Chantelle A.M. Richmond

The determinants of First Nation and Inuit health: a critical population health approach.

Environmental dispossession disproportionately affects the health of Canadas Aboriginal population, yet little is known about how its effects are sustained over time. We use a critical population health approach to explore the determinants of health in rural and remote First Nation and Inuit communities, and to conceptualize the pathways by which environmental dispossession affects these health determinants. We draw from narrative analysis of interviews with 26 Community Health Representatives (CHRs) from First Nation and Inuit communities across Canada. CHRs identified six health determinants: balance, life control, education, material resources, social resources, and environmental/cultural connections. CHRs articulated the role of the physical environment for health as inseparable from that of their cultures. Environmental dispossession was defined as a process with negative consequences for health, particularly in the social environment. Health research should focus on understanding linkages between environmental dispossession, cultural identity, and the social determinants of health.

Social Support and Thriving Health: A New Approach to Understanding the Health of Indigenous Canadians

OBJECTIVES We examined the importance of social support in promoting thriving health among indigenous Canadians, a disadvantaged population. METHODS We categorized the self-reported health status of 31625 adult indigenous Canadians as thriving (excellent, very good) or nonthriving (good, fair, poor). We measured social support with indices of positive interaction, emotional support, tangible support, and affection and intimacy. We used multivariable logistic regression analyses to estimate odds of reporting thriving health, using social support as the key independent variable, and we controlled for educational attainment and labor force status. RESULTS Compared with women reporting low levels of social support, those reporting high levels of positive interaction (odds ratio [OR]=1.4; 95% confidence interval [CI]=1.2, 1.6), emotional support (OR=2.1; 95% CI=1.8, 2.4), and tangible support (OR = 1.4; 95% CI = 1.2, 1.5) were significantly more likely to report thriving health. Among men, only emotional support was significantly related to thriving health (OR=1.7; 95% CI=1.5, 1.9). Thriving health status was also significantly mediated by age, aboriginal status (First Nations, Métis, or Inuit), educational attainment, and labor force status. CONCLUSIONS Social support is a strong determinant of thriving health, particularly among women. Research that emphasizes thriving represents a positive and necessary turn in the indigenous health discourse.

Social support, material circumstance and health behaviour: Influences on health in First Nation and Inuit communities of Canada

An expansive literature describes the links between social support and health. Though the bulk of this evidence emphasizes the health-enhancing effect of social support, certain aspects can have negative consequences for health (e.g., social obligations). In the Canadian context, the geographically small and socially interconnected nature of First Nation and Inuit communities provides a unique example through which to explore this relationship. Despite reportedly high levels of social support, many First Nation and Inuit communities endure broad social problems, thereby leading us to question the assumption that social support is primarily health protective. We draw from narrative analysis of interviews with 26 First Nation and Inuit Community Health Representatives to critically examine the health and social support relationship, and the social structures through which social support influences health. Findings indicate that there are health-enhancing and health-damaging properties of the health-social support relationship, and that the negative dimensions can significantly outweigh the positive ones. Social support operates at different structural levels, beginning with the individual and extending toward family and community. These social structures are important as they reinforce an individuals sense of belonging, however, these high-density networks can also exert conformity pressures and social obligations that promote health-damaging behaviours such as domestic violence and smoking. The poor material circumstances that characterize so many First Nation and Inuit communities add another layer of complexity as limited resources can trap individuals within the confines of their immediate social contexts. Research and policy interventions must pay close attention to the social context within which social support, health behaviours and material circumstances interact to influence health outcomes among First Nation and Inuit communities.

The Social Determinants of Inuit Health: A Focus on Social Support in the Canadian Arctic

Abstract Objectives. Societies that foster socially supportive networks produce healthier populations. Social support is a significant determinant of health among Canada’s Inuit population; however, little is known about the characteristics that provide access to social support among Inuit. This exploratory analysis describes how 4 types of social support (namely, positive social interaction, emotional support, tangible support and affection and intimacy) differ in relation to various determinants of health. Study design. Micro-data from the Arctic Supplement of the 2001 Aboriginal Peoples Survey (n=26,290) was used. Methods. Cross-tabulations and multivariate logistic regression analyses were used to examine levels (high/low) of the 4 types of social support among the full Inuit sample (n=26,290) as they relate to age, gender, geographic region, marital status, Aboriginal language use and participation in traditional harvesting activities. Results. Certain subsegments of the Inuit population were less likely to report high levels of social support, including men, the elderly (aged 55+) and the unmarried. Some Inuit-relevant determinants were also found to decrease the odds of reporting high levels of social support, including being unable to speak or understand an Aboriginal language, not participating in traditional harvesting activities and living in Nunavik. Conclusions. Research that frames Inuit health within the social determinants of health is in its relative infancy; however, evidence from the social epidemiological literature indicates that those with diminished access to social support also suffer poorer health outcomes. Future research should build on the findings of this study to examine how the relationship between various health outcomes (e.g., respiratory disease, suicide attempts, self-rated health) and social support may respond along a social gradient. Such analysis will build on the paucity of literature specific to Inuit health and social conditions and set priorities for policy and programming efforts that will improve the social determinants of Inuit health.

Community-Based Participatory Research (Cbpr) with Indigenous Communities: Producing Respectful and Reciprocal Research

The health disparities between Indigenous and non-Indigenous peoples in Canada continue to grow despite an expanding body of research that attempts to address these inequalities, including increased attention from the field of health geography. Here, we draw upon a case study of our own community-based approach to health research with Anishinabe communities in northern Ontario as a means of advocating the growth of such participatory approaches. Using our own case as an example, we demonstrate how a collaborative approach to respectful and reciprocal research can be achieved, including some of the challenges we faced in adopting this approach.

