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Chapter 1: The History of Health Care in Canada MULTIPLE CHOICE 1. When and where was Canada’s first medical school established? a. Saskatoon, in 1868 b. Ottawa, in 1867 c. Montreal, in 1825 d. Kingston, in 1855 ANS: C Feedback A The first medical school was not established in Saskatoon in 1868. B The first medical school was not established in Ottawa in 1867. C The first medical school in Canada was established in 1825 in Montreal. D The first medical school was not established in Kingston in 1855. DIF: Cognitive Level: Knowledge REF: p. 4 2. In 1834, William Kelly deduced which public health principle? a. Vaccination can successfully eradicate smallpox. b. Education is directly related to health. c. Quarantine effectively contains infections. d. Sanitation and disease are related. ANS: D Feedback A William Kelly did not deduce that smallpox could be eliminated with a vaccine. B William Kelly did not deduce that education level was related to health. C William Kelly did not introduce quarantine to contain disease. D William Kelly suspected a relationship between sanitation and disease and deduced that water might be a source of contamination. DIF: Cognitive Level: Knowledge REF: p. 5 3. Which of the following volunteer organizations was involved in the evolution of health care in Canada? a. The Order of St. John b. The Veterans’ Society c. The St. Andrew’s Society d. The Canadian Nurses Association ANS: A Feedback A The Order of St. John was introduced in Canada in 1883; the members had knowledge of first aid, disaster relief, and home nursing. B The Veterans’ Society did not play a part in the evolution of health care in Canada. C The St. Andrew’s Society did not play a part in the evolution of health care in Canada. D The Canadian Nurses Association did not play a part in the early evolution of health care in Canada. DIF: Cognitive Level: Knowledge REF: p. 6 4. What did the Hospital Insurance and Diagnostic Services Act (1957) propose? a. Provinces without a health insurance plan must pay additional federal tax. b. Provinces and territories with a health insurance plan would receive substantial funding from the federal government. c. Certain services would no longer be funded by the federal government. d. Physicians would be allowed to charge a fee for service to the client. ANS: B Feedback A The Hospital Insurance and Diagnostic Services Act did not propose an increase in tax for provinces without a plan. B Under the Hospital Insurance and Diagnostic Services Act (1957), provinces and territories with a health insurance plan would have funding matched by the federal government by 50 cents for every dollar. C The Hospital Insurance and Diagnostic Services Act did not propose the removal of insured medical services. D The Hospital Insurance and Diagnostic Services Act did not allow physicians to charge a fee for service. DIF: Cognitive Level: Knowledge REF: p. 13 5. What major change in political thinking occurred in post–World War II Canada in relation to health care? a. Universities should educate more nurses. b. The government should not be required to provide access to primary health care. c. Individual families should be responsible for absorbing the cost of health care. d. Governments should be responsible for providing basic services like health care. ANS: D Feedback A The need to educate more nurses was not part of post–World War II thinking in Canada. B The lack of responsibility of the government to provide health care was not part of post–World War II thinking in Canada. C The belief that families should bear the cost of health care was not part of the political thinking in post–World War II Canada. D In post–World War II Canada, and in the aftermath of a depression, the thinking shifted to the idea that governments had an obligation to provide Canadians with a better standard of living, including access to quality health care. DIF: Cognitive Level: Analysis REF: p. 12 6. What important act was passed by the government of Tommy Douglas in Saskatchewan in 1947? a. The Hospital Insurance Act b. The Medical Care Act c. The Hospital Insurance and Diagnostic Services Act d. The Canada Health Act ANS: A Feedback A The Hospital Insurance Act was passed by the government of Saskatchewan, led by Tommy Douglas, in 1947. It guaranteed Saskatchewan residents hospital care in exchange for a modest insurance premium payment. B The Medical Care Act was not passed in Saskatchewan in 1947. C The Hospital Insurance and Diagnostic Services Act was not passed in Saskatchewan in 1947. D The Canada Health Act was not passed in Saskatchewan in 1947. DIF: Cognitive Level: Knowledge REF: p. 14 7. What important recommendation was embodied in the Hall Report? a. Individuals should take responsibility for some of their