Mirror, Mirror on the Wall-Structural Racism and Indigenous Child Health-Social Ecological Model
- chatyrbok4
- Feb 28, 2021
- 8 min read
Updated: Mar 23, 2021
I raise up my voice - not so I can shout but for those without a voice can be heard - Malala Yousafzai
Photo retrieved February 26, 2021 from https://unsplash.com/@mannyb?utm_source=wix-media-manager&utm_medium=referral
Introduction
Indigenous voices are often silenced when it comes to healthcare. The effects of residential schools and the oppression from colonialism has dictated multi-generational trauma and current health outcomes as a result of those systems. The World Health Organization has recognized colonization as the most significant social determinant of health affecting Indigenous peoples worldwide (Cunningham, 2009). The current biomedical policies developed through colonialism continue to be evident in today's healthcare. "Structural racism is defined as the macro-level systems, social forces, institutions, ideologies, and processes that interact with one another to generate and reinforce inequities among racial and ethnic groups" (Juutilainen et al, 2014). Additionally, the Indian Act which"is an evolving, paradoxical document that has enabled trauma, human rights violations and social and cultural disruption for generations of Indigenous peoples."continues to oppress Indigenous children's equitable rights to healthcare (Henderson, 2020). Over the years, many amendments have been made to the Indian Act, recognizing the unfair treatment and government policy controlling First Nation communities. In fact it was as recent as 2008 that Indigenous people living on reserves were finally recognized in the Human Rights Act and could file complaints of discrimination (Government of Canada, 2017).
"Studies suggest that historical legacies of social oppression are the present day social forces that influence racial inequalities in health, with racism as the link between race and health' (Juutilainen et al, 2014).
When discussing policies influencing health, this would align with Bronfenbrenner's fifth layer of the Social Ecological Model (SEM). In order to understand structural racism and how it influences a child's health, we have to be able to see the problem, in order to be part of the solution. I will first examine the SEM's stages more in depth, then using Manitoba as an example, I will apply the SEM to show the disparities in health affecting Indigenous children living in remote northern communities.
A quick summary into the barriers the inequities Indigenous children are facing in Canada.
Macleans (2017) Why Indigenous children are overrepresented in Canada's foster care system Retrieved March 8, 2021 from https://www.youtube.com/watch?v=MBLCd7yle8g
When discussing the social ecological model, the video below, which provides a great explanation in showing the relations between the different influencing factors that can impact child's health, from individual to family to social policies.
Retrieved from https://www.youtube.com/watch?v=5htRhvm4iyI
A child's health and development is framed and dependent on multiple factors, including family, school, home, neighbourhood and community environments. Additionally, in turn each of these are influenced by broader social, economic, political and cultural factors. As seen in the above video, the SEM is divided into five stages. Kilnowski (2017) describes the five stages beginning with the stages closest to the individual. The microsystem (or Intrapersonal) describes factors that are closest to the individual. This stage is usually the most influential and encompasses relationships in the immediate areas surrounding the individual. The second stage is the mesosystem (or interpersonal) which focuses on areas that the individual has direct interaction with such as school, work, church and their immediate environment of their neighbourhood. The exosystem (or organizational) does not directly impact the individual, but can have both negative and positive interaction and influence their community and social networks. The macrosystem (or community) includes societal, religious, and cultural values and influences. Lastly, the chronosystem (or public policy) contains both internal and external elements of time and historical content; in revised models, this level includes the influence of policy.
Manitoba currently has 63 First Nation reserves, with 23 that are inaccessible by year round roads.
It is a well-known fact that Indigenous people face a disproportionate amount of adverse health outcomes compared to those non-indigenous populations (Halseth & Greenwood, 2019,Reading & Wien, 2009).
Halseth and Greenwood further state that Indigenous children are influenced by “factors at the level of the family, community, and the broader societal systems and structures in which they live” (2019). Children living on reserve had higher rates of diabetes, dental surgeries, lower respiratory tract infections and developmental disabilities compared to those children living off reserve in Manitoba (Chartier et al., 2020). The history of residential schools have left a legacy of long lasting and intergenerational effects on physical, emotional, spiritual and mental well-being of Indigenous people (Wilk, Maltby and Cooke, 2017). The policies and process that were historically put in place by the Government of Canada, showed they instituted 132 Indian Residential Schools across Canada. As a direct result of Indigenous children being ripped away from their parents by the Canadian government to try and assimilate them to the European ways, the Indigenous people have ended up losing their way of life, educational opportunities, poorer health outcomes, parenting and family structures and of course their culture and language. Those policies that were instituted then, still impact Indigenous health today, especially the children.
"Children are exposed to many experiences, both nurturing and stressful, which can have different effects on them as individuals"(Emerging Minds, 2021). The family plays an integral part in a child's development, but what happens when the family is not functioning at an optimal level or policies that are in place restrict equitable services? The SEM provides a framework for us to examine the health of Indigenous children living in remote northern communities. We will explore the impact and influences following the stages in the SEM and how structural racism is playing a strong role in the overall health of Indigenous children.
Social Ecological Model
Intrapersonal (Microsystem) - Right from the early stages of gestation children are already experiencing the effects of inequitable health care. High incidences of maternal diabetes, addictions, poor housing and environmental conditions, high rates of teen pregnancy, poor nutrition are all impacting children’s health before they are even born (Chartier et al, 2020). The power differentials must be broken down between our health system and our Indigenous population in order to make a more culturally safe environments and allow their comfort in voicing their concerns. The remote and environmental conditions that many children grow up in directly attribute to their poorer health outcomes (Chartier et al, 2020).
