These determinants, among others, include peace, income, shelter, education, food, a stable ecosystem, sustainable resources, and social justice and equity 3. Essentially, a social determinant of health lens considers both the causes of the causes of disparities 5 and the causes that underlie the causes of the causes 6. Such a framework is imperative to understanding the enduring health inequities between Indigenous and non-Indigenous peoples.
In Canada, Aboriginal children experience higher rates of infant mortality 8 , tuberculosis 9 , injuries and deaths 10 , youth suicide 11 , middle ear infections 12 — 14 , childhood obesity and diabetes 15 , dental caries 16 and increased exposure to environmental contaminants including tobacco smoke 12 , 14 , Immunization rates for Aboriginal children are lower than those of non-Aboriginal children 18 , 19 , as are rates of accessing a doctor These health inequities can only be understood and intervened upon if understood as holistic challenges.
Social determinants of health and the future well-being of Aboriginal children in Canada
Such an understanding requires moving beyond the physical realm, or the absence of disease, to include the social, spiritual and emotional realms. Aboriginal children are born into a colonial legacy that results in low socioeconomic status 21 , high rates of substance abuse 22 and increased incidents of interaction with the criminal justice system These are linked with intergenerational trauma associated with residential schooling 24 and the extensive loss of language and culture The basis of adult health and health inequity begin in early childhood First, there are proximal determinants of health.
These have a direct impact on the physical, emotional, mental and or spiritual health of an individual, and include employment, income and education. Second are intermediate determinants, the origin of proximal determinants, inclusive of community infrastructure, cultural continuity and health care systems. Third are the distal determinants, which include colonialism, racism, social exclusion and self-determination; these comprise the context in which intermediate and proximal determinants are constructed and 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 Figure 1. Adapted from reference 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.
Social determinants of health and the future well-being of Aboriginal children in Canada
The reserve system precipitated great and sudden changes in lifestyle and patterns of settlement The Indian Act also governed the Indian Residential Schools, institutions that operated for more than years, with the last school in Canada closing in This experience resulted in collective trauma, consisting of… the structural effects of disrupting families and communities; the loss of parenting skills as a result of institutionalization; patterns of emotional response resulting from the absence of warmth and intimacy in childhood; the carryover of physical and sexual abuse; the loss of Indigenous knowledges, languages, and traditions; and the systematic devaluing of Indigenous identity Child welfare systems continue to intervene in the lives of Aboriginal families in Canada at a rate greater than any other population in the country 33 , and currently more Aboriginal children live as governmental wards than were ever in residential schools.
Both colonization and colonialism are more than economic or material structures.
- Six Months Later.
- The Salesman.
- Baby Loves Shapes (Sassy)!
- The Presley Plot.
- Men of Smithfield: Mark and Tony.
Colonialism results in multiple forms of discrimination. Stemming from racism are microaggressions, which are often very subtle. Racism, along with these microaggressions, is evidence of advanced colonization 39 and has become entrenched in society. Taken together, these realities can be considered Aboriginal-specific determinants of health in that they result in a disproportionate experience with socioeconomic inequities that are rooted in a particular socio-historical context.
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 For Aboriginal people, the right to identify as an Indigenous person, the right to practice Indigenous ceremonies, and the right to speak an Indigenous language, are all crucial to identity and health, both of which are also especially linked to spirituality Language and cultural revitalization are viewed as health promotion strategies If Aboriginal children are provided opportunity for growth and development that fosters and promotes cultural strengths and citizenship, health disparities resulting from the impacts of colonialism may be lessened.
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.
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Approaches must be flexible, while also addressing historical and contemporary determinants and should include decolonizing strategies. Interventions should not target individual behavioural change or focus solely on proximal determinants of child health. Instead, interventions should account for broader contexts and distal determinants that continue to influence the context and, thus, the health of the child.
These broad contexts require collaborations across and between sectors and disciplines; medical or even health sectors alone cannot address or influence these determinants of health and must work in concert with other sectors such as education, child welfare, housing and justice, among others. A critical starting point is to create 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.