health care costs. b. Preventive health measures would be a wise investment. c. Extra billing should not be part of Canada’s health care system. d. Provinces should retain full control as well as financial responsibility for health care. ANS: C Feedback A The Hall Report did not propose that individuals pay for some of their health care costs. B The Hall Report did not propose that preventive health measures would be a wise investment. C The Hall Report recommended an end to extra billing and suggested that, instead, doctors be allowed to operate entirely outside of the Medical Care Act. D The Hall Report did not propose that provinces should retain all financial responsibility for health care. DIF: Cognitive Level: Analysis REF: p. 17 8. Why did the Established Programs Financing (EPF) mechanism of funding become inadequate for health care? a. The government imposed many corporate tax cuts. b. Health care spending increased dramatically, causing provincial and territorial overspending. c. The cost of education took up more dollars than had been anticipated. d. The population of Canada increased much faster than was anticipated. ANS: B Feedback A Tax cuts did not cause the inadequacy of funding. B In the few years following the introduction of the EPF Act, health care spending continued to increase dramatically, resulting in provincial and territorial overspending and necessitating cuts to health care. C Education cost was not the reason for inadequate health care funds. D The population increase was not the reason for inadequate funding of health care. DIF: Cognitive Level: Synthesis REF: p. 17 9. Which of the following is a main principle of the Canada Health Act? a. Health insurance should cover 100% of dental care. b. Health insurance should cover all medical services. c. All residents of Canada should be provided with health care. d. Eligible Canadians should receive accessible health care. ANS: D Feedback A Health insurance for dental care was not covered by the Canada Health Act. B The Canada Health Act mandated insurance for all medically necessary services. C The Canada Health Act sought to provide care for all eligible Canadians, not every person living here. D One of the Canada Health Act’s goals was to provide accessible health care to eligible Canadians. DIF: Cognitive Level: Analysis REF: p. 18 10. Which amendment to the Canada Health Act did the Romanow Report recommend? a. Canadians should pay user fees when they access the health care system. b. Funds for health care should be donated from private sources. c. The criterion of accountability should be added. d. Canadians in less accessible areas should pay a higher insurance premium. ANS: C Feedback A The Romanow Report did not recommend user fees. B The Romanow Report did not recommend funding for health care from private sources. C The Romanow Report recommended that the criterion of accountability should be added to the Canada Health Act. D The Romanow Report did not recommend that rural Canadians pay higher insurance for health care. DIF: Cognitive Level: Knowledge REF: p. 31 Chapter 2: Health and the Individual MULTIPLE CHOICE 1. Which of the following is the most current definition of wellness? a. The absence of disease b. The absence of risk factors in an individual’s life c. The perception that an individual has of his or her risk factors d. The way an individual feels about his or her health and quality of life ANS: D Feedback A The absence of disease does not define wellness; a person may feel well in spite of disease (e.g., a well-controlled diabetic). B Risk factors do not define wellness. C Risk factors do not define wellness. D This definition of wellness takes into account that an individual can describe himself or herself as “well,” even when he or she has a disease. DIF: Cognitive Level: Comprehension REF: p. 41 2. Historically, health was described as absence of disease. How did the World Health Organization (WHO) define health in 1948? a. As a high level of physical fitness b. As a sense of wellness c. As being multidimensional d. As a condition caused by social circumstances ANS: C Feedback A Physical fitness is part of a state of health, but it is not multidimensional. B Wellness is part of a state of health, but it is not multidimensional. C In 1948, the WHO described health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” D Social circumstance is a factor in health, but it does not describe it. DIF: Cognitive Level: Knowledge REF: p. 42 3. Which of the following lists incorporates three holistic elements of wellness? a. Financial, physical, emotional b. Fitness, intellectual, spiritual c. Absence of disease, emotional, social d. Physical, emotional, intellectual ANS: D Feedback A Financial health is not an element of wellness. B Fitness is not an element of wellness. C