lecture 5 iess.pdf

Indigenous People, Health and the Environment Indigenous people, health and the relationship with mechanical hazards and benefits in the environment Lecture 5 1 1 Environmental Health Hazards/Benefits Model and Approach: Mechanical Benefits: e.g. motor vehicle, traditional form of transportation...

Indigenous People, Health and the Environment Indigenous people, health and the relationship with mechanical hazards and benefits in the environment Lecture 5 1 1 Environmental Health Hazards/Benefits Model and Approach: Mechanical Benefits: e.g. motor vehicle, traditional form of transportation, home, workplace (traditional and contemporary) benefits Hazards: e.g. motor vehicle, home, agriculture, workplace injury Chemical Benefits: e.g. nutrients, anti-oxidants other critical elements of traditional plants, foods and other medicines Hazards: e.g. toxic metals, air pollutants, solvents, pesticides Biological Benefits: e.g. traditional food species, traditional plants Hazards: e.g. bacteria, viruses, parasites and other pathogenic organisms Psychosocial Benefits: e.g. stress-relief, balance, identity, cultural connection Hazards: e.g. stress, lifestyle disruption, effects of social change, marginalization, unemployment Physical Benefits: e.g. temperature, sound (music) Hazards: e.g. radiation, temperature, sounds (noise) 2 2 1 Mechanical Benefits Those benefits posed by the transfer of mechanical or kinetic energy (energy of motion) which can result in immediate or gradually acquired health improvement or maintenance • Mechanical relationships (e.g. use of motorized vehicles) can provide a variety of kinds of benefits for various aspects of health Examples: Contemporary (transportation to employment, use of mechanized means for commercial resource harvesting) or traditional/subsistence activities (hunting/fishing/gathering via mechanized means e.g. ATV, firearms) Risks / Benefits are linked 3 3 Categories of Health Benefit • Body – physical health physical • Heart – social, cultural health • Mind – mental health mental, emotional, social, spiritual • Spirit – spiritual health 4 2 Health Benefits of Interactions with Mechanical Elements of the Environment • Physical activity • Transportation and mechanisms of traditional activities – work (socio-economy, health) – traditional activities and livelihoods (physical, cultural, mental, spiritual health, identity, socio-economy) Literatures / Sources Caring for Country Traditional Foods and Nutrition Therapeutic Landscapes Indigenous knowledge narratives 5 5 Healthy Country = Healthy People Participation in Indigenous Cultural and Natural Resource Management = Physical health and well-being • More frequent exercise • Lower obesity, diabetes, renal disease, CVD, psychological stress • Better nutritional status (e.g. omega-3 fatty acids; iron) • Improved socio-economic well-being • Food sources and other valued resources • Decreased health costs • “Sustainable livelihoods” Burgess et al., 2009 and Weir et al., 2011 6 6 3 Healthy Country / Environment = Healthy People Physical health benefits • Physical health and well-being • More bush meat consumption • More bush fruit and vegetable consumption • Lower obesity • Lower type II diabetes • Lower blood pressure • Lower risk for heart disease • Lower ‘distress’ Burgess et al., 2009 7 7 Mechanical Hazards “Those hazards posed by the transfer of mechanical or kinetic energy (energy of motion) which can result in immediate or gradually acquired injury” (Yassi et al., 2001: p92) • • • • Mechanical hazards can cause injury or trauma Events or circumstances of exposure and injury / trauma used to be referred to as accidents BUT injuries are predictable and preventable Accidents implies they are random and uncontrollable events Examples: Car crash, falling down the stairs, suicide by gunshot, murder or physical assault, burn from kettle, falling off a bicycle or ATV, lifting a heavy object 8 8 4 Categories of Injury and Health Impact – Unintentional • Car crash, fall, repetitive strain injuries (lifting – and the ‘cumulative trauma’) – Intentional • Self-inflicted (Suicide) • Homicide / abuse / assault For each you could measure: Injury morbidity (e.g. Injury related hospitalizations or disability) • Injury related illness or disability Injury mortality • Injury related death 9 9 Factors Influencing the Relationship between Indigenous Peoples and Mechanical Hazards/Benefits • Perception of risk/benefit including knowledge and awareness of impact of hazard or benefit on health (e.g. on the land livelihoods and IK and experience) • Cultural attitudes / norms towards risk-taking and injury/importance of practicing beneficial activities for health or culture