A summary of my learning from MHST 601 and application of concepts to Indigenous health in Canada

MHST 601 has been a valuable opening chapter to my journey through the Master of Health Studies program at Athabasca University. This week, I am reflecting on what I have learned, and summarizing my research within the course.

Professionalism

Professionalism is an important part of being a healthcare worker. Confidentiality of patients and coworkers is an ethical and legal obligation that we must uphold. My local health authority code of conduct (https://www.interiorhealth.ca/AboutUs/Policies/Documents/StandardsofConductforIHAEmployees.pdf) and the Canadian Society of Respiratory Therapists code of ethics (https://www.csrt.com/rt-profession/#codeofethics) are two of the main documents I can refer to about maintaining a professional identity online, and outside of work as a respiratory therapist working in Interior Health Authority. During this course, I explored how to be appropriate and professional while using social media, and also, how I could make a difference in the health of people around the world using social media. Social media is a far-reaching communication tool that can be used to educate people, and impact health greatly (Ventola, 2014). One post or video can reach millions of people, and people with similar health issues can connect with each other, with hundreds of miles between them.

Defining Health

Defining health is essential to measuring and assessing it. In MHST 601, we spent time researching the current definition of health and finding ways it could be refined. A highlight was finding out how the current definition, a “State of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity,” could be refined (WHO, 2018). A common theme was to change the definition to include elements of resilience, and living well with chronic disease (Huber, 2011). Another interesting theme was changing the definition to include a measure of tolerance (Brook, 2017). Brooke published a paper discussing how people who feel hate towards certain groups of people should not be viewed as healthy (Brook, 2017). People may function well in all areas of health, but if hatred pervades their life, how can they be viewed as healthy (Brook, 2017)? In his article, Brooke called for medical professionals to step up in promoting tolerance as a measure of health, he further explained that “hate is contagious and deadly,” comparing it to other contagious and deadly diseases, which health professionals should continuously work to eradicate (Brook, 2017).

Indigenous Health Issues in Canada using a Socioeconomic Model

Social and economic circumstances greatly impact health in people (BCNU, 2015). When socioeconomic and environmental conditions improve, population health improves (BCNU, 2015). This improvement is for many reasons, including access to better education, nutrition, and housing.

Canada is home to several vulnerable groups that experience disparities in health compared to other Canadians. Inuit, First Nations, and Metis people are three distinct groups that are often grouped together because they are the first people of Canada, and they have all experienced systemic oppression (Ferris, 2011). This oppression has led to vulnerability, and higher rates of disease and illness (Ferris, 2011). Aboriginal populations have higher rates of diabetes, hypertension, kidney disease, diseases caused by environmental contamination, and infectious diseases (NCCAH, 2013). In addition, mental health issues, homicide, suicide, interpersonal violence, and infant/young child mortality disproportionately affects Aboriginal people, negatively (NCCAH, 2013).

Disparities in health between Aboriginal and non-Aboriginal Canadians may be seen by some as a result of specific behaviours and lifestyle choices, however, many of these behavioural determinants are a result of Aboriginal-specific social determinants that arose from colonialism in Canada (Appiah-Kubi, 2015). The colonization of Canada resulted in forced removal of children from their families and communities, forced relocation of communities, loss of land, loss of language, and erosion of Indigenous culture (NCCAH, 2013). These complex factors make it important to research disparities in health in Aboriginal groups using a multilevel model of health. Figure 1 shows an example of a multilevel socioeconomic model of health for Aboriginal people.

Figure 1 Reprinted from Appiah-Kubi, Tracy. (2015). Social Determinants of Aboriginal Peoples’ Health in Canada. Retrieved on December 3, 2018 from www.healthyweightsconnection.ca/ModuleFile/resource?id=3368

Social and economic factors have directly and indirectly produced health outcomes for Aboriginal Canadians (Appiah-Kubi, 2015). For example, during the colonialism period in Canada, Aboriginal people were forbidden from obtaining food through their traditional methods, such as hunting, trapping, and fishing (Appiah-Kubi, 2015). As a result, they became reliant on the food of colonizers, which was inferior in terms of nutrition and quality (Appiah-Kubi, 2015). In addition, they were introduced to harmful substances, such as alcohol, which have had a lasting negative impact on health in Aboriginal populations (Appiah-Kubi, 2015). These impacts are examples of how upstream, historical factors can impact individual behaviours and lifestyle choices for generations.

The racism and discrimination experienced by Aboriginal people led to the denial of resources and circumstances that were necessary for maximizing socioeconomic status (SES) (Appiah-Kubi, 2015). Social determinants of health create circumstances and environments that lead to other determinants of health. For example, living in poor housing conditions can lead to increased incidence of illness and disability, which can then affect ability to participate in gainful employment (Appiah-Kubi, 2015). This can then compound issues related to poverty, such as affording nutritious, whole foods. These low socioeconomic circumstances contribute to downstream heath issues such as addiction and depression as well (Appiah-Kubi, 2015).

One health issue I focused on in MHST 601 was the growing public health issue, obesity. WHO defines overweight as a body mass index (BMI) greater than or equal to 25, and obesity as a BMI greater than or equal to 30 (WHO, 2018). Obesity is a problem because it is a major risk factor for several non-communicable diseases including cardiovascular disease, heart disease, stroke and diabetes (WHO, 2018). In addition, it can have psychological effects, and is a risk factor for musculoskeletal disorders, such as osteoarthritis (WHO, 2018). Figure 2 shows how obesity can flow from upstream determinants to downstream diseases.

Figure 2 Reprinted from Lakerveld, J., & Mackenbach, J. (2017). The Upstream Determinants of Adult Obesity. Obesity facts, 10(3), 216-222. “A stream depicting the chronological order from upstream determinants to downstream diseases.”

