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Population health is in essence an evaluation of upstream determinants of health as well as health outcomes. The entire aspect of population health includes health determinants, results, health policies and engagements that are linked to them. The evaluation of upstream determinants and health results are used in all the activities of the public healthcare delivery system and all agencies that struggle with health improvement.

Health inequality indicates that the high value devoted by Canadians to universal healthcare does not match the equal access to fundamental materials and social conditions, which protect and promote health. If social and local inequalities continue to rise in Alberta, then the potential of health disparities will increase to unprecedented level. Major policies, including those that guide consumption, income and social programs, which impact the distribution of social and material resources in Alberta, have been insufficient in addressing health disparities among the local populace. This paper utilizes an aggregate of 30 pregnant women in Alberta in order to assess the population health among pregnant women in this region.

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Income Level in Alberta

The Canadian Household Survey estimates that 95.1% of Canadians above the age of 15 are in some form of employment, whether in the private or public sector. The source of income comes from different areas, mainly from market sources and governmental transfers. By the end of 2014, the amount of income received by Canadian citizens majorly came from market income, while government transfers formed the remainder. Income emanating from employment sources constituted roughly 84.7% of all family income.

Despite these promising figures, a survey conducted on income data from 2000 to 2004 points out that the rate of poverty in Alberta has remained the same since 2000. The study has noted that the poverty level has stagnated in Alberta despite the economic growth. What is more, the income gap between the poor and the rich in Alberta is increasing at a tremendous rate. When compared to the total after tax income, this gap is even larger.

The Current State of Midwifery in Canada

Canadian aboriginal midwives have for a long time been encountering social, political and cultural hurdles in their profession. They have negatively influenced health outcomes and cultural aspects. Furthermore, the modernization of in technology has diminished the role of a traditional midwife. However, the new perspective with regard to how the American and Canadian governments view these traditional midwives should reverse this new trend. It is expected to incorporate the merging of a traditional midwife with modernity so as to provide enhanced maternity services attempting to boost the general healthcare delivery for pregnant women.

In modern times, most Canadian states are endeavoring to support and incorporate modern forms of midwifery, which are more advanced than the traditional ones. This trend has subsequently led to the categorization of professional midwifes under different titles such as CPM, CM, CNM and so on, depending on their area of certification and experience. Different titles of midwifes also attract different salaries. Interestingly, the services of midwifes of all levels or categories have been standardized across all regions. Therefore, it is only important for the local government and responsible stakeholders to state initiatives that will ensure that those who practice midwifery are well trained and adequately prepared to perform their roles effectively. This approach will subsequently ensure quality healthcare and improved child delivery, thus reducing potential complications in pregnant women.

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Alberta Health Community Diagnosis

There are several aspects that determine population health. They can be environmental, personal, social, economic and geographical. These aspects, also referred to as the determinants of health, can be utilized to assess the individual as well as the population health. The aspects that have the utmost influence on population health are entrenched in the society’s economic and social relationships. Therefore, environmental aspects, individual behavior as well as healthcare emerge to be less important than the social aspects.

Several studies carried out by various authors have established that Alberta citizens do not have sufficient access to health because of a number of reasons, which include structural and financial barriers. Financial barriers include inadequate or lacking health insurance. On the other hand, structural barriers include insufficient or no transportation as well as poor geographical access to organizational barriers and health providers. Considering demographic and economic features of health population in Canada, there is no doubt that Albertans are facing barriers to acquiring healthcare.

Social determinants reflect physical circumstances and social issues in a specific environment where individuals work, grow and learn. Physical and social determinants of population health have a strong impact on its functioning, health, and quality of life. The behavior of an individual is also a critical factor, which could influence health outcomes in relation to the person’s choice of food, smoking, and drinking, lifestyle and so on. For example, individuals who suffer from a habit of smoking have a possibility of acquiring lung cancer and other lung diseases. Essentially, there are some biological and genetic factors, which have more influence on the population health than others. For instance, elderly people are more prone to health-related risks when compared to adolescents and teenagers because of the physical and cognitive effects of aging.

