HSCI 340 Midterm 2

Enhancing Indigenous health: Greenwood & de Leeuw summary

fostering indigenous cultural continuity - the right to identify as indigenous lifeways and value systems focus on social determinants rather than biomedical ones address not only behaviours and proximal determinants but also broader contexts collaboration across disciplines and sectors educators, awareness, relationship building, research, community based partnerships strengthen indigenous self determination - a distal determinant of health

Explanations of health inequalities

genetic differences and biological disposition differences in behavioural risk facotrs differences in mateiral living conditions economic and political structures and their underlying ideologies

Some Health inequities can be accounted for by __________________, most inequities result from living in conditions that do not support health but instead harm it.

genetic disposition or biology

Alex Wilson's article presents findings from a research study she undertook to learn more about what two-spirit identity means to other two-spirit people. What research question does Wilson begin with?

how does the empowered identity of a two spirit person appear within the context of sustained homophobia, sexism, and racism?'

reclaiming two spirit roles and identities

i.For two spirit people, claiming traditional cultural roles and responsibilities has the power to instill positive identities and healthy self concepts ii.Achieving a positive self identity is vital to the development of self esteem and good health among two spirit people iii.Many two spirit people gain strength from being comfortable with who they are within the context of a supportive community, whether on reserve , in an urban center or rural area

building two spirit community

i.Two spirit community groups have a long history of organizing gatherings in both canada and the US , and grassroots organizing continues to be an important source of affirmation and cultural revitalization for two spirit people

Health inequities differ along

important dimensions of peoples ascribed identities and situations of social locations.

racialization and immigration processes

influence and are influenced by class and gender, because "the failure to attend to how social categories depend on one another for meaning renders knowledge of any one category both incomplete and biased" (Cole, 2009, p/ 173).

disease

is a biological express of social inequity

sexuality

is the expression of an individual as a sexual being, including their sexual identity and sexual attractions.

within settler colonialism what is the most important concern

land/water/air/subterranean earth

community based participatory research

o Collaboration between indigenous researchers and community participants through sharing knowledge and relevant lived experiences to promote social change o Grounded by indigenous community relations to challenge the oppressive acts of colonization by reconstructing concepts of health to include indigenous knowledge

gender

o Gender is the expression, behavior or identification of a person masculine, feminine, and androgynous or any mix thereof. They are culturally specific and change overtime

Who were the researchers and community partners in this project? community based participatory research

o Researchers : Laurie- Ann Lines - a member of YKDFN and Dr. Jardine o Research was conducted in partnership members of the YKDFN wellness division who were active in planning, implementation and interpretation of the research, including assisting in work shop organization and participant recruitment and analysis of results and manuscript preparation o Additional research partners included two community research assistants and traditional knowledge and cultural resource workers

Centering youth voices in Indigenous health research

population size traditional values lacking social agency in western society future leaders

SDOH - allows us to understand connection between individual & collective experiences, role of colonial legacies in Indigenous health

proximal, intermediate distal

what to know about race (10)

race is a modern idea race has no genetic basis human subspecies don't exist skin color really is only skin deep most variation is within, not between ' races' slavery predates race race and freedom evolved together race justified social inequalities as natural race isn't biological but racism is still real colorblindness will not end blindness

sex

refers to the physical characteristics, chromosomes and hormone balances which are used to medically determine whether a person is male, female, intersex or transsexual

and how does she understand her own Two-Spirit identity?

"As a two spirit woman, I know that an understanding and expression of my own identity is very different from those that prevail in most other canadian cultures and I am very grateful for this. For me, two spirit identity is empowering. As an educator and psychologist, I wanted to learn more about what our identity means to other two spirit people and how this empowered identity appears within the context of the sustained racism, homophobia and sexism that most of us have experienced"

What are the differences between the "Coming in" process of Two-Spirit, and the mainstream non-Indigenous/Western notion of LGBTQ+ "Coming out"?

"Coming in does not center on the declaration of independence that characterizes 'coming out' in mainstream depictions of the lives of LGBTQ+ people. Rather, coming in is an act of returning, fully present in ourselves, to resume our place as a valued part of our families, cultures, communities , and lands in connection with all our relations ' ( wilson 2015)

racialization and structural racism -> white privilege

"In my class and place, I did not see myself as a racist because I was taught to recognize racism only in individual acts of meanness by members of my group, never in invisible systems conferring unsought racial dominance on my group from birth." (Peggy McIntosh, 1990) "I think one's own individual experience is sacred. Testifying to it is very important—but so is seeing that it is set within a framework outside of one's personal experience that is much bigger, and has repetitive statistical patterns in it" (Peggy McIntosh, 1990)\ "The slick thing about whiteness is that you can reap the benefits of a racist society without personally being racist." — John A. Powell, legal scholar

racialization and structural racism

"One factor seems clear about all of the interlocking oppressions. They take both active forms, which we can see, and embedded forms, which as a member of the dominant group one is taught not to see." (Peggy McIntosh, 1990)

Inequities follow particular

"fault-lines" in society/the social organization of populations.