Figure 3 shows rates of obesity and overweight body mass indices (BMI) for Aboriginal and non-Aboriginal groups in Canada (Statistics Canada, 2015). In the chart, you can see that while the number of overweight Canadians is consistent between non-Aboriginal and Aboriginal groups, the rates of obesity are higher in Aboriginal groups.

Figure 3 Reprinted from Statistics Canada. (2015). Percentage of population who are overweight or obese by Aboriginal and non-Aboriginal populations, aged 18 and over, Canada. Retrieved on December 3, 2018 from https://www150.statcan.gc.ca/n1/pub/82-624-x/2013001/article/chart/11763-03-chart3-eng.htm

It is simple to say that the solution to obesity is eating healthier and exercising, but the barriers that Aboriginal people face are complex and exist on multiple levels, as was discussed earlier. For some, there are language barriers to using education tools and resources available (Ferris, 2011). Some Indigenous people report not having a grocery store or food bank on the reserve they live, and also, not having transportation to get off the reserve and access these resources (Ferris, 2011). In regards to physical activity, socioeconomic circumstances can lead to people not having the money to afford the right gear to go outside and be active, for example, not having warm enough clothes (Ferris, 2011). In some cases, there are dangers to going outside on reserves, for instance, some Aboriginal people have reported being afraid of wild dogs and other animals that run free on some reserves (Ferris, 2011). In order to change the rates of childhood obesity, systemic effects of poverty, and the intergenerational effects of residential schools must be addressed (Ferris, 2011).

The emergence of the First Nations Health Authority (FNHA) in BC, has been a step in the right direction to improving health inequities among First Nations people (FNHA, n.d.). The FNHA plans, manages, delivers and funds health programs in partnership with First Nations communities in BC (FNHA, n.d.). The services FNHA provides are focused on prevention and health promotion in areas such as mental health and wellness, communicable disease control, and child, youth and maternal health (FNHA, n.d.). In addition, the FNHA works to provide culturally safe and appropriate care for First Nations people (FNHA, n.d). A discussion on the sustained multilevel interventions required to improve health equity for Aboriginal groups is beyond the scope of this blog post, however I will mention that in December of 2015, the National Collaborating Centre for Aboriginal Health (NCCAH) hosted a gathering of people from diverse national and provincial Indigenous organizations to discuss and review current evidence related to the social determinants of Indigenous health (NCCAH, 2017). Some conclusions made in the gathering were that in order for Indigenous people to continue to move forward and heal, there must be reconciliation for the past (NCCAH, 2017). This reconciliation includes Indigenous rights to self-determination, and the eradication of poverty (NCCAH, 2017). It was racism and oppression that greatly impacted the health of this large group of Canadians, and Brooke’s paper about including a measure of tolerance in the definition of health is significant and relevant in part, for this reason.

In conclusion, MHST 601 has been a learning experience with regard to health, and the improvements on many levels that are required to improve the health of Canadians and to improve health equity for vulnerable groups. I look forward to continuing to learn and explore these topics more during my academic and professional career.

References

Appiah-Kubi, Tracy. (2015). Social Determinants of Aboriginal Peoples’ Health in Canada. Retrieved on December 3, 2018 from www.healthyweightsconnection.ca/ModuleFile/resource?id=3368

BC Government. (2015). First Nations Health and Well-being. Retrieved on November 9, 2018 from https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/reports-publications/special-reports/first-nations-health-and-well-being-interim-update-nov-2015.pdf

British Columbia Nurses Union (BCNU). (2015). Position statement: Social determinants of health. Retrieved on December 4, 2018 from https://www.bcnu.org/AboutBcnu/Documents/position-statement-social-determinants-of-health.pdf

Ferris, M. A. (2011). Preventing Obesity in Canada’s Aboriginal Children: Not Just a Matter of Eating Right and Getting Active. International Indigenous Policy Journal, 2(1) . Retrieved from: http://ir.lib.uwo.ca/iipj/vol2/iss1/

First Nations Health Authority. (n.d.). About the FNHA. Retrieved on November 8, 2018 from http://www.fnha.ca/about/fnha-overview

Huber, M. (2011). Health: How Should we Define it? BMJ: British Medical Journal, 343(7817), 235-237. Retrieved from http://www.jstor.org/stable/23051314

Lakerveld, J., & Mackenbach, J. (2017). The Upstream Determinants of Adult Obesity. Obesity facts, 10(3), 216-222.

National Collaborating Centre for Aboriginal Health (NCCAH). (2013). An Overview of Aboriginal Health in Canada. Retrieved from https://www.ccnsa-nccah.ca/docs/context/FS-OverviewAbororiginalHealth-EN.pdf

National Collaborating Centre for Aboriginal Health. (2017). Transforming our realities : The determinants of health and indigenous peoples. Retrieved October/14, 2018, from http://0-www.deslibris.ca.aupac.lib.athabascau.ca/ID/10094282

Statistics Canada. (2015). Percentage of population who are overweight or obese by Aboriginal and non-bb Aboriginal populations, aged 18 and over, Canada. Retrieved on December 3, 2018 from https://www150.statcan.gc.ca/n1/pub/82-624-x/2013001/article/chart/11763-03-chart3-eng.htm

Ventola, C. L. (2014). Social Media and Health Care Professionals: Benefits, Risks, and Best Practices. Pharmacy and Therapeutics, 39(7), 491–520.

World Health Organization. (2018). Constitution of WHO: principles. Retrieved October 2, 2018 from http://www.who.int/about/mission/en/

World Health Organization. (2018) Obesity and Overweight. Retrieved on November 26, 2018 from http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight