Abstract
Objectives: Mainstream environmental assessment (EA) methodologies often inadequately address health, social and cultural impacts of concern for Canadian indigenous communities affected by industrialization. Our objective is to present a holistic, culturally-appropriate framework for the selection of indigenous health indicators for baseline health assessment, impact prediction, or monitoring of impacts over time.
Methods: We used a critical population health approach to explore the determinants of health and health inequities in indigenous communities and conceptualize the pathways by which industrialization affects these determinants. We integrated and extended key elements from three indigenous health frameworks into a new holistic model for the selection of indigenous EA indicators.
Results: The holistic model conceptualizes individual and community determinants of health within external social, economic and political contexts and thus provides a comprehensive framework for selecting indicators of indigenous health. Indigenous health is the product of interactions among multiple determinants of health and contexts. Potential applications are discussed using case study examples involving indigenous communities affected by industrialization.
Conclusion: Industrialization can worsen indigenous health inequities by perpetuating the health, social and cultural impacts of historic environmental dispossession. To mitigate impacts, EA should explicitly recognize linkages between environmental dispossession and the determinants of health and health inequities and meaningfully involve indigenous communities in the process.
Key Words: Aboriginal health, environmental impact assessment, determinant of health, indicators
Résumé
Objectifs: Souvent, les méthodes d’évaluation environnementale (EE) ordinaires n’abordent pas suffisamment les impacts sanitaires, sociaux et culturels de l’industrialisation sur les populations indigènes du Canada. Nous avons voulu présenter un cadre holistique, adapté aux différences culturelles, pouvant servir à sélectionner des indicateurs de santé indigène qui se prêtent 1) à l’évaluation de l’état de santé de départ, 2) à la prédiction des impacts et 3) à la surveillance de ces impacts au fil du temps.
Méthode: Au moyen d’une approche critique de santé des populations, nous avons analysé les déterminants de la santé et les iniquités en santé dans des populations indigènes et conceptualisé les voies par lesquelles l’industrialisation influence ces déterminants. Nous avons intégré et généralisé les éléments clés de trois cadres de santé indigène afin de créer un nouveau modèle holistique de sélection d’indicateurs indigènes pour les EE.
Résultats: Notre modèle holistique conceptualise les déterminants individuels et collectifs de la santé en tenant compte des contextes sociaux, économiques et politiques externes, ce qui donne un cadre global pour la sélection d’indicateurs de la santé indigène. La santé indigène est le produit des interactions entre de multiples contextes et déterminants de la santé. Les applications possibles du modèle sont abordées à l’aide d’études de cas impliquant des populations indigènes touchées par l’industrialisation.
Conclusion: L’industrialisation peut aggraver les iniquités en santé vécues par les populations indigènes en perpétuant les impacts sanitaires, sociaux et culturels de la dépossession historique de leur environnement. Pour atténuer ces impacts, une EE doit explicitement reconnaître les liens entre la dépossession environnementale, les déterminants de la santé et les iniquités en santé et impliquer concrètement les populations indigènes dans le processus.
Mots Clés: Indiens d’Amérique nord, étude d’impact environnemental, déterminant de la santé, indicateurs d’état sanitaire
Footnotes
Conflict of Interest: None to declare.
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