The absence of disease is not an element of wellness. D Models of wellness have five to seven elements of health that contribute to wellness: physical, emotional, intellectual, spiritual, social, and (in some models) environmental and occupational. DIF: Cognitive Level: Comprehension REF: p. 42 4. What does social wellness refer to? a. An ability to make appropriate, informed decisions b. Relating effectively to others c. An ability to understand oneself and to recognize personal strengths and limitations d. Seeking to contribute to society ANS: B Feedback A An ability to make appropriate, informed decisions refers to intellectual wellness. B Social wellness is defined as relating effectively to others, including being able to form close, loving relationships, to laugh, to communicate effectively and emphatically, to be a good listener, and to respond appropriately. C An ability to understand oneself and to recognize personal strengths and limitations refers to emotional wellness. D Seeking to contribute to society refers to spiritual wellness. DIF: Cognitive Level: Knowledge REF: p. 45 5. A personal support worker is asked by his patient what an “exacerbation” of his disease means. Which of the following is the correct response? a. The patient is showing a worsening of the signs of his disease. b. The patient is showing no symptoms of his disease at the present time. c. The patient is showing a group of symptoms. d. The patient is feeling unhealthy, even though he has no active disease at the present time. ANS: A Feedback A An exacerbation of a disease is when a patient shows a reappearance of the symptoms of a disease or shows an increase in the severity of a disease. B Showing no symptoms of a disease is a definition of remission. C Showing a group of symptoms is a definition of a syndrome. D Feeling unhealthy, even though one has no active disease at the present time, is a way of describing illness. DIF: Cognitive Level: Comprehension REF: p. 47 6. How is the holistic model of health described? a. It is a model that states that health is the absence of disease. b. It is a model that proposes that health is a process that evolves and progresses. c. It is a model that considers all parts of the person. d. It is a model that measures one’s state of health. ANS: C Feedback A A model that states that health is the absence of disease refers to the medical model. B A model that proposes that health is a process that evolves and progresses refers to the wellness model. C The holistic model of health considers all parts of the person. For example, when a client has newly diagnosed hypertension, health professionals will consider weight, risk behaviours, diet, stress, and ability to follow a medication regime. D A model that measures one’s state of health refers to the health–illness continuum. DIF: Cognitive Level: Synthesis REF: p. 49 7. Which of the following are examples of self-imposed risk behaviours? a. Smoking, sedentary lifestyle, low income b. Smoking, sexual promiscuity, sedentary lifestyle c. Smoking, substandard living conditions, sedentary lifestyle d. Smoking, sedentary lifestyle, lack of education ANS: B Feedback A Financial income is not necessarily controlled by the individual. B An individual has a choice about all of these risk behaviours, so they are selfimposed risks. C Living conditions are not necessarily controlled by the individual. D Level of education is not necessarily controlled by the individual. DIF: Cognitive Level: Comprehension REF: p. 49 8. “Compensation” lies at the centre of the health–illness continuum. What does this mean? a. The client is close to an optimal health state. b. The client is close to a poor health state. c. The client is in an optimal physical health state but is mentally unhealthy. d. The client is neither in an optimal nor poor health state but is able to continue with life activities. ANS: D Feedback A Compensation does not occur when a patient is close to an optimal health state. B Compensation does not occur when a patient is close to a poor health state. C The health–illness continuum looks at all dimensions of health. If an individual is mentally unhealthy and unable to continue with life even though he or she is physically healthy, then the individual is not “compensated.” D Compensation occurs when an individual is able to accommodate a malady and resume or adapt to his or her daily activities. DIF: Cognitive Level: Comprehension REF: p. 55 9. What behaviour might be observed during the “acknowledgement” stage of illness? a. The individual is unable to ignore his or her symptoms and seeks help. b. The individual denies the diagnosis and seeks a second opinion. c. The individual acknowledges the presence of symptoms and continues with his or her regular activities. d. The individual analyzes his or her