Midterm Studying Part 3

Question 1

What are social determinants of health?

Answer 1

A determinant of health is simply something that can impact an individual’s, a family’s or a community’s health.

Question 2

“Social Determinants”

Answer 2

Determinants resulting from social constructions and situations.

Provide us with a framework for understanding health and what influences it.

The conditions in which people are born, grow, live, work, and age, including the health system.

Question 3

Social Determinants of health include:

Answer 3

gender, early life, education, employment and working conditions, food security, health care services, housing, income and income distribution, social safety net, social exclusion/inclusion, minority status, Indigenous status, unemployment and employment security.

Question 4

12 key determinants of health

Answer 4

Income and Social Status:
Social Support Networks
Education and Literacy
Employment/Working Conditions
Social Environments
Physical Environments
Personal Health Practices and Coping Skills
Healthy Child Development
Biology and Genetic Endowment
Health Services
Gender
Culture

Question 5

“Health Disparities, Inequalities, and Inequities”

Answer 5

The terms disparity and inequality are often used interchangeably to signify that something is not equal

Inequities also signify that something is not equal, however it implies that things are unequal as a result of a social injustice

Question 6

“Charter of Rights and Freedom”

Answer 6

Fundamental Freedoms
Democratic rights
Mobility rights
Legal rights
Equity rights
Language Rights
Other
Aboriginal rights (treaty rights, receive more direct constitutional protection under section 35 of the Constitution Act)

Question 7

Fundamental Freedoms:

Answer 7

Consciousness
Religion
Thought
Belief
Expression
Press
Peaceful Assembly
Association

Question 8

What are mobility rights?

Answer 8

Right to enter, leave and remain in Canada

Question 9

What are legal rights?

Answer 9

Life, liberty and security, detention, unusual punishment

Question 10

What are equity rights?

Answer 10

Protection and benefits

Question 11

What are language rights?

Answer 11

English and French

Question 12

What are aborignal rights?

Answer 12

Treaty rights, receive more direct constitutional protection under section 35 of the Constitution Act.

Question 13

“Rights”

Answer 13

Equally to men and women
Multicultural
Does not extend to hate and obscenity

Question 14

Indigenous people are:

Answer 14

Have lower median after-tax income;

Are more likely to experience unemployment;

Are more likely to collect employment insurance and social assistance;

Are more likely to live in housing in need of major repairs;

Are more likely to experience physical, emotional or sexual abuse;

Are more likely to be victims of violent crimes; and

Are more likely to be incarcerated and less likely to be granted parole.

Question 15

United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP)
after careful consideration, Canada formally endorsed this Declaration when?

Answer 15

November 2010

Question 16

“Health Services”

Answer 16

Provincial systems provide most acute and intensive services for ALL Aboriginal populations (ie/ hospital services)

The Federal government provides some health services for on-reserve status First Nations and Inuit communities as well as Non-Insured Health Benefits (NIHB)

Question 17

Self Determinant and Self Government

Answer 17

Self-Government introduces a third approach for First Nations and Inuit communities to increase their control over health programs and services.

Under this policy, First Nations may be entitled to make certain laws governing their community with respect to health.

Movement towards self-government that builds upon the ideas of health transfer, and would allow for greater self-determination

Question 18

“Health Transfer”

Answer 18

Health Transfer is a complex process, with opportunities and limits, that shifts varying levels of control from FNIHB to First Nations communities in regards to the administration of health services
Health Transfer allows for some administrative flexibilities and control over funding, however, it still exists within a larger system that has significant restraints.

Question 19

“Chandler and Lalonde”

Answer 19

The province-wide rate of Aboriginal youth suicide (which was 5x the national average) was not capturing the reality of the province’s communities

In the period covered by the study, 90% of suicides were in less then 10% of the bands

Youth suicide is not an ‘Aboriginal’ issue – it is an issue in some Aboriginal communities
Suicide rates were associated with the presence or absence of six factors.

Question 20

The six factors associated with cultural continuity include:

Answer 20

Land claims;
Self-government;
Education services;
Police and fire services;
Health services;
Cultural facilities.

Question 21

“Cultural Continuity”

Answer 21

Culture as something that is potentially enduring or continuously linked through processes of historical transformation with an identifiable past of tradition (Kirmayer)

Cultural continuity, or “being who we are”, is foundational to health in successful First Nations.

Question 22

“Self-Determination”

Answer 22

Determine their political status and freely pursue their economic, social, and cultural development; and dispose of and benefit from their wealth and natural resources.

Under international treaty law, Canada is obligated to respect the First Nations’ right of self-determination.

Question 23

“Health Governance”

Answer 23

The rationale for Indigenous control of Indigenous health services is clearly laid out in the RCAP findings and recommendations.

Implementing those recommendations in practice is much more complicated, with diverse results in diverse Indigenous territories.

Question 24

“Health Care Interactions”

Answer 24

Typically, studies of health-care interactions have focused on doctor–patient relationships. Many focus:

On the social, economic, political, and historical determinants of health care;

Power differentials and social conflict in health care;

The capacity of people to navigate health-care systems;

Professional control of health services.
The factors that influence health-care interactions are understood as occurring within a set of wider social relations that, though often not visible, profoundly influence patient–provider relations.

Question 25

Access to health care:

Answer 25

Aboriginal People are less likely to seek help when symptoms are present

Aboriginal People are more likely to be diagnosed at a later stage of disease than non-Aboriginal people

Question 26

Health Council of Canada Report:

Answer 26

Doctors who would not prescribe painkillers to Aboriginal people (even when they were in severe pain)

Emergency room patients who were assumed to be under the influence of drugs or alcohol and not given proper assessments as a result.

Code words to signal dismissively to colleagues that the next patient is an Aboriginal person

Keeping mothers and newborn babies longer than necessary to ‘assess’ whether she will be a good parent

Question 27

First Nations Women’s Encounters with Mainstream Health Care Services:

Answer 27

A study conducted by Browne and Fiske examined mainstream health care encounters from the viewpoint of First

Nations women from a reserve community in Northwestern Canada.

Dismissal by Health Care Providers

Transforming oneself to gain credibility

Negative stereotypes about First Nation women

Marginalization from the Mainstream
Situations of vulnerability

Disregard for personal circumstances

Question 28

“Access to treatment”

Answer 28

Approximately 25% of Aboriginal persons living with HIV/AIDS respondents report being denied services because they were believed to have been drinking whether they were or not.

Question 29

Alcohol use and access to treatment:

Answer 29

Twenty one percent of (people living with AIDS) reported having been denied community based care/in-patient care at least once in their lives for having drank alcohol when in fact they were sober.

Twenty eight percent reported to not seek in-patient care out of fear of being denied services for having drank alcohol — whether they were sober or not.

Question 30

Clinical encounters between nurses and First Nations women in a Western Canadian Hospital:

Answer 30

Relating across presumed “cultural differences”
Constructing the “Other”
Assumptions influencing clinical practice
Responding to routine patient requests

Question 31

Intimidating and Alienating Health Care:

Answer 31

A lack of respect for traditional Indigenous approaches to healing

Power differentials and different communication styles between provider and patients

Use of complicated medical terminology instead of conversational language

Western focus on disease rather than on the whole person and life circumstances

Lack of ‘space’ for ceremonies.