What would a culturally competent health care system look like?

- A culturally diverse staff that reflects the communities served, professionally trained interpreters and translators, the acknowledgement of racism, the inclusion of anti-racist perspectives in organizational policy, staff training, training for health care providers about the cultures of the people they serve, linguistically and culturally appropriate educational materials, and culturally specific health care settings

differences in behavioural risk factors

- Holy trinity or risk - tobacco, physical activity, diet - Emphasis on health choices in Canada underlines the emphasis on this approach - Focus of Health Promotion

Explanations of health inequities genetic differences and biological disposition

- Inequalities understood as reflecting influence of genes and biologic processes - It's a predominant explanation of health inequalities in biomedical circles e.g. alleged genetic disposition of Aboriginals to type 2 diabetes or kidney failure in non-Europeans - Health inequalities = racial differences in genetic make-up - No compelling evidence exist to support this claim; there is greater heterogeneity within than between 'racial' groups - This approach implicitly justifies health inequalities and promotes medicalization.

health inequities

- Observed differences in health outcomes among individuals, groups, or jurisdictions including countries. - Manifest themselves in differences in life expectancy, mortality rates, or instances of disease and injury.

differences in material living conditions

- Operates through material, behavioral and psychological pathways to influence health - Objective living conditions shape peoples health

shift from individual level culturall explanations to broader structural conditions that limit life oppurtunities

- Processes of racialization and discrimination - Residential segregation - Immigration policy

what is coming in in the narrative of two spirits

. In the narrative of two spirit, coming in is not a declaration or an announcement. It is an affirmation of interdependent identity, an aboriginal person who is GLBT comes to understand their relationship to and place and value in their own family, community, culture , history and present day world. Simply, " coming in ' is not a declaration or an announcement; it is simply presenting presenting oneself and being fully present as an aboriginal person who is GLBT

racialization

A process by which certain groups are categorized as inferior and marginalized because of perceived physical and socio-cultural differences, including skin colour, cultural beliefs, religious markers, accent, and citizenship status.

resurgence of indigenous gender roles

.Integral to broad efforts to rebuild indigenous communities, cultures and knowledge Aboriginal men, women and two spirit people have long been creating spaces in which to develop stronger communities , share cultural knowledge and reclaim their individual and collective responsibilities within indigenous cultural systems. *This reclamation of pride in identity counters the dehumanization of colonialism and the erasure of non binary gender identities* *Growth of knowledge on indigenous gender roles and identities has given rise to a growth in two spirit individuals*- artists, singers, dancers, etc - arts lets two spirit people to express their experiences, identities, stories, creativity in ways that stretch beyond their limitations of the english language Two spirit people can represent themselves in ways that are self determined, individualized, and culturally specific breaking out of many of the colonial norms Revitalization of indigenous art and cultural expression is central to individual and community health - connected a range of creative practices to individual and collective resilience, strength and overall well being

findings

1. There is a relationship between the health of community members and the land 2. Future health solutions should take place on the land, and have a role for youth 3. 'Being healthy' = people and land living symbiotically

How does Sarah Hunt define the term, "Two-Spirit"?

A term popularly used by Indigenous people to identify a range of roles and identities which may span, and even complicate, distinctions between gender, sex and sexuality (Indigenous and part of LGBTQ)

racialized group

A term to describe visible minorities and is used to capture the fact that certain groups are treated as inferior by the dominant group

acculutration

Acculturation: a multidimensional process by which newcomers to a country take on the values and behaviours of their host country

The authors argue that intersectionality theory can serve as a guiding framework for shifting the focus in immigrant health research. What do they say intersectionality theory can offer?

Analyses that focus on gender, race, or class independently are insufficient because these social positions are experienced simultaneously. Whereas intersectionality has had an impact on both feminist theory and Critical Race Theory, its integration into the health inequalities literature has been limited

race is a modern idea

Ancient societies, like the Greeks, did not divide people according to physical distinctions, but according to religion, status, class, even language. The English language didn't even have the word 'race' until it turns up in 1508 in a poem by William Dunbar referring to a line of kings.

Race justified social inequalities as natural

As the race idea evolved, white superiority became "common sense" in America. It justified not only slavery but also the extermination of First Nations, exclusion of Asian immigrants, and the taking of Mexican lands by a nation that professed a belief in democracy. Racial practices were institutionalized within American government, laws, and society.

On page 11, Sarah Hunt writes: "... in Canada, colonialism itself is arguably a distal determinant of health for Indigenous peoples". Explain what this means.

Being a distal factor means it is a factor in the root of the problem that impacted and continues to impact the future of Indigeous populations and is the reason why they experience an unequal share of the burden or their own set of burdens.

ethnicity and health

Canada is one of the most ethnically diverse countries in the world In 2016, nearly 7,700,000 people identified themselves as a member of a visible minority group. They represented 22.3% of the total population. Combined, the three largest visible minority groups - South Asians, Chinese and Blacks - accounted for 61.5% of the visible minority population in 2016 Reliable health-related research on racialized populations in Canada is relatively rare. One reason for this is that care registry data in Canada, unlike in the United States, does not regularly record race or ethnicity statistics.

What do cultural explanations for immigrant health outcomes typically propose?

Cultural explanations for immigrant health outcomes in the United States typically propose that culture influences social norms and individual health behaviors—such as, smoking, drinking, and dietary patterns—to impact health outcomes

Culturalist Explanations of health

Culturalist explanations of health recognize the importance of structural differences in the meaning of health and illness among people of different ethnic backgrounds as well as the effects of these in diagnosis and treatment

define culturally competent health care and provide an example

Culturally competent health care: delivery of health care services in a way that recognizes the cultural beliefs and needs of those they serve For ex. Delivering health services in the language of those needing the care. Another ex. Services provided are seen as culturally appropriate For ex. Arabic women tend to have a strong cultural preference for antenatal care provided by women, but this is often unavailable

main thematic areas of focus of epidemiology

Disease Etiology, Outbreak, Surveillance and Screening.

Ecosocial Approach Model Dr. Nancy Krieger (2011), one of the pre-eminent social epidemiologists of our time has conceptualized an ecosocial model and has suggested six distinct pathways through which racism impacts health:

Economic and social deprivation Toxic substances and hazardous conditions Discrimination and other forms of socially inflicted trauma (mental, physical, and sexual, directly experienced or witnessed, from verbal threats to violent acts) Targeted marketing of harmful commodities (examples include 'junk' food, tobacco, alcohol, as well as legal and illicit drugs) Inadequate or degrading medical care Degradation of ecosystems, including as linked to systemic alienation of Indigenous populations from their lands and corresponding traditional economies.

In one sentence, can you state what the authors say is not accounted for in even the expanded acculturation-based explanatory frameworks?

Even expanded acculturation models still do not account for the notion that structural factors likely impact health in broader ways than simply influencing an individual's cultural orientation.

why?

Health inequities differ along these dimensions because those in these and other social locations may experience significantly different life circumstances and differing exposure and access to SDH.

healthy immigrant effect

Healthy immigrant effect: refers to the finding that newly arrived immigrants appear to have a health advantage but after a period of time their health status tends to converge toward that of the host population

settler colonialism

Immigrants seize land from the indigenous population and become the dominant population.

core criticism of employing acculturation in the examination of immigrant health outcomes

Increasingly scholars have noted the limitations of the concept of acculturation, with some calling for discontinuing its use in health research A core criticism highlighted by some scholars is that employing acculturation as the central concept in the examination of immigrant health outcomes in the United States ignores the socio-historical contexts of migration, the racialization of contemporary immigrants, and the role these factors play in the differential social integration of immigrants

Briefly explain how homophobia, transphobia, cisnormativity and heteronormativity are structural factors influencing the health and well-being of Two-Spirit people

Indigenous communities are impacted by the colonial imposition and internalization of homophobia, transphobia, cisnormativity and heteronormativity, which contributes to health inequities among individuals whose gender and sexuality do not conform to dominant norms.

social and political determinants of health perspective

Instead is examines how membership is society's historically constituted groups influences health and wellness trends.

Heteronormativity:

Is the belief that people fall into distinct and complementary genders (men and women) and that heterosexuality is the norm. This belief system is culturally biased in favor or opposite-sex relationships.

Social and Political Determinants of Health

Key here is that patterns of health and disease in the population can be understood by examining patterns of social relations between specified groups as expressed in everyday living and working conditions. - Issues like racism which are at the center of discrimination should be at the basis of understanding health.

factors immigrant people say explains their reluctance to use mental health services

Language barrier Feelings of isolation and loneliness - since they are often without a network of friends or family Anxieties around meeting new gender role expectations Social stigma

How does the health status of refugees differ from the health status of other immigrant groups entering Canada?

More likely to experience socio-economic disadvantages than other immigrant groups Have greater health needs , particularly related to emotional and mental health including PTSD More likely to have high rates of unemployment and welfare dependency compared with those born in canada and with other immigrants Refugee experience and the resettlement process is often traumatic: a loss of personal and cultural identity, depression, PTSD, developmental problems in children and family violence are commonly identified as health issues

Skin color really is only skin deep

Most traits are inherited independently from one another. The genes influencing skin color have nothing to do with the genes influencing hair form, eye shape, blood type, musical talent, athletic ability or forms of intelligence. Knowing someone's skin color doesn't necessarily tell you anything else about him or her.

Race has no genetic basis.

Not one characteristic, trait or even one gene distinguishes all the members of one so-called race from all the members of another so-called race.

most variation is within, not between races

Of the small amount of total human variation, 85% exists within any local population. About 94% can be found within any continent. That means two random Indian people may be as genetically different are a Korean and an Indian person.

explanations of healthy immigrant effect

One might be that the immigrant process is such that it selects what are perceived as the best immigrants on the basis of education, language ability, job skills, and health, and screens out those people who have serious health problems <- best explains the effect Self selection - people who choose to emigrate are in better health and as a result are able and motivated to move, excluding those who are sick

Colorblindness will not end racism

Pretending race doesn't exist is not the same as creating equality. Race is more than stereotypes and individual prejudice. To combat racism, we need to identify and remedy social policies and institutional practices that advantage some groups at the expense of others.

Jardine, YDFNWD, & Lines: Research design

Strength-based approach to understanding what health and healthy communities mean to Indigenous youth in northern Canada Methodology: community-based participatory research, Indigenous research lens "decolonizing CPBR approach" (pp.3) Relationships between researchers & YDFN On-the-land camp Mixed methods, collective analysis

How is "structural racism" defined

Structural racism refers to the ideologies, practices, processes, and institutions that operate at the macro level to produce and reproduce differential access to power and to life opportunities along racial and ethnic lines

Briefly summarize Indigenous categorizations of sexuality and gender prior to colonization.

Prior to colonization, Indigenous categorizations of gender emerged within other cultural and social practices, and were as diverse as Indigenous cultures themselves. Indigeous views on sexuality were not rooted in heteronormativity, but rather they accounted for diverse sexual practices and identities. Indigenous understandings of gender and sexuality placed an individual's role within their social structure, as well as whithin an individual's physical sex and sexual preferences. Gender roles and sexual identities were based on multiple societal factors and reflected Aboriginal culture, political and spiritual worldviews, which are different cross-culturally.

Which structural factors need to change in order to improve health outcomes in racialized communities?

Provide culturally competent health care: Ability to deliver health services in the language of those needing the care → provide interpreters and bilingual health care workers Services provided are seen as culturally appropriate → example certain cultures prefer having women as their health care providers Transportation issues, shortage of services,lack of child care, and health equity.

Economic and political structures and their underlying ideologies

Public policies are often made in the interest of elite of powerful groups in society even though they are justified as being essential to all.

Race isn't biological, but racism is still real

Race is a powerful social idea that gives people different access to opportunities and resources. Our government and social institutions have created advantages that disproportionately channel wealth, power, and resources to white people. This affects everyone, whether we are aware of it or not.

racialized disparities

Racialized immigrants are more likely to experience stressors such as racism, discrimination, unemployment, poverty, homelessness, inadequate housing, and lack of access to services.

resiliency

Resiliency is the ability to adapt to adversity, trauma, tragedy or significant sources of stress- it helps us to adapt to change and find ways to thrive ( Gray Smith , 2012)

Jardine, YDFNWD, & Lines: Background themes

SDOH approach: new in Western thinking, not new for Indigenous people Persistent disparities in Indigenous health Colonialism most important determinant of Indigenous health Challenges with addressing health inequities - strengths based approaches Centering youth voices in Indigenous health research

what is the indian act

Sets out certain federal government obligations and regulates the management of Indian reserve lands, Indian moneys, and other resources. The act defines Indian as "a person who, pursuant to this Act, is registered as Indian or is entitled to be registered as an Indian

social exclusion

Social exclusion: a process whereby some groups in society are denied access to material and social resources thereby excluding their full participation in society. It produces inequality in outcomes. A marginalizing, racialization practice that can lead to health disparities

what needs to be understood and addressed if health inequities are to be reduced

Social structural factors, which largely operate outside of the formal health care system

What are the two specific lines of inquiry that the authors suggest are important to attend to in future research? Why are these lines of inquiry important?

Specific lines of inquiry regarding immigrants' experiences with day-to-day discrimination, as well as the roles that place and immigration policies play in shaping immigrant health outcomes. We conclude with suggestions for how to better integrate intersectionality theory in future research on immigrant health. In particular, we recommend that future research examine the racialization of immigrants across the full spectrum of the U.S. ethnoracial hierarchy and across place. Such examinations would help shift the focus from immigrant cultures to the racial ideologies, policies, and day-to-day "othering" practices that serve to assign privilege to some groups and strip others from health-promoting resources. In particular, we suggest that analyses that treat immigration policies as health policies are imperative.

structuralist explanations

Structuralist explanations stress the significance of social location as a major factor in health outcomes .These explanations look at social inequality and social determinants of health as important predictors of health status

Race and freedom evolved together.

The U.S. was founded on the radical new principle that "All men are created equal." But the early US economy was based largely on slavery. How could this anomaly be rationalized? The new idea of race helped explain why some people could be denied the rights and freedoms that others took for granted.

what do the authors argue in this paper - Viruell-Fuentes, Edna A. Et al. (2012)

The authors argue for a shift from individual culture-based frameworks, to perspectives that address how multiple dimensions of inequality intersect to impact health outcomes

what epidemiology should be

The essence of epidemiology Is whether is can explain past and present social inequities in health through integrating social and biologic understandings of health disease & wellbeing. Epidemiologic theory should embrace population- level thinking, reject assumptions of biomedical individualism It should NOT abstract the individual from the social relations as shaped by history.

