Incident #2: Michelle checking her pocket for the map to give it one last look, only to realize it’s nowhere to be found. Good thing it turned up … in her father-in-law’s pocket! Incident #3: Backcountry camping fees? Strictly enforced and payable at the start of the trail? Needless to say, we knew nothing of backcountry camping fees. To add to the confusion, we received five different answers from five different people about how we could pay and how much it was – luckily, the parents-in-law come to the rescue, making up for the near-fiasco with the map. Despite the multiple incidents, we head out on the trail (half an hour later than expected), arriving safe and sound about 4 hours later at beautiful Bear Beach.

This was one of the 15 or so times that Michelle walked up during the Day 2 experience. Also, love the pink!

Day 2: Bear Beach to Chin Beach

By 10am we had packed up our wicked awesome camp site – complete with giant table – and were striking out on the trail behind a group of Japanese tourists, Team Texas and a hardcore young man who was, apparently, doing the entire trail in three days. The kid was moving fast.

For seven hours – over about 12 kilometers – John and I hiked up and over about 15 different headlands. This basically meant walking up for about 150-200 meters, looking around at the gorgeous, lush and spectacular scenery, and then walking down for about 150-200 meters. And then we crossed a creek. And then we did it all over again. Other than expelling a combined 30 liters of sweat and starting to feel our packs weighing on our shoulders in achey new ways, this part of the trail was an achievement of epic proportions with very little collatoral damage to our bodies, minds and/or souls. By 7pm we settled into a delicious meal of quinoa next to a modest little fire and watched seagulls feast on shellfish under a misty sunset.

The 16 kilometer marker was a long, long, long time coming. Mostly because we either missed marker 15 or it's missing along the trail. Needless to say, we stopped for lunch here.

Day 3: Chin Beach to Sombrio Beach

MICE! That’s right. Focusing a lot – perhaps too much – on nefarious bears and cougars, we underestimated the chewy vigour of some other four-legged creatures who live on Vancouver Island’s West Coast. During the night, a gang of wild mice gnawed through our packs in search of delicious treats. Luckily, no trail mix or my candies were harmed.

This hike was similar to – but not the same as – day two. We went up, up, up a lot right away, but there wasn’t as much repetition. Also, a kilometer of the hike took place along about a flat and groomed old logging road. Quite a nice respite!

Arriving at Sombrio Beach, John and I learned a lesson about “maps” and “distances” at Sombrio. The 20.7 kilometers listed on the map got us to Sombrio Point, not the beach itself. No, to get to the beach we hiked with our tired legs (in utter silence, which says a lot) along a sheer cliff, through some slippery, smelly muck and up, over and around two coves. Though the trail wasn’t actually all that technical, this is the place where – because of sheer fatigue – we could’ve died quite easily because of one little misstep (or perhaps because we let our guard down against the roaming packs of radioactive ninja mice that the Juan de Fuca Trail might possibly yield).

Oh, and Sombrio is the place where we started having deeper conversations with our new friends, the Texans, who were particularly impressed by the awesomeness of our campsite and my very pink hiking attire.

John relaxes by our very awesome campsite and even more awesome fire at Sombrio Beach.

Day 4: Sombrio Beach to Payzant Creek

Before leaving Sombrio we stumbled across a family of sea otters.

Waking up to the sound of crashing waves might be the best sound. Ever. Follow that with a delicious Spanish Frittata breakfast (thanks, MEC!), coffee, and a flawless pack-up, and we found ourselves setting out happily for an apparently “moderate” (according to aforementioned “map”), albeit long (13 km), day. The day was, actually, quite moderate – if one were to compare it to the gruelling terrain of the previous two days. Compared to day one, it was definitely harder and almost twice as long.

The hike itself was gorgeous. We left the comfort of the coastline for the more mysterious woods, finding ourselves surrounded by old growth trees and cooler temperatures. Setting up camp in the middle of a rainforest, mist and sunshine streaming through the myriad of trees, was one of the memorable moments of the trip. Team Texas wandered in a few hours after us – we felt a bit better about how incredibly sore we were after seeing them limp and drag themselves into the campsite. As we weren’t allowed fires in the woods, Day 4 was an early night – we were asleep no later than 9:30pm (which was probably a good thing, as it allowed our bodies to recuperate from the pain we had inflicted upon them).

The towering trees around Payzant Creek!

Day 5: Payzant Creek to Botanical Beach

A bittersweet day – a mere 7 km and we would be back in the real world! While we were looking forward to a homecooked meal and mostly, well, not smelling, it was sad leaving the calm, relaxing and awe-inspiring wilderness. This short four hour hike out, with lots of boardwalks and more and more hikers as we got closer to Botanical Beach, included a permit-check by a BC Parks Ranger/Warden/Guide/Hero as well as many fun chats with our Texan friends as well as Jonathan, a lone hiker from Winnipeg who was just downright delightful.

 Final Reflections

Since monkeys jumped down from trees, crossed the svannah, killed all the dinosaurs, and turned into people we’ve had a very interesting relationship with nature. We’ve worshipped, groomed, destroyed, restored, protected, developed, and celebrated the Earth during our time here. And that might be the coolest thing about getting out into nature and away from so much urbanity – a simple and fun five days in the woods is enough to remind any city dweller that people are a part of the natural environment and it’s a part of us. Taking time to appreciate this relationship is as important as it is enjoyable.

Thanks, Juan de Fuca Trail for being so darn enjoyably natural!