Advertisement

Canadian Journal of Public Health

, Volume 105, Issue 3, pp e209–e213 | Cite as

Reconceptualizing determinants of health: Barriers to improving the health status of First Nations peoples

  • Robert Nesdole
  • Debora Voigts
  • Rein Lepnurm
  • Rose Roberts
Commentary

Abstract

Comparing the key determinants of health articulated by the Public Health Agency of Canada (the Agency) with the spiritual and cultural knowledge systems of First Nations peoples, as expressed by the Four Worlds International Institute for Human and Community Development (Four Worlds) and their 14 determinants of well-being and health, reveals differing philosophical perspectives. The key determinants of health can be interpreted as lacking a holistic and inclusive approach to public health services. As a result, many public health programs in Canada marginalize, ignore and suppress the needs of First Nations communities and people. Incorporating the Four Worlds guiding principles and its 14 health determinants model within the context of Canadian public health services geared towards First Nations populations provides the opportunity to develop a deeper understanding of social determinants of health. Therefore, when implementing public health initiatives to address the health status of First Nations people in Canada, it is important that the Agency incorporate the guiding principles of the Four Worlds: Development Comes from Within; No Vision, No Development; Individual and Community Transformations Must Go Hand in Hand; and Holistic Learning is the Key to Deep and Lasting Change. Reconceptualizing the key determinants of health to encompass the worldview expressed by the Four Worlds acknowledges the cultural wisdom of First Nations people and offers the potential to develop more inclusive public health services.

Key Words

First Nations Aboriginal health status determinants of health population health Four Worlds International Institute for Human and Community Development Public Health Agency of Canada 

Résumé

Une comparaison entre les grands déterminants de la santé définis par l’Agence de la santé publique du Canada («l’Agence») et les systèmes de connaissances spirituelles et culturelles des Premiers Peuples, comme exprimés par l’organisme Four Worlds International Institute for Human and Community Development («Four Worlds»), et leurs 14 déterminants du bien-être et de la santé, révèle des perspectives philosophiques différentes. Les grands déterminants de la santé peuvent être interprétés comme étant insuffisamment inspirés par une approche holistique et inclusive en ce qui a trait aux services de santé publique. Par conséquent, de nombreux programmes de santé publique au Canada marginalisent, négligent et suppriment les besoins des communautés des Premières nations et de leurs membres. Dans le contexte des services de santé publique du Canada axés sur les populations des Premières Nations, intégrer les principes directeurs de Four Worlds et son modèle des 14 déterminants de la santé offre la possibilité d’approfondir notre compréhension des déterminants sociaux de la santé. En conséquence, lorsque l’Agence met en oeuvre des initiatives de santé publique pour améliorer l’état sanitaire des Premiers Peuples au Canada, il est important qu’elle intègre les principes directeurs de Four Worlds: «le développement vient de l’intérieur»; «pas de vision, pas de développement»; «les transformations individuelles et collectives doivent aller de pair»; et «l’apprentissage holistique est la clé d’un changement profond et durable». Repenser les grands déterminants de la santé pour qu’ils englobent la vision du monde exprimée par Four Worlds reconnaîtrait la sagesse culturelle des Premiers Peuples et offrirait la possibilité de mettre au point des services de santé publique plus inclusifs.

Mots Clés

Premières Nations autochtone état sanitaire déterminants de la santé santé des populations Four Worlds International Institute for Human and Community Development Agence de la santé publique du Canada 