In Alberta, geographic location is one of the most critical issues affecting the quality of healthcare in this state. In the survey, respondents have pointed out that though the majority of pregnant women and other patients have access to health services provided by Canada Health Act, rural regions, including Alberta, still lack major social services and are medically underserved. Furthermore, poor access to health facilities by Alberta women has been highlighted by the lack of information about sexuality, positive human relations, physical violence and drug abuse, which are common problems in this region.

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Socio-Economic Determinants

Economists have for a long time been claiming that economic inequality eventually leads to other inequalities. Clark et al. (2014) point out that income disparities are more closely associated with resource inequalities, which go along with the disparities in education access, nutrition, and other life necessities (p. 5). Several studies portray that wealth is more evenly distributed as compared to income, and, therefore, the most familiar measure of inequality involves income.

The most recent report shows that the top 5% of households in Canada received 22.1% of equivalence-adjusted cumulative income for last year, which was almost as much as the bottom 58% of households. However, economists argue that income data has too many flaws and cannot be the primary inequality measure. On the other hand, almost all inequality measures use income even before transfer pavements, such as food stamps, social security and unemployment benefits, and taxes, which may eventually reduce inequality. However, some evidence-based studies show that transfers and taxes reduce income

Consequently, low social-economic status influences lifestyle choices of Albertans. For instance, among Albertan women, health-related behaviors, including cigarette smoking, obesity, laziness or physical inactivity, are common phenomena. Moreover, there attributes are usually related to low-social economic background.

Environmental Determinants

Another determinant that is also crucial with regard to human health is an environmental factor. The environment has a potential of affecting the health of a population positively owing to the fact that it acts as a source of recreation, nutrition, and exercising. However, there is a number of ways in which the environment can cause diseases, since it can also be a breeding ground for germs. What is more, the environmental disruptions including floods, volcanoes, droughts, earthquakes, storms could pose as health risks

There has been a perception that Albertans are disconnected such from environmental matters as global warming. A study performed by the Pew Research Center (2013) points the Canadians have a lot of concern for environment, especially global warming. The same study has established that 76% of Albertans are concerned that the increasing rate of global warming is affecting them negatively. Among the reasons for high concern for the environment is the fact that Canadians who live in rural areas are under the risk of pollution. Furthermore, the neighborhoods of Albertans are located near power plants and highways. In addition, findings derived from this study indicate that this population has been exposed to high levels of toxic nitrogen dioxide, which is 38% higher compared to other regions. Nitrogen dioxide is related to respiratory ailments. On the other hand, carbon dioxide, which is emitted by power plant and vehicles, is linked to global warming. High levels of exposure to carbon dioxide have stirred the community to support regulations related to pollution.

According to Chakraborty, Maantay and Brender (2011), scientists have made a noteworthy contribution by providing insights on how cultural and social structures as well as processes influence human health. It has been found out that cultural and social factors do influence health by making people exposed to diseases, risky behaviors, efforts relating to health promotion and availability/accessibility of health care. Social cultural factors are quite significant in shaping responses and perceptions in relation to health problems and the effect of poor health on the well-being and life of an individual. Additionally, such factors also contribute to the understanding of societal processes, including mortality and survival, present and changing morbidity rates, and so on. Various studies have disclosed the significance of cultural and social factors in relation to population health. They have also provided the insight concerning the available opportunities for improving health by better understanding the mechanisms that link cultural and social environments to particular health outcomes.

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Health Promotion Approaches among Pregnant Women

Johnson (2011) explains that nursing is the fostering of effective and efficient behavioral functioning in the patient that curbs or prevents sickness. In this respect, midwives can only be able to effectively foster behavioral functioning among patients if they are well trained to do so.  Health promotion enhances health determinants’ control over patients motivating them to make informed decisions concerning their health. Nurses and midwives are required to consider health promotion as a means of resolving health issues and challenges that their clients encounter. Moreover, they are expected to communicate any prevalent or emerging issue to the client.