structural racism

The ideologies, practices, processes and institutions that operate at the macro level to produce and reproduce differential access to power and to life opportunities along racial and ethnic lines. - Structural racism influences health because it is embedded in societal- level institutions, policies, and practices (Viruell-Fuentes et al., 2012)

Briefly summarize the social barriers Two-Spirit people often face in urban centers

They often face a different set of social barriers in urban centers. These challenges include finding housing and employment, dealing with racism and exploitation, and experiencing barriers in accessing services. These barriers contribute to housing instability and the need to move frequently, both within urban centers and between rural and urban areas in efforts to find greater access to support and resources.

what did patrick wolfe emphasized

This is why Patrick Wolfe (1999) emphasizes that settler colonialism is a structure and not an event. In the process of settler colonialism, land is remade into property and human relationships to land are restricted to the relationship of the owner to his property

The authors argue that these responses are still missing important parts of "the story". What are they missing?

Those that consider the cultures of societal institutions that reproduce inequalities, or those that consider the collective strategies that groups targeted with racism develop to cope with and resist the effects of structural racism

Briefly summarize the impact of colonization on Aboriginal gender and sexuality.

Through the Indian Act, residential schools, Christian teachings and other assimilative policies and processes, Aboriginal people were forced to follow a heteropatriarchal model of marriage in order to gain rights and status. Colonial processes, which continue today, imposed new social norms and legal rights which altered Aboriginal gender roles and understandings of sexuality.

slavery predates race

Throughout much of human history, societies have enslaved others, often as a result of conquest or war, even debt, but not because of physical characteristics or a belief in natural inferiority. Due to a unique set of historical circumstances. The slave system in the United States was the first slave system where all the slaves shared similar physical characteristics.

In the conclusion of this paper, Wilson writes: "The narrative arc of these stories of two-spirit people is really about journeying along a circular path?" (p197). How is this related to the "Coming in" process of Two-Spirit?

Two spirit identity is about circling back to where we belong, reclaiming, reinventing, and redefining our beginnings, our roots, our communities, our support systems, and our collective and individual selves. We "come in"

What would you say are the key findings of Wilson's research?

Two spirit identity is one that reflects aboriginal peoples' process of "coming in " to an empowered identity that integrates their sexuality, culture, gender and all other aspects of who they understand and know themselves to be Two spirit people' understanding of sexuality is inseparable from their culture and socio-historical position. For two spirit people, who typically live with sustained racism, homophobia and sexism, the process of "coming in" to their identity is likely to be very different from the conventional ' coming out ' story circulated in mainstream canadian (GLBT) culture.

Alex Wilson suggests that Two-Spirit as a self-descriptor could be considered an identity. According to Wilson, what does Two-Spirit encompass,

Two spirit identity may encompass all aspects of who we are, including our culture, sexuality, gender, spirituality, community and relationship to the land

Explain why Two-Spirit is not an identity, according to Harlan Pruden

Two spirit is a community organizing strategy or tool and not an identity. Although it is often positioned as an identity is it neither an end point nor an identity. Becomes highly problematic when treated and positioned as an identity Two spirit mean something slightly different depending on the individual's nation affiliation and therefore there is no one definition of two spirit to be defined

Harlan Pruden begins with the question, "What and who is Two-Spirit?" How does Harlan answer this question? In other words, how is Two-Spirit defined in this reading?

Two spirit is a way for two spirit communities to organize; in other words, a way to identify those individuals who embody diverse ( or non-normative) sexualities, genders, and gender expression and who are indigenous to Turtle Island ( turtle island is used to reference north america - while not affirming or recognizing the two nation states of canada or the United states of america) Becomes highly problematic when treated and positioned as an identity Two spirit refers to history/ tradition that predates western and colonial notions and concepts of LGBTQ+ and thereby is about reclaiming and restoring a place of honor and respect within the individual's nation. This work is deep colonizing work that calls two spirit people home and is thereby a mending of the sacred loop ( Gunn Allen 1986)

Why is it important to use a strength-based approach that centers the perspectives of Two-Spirit youth?

Two-Spirit youth are often portrayed as an "at risk" population due to their poor health and concerns about their safety. This at risk label categorizes them as a problem population which causes stigma. Focusing on their strengths allows individual youth to name their own experience within a framework of self-determination.

Human subspecies don't exist

Unlike many animals, modern humans simply haven't been around long enough or isolated enough to evolve into separate subspecies or races. Despite surface appearances, we are one of the most similar of all species.

How have linguistic issues been understood as a barrier to receiving good health care?

When immigrants lack the necessary language skills they find it difficult to schedule appointments, to describe their problems or to understand verbal and written instructions, all of which compromise the quality of care . Inability to communicate undermines the faith a patient has in the care received and decreases the likelihood of returning for further help. Can also contribute to stress

Alex Wilson notes that "Anthropologists and gay historians have produced a substantial body of work on sexuality and gender in Indigenous North American communities" (p193). What has this work tended to overlook?

