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
Footnotes
Conflict of Interest: None to declare.
References
- 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. [Google Scholar]
- 2.Irvine J, Quinn B, Stockdale D. Northern Saskatchewan Health Indicators Report 2011. 2011. [Google Scholar]
- 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. doi: 10.1016/S0140-6736(06)68892-2. [DOI] [PubMed] [Google Scholar]
- 4.Wilson D, Northcott H. Dying and Death in Canada. Toronto, ON: University of Toronto Press; 2008. [Google Scholar]
- 5.Aboriginal AffairsNorthern Development Canada. Royal Commission Report on Aboriginal Peoples. Stage two: Contact and co-operation; 1996. [Google Scholar]
- 6.Health Council of Canada. The Health Status of Canada’s First Nations, Metis and Inuit people. 2005. [Google Scholar]
- 7.Aboriginal AffairsNorthern Development Canada. Royal Commission Report on Aboriginal Peoples. 1996. [Google Scholar]
- 8.British North America Act, 1867, 30–31 Vic., c. 3 (U.K.). Ottawa: Department of Justice.
- 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. 1998. [Google Scholar]
- 10.Nesdole R, Voigts D, Lepnurm R. Northern Inter-Tribal Health Authority. Health Status Report 2011. 2012. [Google Scholar]
- 11.Indian Act. R.S.C, 1985, c. I-5. Ottawa: Department of Justice.
- 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. doi: 10.1007/s10447-005-9008-8. [DOI] [Google Scholar]
- 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. doi: 10.1177/0829573506298751. [DOI] [Google Scholar]
- 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. doi: 10.7870/cjcmh-2000-0007. [DOI] [PubMed] [Google Scholar]
- 15.Pimatisiwin. 2011.
- 16.Beavon D, White J, Wingert S, Maxim P, editors. Aboriginal Policy Research: Moving Forward, Making a Difference. Toronto: Thompson Educational Publishing Canada; 2007. [Google Scholar]
- 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.Public Health Agency of Canada. What Makes Canadians Healthy or Unhealthy? Ottawa: The Agency. 2013. [Google Scholar]
- 19.Rose R, Prince Albert Grand Council . Reconnecting to the Land: Reclaiming Traditional Lifestyles as a Pathway to Health. 2013. [Google Scholar]
- 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. doi: 10.1016/j.jada.2009.06.362. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.The Healing Journey. 2006. Safety Plans. Available at: http://www.thehealingjourney.ca/inside.asp?219 (Accessed February 25, 2013).
- 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.Wilson K. Therapeutic landscapes and First Nations peoples: An exploration of culture, health and place. Health Place. 2003;9:83–93. doi: 10.1016/S1353-8292(02)00016-3. [DOI] [PubMed] [Google Scholar]
- 24.Nettleton C, Napolitano D, Stephens C. An Overview of Current Knowledge of the Social Determinants of Indigenous Health: Working Paper. 2007. [Google Scholar]
- 25.Royal Commission on Aboriginal Peoples. Treaty Making in the Spirit of Co-existence: An Alternative to Extinguishment. 1995. [Google Scholar]
- 26.Cutler D, Lleras-Muney A. Education and Health: Insights from International Comparisons. National Bureau of Economic Research. 2012. [Google Scholar]
- 27.National Council on Welfare. Welfare Incomes 2005. 2006. [Google Scholar]
- 28.Holden B, Chapin N, Dyck C, Frasier N. Canadian Council on Social Development. 2009. Poverty Reduction Policies and Programs: Saskatchewan. [Google Scholar]
- 29.Statistics Canada. 2006 Census. Ottawa: Statistics Canada; 2006. [Google Scholar]
- 30.Statistics Canada. Canada’s Changing Labour Force. 2006. [Google Scholar]
- 31.Anderson MC, Robertson CL. Seeing Red: A History of Natives in Canadian Newspapers. Winnipeg, MB: University of Manitoba Press; 2011. [Google Scholar]
- 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. [Google Scholar]
- 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. doi: 10.17953/aicr.25.2.l7u55326lxtn208g. [DOI] [Google Scholar]
- 34.Pfeifer JE, Ogloff JRP. Mock juror ratings of guilt in Canada: Modern racism and ethnic heritage. Soc Behav Personal. 2003;31:301–12. doi: 10.2224/sbp.2003.31.3.301. [DOI] [Google Scholar]
- 35.Roberts JV, Doob AN. Race, ethnicity, and criminal justice in Canada. Crime and Justice: A Review of Research. 1997;21:469–522. doi: 10.1086/449256. [DOI] [Google Scholar]
- 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.Lee M. Cree (Nehiyawak) Teaching. 2006. Available at: http://www.fourdirectionsteachings.com/transcripts/cree.html (Accessed March 1, 2013).
- 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.Battiste M. Indigenous knowledge: Foundations for First Nations. 2005. [Google Scholar]
- 40.Int Indigenous Policy J. 2011.
- 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. doi: 10.1016/j.foodpol.2006.02.001. [DOI] [Google Scholar]
- 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. doi: 10.1016/j.healthplace.2004.04.003. [DOI] [PubMed] [Google Scholar]
- 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. doi: 10.1080/10599240902739737. [DOI] [PubMed] [Google Scholar]
- 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. doi: 10.1017/S1368980008004515. [DOI] [PubMed] [Google Scholar]
- 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. doi: 10.1016/j.socscimed.2012.03.043. [DOI] [PubMed] [Google Scholar]
- 46.Barsh RL. Canada’s Aboriginal peoples: Social integration or disintegration? Can J Native Studies. 1994;14:1–46. [Google Scholar]
- 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. doi: 10.1046/j.1038-5282.2003.02010.x. [DOI] [Google Scholar]
- 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.Brant-Castellano M. Healing narratives: Recovery from residential school trauma. Transition. 2006;36(4):3–6. [Google Scholar]
- 50.IndianNorthern Affairs Canada. Royal Commission Report on Aboriginal Peoples. 1996. [Google Scholar]
- 51.National Collaborating Centre for Aboriginal Health. Employment as a Social Determinant of Health of First Nations, Inuit, and Métis Health. 2009. [Google Scholar]
- 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. doi: 10.1016/j.pcl.2009.09.016. [DOI] [PubMed] [Google Scholar]
- 53.Auer AM, Andersson R. Canadian Aboriginal communities: A framework for injury surveillance. Health Promot Int. 2001;16(2):169–77. doi: 10.1093/heapro/16.2.169. [DOI] [PubMed] [Google Scholar]