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Final Reflection-The Whole Picture-Indigenous Child Health-Self-Determination for a Better Future

Updated: Apr 6, 2021



INTRODUCTION


Reflecting on our learning journey, we have put together a path leading us to a fuller picture of health for everyone and how we, as a healthcare professional fit in to it. We began looking at ourselves as a professional and how we fit into the healthcare system in our province. We explored the definition of health and the social determinants that affect it. We discovered influences surrounding our health and how to integrate it into a health model. Finally, we looked at the effects of chronic diseases in health and the health disparities vulnerable populations face all the while looking at future directions in health. The relationships and interconnectedness of one upon the other paints a whole picture showing us that optimal health in every sense of the word is difficult to achieve due to the many factors affecting it. Focusing on the First Nations children, we will chart the path from our learning perspective.


WHAT IS HEALTH


Due to the effects of colonialism, First Nations people often do not voice their concerns when it comes to health. Is this due to them feeling they will be judged or is it due to past traumas and oppression from colonialism? "Indigenous Canadians suffer from disproportionate increases in diabetes, hypertension, substance abuse, mental health concerns, and overall morbidity and mortality in addition to having significantly reduced life expectancy" (Kim, 2019). Healthcare for First Nation children has long been substandard compared to non-Indigenous children. The World Health Organization (WHO) defines health as "... a state of complete physical, mental, and social well-being and not merely the absence of disease of infirmity” (World Health Organization, 2008). Just having the absence of disease is not indicative of optimal health. Health is in the eye of the beholder. The WHO definition uses the word complete to to define health. Health can have many meanings, as it is as unique as we are. Health is a snapshot in time depending on what is going on in your life when health is being assessed and therefore it is difficult to have a universal definition that covers all aspects.  Our Canadian Indigenous population, especially the children, have faced health disparities for generations and the influences surrounding their health is not easy to universally define.


Retrieved April 5, 2021 from https://www.youtube.com/watch?v=AJQ04Af_XxI


GOVERNANCE-FIRST NATION HEALTH FUNDING


The Federal and Provincial Governments are primarily responsible for funding health on reserves. Due to historical agreements, health funding still creates ambiguity today (Lavoie et al, 2008). Currently, nearly all First Nations reserves have access to services located on-reserve such as Health Centers or Nursing Stations, depending on the level of care and population of reserve. Physicians typically are funded by the province to visit communities on a regular basis to provide primary care, often on a rotating schedule. Thus care may be under a different physician and rarely is there a visiting pediatrician. Patients requiring secondary or emergency care are transported to the nearest urban center, sometimes requiring multiple modes of transportation. Cooperation between First Nations and government to design and implement healthcare is a step in reconciling health disparities among Indigenous children. Health Canada provides program funding on reserve to help enhance the health for First Nation children, such as, Jordan’s Principle, Headstart, and Maternal Child and Young Health programs (Government of Canada, 2021).



SOCIAL DETERMINANTS OF HEALTH


There has been considerable progress in health research and learning about factors that have the ability to influence our health that are outside the health system and not just solely relying on our own personal choices. The effects of colonialism on the Canadian Indigenous people are far-reaching and continue to show the health inequities displayed in today's communities (Kim, 2019). In the Indigenous culture, children are seen as a gift from the creator and therefore are considered the center of many Indigenous cultures and held in the highest regard. The history of colonization is the most significant social determinant of health affecting Indigenous peoples (Smylie, 2013). Due to historical traumas, generations of children have been affected and are a casualty of the years of governmental oppression. According to the World Health Organization (2021) the social determinants of health (SDoH) are considered “conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life". These include such factors as income and social status, employment and working conditions, education and literacy, childhood experiences, physical environments, social supports and coping skills, healthy behaviors, access to health services, biology and genetic endowment, gender, cultures and race / racism (Government of Canada, 2021).


As much as the determinants of health can affect positively,

they can negatively impact you as well.


Indigenous children are born into a legacy left by colonialism, that results in poverty, increase rates of substance abuse and higher interactions with the justice system (Greenwood et al, 2012). The SDoH affecting children such as poverty, low educational outcomes, poorer health, decrease coping skills attribute to generations of children repeating the same traumas and health outcomes experienced by their ancestors. The colonial process and residential schools has resulted in Indigenous people having diminished self-determination and a lack of influence in policies that directly relate to them as individuals and their communities (Reading and Wien, 2009). The cycle needs to be broken and past travesties reconciled to change the future directions of health for Indigenous children.


