Indigenous People, Health and the Environment Lecture 3 PDF

10/3/23 Indigenous People, Health and the Environment Learning what to focus on: Alternative Views and Understandings of Health and Wellbeing Lecture 3 1 1 Reminders Academic Integrity Module - Due next week (Oct 10th) Writing Assignments – Honouring Truth and Reconciliation – due Oct 10th as op...

10/3/23 Indigenous People, Health and the Environment Learning what to focus on: Alternative Views and Understandings of Health and Wellbeing Lecture 3 1 1 Reminders Academic Integrity Module - Due next week (Oct 10th) Writing Assignments – Honouring Truth and Reconciliation – due Oct 10th as opportunity for 2% towards the 20% for seminars and guest visits Assignment #1 - Due Oct 10th via Blackboard in the Assignments folder unless you have requested and been approved for an extension 2 1 10/3/23 Variables and Attributes • Quantitative – Describes a characteristic in terms of a numerical value – Expressed in some units of measurement – E.g. height (ft in, cms), blood concentration of PCB (ug/kg) • Qualitative (attributive / categorical) – Describes the attribute of a characteristic (by classifying it into categories to which a subject either belongs or does not) or a property or quality that a subject either possesses or does not – Notion of magnitude is absent or implicit – E.g. access to health care, sickness, blood group, gender, selfreported health, etc. 3 3 Variables and Attributes Objective measurement • (of a symptom or manifestation of disease) : perceptible to persons other than the affected individual • involving or deriving from sense perception or experience with actual objects, conditions, or phenomena <objective awareness>, <objective data> Subjective measurement • arising out of or identified by means of one's perception of one's own states and processes <a subjective symptom of disease> • characteristic of or belonging to reality as perceived rather than as independent of mind (phenomenal) 4 4 2 10/3/23 First Nations - Cancer • Cancer rates among Ontario First Nations between 1968-1991 Marrett and Chaudhry, 2003 Objective - Quantitative 5 5 Self-Reported Health Do you feel your general / mental health is “Excellent”, “Very Good”, “Good”, “Fair” or “Poor”? Class response = 58% Subjective – Qualitative …that has been quantified http://www.statcan.gc.ca/pub/82-624-x/2013001/article/chart/11763-01-chart1-eng.htm 6 6 3 10/3/23 • Higher self-rated health among Indigenous residents than expected knowing status of chronic health issues that exist • Slightly better self-rated health among non-Indigenous residents than Indigenous (Very good and Excellent) • Poorer self-rated health among Urban Indigenous residents Recommended reading: Wiseman, 1999 Korpela and Ylen 2007 Bomback and Bruce 2012 7 7 • Self-reported health is actually a good proxy for morbidity and mortality indicators in homogeneous populations • May be inaccurate (higher or lower than some objective measurements) in some groups though (e.g. Indigenous Australians and Torres Strait Islanders) • Consider: – Social Comparison Theory - in the absence of objective comparisons we compare ourselves with others (e.g. Urban Australian Indigenous) – Health Identity Theories – different cultural views of “health” or “illness” – Survey Methods and Instruments – differences in approach (“interrogatory directness” Vs Indigenous story telling), variations in conceptualizations or self-constructions of the notion of “health” 8 8 4 10/3/23 ‘Data’ Quality is the Key • Reliability: – Inherent performance of the procedure. A reliable procedure is one that gives consistent results when it is applied more than once to the same subject under similar conditions. • E.g. a clearly defined categorical question of mutually exclusive categories asked in the same way each time among the same group of individuals (e.g. self-rated health) • Validity: – A measurement is valid if it measures what it is supposed to measure/assess – Answers from oral interviews in some groups may not be ‘valid’ measures • E.g. Measures of ‘safe behaviour practicing’ (e.g. wearing a helmet) among young males; smoking among smokers (cultural norms, stigma, interview / research bias) 9 9 What is ‘scientific’ research ? Web Definitions • ‘research into questions posed by scientific theories and hypotheses ‘ • ‘The systematic, controlled, empirical and critical investigation of hypothetical propositions about the presumed relations among natural phenomena ...’ • ‘Investigation performed using the scientific method’ • All ‘scientific research’ (natural science, physical science, social science, medical science) has a ‘method’ 10 5 10/3/23 Research and the scientific method 11 But no knowledge system is infallible: Science and the Raven Paradox • ‘All ravens are black’ (Hemple, 1965) • No theory is immune to challenge or debate. As new evidence is uncovered, science must adapt and change to assimilate the new data. • 1 in 10 000 clutches of raven eggs contain albinos 12 6 10/3/23 Reductionism and Science – Is the smallest scale the most powerful to understand complex issues? • An approach to understand the nature of complex things by reducing them to the interactions of their parts, or to simpler or more fundamental things • A philosophical position that a complex system is nothing but the sum of its parts, and that an account of it can be reduced to accounts of individual constituents. 13 Cree and Inuit relationships to the environment Perhaps Indigenous ‘models’ are more valuable and helpful to learn about complex systems with as they are, and always have been at the ‘forefront’ of observing, understanding and relying on the environment (complex) and a relationship with it. From McDonald et al., 1997 Voices From the Bay 14 33 14 7 10/3/23 Understanding and Respecting KnowlegeS • Karl Popper science and pseudoscience https://www.youtube.com/watch?v=-X8Xfl0JdTQ&t=1s • What is Indigenous Knowledge? https://www.youtube.com/watch?v=AZ6gvd-HaP8&t=27s • Indigenous Knowledge has value-watch on own https://www.youtube.com/watch?v=c-PwEnC-Rj8 15 Approaches to Exploring Health-Environment Relationships Environmental Health Hazards Model and Approach Biological (e.g. bacteria, viruses, parasites and other pathogenic organisms) Chemical (e.g. toxic metals, air pollutants, solvents, pesticides) Physical (e.g. radiation, temperature, noise) Mechanical (e.g. motor vehicle, home, agriculture, workplace injury) Psychosocial (e.g. stress, lifestyle disruption, effects of social change, marginalization, unemployment) Yassi et al. 2001 Recommended reading: Frumkin, H. 2001. Beyond Toxicity, Am J Prev Med. Fig 20-3 Cunningham et al. 2005 16 16 8 10/3/23 Approaches to Exploring Health-Environment Relationships Adapted Environmental Health Hazards/Benefits Model and Approach Biological Hazards: e.g. bacteria, viruses, parasites and other pathogenic organisms Benefits: e.g. traditional food species, traditional plants Chemical Hazards: e.g. toxic metals, air pollutants, solvents, pesticides Benefits: e.g. nutrients, anti-oxidants other critical elements of traditional plants, foods and other medicines Physical Hazards: e.g. radiation, temperature, sounds (noise) Benefits: e.g. temperature, sound (music) Mechanical Hazards: e.g. motor vehicle, home, agriculture, workplace injury Benefits: e.g. motor vehicle, traditional form of transportation, home, workplace (traditional and contemporary) benefits Psychosocial Hazards: e.g. stress, lifestyle disruption, effects of social change, marginalization, unemployment Benefits: e.g. stress-relief, balance, identity, cultural connection 17 17 Approaches to Exploring Health-Environment Relationships: Determinants of Health Approach • • • • • • • • • • • • Income and social status Social support networks Education and literacy Employment / work conditions Social environments Physical environments Personal health practices and coping skills Healthy child development Biology and genetic endowment Health services Gender Culture Public Health Agency of Canada, 2004 18 9 10/3/23 Approaches to Exploring Health-Environment Relationships: Ecosystem/Socio-Ecological Approach • An ecosystem is a “system description of the interacting biota and environment of some place over some time period.” (Allen et al., 1993) • “The ecosystem approach sees humans as living in the biosphere as a home rather than the planet being the house of man.” (Allen et al., 1993) ( synonyms = socio-ecological system, eco-social