The knowledge of health promotion is expected to equip clients with the insights that are necessary for addressing health issues that they encounter. Consequently, midwifes and nurse practitioners have to be equipped with the skills and knowledge that will be necessary for them to carry out health promotion initiatives for their clients. The process of health promotion can only work if professional midwifes and nurse practitioners have the necessary capabilities and skills. The process will be reinforced if such people are mobilized in controlling their lifestyles and actions according to the health aspects of their environment. Furthermore, positive health aspects should be instilled in clients so that they can understand why and how to maintain their conditions.

According to Johnson’s model, there has to be interaction, organization, and integration of various elements and parts as well as interdependency of behaviors that makes up the whole system. Rodgers (2000) adds that the uniqueness of nursing and midwifery is derived from the fact that they are both an art and a science. He theorized that nurses and midwives ought to be concerned with clients and their relationships with their immediate environments, which are important elements for improving their conditions. According to him, the nature of individuals is irreducible and different with regard to the totality of their various parts. The relation of individuals to their environment is an essential aspect for coordinating multidimensional elements of open systems. 

According to Johnson (2011), the goal of nursing is to assist a patient whose behavior is aligned with social demands, as he has the capability of modifying his behavior in ways that support biological imperatives. A particular patient ought to benefit to the full extent during healthcare provision. In order to provide full benefit to the client, midwives have to undergo special training in order to acquire the necessary knowledge and skills related to their practice.

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Primary Prevention Approaches

The most successful technique of tackling health inequalities among the Albertans is employing primary prevention advances. This aspect refers to the avoidance of disease conditions by reducing exposition to risk factors that lead to such diseases. The measures in primary care may include nutrition, regular physical activities, and a cessation of drinking and/or safe sexual activities. The members of the society may also be encouraged to seek healthcare services whenever they need them.

On the other hand, tertiary prevention is the objective of caregivers and healthcare providers. The knowledge of primary prevention mechanism will assist people to maintain their health as well as prevent various issues from happening. Furthermore, it is important to understand that primary prevention is for the common individuals, while secondary prevention requires the participation of both the healthcare user and the health worker. On the other hand, tertiary prevention is reserved for healthcare providers, since they are the ones with the requisite knowledge. A person’s state of mind, actions and behavior influence disease prevention efforts and related death instances. As a result, an individual is mandated to make changes with respect to his or her lifestyle for effective health promotion. Therefore, primary prevention is important, since it enables members of the society to avoid diseases regardless of whether healthcare providers are available or not.

The Johnson’s model can be applied as a conceptual model for evaluating the needs of pregnant women during child delivery. In particular, this model is a practical tool for implementing all phases of child delivery encompassing the mother’s feelings, desires, and needs.

Fruehwirth (1989) points out that a combination of Johnson’s model and Piagetian theory allows the nurse and/or midwives to objectively describe the behavior of patients, which serves to point out the presence of any particular disequilibrium. Furthermore, this model could be used by midwives effectively for a group where choice-making and problem-solving are necessary for adapting to lifestyle changes.


The uneven access to health care among pregnant women depicts that despite Canada being an advanced nation, there are still some groups of people who face dramatic health disparities. Significant challenges of the Albertan community, including socio-economic and environmental issues, expose it to various health-related risks. Alongside with the lack of insurance, these issues keep people at risk of various ailments. However, health promotion strategies, such as providing primary care preventive skills and improving income levels, have the potential of reducing vulnerability.

CPM care should be made safer, more accessible and cheaper for the clients. In addition, this care should be oriented towards customer care and support. This approach will result in the collaboration between the client and the caregiver. This kind of care is needed today in order to solve maternity woes.

The use of Johnson’s model for the evaluation of the client’s behavioral system is an effective way of determining various factors which can stir the ability of an individual to cope with the situation. For instance, caregivers or practitioners have to instill the necessary knowledge about how to manage or cope with a particular situation into their clients. Consequently, such practitioners must also have the required knowledge and skills alongside the interactive skills. Therefore, such practitioners have to be trained accordingly in these aspects. Generally, midwifes with no or low training are at a disadvantage with regards to the provision of care to the patients. Lastly, the application of models and theories for evaluating clients will enable professional nurses and midwives to categorize observed phenomena and gain insights on various contexts.