Alana Maltby

Residential schools and the effects on Indigenous health and well-being in Canada—a scoping review

BackgroundThe history of residential schools has been identified as having long lasting and intergenerational effects on the physical and mental well-being of Indigenous populations in Canada. Our objective was to identify the extent and range of research on residential school attendance on specific health outcomes and the populations affected.MethodsA scoping review of the empirical peer-reviewed literature was conducted, following the methodological framework of Arksey and O’Malley (2005). For this review, nine databases were used: Bibliography of Native North Americans, Canadian Health Research Collection, CINAHL, Google Scholar, Indigenous Studies Portal, PubMed, Scopus, Statistics Canada, and Web of Science. Citations that did not focus on health and residential school among a Canadian Indigenous population were excluded. Papers were coded using the following categories: Indigenous identity group, geography, age-sex, residential school attendance, and health status.ResultsSixty-one articles were selected for inclusion in the review. Most focused on the impacts of residential schooling among First Nations, but some included Métis and Inuit. Physical health outcomes linked to residential schooling included poorer general and self-rated health, increased rates of chronic and infectious diseases. Effects on mental and emotional well-being included mental distress, depression, addictive behaviours and substance mis-use, stress, and suicidal behaviours.ConclusionThe empirical literature can be seen as further documenting the negative health effects of residential schooling, both among former residential school attendees and subsequent generations. Future empirical research should focus on developing a clearer understanding of the aetiology of these effects, and particularly on identifying the characteristics that lead people and communities to be resilient to them.

Examining individual, interpersonal, and environmental influences on children’s physical activity levels

The purpose of this study was to explore individual-level socio-demographic factors and interpersonal-level factors related to social support, as well as the potential role of neighborhood and school environments that may influence the physical activity (PA) levels of children (ages 9–11). Child and parent questionnaires included individual and interpersonal factors, and PA behaviour. Home postal codes were used to determine the neighbourhood the child resides within, as well as their geographic accessibility to recreation opportunities. The models were assessed using a series of cross-classified random-intercept multi-level regression models as children’s PA may be affected by both the school they attend and the neighbourhood in which they live. In the unadjusted model, PA varied significantly across school environments (γ = 0.023; CI: 0.003–0.043), but not across neighbourhoods (γ = 0.007; CI: -0.008 to 0.021). Boys were found to be more active compared to girls (b = 0.183; CI: 0.092–0.275), while the level of PA was lower for children whose fathers achieved post-secondary education (b = - 0.197; CI: -0.376 to 0.018) than for those whose parents completed only high school. The addition of the individual-level correlates did not have a substantial effect on level 2 variances and the level 2 variance associated with school environment remained statistically significant. At the interpersonal level, children’s perception of parental support (b = 0.117; CI: 0.091–0.143) and peer support (b = 0.111; CI: 0.079–0.142) were positively related to PA. The level 2 variance for the school environment became statistically non-significant when the interpersonal factors were added to the model. At the environmental level, geographic accessibility did not have a significant association with PA and they did not significantly affect level 1 or 2 variance. As many children do not accrue sufficient levels of PA, identifying modifiable determinants is necessary to develop effective strategies to increase PA.

Are Indigenous Determinants of Health Associated with Self-Reported Health Professional-Diagnosed Anxiety Disorders Among Canadian First Nations Adults?: Findings from the 2012 Aboriginal Peoples Survey

We estimated the prevalence of self-reported health professional-diagnosed anxiety disorders among Canadian First Nations adults living off-reserve, and assessed the relationship between anxiety disorders and Indigenous determinants of health (Status Indian, residential school attendance, knowledge of Indigenous language, and participation in traditional activities) using the 2012 Aboriginal Peoples Survey. Multivariable logistic regression models were performed using bootstrap weights. The prevalence of anxiety disorders was 14.5% among off-reserve First Nations adults. There was an increased odds of anxiety disorders among those participating in traditional activities compared to their counterparts (aOR 1.46, 95% CI 1.12–1.90). No association was found between anxiety disorders and other Indigenous determinants of health. There is a high prevalence of self-reported anxiety among First Nations adults living off-reserve. However, further studies are warranted to identify and assess the role of Indigenous determinants of health for anxiety disorders and other prevalent mental health conditions in this population.