While this work has formed the basis of a critique of western cultural assumptions about sexuality and gender, it has only rarely focused on or been informed by the lives of contemporary two spirit people Similarly, while this work may have helped to create a more comfortable and safe living space for non aboriginal lesbian, gay bi, and trans poeple, only a few of these authors appear to have thought about their work might contribute to the well being of contemproary two spirit and other aboriginal people

According to Sarah Hunt, in what ways are Two-Spirit peoples' lives made invisible within much Aboriginal health literature?

While transsexual, transgender and other gender non-conforming people are generally understudied in literature on social determinants of Aboriginal health, their health status clearly reflects the social consequences of not adhering to binary models of gender

epidemiology forms the ....

basis of Public Health policy and proves input into medicine by delineating risk factors.

Greenwood & de Leeuw: Background themes

children are our future - seven generations worldview lack of good quality data for understanding indigenous health indigenous health status a reflection of conditions indigenous peoples face and power structures that shape those conditions SDOH- allows us to understand connection between individual and collective experiences, role of colonial legacies in indigenous health

lack of good quality data for understanding indigenous health

disaggregated data confounding

four themes of resillence that sarah hunt identified within contemporary two spirit struggles

resurgence of indigenous gender roles building two spirit community reclaiming two spirit roles and identities acknowledging two spirit people within health discourse

What is the key concept often used by scholars when examining cultural explanations for health outcomes?

scholars often rely on the concept of acculturation—typically defined in U.S. health research as an individual-level process through which individuals acquire the "behaviors, attitudes and values prevalent within American society Although some scholars point to acculturation as a set of processes, in practice, most use the concept to quantify the extent to which individuals adopt so-called "American" cultural traits via acculturation indices and proxy measures, such as nativity, generational status, language, citizenship status, length of residence in the United States, and age at arrival

We know there is a certain amount of genetic disposition that affects our health but the majority are

socially produced.

The authors tell us that some scholars have responded to this core criticism. What have these scholars proposed?

some scholars have proposed that the concept be broadened to account for the impact of social contexts—such as social networks, neighborhoods, and discrimination—on cultural change. However, several significant caveats remain within these proposed revisions. Despite work that has challenged it, with few exceptions the implied definition of culture as a set of individual-level traits, attitudes, values, and behaviors remains prevalent in much of the public health literature.

epidemiology

study of causes, distribution and impacts of health and disease in a given population.

refugees

tend to be a vulnerable population in that they have not voluntarily chosen to leave their country of origin may also be separated from other family members at the time of resettlement, be survivors of torture and have lost most of their mateiral possessions, wealth and status

"Colonial legislation and policies continue to influence

the health of Aboriginal children and their families, explicit, for instance, in Indian reserves that have unique jurisdictional complexities that result in disparities of service access and ongoing dislocation of people from traditional lands, fishing and hunting sites, and water rights."

the problem of racism

the problem of racism must be seen as one of the primary factors in producing inequitable health outcomes in racialized populations regardless of socioeconomic or educational status racial inequality in health needs to be situated within an historical context and a contemporary reality shaped by racism in its various forms while race is often referred to as a social construct with no real material base, racist assumptions continue to shape institutions and social interactions including those related health and health care

what was the indian residential school system

the residential schools were a deliberate system of forced assimilations that often started with forcible removal of children from their homes and ended in many cases of physical, emotiona, and sexual abuse including slavery, spread of infectious disease, violent punishent for speaking their own language and death

difference between non status indians and status

· . Status Indians are those recognized as Indians under the Indian act. Non-status Indians are those who consider themselves Indians or members of a First Nation but are not entitled to register under this act.

. What is meant by the term "colonialism"? What are some of the consequences of colonialism that underlie the health of Aboriginal peoples in Canada?

· A process by which one nation imposes itself economically, politically, and socially upon another. · Many, if not all, of the factors that underlie the health inequities endured by Aboriginal peoples in Canada- the forced relocation of communities, the loss of lands and resources, the creation of the reserve system, the forced removal of children and subsequent placement into residential schools, policies of cultural suppression and forced assimilation and ongoing racist attitudes

The last several paragraphs of the article list a number of steps that need to be taken to improve the health of Aboriginal children. What are these steps?

· A sense of cultural continuity for First Nations individuals and communities, and likely for Indigenous peoples more broadly, builds resiliency and reduces negative health outcomes, particularly youth suicide · Interventions and practices designed to foster and enhance the health and well-being of Aboriginal children require holistic concepts of health that move beyond biomedical realms and, instead, address and focus upon social determinants. · Raise awareness of the social and historical context in which Aboriginal peoples find themselves. This begins with the education and training of professionals that interact with Aboriginal people on a daily basis. For example, development of a curriculum for the training of health professionals should go beyond presenting Canada's Aboriginal peoples as having poor health status and experiencing substandard social and economic conditions - particularly if those poor health statuses are attributed only to biomedical or physiological failings. · Employing advocates and cultural translators in all healthcare facilities is vitally important to Aboriginal children's health and well-being. These individuals provide relational bridges of understanding between the health care system and the Aboriginal children and their families interfacing with it.

How are colonialism and colonial legacies determinants of health for Aboriginal children?