Hepatitis B in Ghana's upper west region: a hidden epidemic in need of national policy attention.

Like many countries in Sub-Saharan Africa, Hepatitis B virus (HBV) is highly prevalent in Ghana. Using qualitative methods, this paper draws from the political ecology of health theoretical framework to examine perceptions and understandings of HBV in the Upper West Region of Ghana. The findings reveal that extremely low levels of knowledge and pervasive lay misconceptions about the disease within this geographic context are shaped by large scale structural influences. Furthermore, in this context there is essentially no access to HBV immunizations, testing or treatment services which reinforces potential routes for the spread of HBV. An explosive spread of HBV is brewing with the potential to diffuse across space and time while, within the institutional contexts, it is the HIV epidemic that is largely consuming both policy attention and intervention.

“That land means everything to us as Anishinaabe….”: Environmental dispossession and resilience on the North Shore of Lake Superior

This article shares results of a community-based (CBR) study that qualitatively examined the perceived health impacts of environmental dispossession among Elders in two Anishinaabe communities in Ontario, Canada. Through in-depth interviews, Elders (n=46) recounted changes in health and well-being, specifically that related to reduced access to traditional foods and decreased capacity to participate in, and share knowledge of, land-based practices. Elders discussed the ways in which they have remained resilient to these changes in their ways of living. With a greater purpose of proposing solutions that will improve contemporary patterns of Indigenous health, this research underscores the importance of engaging theoretically in concepts of environmental dispossession and resilience.

Anishinabe youth perceptions about community health: toward environmental repossession.

This community-based research applied environmental dispossession as a theoretical framework for understanding Anishinabe youth perceptions about health, social relationships and contemporary Anishinabe way of life in Northern Ontario, Canada. Qualitative interviews with 19 youth reveal considerable worry about their communitys health. Youth perceive changes in the Anishinabe way of life, including decreased access to their traditional lands, to be central to poor health at the community level. Youth emphasized the importance of social relationships for fostering healthy behaviours and developing community wide initiatives that will provide opportunities for reconnecting to land, and for learning and practicing Indigenous Knowledge. This study builds on the growing body of decolonizing research with Indigenous communities, and it concludes by offering the concept of environmental repossession as a way forward for studies on the Indigenous environment-health interface.

Formal Dementia Care among First Nations in Southwestern Ontario

Cet article traite la façon dont les soins de la démence sont prévus pour les collectivités des Premiers Nations du sud-ouest de l’Ontario. Les données ont été saisies au moyen d’entretiens approfondis avec les prestataires de soins de santé et analysées en utilisant une méthodologie fondée sur une théorie constructiviste. Afin de comprendre les soins de la démence, deux cadres interdépendants ont été identifiés: un cadre de prestation des soins et un cadre de connaissances. Le cadre de prestation des soins a défini des objectifs de soins, des éléments de soins dispensés, les barrières de soins, et des stratégies et des solutions de prestation de soins pour surmonter les obstacles. Le cadre de connaissances a défini quatre groupes de parties prenantes: les personnes atteintes de la démence, les prestataires de soins informels, les prestataires de soins formels et la communauté des Premiers Nations. On a précisé les connaissances qu’il faut que chaque partie possède ou dont elle a besoin et les processus de partage – ou, à défaut de partage – des connaissances dans les soins de la démence. Plusieurs barrières, dont beaucoup sont créées par un manque de connaissances, ont eu un impact négatif sur les soins de la démence. Cependant, les professionels de soins de santé avaient des stratégies efficaces pour la prestation de soins qui ont été conçus pour surmonter les obstacles y compris le partage des connaissances. This article explores how dementia care is provided to First Nations communities in southwestern Ontario. Data were collected through in-depth interviews with health care providers and analysed using a constructivist grounded-theory methodology. Two interrelated frameworks for understanding dementia care were identified: a care delivery framework and a knowledge framework. The care delivery framework identified care goals, care elements being provided, care barriers, and strategies and solutions to deliver care and overcome barriers. The knowledge framework defined four groups of knowledge stakeholders: persons with dementia, informal care providers, formal care providers, and the First Nations community. It identified the knowledge each stakeholder held or needed and processes of sharing – or failing to share – knowledge in dementia care. Several barriers, many created by a lack of knowledge, negatively impacted dementia care. However, health care professionals had effective strategies for providing care, designed to overcome barriers and which encompassed elements of knowledge sharing.

Efficacy of a 3-hour Aboriginal health teaching in the medical curriculum Are we changing student knowledge and attitudes?

There is national recognition of the need to incorporate Aboriginal health issues within the medical school curricula. This study aims to evaluate changes in medical students’ knowledge and attitudes about Aboriginal health, and their preparedness to work in Aboriginal communities after attending a 3-hour Aboriginal health seminar. A cross-sectional survey was administered before and after the seminar for Year 1 and 2 medical students at the University of Western Ontario. The survey included four true or false questions and 24 questions using a seven-point Likert scale (1 – strongly disagree, 7 – strongly agree). Eighty two of 130 (64 per cent) Year 1 students and 55 of 86 (63 per cent) Year 2 students completed both questionnaires. Knowledge-based questions were answered correctly by most students before the seminar, with an increasing number of correct responses noted after the seminar (p < 0.05). Students’ perceptions about sociocultural and economic factors affecting health showed uncertainty before the seminar, but changed towards greater agreement regarding its impact on health after the seminar (p < 0.05). Students initially felt unprepared to care for Aboriginal patients before the seminar, but felt more prepared after the seminar (p < 0.05). A 3-hour seminar using both didactic and non-traditional teaching methods appears to be effective in the short term in improving knowledge, changing attitudes and reversing some of the uncertainties medical students have about practicing in Aboriginal communities.