Health Inequalities in Canada Retrieved April 2, 2021 from https://www.youtube.com/watch?v=RMkBUXJLW9g


PUTTING IT IN PERSPECTIVE - SOCIAL ECOLOGICAL MODEL (SEM) VERSUS THE FIRST NATIONS PERSPECTIVE OF HEALTH AND WELLNESS


Healthy communities create healthy families which in turn creates healthy children. A child's health and development is framed and dependent on multiple factors, including family connections, education, physical and community environments. Additionally, each of these are influenced by the broader social, economic, political and cultural factors. The residential school system forced family separation and a genocide of cultural traditions at a time when childhood and adolescence development was critical (Kim, 2019). According to the Alberta Health Services (2020) in order to improve individual health and wellness we must look at 3 levels: individual, community and policy. It is not enough to just look at an individual and their diagnosis, we must look at the entire picture and break down not only what they are experiencing but why, and the factors contributing to that. As we have discovered previously, the SEM can be used to learn more about individual health outcomes from a multilevel approach. Kilnowski (2017) describes five stages of the SEM - Microsystem (Intrapersonal), Mesosystem (Interpersonal), Exosystem (Organizational), Macrosystem (Community) and Chronosystem (Public Policy). Comparing the First Nations Perspective to Health and Wellness (2021) there are 5 circles depicting their perspective model. The first represents the individual and them taking responsibility for their own health and wellness. The second circle illustrates the holistic balance needed between mental, emotional, spiritual and physical aspects of one's life. The third circle represents the values that are ingrained in all of us towards our health and the fourth represents the people surrounding us and our community including the land. Finally the fifth circle represents the social, cultural, economic and environmental factors affecting our health and well-being. When comparing the two models you can see many similarities. Before a child is even born, they have already begun to experience health disparities. The social determinants of health that play a role in childhood development first becomes evident in adolescence (Reading and Wien, 2009). There is a high incidence of teenage pregnancy, with little to no prenatal care and therefore infant well being is already compromised prior to birth. Maternal diabetes, addictions, poor housing, environmental conditions, and poor nutrition are all contributing factors influencing the risk of unhealthy babies being born. (Chartier et al, 2020). Indigenous children have lower education outcomes with fewer children graduating high school than non-Indigenous children, placing them at a disadvantage for employment and income earning which in turn affects housing, nutrition etc. We can begin to see the fuller picture of the effects the SDoH that play a role in Indigenous children's health.


CHRONIC DISEASES


Many of the illnesses and conditions that disproportionately affect Indigenous children, such as obesity, diabetes, and cardiovascular disease, can be directly linked to colonialism, including the Indian Act, the reserve system, and residential schooling (Wilk, Maltby & Cooke, 2017). Indigenous people living on reserve have a rate of diabetes three to five times higher than that of other Canadians (Government of Canada, 2013). Diabetes is prevalent in Indigenous populations and we are seeing it diagnosed in children younger and younger each year. The disproportionate amount of Indigenous children with Diabetes can be related back to colonial processes (Halseth, 2019). Again relating back to the social determinants of health, we can see that there is a direct correlation between Diabetes and affordable nutritious foods, poverty, poor education outcomes, and health inequities that contribute to Diabetes prevalence and the complications related to it. According to Pylpiuk (2021) Indigenous mothers that have Type 2 gestational diabetes or had Type 2 Diabetes as a child have an increase risk of having infants with poorer health outcomes compared to non-Indigenous women. Looking at that information, the need for strong health promotion early in pregnancy and parenting classes will increase health outcomes related to Diabetes in children.


VULNERABLE POPULATIONS


In 2015 The Truth and Reconciliation Commission released the 94 calls to action.

Call to Action number 19…

“We call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess long term trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services.


Manitoba First Nation children have a higher percentage of children in care at 13.9% compared to non-indigenous children at 2% (Chartier et al, 2020). In 2016, in Manitoba Indigenous children represented 19% of the population with 78% in of them in care (Chartier et al, 2020). The overrepresentation of children in care creates a vulnerable population of children for future generations.


FUTURE DIRECTIONS AND CONCLUSION


No one can argue that First Nation children suffer more health inequities than non-Indigenous children. With the global pandemic, this has been proven over the past year the widening gap in health inequities. Due to many of the social determinants of health such as crowded housing, lack of access to healthcare and healthy behaviors have attributed to their increase risk of getting COVID 19. With the implementation of programs such as Nutrition North and Jordan’s Principle, Indigenous children are able to access better healthcare though there is still much to be done to gain equitable care for Indigenous children. By developing Indigenous health and wellness indicators it will move away from the colonial standards of health monitoring and step into the light of Indigenous sovereignty of controlling their own healthcare (Heggie, 2018). As technological advances in virtual care and robotics continues to develop and close the gap on disparities, we as clinicians need to continue to recognize and advocate for better healthcare for Indigenous children.