system) • There is no complete (all the truth and nothing but the truth) description of any ecosystem. Therefore specific components and interactions of interest need to be clearly defined every time you work on issues – even on the same landscape 19 Approaches to Exploring Health-Environment Relationships: The EcoHealth Approach • Involves three groups of people – Researchers, specialists – Community members – Decision-makers • Based on three methodological pillars 1. Transdisciplinarity (integration of knowledges and adoption of common language) 2. Participation (of all groups in all steps of the process) 3. Equity (social and gender and…) 20 10 10/3/23 EcoHealth Approach • Both the outcome (health) and the process (how we achieve it) are important. This is a matter of emphasis, not a categorical difference. • In the literature, it tends to be a split between activists (who focus on process) and academics & bureaucrats (who want to measure outcomes). • If we focus on outcome, we need to ask who defines that outcome, are there “objective” measures? • If we focus on process, we need to ask who is part of that process, and who has the power to influence it. • In actual fact, the process (methodologies) and the outcome (goals – eg “healthy ecosystems”) are closely related. 21 How is the EcoHealth Approach Different ? Traditional epidemiological study - shows increasing rates of malaria in a region, but won’t address how or why the rate is increasing Environmental health study - may recommend the spraying of a pesticide in certain amounts in certain areas to reduce spread of the disease Economic study - may calculate the cost effectiveness per dollar spent on such a spraying program EcoHealth study - brings the multiple specialist disciplines together with members of the affected community before the study begins. Holds pre-study meetings to share knowledge and adopt a common language. These pre-study meetings often lead to creative and novel approaches and can lead to a more “socially robust” solution. This approach is called “Transdisciplinarity”. EcoHealth studies value participation of all involved groups, including decision makers, and they believe issues of equity (between gender, socioeconomic classes, age and even species) are important to fully understand the problem to be studied. Jean Lebel (2003) termed ‘transdisciplinarity, participation and equity’ the three pillars of EcoHealth (www.idrc.ca/ecohealth) 22 11 10/3/23 EcoHealth Approach and Indigenous Populations Why is such an approach possibly attractive for looking at Indigenous environment and health relationships? Philosophy – reciprocal relationship between humans and nature Conceptual orientation – cognizant of the complexity and interconnected nature of the world, including links between social and ecological systems Transdisciplinary approach – allows for others’ ways of knowing and seeing the problem to be recognized Participatory Approach – builds capacity while investigating the issue Gender / Social / Other analyses – recognizes the current disparities facing Indigenous groups 23 Approaches to Exploring Health-Environment Relationships: Planetary Health Approach Guzman et al. 2021 24 12 10/3/23 Approaches to Exploring Health-Environment Relationships: Inuit variation on the Social Determinants of Health https://www.itk.ca/wp-content/uploads/2016/07/ITK_Social_Determinants_Report.pdf 25 Recommended reading: Chandler and Lalonde, 1998; 2004 – Indigenous SDOH 25 Approaches to Exploring Health-Environment Relationships: Traditional Understandings of Illness and Causation Maher, 1999 Recommended reading: Maher, 1999 26 13 10/3/23 Indigenous Approaches / Approaches Based on Traditional Understandings: Maori Health Good health is seen as a balance between: • Mental (hinengaro) • Physical (tinana) • Family/social (whänau), and the • Spiritual (wairua) dimensions Durie, 2004 All four are regarded as essential so there is little support for a uni-dimensional measure of mental health In response to Maori dissatisfaction with existing measures of effectiveness for mental health programming in NZ, the Maori Mental Health Outcomes (MMHO) framework was developed by Maori researchers to measure mental health outcomes associated with interventions