Unmet healthcare needs among indigenous peoples in Canada: findings from the 2006 and 2012 Aboriginal Peoples Surveys

AimThe objective of this study was to assess and compare the prevalence of self-reported unmet healthcare needs (UHN) among Canadian indigenous groups using the 2006 and 2012 Aboriginal Peoples Surveys (APS).Subject and methodsFrequency distributions and cross tabulations were produced to estimate the proportion of indigenous people who reported UHN in 2006 and 2012 and for sub-populations, based on indigenous identity, gender, age, geographic region and urban/rural area. Additionally, frequency distributions were produced for reasons for UHN and types of care needed. Standard errors and confidence intervals were calculated and took into account bootstrap weights.ResultsIn 2006, 11.65% (CI: 11.04, 12.26) of indigenous people reported UHN, and this proportion significantly increased to 13.74% (CI: 12.88, 14.60) in 2012. UHN varied among indigenous identities; however, only Inuit had a significant difference in UHN between 2006 (10.19%, CI: 9.05, 11.33) and 2012 (14.58%, CI: 12.57, 16.59). Individuals aged 18–34 years, females, and those in the Prairies and Territories and in urban areas had significant differences in UHN. The most common reasons for UHN were related to availability, and the majority of respondents reported needing care for physical health problems.ConclusionsFurther research is warranted that examines the association between general factors related to UHN and indigenous-specific factors. Additionally, assessing how chronic disease impacts UHN will provide information on reasons for UHN (e.g., healthcare system-related versus personal circumstances).

Reducing health disparities among indigenous populations: the role of collaborative approaches to improve public health systems

Indigenous peoples (First Nations, Inuit, and Métis) are the youngest and fastest growing portion of the Canadian population. In 2011, approximately 1.4 million people reported an Indigenous identity (Indigenous and Northern Affairs Canada 2013). It is well established that Indigenous peoples in Canada experience a disproportionate burden of health problems compared to the non-Indigenous population (Frohlich et al. 2006). Indigenous peoples are at greater risk for preventable chronic diseases such as type II diabetes, cardiovascular disease, and some cancers (UN Department of Economic and Social Affairs 2009). These disparities in health are not limited to Canada; they are also observed in other colonial nations such as Australia, New Zealand, and the United States (King et al. 2009; UN Department of Economic and Social Affairs 2009). While inequalities in health among individuals and populations are a complex interplay of genetic factors, health behaviours, and socio-environmental determinants (Loppie Reading and Wien 2009), it is likely that the root causes of these disparities are to be found in the structural relations between Indigenous peoples and settler societies, which perpetually disadvantage Indigenous peoples (King et al. 2009). The descendants of original inhabitants experience poorer socioeconomic conditions than do the descendants of settlers or immigrants (Cooke et al. 2007). It is necessary to consider how health behaviours are influenced by both intermediate factors (e.g., community infrastructure, resources, systems, and capacities) and distal determinants (e.g., historical, political, social, and economic contexts; Frohlich et al. 2006; Loppie Reading and Wien 2009). Among the colonial policies in Canada, forced attendance at residential schools was particularly damaging to Indigenous peoples. The residential school system was intended to eliminate Indigenous languages, cultural traditions, and spiritual beliefs of Indigenous children to assimilate them into Euro-Canadian ways of life (Kirmayer et al. 2003; Truth and Reconciliation Commission of Canada 2015). In addition to cultural and social effects of being forcibly removed from their families and culture, many children were subjected to physical, sexual, psychological, and spiritual abuse while attending the schools (Truth and Reconciliation Commission of Canada 2015), which has had lasting consequences such as health problems, substance abuse, increased mortality and suicide rates, and families and community breakdown (Kirmayer et al. 2003). These effects are similar to those experienced in the United States and Australia, where boarding or residential schools were also a form of assimilation (King et al. 2009). Currently, the majority of Indigenous people in Canada reside in urban areas, outside of discrete Indigenous communities (such as First Nations reserve communities) and much of the recent growth in Indigenous population has & Piotr Wilk piotr.wilk@schulich.uwo.ca

Changing BMI scores among Canadian Indigenous and non-Indigenous children, youth, and young adults: Untangling age, period, and cohort effects

The objective of this study was to examine age, period and cohort effects on BMI among Indigenous and non-Indigenous populations, using repeated cross-sectional survey data from the CCHS (2001 to 2014). Cross-classified random-effect two-level models were used to estimate fixed effects for age and its quadratic term (Level 1), and also to estimate random effects for time periods and birth cohorts (Level 2), while controlling for the effects of Level 1 control variables: sex, model of interview and response by proxy. Overall, the results support the hypothesis that age and period effects are primarily responsible for the current obesity epidemic. L’objectif de cette etude etait d’examiner les effets de l’âge, de la periode et de la cohorte sur l’IMC chez les populations autochtones et non autochtones, en utilisant des donnees d’enquetes transversales repetees de l’ESCC (2001 a 2014). On a utilise des modeles a deux niveaux a effets aleatoires croises pour estimer les effets fixes pour l’âge et son terme quadratique (niveau 1), et egalement estimer les effets aleatoires pour les periodes et les cohortes de naissance (niveau 2), tout en controlant les effets du niveau 1 Variables de controle: sexe, modele d’interview et reponse par procuration. Dans l’ensemble, les resultats confirment l’hypothese selon laquelle les effets de l’âge et de la periode sont les principaux responsables de l’epidemie actuelle d’obesite.