References

 

Chartier M, Brownell M, Star L, Murdock N, Rhonda Campbell R, Phillips-Beck W, Meade, C, Au W, Schultz J, Bowes JM, Cochrane B. (2020) Our Children, Our Future: The Health and Well-being of First Nations Children in Manitoba. Winnipeg. MB. Manitoba Centre for Health Policy. Retrieved from April 4, 2021 http://mchp-appserv.cpe.umanitoba.ca/reference/FNKids_Report_Web.pdf


First Nations Health Authority (2021) First Nations Perspective on Health and Wellness Retrieved April 5, 2021 from https://www.fnha.ca/wellness/wellness-and-the-first-nations-health-authority/first-nations-perspective-on-wellness


Government of Canada (2013) Indigenous Health Diabetes Retrieved from April 2, 2021 https://www.sac-isc.gc.ca/eng/1569960595332/1569960634063


Government of Canada (2020) Social Determinants of health and Health Inequalities Retrieved April 2, 2021 from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html


Government of Canada (2021) Indigenous Services Canada – Funding Programs Retrieved April 2, 2021 from https://www.sac-isc.gc.ca/eng/1591289631120/1591289804651


Greenwood, M. L., & de Leeuw, S. N. (2012). Social determinants of health and the future well-being of Aboriginal children in Canada. Paediatrics & child health, 17(7), 381–384.


Halseth, R. & Greenwood, M. (2019). Indigenous early childhood development in Canada: Current state of knowledge and future directions. Prince George, BC: National Collaborating Centre for Aboriginal Health https://www.nccih.ca/docs/health/RPT-ECD-PHAC-Greenwood-Halseth-EN.pdf


Heggie, K. (2018). Indigenous wellness indicators-including urban Indigenous wellness indicators in the healthy city strategy. Healthy City Scholar. Social Policy and Projects Vancouver, British Columbia, Canada Retrieved from https://sustain.ubc.ca/sites/default/files/201862%20Indigenous%20Wellness%20Indicators_Heggie.pdf


Kim, P. (2019) Social Determinants of Health Inequities in Indigenous Canadians Through a Life Course Approach to Colonialism and the Residential School System Health Equity Volume 3.1, Retrieved April 5, 2021 from https://www.liebertpub.com/doi/pdf/10.1089/heq.2019.0041


Kilanowski, J.F., (2017) Breadth of the Socio-Ecological Model,Journal of Agromedicine,22:4,295-297,DOI: 10.1080/1059924X.2017.1358971


Lavoie J.G., Gervais,L., Toner, J.,Bergeron, O., Thomas, G., (2011) The


Pylypiuk, C.,Sellers, E., Wicklow, B., (2021) Perinatal Outcomes in a Longitudinal Birth Cohort of First Nations Mothers With Pregestational Type 2 Diabetes and Their Offspring: The Next Generation Study Canadian Journal of Diabetes Volume 45, Issue 1, February 2021, Pages 27-32 https://0-www-sciencedirect-com.aupac.lib.athabascau.ca/science/article/pii/S149926712030126X?via%3Dihub

 

Reading, C.L. & Wien, F. (2009). Health Inequalities and Social Determinants of Aboriginal Peoples' Health. Prince George, BC: National Collaborating Centre for Aboriginal Health. https://www.nccah-ccnsa.ca/docs/social%20determinates/nccah-loppie-wien_report.pdf


Smylie, J. (2013) Addressing the Social Determinants of Health of Aboriginal Infants, Children, and Families in British Columbia National Collaborating Center for Aboriginal Health Retrieved April 5, 2021 from https://www.ccnsa-nccah.ca/docs/health/FS-SDOHforAboriginalChildren-Smylie-EN.pdf


Wilk, P., Maltby, A. & Cooke, M., (2017). Residential schools and the effects on Indigenous health and well-being in Canada—a scoping review. Public Health Rev 38, 8 https://doi.org/10.1186/s40985-017-0055-6


World Health Organization. (1948, April 7). Constitution of the World Health Organization.https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1


World Health Organization (2021) Social determinants of health. retrieved February 10, 2021








 
 
 

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Sheila Chatyrbok RN BN CAE

St. Amant - Clinical Services

440 River Road

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