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This chapter is a theoretical discussion developed by two PhD-prepared nursing professors. Our thinking is embedded in more than 55 years of mental health nursing practice and academic experience. Many of these years were spent working with children, youth, adults, families and communities in crisis – those who bump into the most pointy edges of life and society. We have walked along with street youth, domestic violence survivors, refugees, young offenders, women preparing for criminal proceedings and people who misuse substances. We have worked and volunteered in community-based non-profit organisations, hospitals, emergency services, community mental health clinics, provincial and federal governments, and the World Health Organization. We have worked primarily in Canada, but have also been touched by the most vulnerable in communities in Mexico, Cuba and India. We have extensive backgrounds in the application of social sciences to health issues.
Our theoretical standpoint is that of critical feminist theory based in realist ontology/epistemology and complexity science, and we use an intersectionality lens to draw this thread through our discussion. Our strong practice and academic backgrounds ground our thinking in interrogating oppressions and their intersections and public system complexity as they relate to criminal justice. In our academic and practice work, we focus on the social determinants of health (SDH). The primary factors that shape the well-being of individuals, families, communities and nations are not medical treatments or lifestyle choices, but rather the living conditions they experience (Mikkonen and Raphael, 2010). These factors are known as the SDH: employment and working conditions; income and its equitable distribution; education and early childhood development; housing and food security; age; gender; and race. The SDH are also related to the extent to which citizens are ‘provided with the physical, social, and personal resources to identify and achieve personal aspirations, satisfy needs, and cope with the environment’ (Raphael, 2009, p 56). According to the World Health Organization (2008, p 1), the SDH are important markers of inequalities in health and well-being:
The poor health of the poor … is caused by the unequal distribution of power, income, goods, and services, globally and nationally, the consequent unfairness in the immediate, visible circumstances of peoples’ lives – their access to health care, schools, and education, their conditions of work and leisure, their homes, communities, towns, or cities – and their chances of leading a flourishing life.
Primary health care (PHC) plays a pivotal role in health system reform locally and globally. The use of well functioning interprofessional primary health care (IPHC) teams is recognized as a key strategy in widespread health system reform across global, national, and provincial jurisdictions. IPHC teams contribute to the improvement of the health and well being of the population. These teams engage in issues that are a priority for citizens, such as: providing good evidence-based care; supporting the efforts of individuals, families, and communities in leading healthy lives; actively and deliberatively involving citizens in decisions affecting their health and health care system; and addressing the systemic social, economic, and political causes of health disparities, such as poverty, violence, and rural isolation. Many jurisdictions have begun to experiment with and implement major changes in the delivery of PHC. This has required that health care managers and practitioners reconsider the ways in which they have traditionally worked. However, although many innovative PHC services were developed, the notion of how to best develop and sustain the service delivery team itself and within what contexts could have used more deliberate attention. There are no documented best practices for rural IPHC team development and sustainability in the scholarly literature. This paper presents the results of a literature review, including the empirical and conceptual evidence regarding team development, team sustainability, and the role of rural context in IPHC team development. An argument for advancing PHC research that focuses on rural IPHC team development and sustainability is posited.
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