· Aboriginal children are born into a colonial legacy that results in low socioeconomic status, high rates of substance abuse, and increased incidents of interaction with the criminal justice system. These are linked with intergenerational trauma associated with residential schooling and the extensive loss of language and culture. Colonial legacies are thus determinants impact aboriginal children's lives and can only be accounted for by applying a social determinants of health lens that is inclusive of multiple realities and considerate of aboriginal distinct sociopolitical, historical, and geographical contexts.

acknowledging two spirit people within health discourse

· Acknowledging two spirit people is vital for the development of programs which are culturally relevant, are inclusive of non binary gender identities and are not structured around heternormative culture. · Efforts to acknowledge the diversity of culturally specific and individual expressions of two spirit identities are vital to decolonial struggles · Research shows that health initiative which reflect identities of two spirit people can have positive impact on their health Addressing intersecting forms of discrimination and embracing two spirit people ' self determined expressions of their identities are thus vital elements of building two spirit resillence

. Explain when, how, and why the Royal Commission on Aboriginal Peoples was created

· Created by the Canadian government in 1991 to address economic, social, and political issues related to First Nations, Metis, and Inuit peoples in Canada. The commissioners held 178 days of public hearings and visited 96 communities

suicide and HIV/AIDS

· Due to the lack of acknowledgement of gender and sexual diversity in national health statistics, no data is currently available on rates of HIV/AIDS for Two-spirit people. Yet research and community initiatives indicate that HIV/AIDS has been a key health concern especially among individuals who are biologically male

The authors of this article provide a rationale for why they have explored the determinants of health from the perspective of Indigenous youth. What is their rationale?

· Exploring determinants of health from the perspective of indigenous youth is critical to identifying and changing the conditions underlying inequities that impact individuals, communities and nations in the next generation youth are the key to future change as they act as roles that can help contribute to the next generation from the experience of past youths are significant figures that act as leaders to take on responsibilities of the community

What are some of the cultural wounds experienced by Indigenous peoples and Indigenous ways of life in Canada?

· Health issues faced by indigenous peoples are a multiplicative product, rather than additive sum, of cultural wounds affecting the entire community and ways of life. · The social determinants of health related to these historical contexts have largely been accepted as one of the key etiologic factors underlying high rates of illness, disease, and mortality in indigenous populations

5. How do housing and living conditions impact the health of Aboriginal peoples in Canada?

· Housing and living conditions are known to directly or indirectly impact people's health. Overcrowding and inadequate housing with poor indoor air quality can lead to respiratory diseases, tuberculosis, allergies, mental health problems, and the spread of potentially deadly viruses. The situation is especially dire for First Nations that live on the reserves.

. Who do you think is the intended readership of this article? What is the main take-away point that the authors want to leave the reader with?

· Intended readership: the general public? Main take-away point: applying a social determinant of health framework to health inequities experienced by aboriginal children can create change - a change that will impact individuals, communities and nations and last for generations. A beneficial change to the future wellbeing of aboriginal children in canada

Why are Inuit communities typically worse off than other Aboriginal communities in Canada?

· Inuit have the highest percentage of food insecurity for both sexes as well as the greatest overcrowding in their homes. This means that their food intake is not sufficient and they are more likely to develop diseases as a result. o Ex: Inuit children have among the highest rates of severe lower respiratory tract infection in the world

define the term aboriginal peoples and who are the aboriginal people of canada

· It is a collective name for all the original inhabitants of North America and their descendents · The Canadian Constitution Act of 1982 recognizes three distinct groups of Aboriginal people: Indians (First Nations), Metis, and Inuit

what effects did it have on health and well being of indigenous peoples in canada

· Many students battled the destruction of their culture, language and identity and were denied cultural opportunities to develop parenting skills, speak their language, take part in spiritual ceremonies or practice cultural activities such as harvesting off the language · The intergenerational consequences of trauma from the attempted cultural genocide are still manifested in the health status of Canadian indigenous populations · Indigenous people continue to suffer an increased burden of illness and to be disadvantaged relative to non indigenous people in Canada on numerous markers of morbidity and mortality, including socioeconomic deprivation, inequalities entrenched in education and healthcare systems, and experiences of violent victimization. · Other issues include high rates of illness, disease and mortality in indigenous populations

How did the Indian Act work to destroy and control Aboriginal communities

· Non-status Indians are not entitled to the same rights and benefits that are available to status Indians. First Nations people live on the reserves while others live off-reserve can create strain and tension among the community

Explain the "Web of Being" framework [Fig. 1]. What are some examples of proximal, intermediate, and distal determinants of Aboriginal Peoples' health? [Note: you might also find it helpful to refer back to the Week 2 reading by Charlotte Reading (2018). Chapter 1: Structural Determinants of Aboriginal Peoples' Health]

· Proximal determinants: They have a direct impact on the physical, emotional, mental and or spiritual health of an individual, and include employment, income and education. · Intermediate determinants: the origin of proximal determinants, inclusive of community infrastructure, cultural continuity and health care systems. · Distal determinants: which include colonialism, racism, social exclusion and self-determination;

. Briefly summarize the evidence about Two-Spirit peoples' health with regard to violence,

· Rates of violence among Two-Spirit people are difficult to gauge because of a lack of statistical data. Two-spirit people may experience targeted violence because of a combination of racism, homophobia, transphobia and sexism, depending on their individual gender and sexual identity

mental health and substance use,

· Research in both Canada and the US found that Two-spirit people are more likely to experience mental health issues such as depression and anxiety, as well as using substances such as drugs and alcohol as coping mechanisms and those are related to intersections of racism, homophobia, transphobia and heteronormativity as well as the intergenerational trauma.