References

  1. 1.
    Health Canada. A Statistical Profile on the Health of First Nations in Canada: Determinants of Health, 1999 to 2003. Ottawa, ON: Health Canada, 2009. Available at: http://www.hc-sc.gc.ca/fniah-spnia/pubs/aborig-autoch/index-eng.php (Accessed October 21, 2013).Google Scholar
  2. 2.
    Irvine J, Quinn B, Stockdale D. Northern Saskatchewan Health Indicators Report 2011. Athabasca Health Authority, Keewatin Yatthé and Mamawetan Churchill River Regional Health Authorities. Population Health, La Ronge, 2011. Available at: http://www.populationhealthunit.ca/media/Northern %20Saskatchewan%20Health%20Indicator%20Report%202011.pdf (Accessed October 21, 2013).Google Scholar
  3. 3.
    Stephens C, Porter J, Nettleton C, Willis R. Disappearing, displaced, and undervalued: A call to action for Indigenous health worldwide. Lancet 2008;367(9527):2019–28.CrossRefGoogle Scholar
  4. 4.
    Wilson D, Northcott H. Dying and Death in Canada. Toronto, ON: University of Toronto Press, 2008.Google Scholar
  5. 5.
    Aboriginal Affairs and Northern Development Canada. Royal Commission Report on Aboriginal Peoples, 1996. Volume 1, Looking Forward, Looking Back.Chapter 5: Stage two: Contact and co-operation. Available at: http://www.aadnc-aandc.gc.ca/eng/1100100014597/1100100014637 (Accessed October 21, 2013).Google Scholar
  6. 6.
    Health Council of Canada. The Health Status of Canada’s First Nations, Metis and Inuit people. 2005. Available at: http://hpclearinghouse.net/files/folders/9407/download.aspx (Accessed October 21, 2013).Google Scholar
  7. 7.
    Aboriginal Affairs and Northern Development Canada. Royal Commission Report on Aboriginal Peoples, 1996. Volume 1, Looking Forward, Looking Back. Chapter 6: Stage three: Displacement and assimilation. Available at: http://www.collectionscanada.gc.ca/webarchives/20071211050833/http://www.ainc-inac.gc.ca/ch/rcap/sg/sg13_e.html#42 (Accessed October 21, 2013).Google Scholar
  8. 8.
    British North America Act, 1867, 30–31 Vic., c. 3 (U.K.). Ottawa: Department of Justice.Google Scholar
  9. 9.
    Bopp M, Bopp J, Lane P. Community Healing and Aboriginal Social Security Reform: A Study Prepared for the Assembly of First Nations Aboriginal Social Security Reform Strategic Initiative. Assembly of First Nations, 1998.Google Scholar
  10. 10.
    Nesdole R, Voigts D, Lepnurm R. Northern Inter-Tribal Health Authority. Health Status Report 2011. Northern Inter-Tribal Health Authority Inc., 2012.Google Scholar
  11. 11.
    Indian Act. R.S.C, 1985, c. I-5. Ottawa: Department of Justice.Google Scholar
  12. 12.
    Shepard B, O’Neill L, Guenette F. Counselling with First Nations women: Considerations of oppression and renewal. Int J Adv Couns 2006;28:227–40.CrossRefGoogle Scholar
  13. 13.
    Barnes R, Josefowitz N, Cole E. Residential schools: Impact on Aboriginal students’ academic and cognitive development. Can J School Psychol 2006;21:18–32.CrossRefGoogle Scholar
  14. 14.
    Hanson I, Hampton, MR. Being Indian: Strengths sustaining First Nations peoples in Saskatchewan residential schools. Can J Commun Mental Health 2000;19:127–42.CrossRefGoogle Scholar
  15. 15.
    Blanchet-Cohen N, McMillan Z, Greenwood M. Indigenous youth engagement in Canada’s health care. Pimatisiwin 2011;9(1). Available at: http://www.pimatisiwin.com/online/wpcontent/uploads/2011/08/05Blanchett-Cohen3.pdf (Accessed October 21, 2013).
  16. 16.
    Beavon D, White J, Wingert S, Maxim P (Eds). Aboriginal Policy Research: Moving Forward, Making a Difference. Volume 4. Toronto: Thompson Educational Publishing Canada, 2007.Google Scholar
  17. 17.
    The Four Worlds International Institute for Human and Community Development Executive Summary. Available at: http://4worlds.org/4w/exesum/execsum.html (Accessed October 21, 2013).
  18. 18.
    Public Health Agency of Canada. What Makes Canadians Healthy or Unhealthy? Ottawa: The Agency, 2013. Available at: http://www.phacaspc.gc.ca/ph-sp/determinants/determinants-eng.php (Accessed October 21, 2013).Google Scholar
