Culture, Health, and Health Care

• Culture, Health and Health Care is the title
• The presentation is by Dr. Grace Spiro
• It was given January 20/22, 2025

Overview

• The lecture includes information on Truth and Reconciliation
• Also includes information on Social Determinants of Health (SDH)
• Includes various Models of Health
• Discusses Determinants of Indigenous Peoples’ Health
• Review the Social/Symbolic Reality Paradigm

Shared Responsibility of Working Towards Reconciliation

• Shown is an image of shoes on the steps of the Manitoba Legislature

Culture and Indigenous Views on Health

• Understandings of health are inseparable from religion and spirituality
• Health beliefs are often based on supernatural phenomena
• Care is delivered by a “medicine man” or shaman from the Indigenous community

Terminology Around Names

• Terms include: Native, NDN, Aboriginal, Indigenous, First Nations, Inuit, Métis, Native American, Cree, and Anishinaabe

Factors Affecting Health

• Traditionally health linked to individual choices and practices
• The choices available are functions of social, economic, cultural, and political circumstances

Key Terms

• Social Determinants of Health (SDH) are conditions in which people are born, grow, work, live, and age
• SDH includes forces and systems that shape daily life conditions such as economic policies and systems, development agendas, social norms, social policies and political systems
• Socioeconomic status (SES) is the social standing/class of an individual or group
• SES is measured as a combination of education, income and occupation

Lalonde Report

• Introduced the health field concept
• Healthcare is not the total answer to achieving health
• Outlined four broad concepts to consider: human biology, environment, lifestyle, and health care organization
• Governments focused on lifestyle, ignoring other concepts

Income

• Income is considered the greatest contributor to individual health
• Higher income correlates with greater life expectancy and better self-rated health
• Socio-economic disadvantage links to higher disease and mortality rates
• Economically marginalized correlates with illness and premature mortality
• Best predictors of cardiovascular disease are civil unrest, poverty, and social and economic change
• Factors include: material deprivation, psycho-social stress, and poor lifestyle choices

Education

• Upward mobility, better informed, ability to secure higher paying work with fewer safety risks, and is closely tied to income correlate with education
• Higher education is associated with better health

Understanding Health

• Biomedical model proposes that illness results from a biological or psychological problem
• Behavioural model proposes that illness results from poor choices
• Considering health using the biological/behavioural model suggests that health problems are individual
• Solutions are aimed at the individual (or downstream) level
• Considering health using the socio-environmental model encourages the examination of social and environmental factors that impact individuals
• Solutions are aimed at the societal level to fix the circumstances in which people become sick

The Parable of the River

• Physicians help/save people
• If physicians are always pulling people out of the river they don't have time to find out why they are falling in

"Upstream" Factors in Health

• Factors in health include smoking, environment, drug use, social inequities, racism, obesity, sexism and stress

Proximal vs. Distal Determinants

• Proximal determinants are downstream
• Distal determinants are upstream

Public Transit

• Availability of public transit is a structural factor
• Impacts access to healthcare and nutritious food, and improves environmental air quality

Determinants of Indigenous Peoples’ Health in Canada

• Colonialism is a determinant of health
• Geographic, economic, historical, narrative, genealogical, and structural determinants are key
• Excluded determinants: spirituality, relationship to the land, geography, history, language, and knowledge systems

Social Determinants of Health

• Can be represented in social ecology like a turtle illustration with proximal determinants as the crown, Intermediate Determinants as the Trunk and Distal Determinants as the roots

The Paradigm

• How folk, popular, and professional options are incorporated in lives affects our well-being
• Individuals differ in conscious understanding and acceptance of social norms and how they follow them
• Differences determine choices made relating to illness
• Includes how we think about our illness, how families respond, and how practitioners respond
• Social and symbolic realities are part of the paradigm
• The social cultural world is social reality
• The bridging reality which links the social cultural world with the psychological and biological/physical reality is termed the symbolic reality
• The symbolic reality makes sense out of inner experience
• It helps shape personal identity in accordance with social cultural norms
• Symbolic meanings influence basic psychological processes, such as attention, state of consciousness, perception, cognition, affect, memory, motivation
• How the symbolic reality connects the social environment with the psychological process (inner experience- flip the switch) is less certain

Case Study: Art Duerksen

• A case study is examined based on Art Duerksen
• Duerksen is 55 years old and was not a runner
• He impulsively joined an ironman triathlon to raise money for charity seven months prior
• Just before Christmas his speech became slurred, his left side lost strength, his vision blurred, and his balance was off
• He sought medical attention
• A main artery at the top of his brain stem had become blocked/leaked blood
• He had suffered some brain damage
• While in hospital, he had another small stroke and went blind in his right eye
• He was optimistic despite the circumstances
• Doctors gave him hope but prepared him for the other possibility
• Medications made him violently ill, work and travel were out
• Duerksen kept telling himself things could be worse
• When he said he wanted to do the triathlon all he got was a disbelieving laugh/stern instruction to relax
• Duerkensen started feeling better and climbed onto a treadmill at the hospital and walked for 5 minutes very slowly a month later
• He went swimming with a snorkel so he would have to move his head a few weeks later
• Bit by bit he added to the distance
• His symptoms were fading
• In midsummer he completed a half-ironman, his vision returned his speech cleared up his strength increased
• He decided to do the triathlon he committed to and swam 3.9 kilometers, biked 180 kilometers, and ran 26 kilometers in 14 hours/33 minutes
• He asked God to run alongside him to keep him safe as he started the race

Summary

• It is important to understand the common factors that constitute culture
• Health beliefs and norms around health/illness are transmitted in cultures
• Culture shared among individuals doesn't mean that culture-sharing group is homogeneous, may/may not adhere to all aspects of their culture
• Culture is dynamic/changing and in flux
• The dominant biomedical culture in North America is based on objectivity and scientific rationality
• Other frameworks of understanding health/illness aren't as widely accepted