What were they seeking to understand?

· Sought to understand youths perspectives of o Interest in health research o Health meaning, issues, and priorities o Tailoring healthy information and research to youth o Their role in future health research o Their role in addressing health issues within their community

What is meant by a strength-based approach to research

· Strength based research is premised on empowering everyone involved in the research ( community members, academic researchers, policy makers, etc ) to create social change. This is consistent with viewing social determinants of health as health promoting factors that are influenced by political ideologies, public policies , societal recognition and outrage and the ability of individuals and communities to effect change

Are any of the concerns of immigrant populations similar to those of Canadian-born populations?

· The longer immigrants live in Canada, there is a greater likelihood that their lifestyle behaviours begin to more closely resemble the behaviours of Canadians in general, including poor health behaviours such as smoking, drinking, and poor dietary habits.

Why do the authors argue that distal determinants can create the greatest impacts?

· They are the most difficult to change. However, if transformed, distal determinants may yield the greatest health impacts and, thus, long-term change to Aboriginal child health inequities. Distal determinants that require attention, including potentially by paediatricians, include ongoing colonial structures, racism, and the lack of Aboriginal peoples' sociocultural and political sovereignty. Colonialism, as a distal determinant of Aboriginal peoples' health, is complex and far from over.

Why are biomedical approaches to medicine less likely to appeal to Aboriginal peoples?

· Unlike the biomedical model which separates the body from other aspects of the person, Aboriginal concepts of health and healing are holistic. They take the view that all living things are interdependent and well-being flows from the balance of the physical, spiritual, mental, and emotional elements of personal and collective life. · Aboriginal peoples view disease as indicating an imbalance between an individual and the world around them → similar to the WHO definition of Health

Why might a strength-based or salutogenic approach be important to improving health in Indigenous communities?

· Using a health promotion lens to shift the focus from a pathogenic approach that emphasizes factors to disease and illness to a salutogenic model that stresses positive, salutary factors that support people's health and wellbeing. · Salutary factors - health promotion factors, factors that support human health and wellbeing, rather than a focus that cause disease. COncerns relationship between health, stress and coping

What does the author of this chapter mean by the social production of Aboriginal ill health

· Various historical documents have confirmed that Aboriginal peoples in Canada were in good health upon the arrival of the Europeans. Rather, the European explorers were the ones more likely to be sick. Hundreds of thousands of Aboriginal peoples got seriously sick or died after their encounters with Europeans. Diseases like the influenza, measles, polio, diphtheria and smallpox were transported from the slums of Europe to the unprotected villages of the Americas · Sociological approaches to understanding health disparities look for social patterns and social determinants of health; these suggest that people are not randomly afflicted by disease and illness.

Describe land as an important determinant of health for YKDFN youth.

· Youth expressed a relationship between the health of community members and the land. The youth envisioned future health solutions as taking place on the land with a distinct youth role in maintaining this relationship through regularly practicing cultural and traditional skills , knowledge and values. · Youth voiced being healthy within a community as being related to a symbiotic balance of relationship of land and people - youth felt that future health initiatives must build on the youth's relationship with the land which must actively uphold, to consequently improve health - Youth identified a connection between health and land as a primary determinant to YKDFN health that should be incorporated in future health solutions · Youth emphasized the importance of having regular cultural activities encouraging healthy physical activity, traditional eating, mental wellness ( stress relief ) , long lasting bonds with people and the environment and improving relationships · Revitalizing youth's connection the land has positive health impacts that reach beyond the direct players of the youth and land, and extend to their family, communities, and surrounding environment. Balanced ecosystems and ownership of all and access to traditional land has been recognized as improving health status for indigenous peoples in other areas of the world · A land lacking any of these qualities will negatively affect the health of community

Describe how the Indigenous youth participants of this study conceptualized their relationship with land

· Youths captured images in the communities. The photos taken on the land depicting health priorities to fully express their concepts of health. Youth emphasized the land health relationship in photos and videos that showed: surviving off the land, learning and passing on traditional knowledge, cultural camp, practicing cultural skills, understanding YKDFN history, gathering and preparing food, being out on land, and working together. Activities that promoted a connection to the land were considered health priorities by the youth

Cisnormativity

· a term used to describe the ways in which institutions, norms and social practices reproduce assumptions of a societal gender binary, along with complete alignment of gender identity and physical sexes