HSS1101E Determinants of Health

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HSS1101E Determinants of Health

• Feb 9, 2009 Aboriginal Health

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Review of Last Class

• Sex and Gender mean different things
• When explaining health differences, the
  determinant Gender/sex interacts with other
  determinants, like age and SES
• Different diseases may affect men and women
  differently
• How much of it is innnate, and how much gender
  construct?
• How we address different diseases will depend on
  our understanding of sex and gender

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Review of Last Class

• Supplemental Readings
• Defining and Measuring Gender A social
  determinant of health whose time has come by
  Susan Phillips
• Women in Canada, 5th Edition by Statistics
  Canada, chapter 3 pp 53-63
• Both are now available on class website

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Aboriginal Health

• Aboriginal Having existed from the beginning
• There are Aboriginal people in many, many
  nations also called Indigenous peoples
• Canada
• USA
• Australia
• Brazil
• New Zealand
• Etc.

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Aboriginal Peoples of Canada

• Government of Canada recognizes three categories
  of Aboriginal people

• First Nations
• Inuit
• Metis

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Terminology

• Officially First Nations refers to Aboriginal
  peoples who are not Inuit or Metis
• In USA, First Nations is also First Peoples
• Indian is still used as a legal term in
  Canadian constitution, but
• Is historically inaccurate
• Is considered offensive by some Aboriginal people

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Population

• Total 1,172,790
• 3.8 of total population. (2006 Census)
• First Nations
• 698,025
• Inuit
• 50,485
• Metis
• 389,785

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Distribution of Aboriginal Peoples in Canada
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Aboriginal Population

• The proportion of the First Nations population
  under 30 years of age was 61.1 in 2000, compared
  with 38.8 for the Canadian population in 2001.
• In 2000, the First Nations birth rate was 23.4
  births per 1,000 population -- more than twice
  the Canadian rate.
• In 2000, One in five First Nations births
  involved teenaged mothers by contrast, far fewer
  births occurred among Canadian teen women (5.6).

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Aboriginal Population

• In 2000, 55.8 of homes on First Nations reserves
  were considered adequate
• According to Northern Affairs Canada, 15.7 of
  Aboriginal homes on reserves are in need of major
  repairs, and 5.3 were no longer habitable or had
  been declared unsafe or unfit for human
  habitation
• In 2000/01, 2 of Aboriginal homes had inadequate
  water
• Down from 43 the previous year
• 31 of Aboriginal homes rely on non-piped water

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Aboriginal Development

• 18.5 of Canadian children live beneath the
  poverty line Canadian Council on Social
  Development, 2002
• 25 of First Nations children in Canada live
  beneath poverty line Campaign 2000
• Canada ranks 4 on UN Human Development Scale
• But Aboriginal communities in Canada, if viewed
  separately, would be 78 beneath Kazakhstan

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Aboriginal Health Compared to the Rest of Us

• On average, life span is 7.4 years shorter for
  men, and 5.2 years shorter for women
• Diabetes rates are triple
• HIV/AIDS rates are double
• Alcohol-related deaths are 4-9 times higher
• Drug-related deaths are 2-7 times higher
• Among men, hospitalization rate is 39 higher
• Among women, hosp. rate is 77 higher
• Psychiatric hospitalization rate 50-100 higher

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Aboriginal Health Compared to the Rest of Us

• Heart disease is 1.5 x higher
• TB infection rates are 8-10 x higher
• Years of life lost, due to injury, is 3.5 x
  higher
• Pertussis rates 2.2 x higher
• Rubella rates 7 x higher
• Notification rate for chlamydia 7x higher
• Notification rate for Hep C 1/3 lower
• Immunization rates for all diseases is lower

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More Aboriginal Health Facts

• Most common cause of death for Aboriginal peoples
  lt44 years injury and poisoning
• Most common cause of death for those gt44
  circulatory disease
• Leading cause of death for youth (10-19 years)
  suicide

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The Law

• Aboriginal identity is spelled out in the Indian
  Act of 1876
• Specifies use of reserve land for use by
  Aboriginal peoples
• Under Canadian constitution (1982) and British
  North America Act (1867), health is the domain of
  Provinces
• Except.
• Aboriginal Health has always been the domain of
  the federal government
• Indian health services used to be part of the
  Indian Affairs ministry
• Since 1945, responsibility was transferred to
  Health Canada
• Since 1980, theres been a gradual transfer of
  some responsibility to Native communities
  themselves
• Before 1960, an Indian could only vote if
  he/she gave up Indian status

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Major Health Issues

• Suicide
• Domestic violence
• Diabetes
• Tuberculosis
• Substance abuse
• Role of traditional knowledge
• Cultural violence
• Eg Residential school system

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Type 2 Diabetes

• Endemic across adult Aboriginals around the world
• Now accelerating among children, as well
• Inuit have traditionally not been affected, but
  their rates are starting to rise
• Lifestyle or genetics?
• Lifestyle stress, idleness, alcohol, diet, LBW
  -gt factors associated with poverty
• Genetics thrifty gene theory

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Tuberculosis

• Studies have shown that First Nations people are
  more at risk than other Canadians of getting TB
  infection Health Canada
• Why?
• Poor primary health care
• Overcrowding
• Poor nutrition

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Traditional Knowledge

• non-Western medicine science
• Classification need to document Native knowledge
  of plants, animals, soil, etc
• Resource management need to harness indigenous
  philosophies and methods
• Technology need to support the use and
  development of evidence-based traditional
  medicine

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Traditional Knowledge

• Declaration of the Rights of Indigenous Peoples,
  1994
• Native peoples have a right to their traditional
  medicines
• Protection of their medicinal plants
• Access to their methods
• Threat? Quackery

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Substance Abuse

• There is no history of a brewing tradition
  alcohol was introduced by Europeans
• There may be a genetic factor lack of alcohol
  dehydrogenase (ADH) enzyme ? not conclusive
• Average Canadian household alcohol consumption
  9.5 L/year
• Average consumption in regions with high
  Aboriginal population (eg, Yukon) 14.8 L/yr
• Despite excessive drinking by some Aboriginals,
  more Aboriginals abstain than do other Canadians
• Tobacco usage has cultural origins

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Results of Substance Abuse

• Alcohol Fetal Syndrome
• Alcohol-related death and injury
• Overall poor health
• Domestic and other Violence
• Spousal abuse
• Child abuse
• Sexual abuse

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Factors Associated with Suicide/Violence/Substance
Abuse

• Stress coping strategy
• Lack of control over ones life
• Indicators of poverty
• Mistrust of Western officialdom, including
  public health interventions and messaging

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Residential Schools

• For over a century, a policy of aggressive
  assimilation was adopted by Canadian government
• Church-run schools that forced children from
  their homes, to be taught Christianity, English,
  Canadian ways 150 000 residents
• Emotional, sexual, physical, cultural abuse was
  rampant
• Final schools closed in 1996, formal apology
  offered in 2008
• Survivors suffer from PTSD, depression, substance
  abuse

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• Thursday
• Guest lecture by librarian
• Next week
• Reading week! No classes!

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Additional Resources

• http//www.hc-sc.gc.ca/fniah-spnia/pubs/index-eng.
  php
• http//www.aboriginalcanada.gc.ca/acp/site.nsf/en/
  ao20028.html
• http//www.ahf.ca