Midterm Studying Part 3 Flashcards
What are social determinants of health?
A determinant of health is simply something that can impact an individual’s, a family’s or a community’s health.
“Social Determinants”
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.
Social Determinants of health include:
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.
12 key determinants of health
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
“Health Disparities, Inequalities, and Inequities”
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
“Charter of Rights and Freedom”
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)
Fundamental Freedoms:
Consciousness Religion Thought Belief Expression Press Peaceful Assembly Association
What are mobility rights?
Right to enter, leave and remain in Canada
What are legal rights?
Life, liberty and security, detention, unusual punishment
What are equity rights?
Protection and benefits
What are language rights?
English and French
What are aborignal rights?
Treaty rights, receive more direct constitutional protection under section 35 of the Constitution Act.
“Rights”
Equally to men and women
Multicultural
Does not extend to hate and obscenity
Indigenous people are:
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.
United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP)
after careful consideration, Canada formally endorsed this Declaration when?
November 2010
“Health Services”
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)
Self Determinant and Self Government
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
“Health Transfer”
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.
“Chandler and Lalonde”
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.
The six factors associated with cultural continuity include:
Land claims; Self-government; Education services; Police and fire services; Health services; Cultural facilities.
“Cultural Continuity”
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.
“Self-Determination”
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.
“Health Governance”
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.
“Health Care Interactions”
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.
Access to health care:
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
Health Council of Canada Report:
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
First Nations Women’s Encounters with Mainstream Health Care Services:
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
“Access to treatment”
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.
Alcohol use and access to treatment:
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.
Clinical encounters between nurses and First Nations women in a Western Canadian Hospital:
Relating across presumed “cultural differences”
Constructing the “Other”
Assumptions influencing clinical practice
Responding to routine patient requests
Intimidating and Alienating Health Care:
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.