  19. 19.
    Rose R and Prince Albert Grand Council. Reconnecting to the Land: Reclaiming Traditional Lifestyles as a Pathway to Health. 2013. Available at: http://kinincommon.com/wpcontent/uploads/2013/04/ReconnectingToTheLand_sm.pdf (Accessed October 21, 2013).Google Scholar
  20. 20.
    Kattlemann KK, Konti K, Ren C. The medicine wheel nutrition intervention: A diabetes education study with the Cheyenne River Sioux Tribe. J Am Diet Assoc 2009;109(9):1532–39.CrossRefGoogle Scholar
  21. 21.
    The Healing Journey. 2006. Safety Plans. Available at: http://www.thehealingjourney.ca/inside.asp?219 (Accessed February 25, 2013).
  22. 22.
    Corntassel J. Re-envisioning resurgence: Indigenous pathways to decolonization and sustainable self-determination. Decolonization: Indigeneity, Education & Society 2012;1(1):86–101.Google Scholar
  23. 23.
    Wilson K. Therapeutic landscapes and First Nations peoples: An exploration of culture, health and place. Health Place 2003;9:83–93.CrossRefGoogle Scholar
  24. 24.
    Nettleton C, Napolitano D, Stephens C. An Overview of Current Knowledge of the Social Determinants of Indigenous Health: Working Paper. 2007. London School of Hygiene and Tropical Medicine. Commissioned by the World Health Organization.Google Scholar
  25. 25.
    Royal Commission on Aboriginal Peoples. Treaty Making in the Spirit of Co-existence: An Alternative to Extinguishment. Ministry of Supply and Services, 1995. Available at: http://qspace.library.queensu.ca/jspui/bitstream/1974/7731/1/Treaty_Making.pdf (Accessed October 21, 2013).Google Scholar
  26. 26.
    Cutler D, Lleras-Muney A. Education and Health: Insights from International Comparisons. National Bureau of Economic Research, 2012. Available at: http://www.nber.org/papers/w17738.pdf?new_window=1 (Accessed October 21, 2013).Google Scholar
  27. 27.
    National Council on Welfare. Welfare Incomes 2005. 2006. Available at: www.cmha.ca/download.php?docid=123 (Accessed October 21, 2013).Google Scholar
  28. 28.
    Holden B, Chapin N, Dyck C, Frasier N. Poverty Reduction Policies and Programs: Saskatchewan. Canadian Council on Social Development, 2009. Available at: http://www.ccsd.ca/Reports/SK_Report_FINAL.pdf (June 5, 2013).Google Scholar
  29. 29.
    Statistics Canada. 2006 Census. Ottawa: Statistics Canada. Cat. No. 97-560-X2006031. 2006.Google Scholar
  30. 30.
    Statistics Canada. Canada’s Changing Labour Force, 2006 Census: The Provinces and Territories. Aboriginal peoples in the workforce. Available at: http://www.statcan.gc.ca/pub/89-645-x/2010001/employmentemploieng. htm (Accessed February 25, 2013).Google Scholar
  31. 31.
    Anderson MC, Robertson, CL. Seeing Red: A History of Natives in Canadian Newspapers. Winnipeg, MB: University of Manitoba Press, 2011.Google Scholar
  32. 32.
    First Nations Information Governance Centre. First Nations Regional Health Survey (RHS) 2008/10: National Report on Adults, Youth and Children Living in First Nations Communities. Ottawa: FNIGC, 2012. Available at: http://fnigc.ca/sites/default/files/First_Nations_Regional_Health_Survey_2008-10_National_Report.pdf (Accessed October 21, 2013).Google Scholar
  33. 33.
    Furniss E. Aboriginal justice, the media, and the symbolic management of Aboriginal/Euro-Canadian relations. Am Indian Cult Res J 2001;25:1–36.CrossRefGoogle Scholar
  34. 34.
    Pfeifer JE, Ogloff JRP. Mock juror ratings of guilt in Canada: Modern racism and ethnic heritage. Soc Behav Personal 2003;31:301–12.CrossRefGoogle Scholar
  35. 35.
    Roberts JV, Doob, AN. Race, ethnicity, and criminal justice in Canada. Crime and Justice: A Review of Research 1997;21:469–522.CrossRefGoogle Scholar
  36. 36.
    Roberts R. Cancer Stories from the Woodland Cree: Exploring Perceptions of Cancer, Health and Illness in Northern Saskatchewan, Canada. Saarbrucken, Germany: VDM Verlag Dr. Muller, 2005.Google Scholar
  37. 37.
    Lee M. Cree (Nehiyawak) Teaching. 2006. Available at: http://www.fourdirectionsteachings.com/transcripts/cree.html (Accessed March 1, 2013).