symptoms and self-treats. ANS: A Feedback A Seeking help is indicative of the individual acknowledging that something is wrong. B Denial is a behaviour associated with the transitional stage. C Acknowledgment of the presence of symptoms and the continuation of one’s regular activities are seen in the preliminary phase. D Analysis of one’s own symptoms and self-treatment are seen in the preliminary phase. DIF: Cognitive Level: Knowledge REF: p. 60 10. Which of the following is a definition of sick role behaviour? a. The inability to accept a diagnosis b. The change of behaviour of hospitalized clients c. A person’s response to disease or illness d. Noncompliance to medication schedule ANS: C Feedback A Denial can be seen in the transitional phase of the stages of illness. B Change of behaviour is an example, not a definition, of sick role behaviour. C Sick role behaviour is an individual’s response to illness, also referred to as a behavioural illness response. D Noncompliance to medication schedule is an example, not a definition, of sick role behaviour. DIF: Cognitive Level: Knowledge REF: p. 57 Chapter 3: Population Health: Introduction and Principles MULTIPLE CHOICE 1. What are three components of population health? a. Determinants of health, health promotion, and disease prevention b. Social environment, health promotion, and disease prevention c. Public health, health promotion, and disease prevention d. Risk behaviours, health promotion, and disease prevention ANS: C Feedback A Determinants of health are causative factors that can influence the health of individuals and populations. B Social environment is a determinant of health. C Population health is a broad definition that provides a framework to analyze information that affects the health of a population. D Risk behaviour is a determinant of health. DIF: Cognitive Level: Knowledge REF: p. 71 2. Name one aspect of public health that differs from population health. a. Public health focuses on the implementation of health promotion initiatives. b. Public health is government funded; population health is not. c. Public health focuses on a scientific approach to health promotion. d. Public health deals with health information. ANS: A Feedback A Although public health and population health both deal with health promotion, public health programs often carry out recommendations made by population health studies, so they tend to focus more on applying measures than on gathering and analyzing information. B Both public health and population health can be funded by government. C Population health focuses on a scientific approach to health promotion. D Both public health and population health deal with health information. DIF: Cognitive Level: Analysis REF: p. 71 3. On what principle did the Public Health Agency of Canada (PHAC) identify determinants of health? a. Individuals should have equal access to health care facilities. b. Health is influenced by the interaction of multiple determinants. c. Socialized medicine is costly. d. Health promotion should be a priority activity. ANS: B Feedback A The principle that individuals should have equal access to health care facilities did not help identify determinants of health. B With the assistance of population health studies, Public Health Agency of Canada (PHAC) identified many factors that influence the health of a population. C Cost of health care did not help identify determinants of health. D Health promotion being a priority activity did not help with the identification of determinants of health. DIF: Cognitive Level: Analysis REF: p. 71 4. Which of the following are determinants of health? a. Medication, education, gender, and physical environment b. Physical environment, education, religion, and gender c. Birth order, income, education, and gender d. Income, education, gender, and physical environment ANS: D Feedback A Medication is not a determinant of health. B Religion has not been identified as a determinant of health. C Birth order has not been identified as a determinant of health. D Income, education, gender, and physical environment are all identified as determinants of health. DIF: Cognitive Level: Knowledge REF: p. 72 5. Which report was first in being instrumental in the development of population health in Canada? a. The Lalonde Report b. The Epp Report c. The Trudeau Report d. The Romanow Report ANS: A Feedback A In 1974, Marc Lalonde produced a report named “A New Perspective on the Health of Canadians” stating that health could be improved through changes in four areas: human biology, environment, lifestyle, and health care organization. B The Epp Report did not start the development of population health. C The Trudeau Report did not start the development of population health. D The Romanow Report did not start the development of population health.