Health advocacy in action: The implementation of an early literacy initiative in Vancouver

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Liu, R., Zazoulina, J., Dueckman, J., Vadeanu, C. Health advocacy in action: The implementation of an early literacy initiative in Vancouver. UBCMJ. 2016: 7.2 (30-31).

° Corresponding author:

a MD Student 2017, Faculty of Medicine, University of British Columbia, Vancouver, BC


There is a growing awareness that physicians, in addition to attending to the medical needs of patients, should also address the patients’ social, emotional, and community connections in order to improve their total well–being. A group of medical students at the University of British Columbia is undertaking an initiative called the Reading Bear Society, which aims to integrate the Health Advocate role highlighted by the Canadian Medical Education Directions for Specialists framework into their learning experience.This article discusses the context and goals for implementing the initiative.

Health advocacy is the practice of providing healthcare–related support

and education at both the individual and the community levels to improve the holistic well–being of patients. The changing face of medicine through the twenty–first century places increasing emphasis on the need for physicians who not only treat ailments, but who also demonstrate proficiency in health advocacy. Medical students are taught that effective practitioners must address the social determinants of their patients’ health, identify the needs of under–served populations, improve awareness of healthy practices, and collaborate with social and community agencies. Indeed, the role of the Health Advocate is highlighted as an essential competency of physicians in the Canadian Medical Education Directions for Specialists (CanMEDS) framework.1 At the University of British Columbia (UBC), medical students must complete a course entitled, “Doctor, Patient, and Society” (DPAS), in which they may pursue a self– directed project option to conduct research or launch community projects. One group of students is integrating the CanMEDS Health Advocate role into their DPAS curriculum by examining the needs and issues of their local Vancouver community and by implementing a service–learning initiative in elementary and secondary schools.

Recent data from British Columbia identified that kindergarten–aged children and  adolescents  are  most  affected    by socioeconomic risk factors—both poverty and affluence—which have been shown to lead to poor academic achievement, youth depression, anxiety, and substance use.2-5This could be in part attributable to the growing economic disparity throughout the province and the consequent breakdown of the normal social fabric, for it is the connection to family and community that sustains a healthy childhood.3,4 Socioeconomic restrictions limit childhood learning resources and are associated with poorer developmental outcomes.2-5 Conversely, a  correlation also exists between affluence, emotional vulnerability, and risk–taking behaviour in teenagers.6 Household and neighbourhood affluence are associated with isolation, a lack of community connectedness, and childhood anxiety disorders.7

With these target populations in mind, a medical student, a Vancouver nurse, and an inner–city school principal, along with the financial and academic support of community stakeholders, co–founded the Reading Bear Society (RBS), a school service program that promotes early  literacy  and school readiness while working to develop social and emotional intelligence in Vancouver’s school communities. By pairing adolescent mentors as reading buddies with kindergarten–aged children from different neighbourhoods and socioeconomic backgrounds, the RBS provides a mutually– beneficial learning opportunity to build connections across the city and to nurture enthusiasm for reading.

Reading buddies meet for eight to ten monthly visits throughout the school year and work through a standardized workbook developed by the RBS team. Each  visit has a unique theme, along with objectives based upon B.C. Curriculum Guidelines for Kindergarten Students and B.C. Curriculum Guidelines for Service Learning for Middle and High School Students.8Through one–on– one reading opportunities and completion of the Reading Bear workbook, the buddy pairs can build compassion and empathy for one another.This bridges the gap created by their disparate socioeconomic backgrounds and ultimately improves learning and health outcomes. Furthermore, in order to bring early literacy into their homes, the kindergarten students are each given books and a teddy bear—The Reading Bear—so that they can practice reading with their bears. Pre–visit orientations and supervision from teachers and volunteers allows for a quality–controlled process, with coaching and mentoring for both the kindergarteners and the older children.

The RBS is founded on the academic and scientific literature that demonstrates the pivotal importance of strong leadership and  inter–sectorial   partnerships   in  the development of early childhood programs.3-5,9,10 A study published in the American Educational Research Journal found that students who engaged in peer– tutoring classrooms demonstrated improved reading, irrespective of the type of learner.9 It has also been shown that children who have early opportunities for social integration, friend making, and literacy at home are more academically successful, are physically and emotionally healthier, and have greater altruistic tendencies.11,12 By providing these mentorship and learning opportunities, it is expected that both kindergarteners and adolescents will show similar improvements in the areas of emotional intelligence and academic success. This evidence–based intervention facilitates early  adjustment to school for kindergarteners through confidence–building, and it also facilitates the development of self–awareness, empathy, and altruism in the older buddies. Testimonials from teachers who observed the program have shed light on the positive impacts of these relationships on the most vulnerable participating children.

Now in its second year of operation, the RBS aims to target these goals as well as to rigorously assess the effects of the buddy reading sessions through a research project. The aim of the study is to gather evidence and to determine the effectiveness of the RBS approach in enhancing the education, emotional development, and community spirit of the young minds. The research team now consists of seven UBC medical students who are currently enrolled in DPAS and who maintain the same ambition as the original co–founders: to be health advocates for vulnerable youth in the local community.

Another unique quality of the RBS is that it sets out to implement the City of Vancouver’s Healthy City Strategy, a “long–


RBS is founded on the academic and scientific literature that demonstrates the pivotal importance of strong leadership and inter–sectorial partnerships in the development of early childhood programs.

term, integrated plan for healthier people, healthier places, and a healthier planet.”13 The city has developed “Building Blocks  of a Healthy City for All,” a document that elaborates on the Healthy City Strategy by setting goals to guide the implementation of community programs and the changes to take place in Vancouver over the next ten years.13 There is substantial overlap between the goals of the city and the pillars upon which the RBS is built. The first of these pillars is Early Literacy, which is harmonious with the city’s goals to promote learning throughout life and to offer all children a healthy start.The RBS also values Community and engages citizens from across the city to participate in Intergenerational Mentorship. By Educating the Heart–Mind, we help to build supportive networks that promote inclusion of all diverse parts of our city. Much of this is synonymous with the “Building Blocks” set forth in the city’s strategy and the medical students’ goals as health advocates.

Endorsement from the City of Vancouver and implementation as a service–learning program under the B.C. Ministry of Education would allow the RBS to secure the sustainability of the program and to reach more students. One barrier to city– or province–wide implementation is the potential concern that the program could be perceived as a unilateral charity being distributed in the lower–income areas of the city. However, it is strongly believed that each student has something unique and valuable to offer, creating a mutually– beneficial experience for kindergarten–aged and adolescent students.

As evidenced by the current progress of the RBS, it is clear that the DPAS self– directed project option has proven an invaluable opportunity for students to explore the CanMEDS Health Advocate role. By addressing the social, emotional, and community impacts of childhood adversity through this program, medical students are inspired to believe that, as physicians, it is possible to meaningfully impact the health outcomes of their communities.


We would like to thank Joanne Roussy, PhD for her continuous support in the project and for contributing to the editing of the article.


The authors do not have any conflicts of interest to disclose.


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