Students in the health professions who are not trained to understand socioeconomic and historical contexts may be vulnerable to adopting common, social stereotypes about Indigenous peoples Concentrated effort is required to include the knowledge and strengths held by Aboriginal peoples into the curriculum. Elliott and de Leeuw 44 write that:. This type of education opens opportunities for transmission of knowledge to other disciplines and even broader society.
These individuals provide relational bridges of understanding between the health care system and the Aboriginal children and their families interfacing with it. While much baseline data about Indigenous peoples are needed, intervention research aimed at improving the lives of Aboriginal children is also necessary. This type of research demands collaborative partnerships with Aboriginal communities based on respectful, equitable relationships. Recognizing multiple ways of knowing and being in the world is fundamental to effective research and effective health care practice, with and for Aboriginal peoples.
Over the years I've hired many parents who have chosen to work flexibly — either part-time or from home part of the time — and who otherwise might have left the workplace. As a result, we've found some great people. The recession and the resultant cuts have hit women hardest. The Fawcett Society estimates that by the average mother who is raising children alone will have lost the equivalent of one month's income per year.
In the workplace, women on maternity leave find themselves made redundant before worse-performing male colleagues. Pay and pension divides remain. Even the highest-flying career women can find a radical shift in their standing when they have children. Katie Powell was a corporate executive for more than a decade. She orchestrated the launch of Thomson Reuters, a brand now ranked 34th in the world by Business Week.
But in , while she was on maternity leave with her daughter Molly, her role was moved to New York. I ran a big team. You have this illusion that you can pick up where you left off but when I returned all the roles I was offered involved a lot of travel. Having a baby is an incredible journey, but you go back into the workplace and all of a sudden you go from this senior role to a career full stop.
Powell left Thomson Reuters and launched Mama Jeanius , a maternity jeans business, in She also has a small interior design consultancy and runs them both around the needs of her two children. Giving women the right tools. I think we need to embrace working from home. Childcare costs too can cripple households. There's a lot of women who are working literally for nothing by the time they've paid for childcare. In late , the embattled commission released a report with more than 60 policy recommendations, including sensitivity training for police and frequent reviews of cold cases.
Many of the items, however, were never implemented. Meanwhile, indigenous activists found their work under siege nationwide. The thesis made news because its count was so much higher than any previously reported — and because an academic, not the government, had produced it. The government report hit Canada like a cold shock. Yet it dismissed calls for a national inquiry into the origins of the crisis. When two more young women were brutalized in Winnipeg later that summer, that refusal seemed all the more galling. The man charged in her slaying, Raymond Cormier, had more than 90 criminal convictions.
The Vanishing of Canada’s First Nations Women
He was finally arrested in December She had been sexually assaulted and thrown into the frigid water — only to crawl out and be attacked again. Unlike Fontaine, she survived. She is not related to Stephen Harper. In December , the shy teenager appeared before a meeting of First Nation elders and called on the Canadian government to take action. Within hours, aboriginal women nationwide were tweeting photos with the same caption. Veteran activist Bernadette Smith helped organize a volunteer group called Drag the Red, which used nets, chains, and hooks to search the Red River for more human remains.
In March , a U. It, too, recommended a national inquiry.
Aboriginal women would need to be in charge. Public awareness peaked in an election year. Canadians overwhelmingly elected Trudeau last October. One of his first acts was to announce a national inquiry. Bennett, whom Trudeau tapped to craft an inquiry, is in a reflective mood. Yet the ultimate goal lies further down the road. Stemming the crisis could require a combination of police reform, job creation, educational opportunities, domestic violence prevention, substance abuse treatment, improved public transportation, and anti-racism campaigns.
Recommending change is easy enough. As the inquiry moves forward, many women are continuing the painstaking grassroots work that pushed the government to act. She wants to show me a beaded breastplate she crafted in tribute to her older sister. She wears it when she dances. The butterfly symbolizes the stages of grief. Canada continues to allow them to do that.
She just feels ready for a change. Marin Cogan is a journalist living in Washington, D. Sign up for free access to 3 articles per month and weekly email updates from expert policy analysts. Create a Foreign Policy account to access 3 articles per month and free newsletters developed by policy experts. Sign up for free access to 3 articles per month and weekly email updates from expert policy analysts Sign Up. Already have an account?