2. Social Determinants of Indigenous Health .
Social determinants of health include income and social status; social support networks; education; employment/working conditions; social environments; physical environments; personal health practices and coping skills; healthy child development; gender; and culture. Social determinants influence health on a large scale by impacting health behaviours, vulnerability and individuals’ capacity to deal with health stressor. Individuals that experience inequality in the social determinants of health tend to experience greater burden of health problems and are often restricted from access to resources that might alleviate those problems.
Before going further it is important to note the Indigenous holistic perspective of health
Indigenous ideologies embrace a holistic concept of health that reflects physical, spiritual, emotional and mental dimensions. It is the interrelatedness between these dimensions that help shape indigenous peoples’ health instead of the traditional ‘silo’ approach to health that is commonly seen in the healthcare system. This ‘silo’ approach often fails to address the complexity of most health issues of Indigenous people.
2.1 Socio-Political Context
Indigenous people are unique in their relationship with the Canadian government especially under the provisions made under the Indian Act of 1876, which includes health care. The act itself was created as a result the colonial process and has impacted Indigenous people throughout history in the political, social and economic domain. The colonial process has resulted losses of land accompanied by diminished self-determination, language and socio-cultural resources for Indigenous communities. The impact of the Indian Act trickled down throughout the years hindering the economic development of the indigenous communities, thus, contributing to their inability to alleviate health problems related to socioeconomic status
2.2 Physical Environments
The physical environments that are largely detrimental to the health of Indigenous people has been imposed through historic dispossession of traditional territories as well as current reserve or settlement structures. These structures resulted in substantial housing shortages and poor quality of existing homes. This, consequently, contributed to overcrowding that is prevalent in the Indigenous communities as well as homelessness for Indigenous people living in Urban areas. Further, many on-reserve homes are infested with mold due to overcrowdedness and poor ventilation. This mold infestation has resulted in increased incidents of asthma and allergies among Indigenous children.
Moreover, Indigenous people living in remote rural and serserve communities are faced with considerable challenges accessing food . This is due to difficulty acquiring food whether it is market or traditional foods. Transporting food to the remote communities has the added cost of transportation which further contributes to the lack of affordability, and thus lack of access, to healthy, nutritious food by most Indigenous families. Lastly, poor sanitation and lack of access to safe water supplies represents physical conditions that further contributes to the gap that is evident in indigenous health. These conditions have further been exacerbated by the lack of community resources.
2.3 Employment and Income
Colonization, colonialism, systemic racism and discrimination, created inequality in Indigenous people’s access to resources and conditions necessary to support advancement in socioeconomic status. This inequalities are evident in many areas such as unemployment, scarce economic opportunities, poor housing, low literacy and educational attainment, as well as limited community resources. The low socioeconomic status is further contributing to Indigenous peoples’ lack of access to nutrient-rich food by impacting income, and consequently the affordability of healthy food. This lack of access to nutritious food is further contributing to higher rates of obesity and diabetes and poor cardiovascular and renal health. Low socioeconomic status is also linked to to social exclusion, which negatively impacts the number of indigenous people who seek education and further training .
These different factors consequently result in psychosocial stress, which is linked to violence, addictions, poor parenting and lack of social support. The accumulation of these different factors result in poor mental health, increased vulnerability to infection and other medical conditions.
Given the above mentioned conditions, it is no surprise that Indigenous people are less likely than Canadians to participate in the labour force , and if they are part of the labour force, their rate of unemployment is between two and three times higher than for other Canadians. Further, for those that do find a job, their earnings are considerably lower than other Canadians.
2.4Education
Education is also a component of socio economic status and has an impact on Indigenous health. Inadequate education often includes poor literacy, which impacts one's’ ability to acquire and comprehend health related knowledge. Insufficient education also diminishes the attractiveness of individuals within the labour market, often resulting in low paying job. Despite the growing number of Indigenous peoples who are pursuing a post-secondary education, inadequate educational opportunities for most adults is a result of lack of promotion of education amongst indigenous children . Moreover, approximately 22% of Indigenous youth drop out of high schools contributing to diminished literacy and low employment, and consequently increased poverty in future generations .
2.5 Educational Systems
As mentioned above, education has profound impact on employment, income, and thus living conditions. Despite the positive impact of education, programs that are currently in place to support indigenous people pursuit of education are often underfunded . Further, the education system is currently not equipped to address and manage children with consideration of social determinants impacting Indigenous children educational experience
2.6 Environmental Stewardship
Another determinant of health is environmental stewardship. Unfortunately, over the past hundred year, the relationship of indigenous people with the environment has transitioned to one of dispossession and disempowerment. Indigenous people can no longer express autonomy with respect to their traditional territories, for example, they are not permitted to share in the profits of natural resources on their land. Further, environmental contaminants which impacted wildlife and natural water resources has fragmented the relationship indigenous people have with the natural environments that once sustained community health.