How to start?
Health promotion is often described as “a process of enabling people to increase control over and improve their health.” What I aim to share here is a health promotion story that, I hope, will spark dialogue – and even debate.
I offer myself as an example, not with the intention of being self-indulgent, but instead, if this piece can help even one person, it is worthwhile having my situation out there for public consumption.
Before I get into the next part, I want to provide the context that I am, truly, the healthiest person I know. I absolutely love healthy food. Every day, I exercise, meditate, spend time with family and friends and relax. I love my work, and I think often how fortunate I am to have a research and teaching focus reflecting who I am and what I believe in so passionately.
IRWIN
As a teacher, my primary goal is to ignite passionate critical thinking, evidence-based decision making that incorporates personal values and questioning of the status quo. To this end, what I am currently experiencing is an opportunity to extend health promotion critical thinking outside my classroom and into a more public domain. Although I would be fully within my right to be vague about what’s happening, doing so would feel entirely out of integrity with who I am, what I value and what I represent professionally and personally.
I will leave my classrooms abruptly this year (an advanced, fourth-year Health Promotion class and a graduate level Health Promotion class), yet my hope is that sharing this story helps me contribute to my students’ – and perhaps others’– health promotion decisions.
Seven or eight years ago, I was diagnosed with cancer. And I was angry.
As a health promotion specialist, professor, embracer and advocate, my first thought was, “How the hell did I get cancer?!”
Realizing that line of thinking would make my cancer journey much nastier than it needed to be, I quickly decided that, while I did not like having cancer (understatement), I would find a way to get some benefit from it. I would learn from it, and use what I learned to help others.
That commitment was my ‘go-to’ place. Whenever I have come up against a struggle, I’ve continued with that philosophy, and I find it helpful to shift a negative experience into a more empowering one. I missed the point upon diagnosis. It wasn’t about ‘why’ I got it; it was an opportunity for me to be in a place of gratitude I had treated my body and mind so well, that it could get me through that time and continue to thrive in my life.
Some years after my cancer diagnosis, I gave a talk, entitled Survivorship: How do you want it to be?, for the Cancer Care Talks series about the challenges of feeling out of control, and finding something about which to take control, no matter how small.
Fast-forward almost two years to today.
I’m sitting in a breast cancer specialist’s office discussing my latest set of scans and the mysterious ‘new, yet unidentifiable thing’ that has taken up residence in my breast and, therefore, we need to increase the frequency of the scans even more if we’re to continue this course of action. I look to a bulletin board in the room, upon which is hanging an ad for the Cancer Care Talks lecture.
Realizing there was a message there for me in that synchronistic moment, I immediately asked myself, ‘What do you need?’ The answer was already there.
I had my first biopsy when I was 19 and have been scanned with some combination of mammograms/ultra sounds/MRIs over the next 20-some years. I needed it all to stop. I needed to stop the scanning, biopsies, anxieties of knowing that, statistically, I have a one-in-three chance of developing breast cancer, constant pain from all of the ‘stuff’ in my breasts, ‘waiting’ to find ‘it’ early, stress hormones (and contrast dye for scans) that run through my body on a much-too-regular basis.
And yet, I also knew it would be foolish for someone with my history to just say ‘no’ to scanning.
What was already clear to me became ‘in flashing lights’ clear; it was time to embrace that my breasts are a part of my past, and had no place in my future. I felt peace, in my heart and mind, where I had felt anxiety, lack of control and dread.
We all have many determinants of health that make up our own personal equation, if you will, that help to determine our health status.
I have many excellent aspects of my life that support outstanding health – including an amazing husband, family, friends and exceptional students; fabulous employment; great childhood development opportunities, etc. I also take control of my lifestyle in a very proactive manner. But the reality is, I have yet to find success when it comes to changing my family history and my own history.
Therefore, it has become clear the wisest option for me is no longer feel a prisoner of my 20-plus-year struggle with my breast health and, instead, move forward with a double mastectomy.
Because there is currently some little ‘gem’ that is currently not able to be identified, we don’t really know what is in there. Hopefully, there is nothing concerning that shows up on the pathology post-surgery, and if there is, I will deal with it the best way I know how.
For me, the time has come to embrace the next chapter of my breast-free life.
This is not a decision I take lightly, nor is it one that is right for everybody. (To be clear, I am not advocating for anybody else to make this decision. I am advocating for dialogue to help those who are considering this, or similar decisions for health, to have more space to do so.) This is a decision I know is right for me. I know embracing this decision with peace is an incredible kindness I am giving myself. I believe strongly in the power of kindness toward the self and others.
Connected to this, I also believe in the power in health promotion as a practice, a science and an opportunity to engage in courageous conversations. Health promotion is not something that fits within the tidy boundaries of a classroom. It is (or could be) in action all around us – every day. It is influenced by our background, supports, our behaviours, our environments, our thoughts and our decisions.
My hope from this piece is two-fold. One, that it will help contribute to a critical dialogue that can help women and men going through similar situations talk more openly about it. And two, that each person reading this will consider what are the variables influencing his/her own health, and see if there are any decisions that would help them feel more in control of their health, whatever ‘health’ means to them.
Health Sciences professor Jennifer Irwin is also a certified life coach with the International Coach Federation and has focused training in motivational interviewing. While her research focuses primarily on obesity prevention and treatment, her areas of specialization include motivational interviewing and life coaching for health-related behaviour change and the promotion of physical activity and healthy dietary intake behaviours.