Interpersonal (Mesosystem) – This involves relationships between 2 or more groups of people in the Microsystem. In all aspects of education, reading, writing, math and even graduating from high school, children living on reserve were significantly lower than other non-indigenous Manitobans (Chartier, 2020). Physical environments such as crowded housing conditions can indirectly contribute to substance abuse for parents, which may result in poor school performance among youth and children (Halseth & Greenwood, 2019). According to Chartier et al, (2020), First Nation children were less likely to graduate from high school (46.5%) compared to those non Indigenous Manitobans (89.7%). The interactions between the interpersonal and intrapersonal influence a child's development.
Organizational (Exosystem) – The impacts of the organizational stage may not directly involve the child but can influence a child’s wellbeing and development. It explores how other factors in the child’s life affects who they are. For example, parental abuse or addictions can indirectly influence the child’s development. A parent may lose their job, come home be verbally or physically abusive, the child is then apprehended by CFS and placed in the system. According to Chartier (2020) in all aspects of social services such as children in care or involved with CFS, Indigenous children on reserve were more apt to be involved in that system than non-indigenous children living in Manitoba. According to Statistics Canada 7.7% of children in Canada are Indigenous with 52.2% of children that are living in foster care are Indigenous (Government of Canada, 2020).
Community (Macrosystem) – This stage looks at cultural elements which have an impact on a child, including values, or religion. A lot of cultural and traditional knowledge was lost due to historical impacts of colonialism. This factor in the SEM can include socioeconomic status, ethnicity, geographic location and ideologies of the culture. “Remote communities, whether they are Métis, Inuit, or First Nations, suffer from a lack of economic development that might help to ameliorate health problems related to socioeconomic status” (Halseth and Greenwood, 2019). When looking at the macrosystem, like the video indicated, ask yourself how different would a child's life be if they grew up say in Canada versus a 3rd world country? Geography can play an instrumental role in influences on your health.
Public Policy (Chronosystem) – This stage of the SEM reflects upon situations/circumstances/events from their past. The effects of colonialism and residential schools have continued to impact the health and wellness of Indigenous populations. The intergenerational trauma faced by this population has had long lasting and detrimental effects. The continued government policies that continue to impact the health inequities continues to be a barrier to health equity for Indigenous children. Transitions in a child’s life overtime influence their health. For example, if a child has been removed from their home and community to be placed in the foster system, the detrimental effects this can lead to on their health such as depression, decreased exposure to their culture and heritage, sense of belonging in their community and the list goes on.
Take a look at this video by Cindy Blackstock, a true advocate for Indigenous Child Health.
The following are just a few examples of the effects of structural racism within our society today, blatantly affecting Indigenous health. Keep in mind these are only a few of the stories that have been publicized and that many stories have gone unheard.
The Brian Sinclair Story - Another example of structural racism within our healthcare system.
Joyce Echaquan's Story - Yet another example of structural racism against Indigenous people.
Conclusion
"In order to have healthy children, one must have healthy parents, and healthy parents come from healthy grandparents" (Chartier et al, 2020). The structural racism that continues to exist and perpetuate the poorer health outcomes, must begin to address the surrounding influences. What is the sense of addressing the health diagnosis if we are just going to send people back to the environment that is making them sick. "Healthy communities are comprised of healthy people with healthy children at the centre of all that we do"(Chartier et al, 2020). As a health clinician we have an obligation to ensure we are focused on the person as a whole and the external factors affecting their health. “Clinicians have a special role to play in ensuring that real-world efforts to address SDOH truly improve individuals’ health and wellbeing, promote informed choices, and support health equity. (DeCamp et al., 2020).
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 February 19, 2021 http://mchp-appserv.cpe.umanitoba.ca/reference/FNKids_Report_Web.pdf
Cunningham M., (2009). Chapter V: Health. In United Nations, Permanent Forum on Indigenous Issues, State of the world’s Indigenous peoples. New York: United Nations, 2009:156–87.
DeCamp, M., DeSalvo, K., & Dzeng, E. (2020). Ethics and Spheres of Influence in Addressing Social Determinants of Health. Journal of General Internal Medicine, 1-3. https://www.semanticscholar.org/paper/Ethics-and-Spheres-of-Influence-in-Addressing-of-DeCamp-DeSalvo/e49c2afa6b4dfaa79f152246b6121b1d7483af98
Emerging Minds (2021). The Child and Their Local Ecology Retrieved from March 4, 2021 https://emergingminds.com.au/our-work/guiding-principles/children-local-ecology/
Government of Canada (2017). Indigenous Peoples and Human Rights Retrieved March 5, 2021 from https://www.canada.ca/en/canadian-heritage/services/rights-indigenous-peoples.html
Government of Canada (2020). Statistics Canada Reducing the number of Indigenous children in care retrieved from February 19, 2021 https://www.sac-isc.gc.ca/eng/1541187352297/1541187392851
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
Henderson, W. B. (2020) "Indian Act". The Canadian Encyclopedia, 16 December 2020, Historica Canada. https://www.thecanadianencyclopedia.ca/en/article/indian-act. Accessed 26 February 2021.
Juutilainen, S. A. , Miller, R. , Heikkilä, L. , Rautio, A. (2014). Structural Racism and Indigenous Health: What Indigenous Perspectives of Residential School and Boarding School Tell Us? A Case Study of Canada and Finland. The International Indigenous Policy Journal, 5(3) . Retrieved from: http://ir.lib.uwo.ca/iipj/vol5/iss3/3 DOI: 10.18584/iipj.2014.5.3.3
Kilanowski, J.F., (2017) Breadth of the Socio-Ecological Model,Journal of Agromedicine,22:4,295-297,DOI: 10.1080/1059924X.2017.1358971
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
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
Comments