for Maori. Based on Maori perspectives of health and views of clinicians, patients and family were independently asked to rate the effect of a particular intervention on: hinengaro (mental/behavioural domain) tinana (physical health) whanau (family/social health) wairua (spirituality) Additionally, two other approaches were taken to measure spirituality: The first - As a result of a particular intervention, had participants become ‘stronger as a Maori’? (5 pt scale) The second – A measure concerned with feeling valued and generally ‘healthier from a spiritual point of view’ Clinical trials suggest that the measures, constructed around Maori perspectives of health, provide a more useful outcome measurement tool specific to Maori as individuals and members of their 27 community. Recommended reading: Durie, 2004 27 Narrative as Metric Health as Balance To understand health in the Sto:lo way is to understand ‘balance’. According to one elder, to be healthy the person needs to: “..understand that everything inside of you has got to be balanced. . . . Balance is walking mentally, spiritually, physically. . . . You have to have a good understanding of what it means to yourself and everything around you . . . like the ground, nature, and the family.” (Sto:lo Elder in Labun and Emblen, 2007) 28 28 14 10/3/23 Traditional Approaches Circle of Life (by Norma Kassi) Examples: Body: how am I feeling physically ? (self-rated on 5 pt scale; collection and analysis of individual narratives in community) Spirit: Did I do a prayer today? (frequency report of participation / recognition of spiritual practices; collection and analysis of commonality of participation in prayer practices in a community/group) 29 29 Ultimate Goal: Use of and critical engagement with Knowledges to enhance understanding of the environmenthealth relationship ‘Western’ Sciences (environmental, health, social, physical, natural) I E S S Indigenous Knowledges Recommended reading: Evering, 2012 30 30 15 10/3/23 Recommended Readings (in Supporting Readings folder) Chapters 5-7 in Aboriginal Health in Canada – Perspectives on historical health and healing, Medical Traditions in Aboriginal cultures etc Bomback, AE and Bruce, SG. 2012. Self-rated health and ethnicity: focus on Indigenous populations, IJCH (http://dx.doi.org/10.3402/ijch.v71i0.18538) Chandler, M, and Lalonde, C. 1998. Cultural continuity as a hedge against suicide in Canada’s First Nations. Transcultural Psych. 1-20. (in lecture 2 folder) Chandler, MJ, and Lalonde, C. 2004. Cultural continuity as a moderator of suicide risk among Canada’s First Nations, in The Mental Health of Canadian Aboriginal Peoples (Kirmayer and Valaskakis (Eds). (in lecture 2 folder) Durie, M. 2004. Understanding health and illness: research at the interface between science and Indigenous Knowledge. International Journal of Epidemiology, 33: 1138-1143 Evering, B. 2012. Relationships between knowledge(s): implications for ‘knowledge integration’, J Environ Stud Sci, 2:357-368. Frumkin, H. 2001. Beyond Toxicity: Human health and the environment, Am J Prev Med, 29(3) Guzman et al. 2021. A framework to guide planetary health education, The Lancet Planetary Health, Volume 5 Issue 5, Pages e253-e255, DOI: 10.1016/S2542-5196(21)00110-8 Johnson, et al. 2007. Ecohealth and aboriginal testimony of the nexus between human health and place. EcoHealth, 4:489-499 Korpela, KM, and Yien, M. 2007. Perceived health is associated with visiting natural favourite places in the vicinity. Health & Place, 13: 138-151 Maher, P. 1999. A review of “Traditional” Aboriginal health beliefs, Australian Journal of Rural Health, 7: 229-236 Panelli, R., and G. Tipa. 2007. Placing well-being : A Maori study of cultural and environmental specificity. EcoHealth, 4: 445460. Wiseman, VL. 1999. Culture, self-rated health and resource allocation decision-making. Health Care Analysis, 7:207-223. 31 Reminders Academic Integrity Module - Due next week (Oct 10th) Writing Assignment – Honouring Truth and Reconciliation – due next week as opportunity for 2% towards the 20% for seminars and guest visits Assignment #1 - Due next week (Oct 10th) via Blackboard in the Assignments folder unless you have requested and been approved for an extension 32 16