  38. 38.
    Horvath S, Dickerson MO, MacKinnon L, Ross, MM. The impact of the traditional land use and occupancy study on the Dene ‘Tha First Nation. Can J Native Studies 2002;XXII(2):361–98.Google Scholar
  39. 39.
    Battiste M. Indigenous knowledge: Foundations for First Nations. 2005. Available at: http://www.win-hec.org/docs/pdfs/Journal/Marie%20Battiste%20copy.pdf (Accessed January 23, 2013).Google Scholar
  40. 40.
    Robbins JA, Dewar J. Traditional indigenous approaches to healing and the modern welfare of traditional knowledge, spirituality and lands: A critical reflection on practices and policies taken from the Canadian indigenous example. Int Indigenous Policy J 2011;2(4). Available at: http://ir.lib.uwo.ca/iipj/vol2/iss4/2 (Accessed January 23, 2013).
  41. 41.
    Samson C, Pretty J. Environmental and health benefits of hunting lifestyles and diets for the Innu of Labrador. Food Policy 2006;31:528–53.CrossRefGoogle Scholar
  42. 42.
    Richmond C, Elliot SJ, Matthews R, Elliot B. The political ecology of health: Perceptions of environment economy, health and well-being among ‘Namgis First Nation. Health Place 2005;11:349–65.CrossRefGoogle Scholar
  43. 43.
    Stroink ML, Nelson, CH. Aboriginal health learning in the forest and cultivated gardens: Building a nutritious and sustainable food system. J Agromed 2009;14:263–69.CrossRefGoogle Scholar
  44. 44.
    Downs SM, Arnold A, Marshall D, McCarger LJ, Raine KD, Willows ND. Associations among the food environment, diet quality and weight status in Cree children in Quebec. Public Health Nutrition 2009;12(9):1504–11.CrossRefGoogle Scholar
  45. 45.
    Willox AC, Harper SL, Ford JD, Landman K, Houle K, Edge VL; Rigolet Inuit Community Government. “From this place and of this place”: Climate change, sense of place, and health in Nunatsiavut, Canada. Soc Sci Med 2012;75:538–47.CrossRefGoogle Scholar
  46. 46.
    Barsh, RL. Canada’s Aboriginal peoples: Social integration or disintegration? Can J Native Studies 1994;14:1–46.Google Scholar
  47. 47.
    Kirmayer L, Simpson C, Cargo M. Healing traditions: Culture, community and mental health promotion with Canadian Aboriginal peoples. Australasian Psychiatry 2003;11(Suppl):S15–23.CrossRefGoogle Scholar
  48. 48.
    Aboriginal Healing Foundation. A Healing Journey: Final Report Summary Points. Available at: http://www.ahf.ca/downloads/final-report-summary-3.pdf (Accessed January 23, 2013).
  49. 49.
    Brant-Castellano M. Healing narratives: Recovery from residential school trauma. Transition 2006–2007;36(4):3–6.Google Scholar
  50. 50.
    Indian and Northern Affairs Canada. Royal Commission Report on Aboriginal Peoples, 1996. Volume 1, Looking Forward, Looking Back. Chapter 4: Stage one: Separate worlds. Available at: http://www.collectionscanada.gc.ca/webarchives/20071115053257/http://www.ainc-inac.gc.ca/ch/rcap/sg/sgmm_e.html (Accessed October 21, 2013).Google Scholar
  51. 51.
    National Collaborating Centre for Aboriginal Health. Employment as a Social Determinant of Health of First Nations, Inuit, and Métis Health. 2009. Available at: http://www.nccah-ccnsa.ca/docs/fact%20sheetsdocs/fact%20sheets/social%20determinates/NCCAH_fs_employment_EN.pdf (Accessed October 21, 2013).Google Scholar
  52. 52.
    Berger LR, Wallace LJ, Bill, NM. Injuries and injury prevention among indigenous children and young people. Pediatr Clin North Am 2009;56(6):1519–37.CrossRefGoogle Scholar
  53. 53.
    Auer AM, Andersson R. Canadian Aboriginal communities: A framework for injury surveillance. Health Promot Int 2001;16(2):169–77.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2014

Authors and Affiliations

  • Robert Nesdole
    • 1
  • Debora Voigts
    • 1
  • Rein Lepnurm
    • 1
  • Rose Roberts
    • 2
  1. 1.MERCURi Research Group, School of Public HealthUniversity of SaskatchewanSaskatoonCanada
  2. 2.College of NursingUniversity of SaskatchewanSaskatoonCanada

Personalised recommendations