e.g. Land diving (https://www.youtube.com/watch?v=A88fFm9dbVQ – 4 mins) • Socio-economic reality and risk tolerance / benefit need (e.g. Mohawk steelworkers: Mohawk Ironworkers https://www.youtube.com/watch?v=XNiNSN_j7yU – 2 mins; High Steel https://www.youtube.com/watch?v=Qrl6tOcvrUM – 14 mins) • Balance of perceived risks Vs necessities of survival / benefit need 10 10 5 Injury Mortality in Canada • Most under-recognized public health problem • Greatest cause of death for N Americans (aged 1-44) – Canada: Injury = 63% of deaths (aged 1-24) (Shah, 1994) Ranking and number of deaths for top 10 leading causes, Canada, 2000, 2010, 2011 – Increased development = decreased injury (except automobile accidents) • Under-reporting of non-fatal injuries http://www.statcan.gc.ca/daily-quotidien/140128/t140128b001-eng.htm http://www.paho.org/english/HIA1998/Canada.pdf 11 11 Injury Mortality in Canada • Most under-recognized public health problem • Greatest cause of death for N Americans (aged 1-44) – Canada: Injury = 63% of deaths (aged 1-24) (Shah, 1994) Age-standardized mortality rates for top 10 causes 2000, 2010, 2011 – Increased development = decreased injury (except automobile accidents) • Under-reporting of non-fatal injuries http://www.statcan.gc.ca/daily-quotidien/140128/t140128b002-eng.htm http://www.paho.org/english/HIA1998/Canada.pdf 12 12 6 Injury Mortality in Canada Life Course Perspective • Most under-recognized public health problem • Greatest cause of death for N Americans (aged 1-44) – Canada: Injury = 63% of deaths (aged 1-24) (Shah, 1994) Ranking and number of deaths for the top 10 causes, by age group, 2000 and 2009 – Increased development = decreased injury (except automobile accidents) • Under-reporting of non-fatal injuries http://www.paho.org/english/HIA1998/Canada.pdf http://www.statcan.gc.ca/pub/84-215-x/2012001/table-tableau/tbl003-eng.htm 13 13 Injury Mortality in Canada Vulnerable Groups: • Elderly – sensitivity and health status (e.g. osteoporosis) • Children – sensitivity and higher rates of exposure • Disadvantaged groups – income and living conditions • Indigenous populations – health status, rates of exposure (livelihoods and land based activities), access to emergency health services, income and living conditions • Males – higher rates of exposure 14 http://dsol-smed.hc-sc.gc.ca/dsol-smed/is-sb/index_e.html 14 7 Injury and Indigenous and Remote Populations in Canada (AFN/FNIGC, 2007) Inuit and Injuries “Unintentional injuries are a major source of morbidity and mortality among Canadian Inuit. Along with suicides, injuries are the main contributor to disparities in mortality rates between Inuit young adults and those in the rest of Canada.” 15 http://www.itk.ca/health/InjuryPrevention-Index.php (GNWT, 2004) 15 Injury and Indigenous Populations • Injury (intentional and unintentional) is the leading cause of death for Native Americans 119yrs old (2006) Berger et al. 2009 • Injury and mental health are the leading contributions to the health gap (life expectancy) between Indigenous and non-Indigenous Australians in the 15-34 yrs old group (2003) Vos et al. 2008 16 16 8 Key Sources of Injury for First Nations Mechanical Hazards (AFN/FNIGC, 2007) (FNIGC, 2012) 17 17 Measuring the Impact of Injuries Disability-Adjusted Life Year (DALY) Years of life lost (YLL) + Years lost to ‘disability’ (YLD) Disability – measure of inability to perform ‘activities of everyday life’(non-fatal injury x weighting for duration and severity of disability) More severe the outcome, the higher the associated DALYs 1 DALY = 1 yr lost of ‘healthy life’ Useful because it includes impact of fatal and non-fatal injuries Potential Years of Life Lost (PYLL) Standard Age (65) - Age at death = PYLL e.g. traffic fatality at age 20 = 45 PYLL e.g. traffic fatality at age 60 = 5 PYLL Injury morbidity Injury mortality Injuries are a significant source of PYLLs and costs to the health care system today (e.g. PYLL rates due to injury in Nunavut were 4 times the Canadian rate in 1999) (e.g. $7.5 million cost to health care system in the NWT in 2001) Mathers et al., 2001 18 Yassi et al., 2001 18 9 Host-Agent-Environment There are no such things as “accidents” Context for a mechanical hazard related injury can be described by: ENVIRONMENT Location where the HOST and AGENT coincide HOST Person susceptible to injury -age, gender, sensitivity, behaviour, exposure frequency AGENT Hazard that is capable of inducing injury 19 Yassi et al., 2001 19 Injury Settings • Workplace – Has been the focus of significant prevention programs – Establishment of compensation programs • Home • Environment / community – Have received comparatively less attention – No one group tasked with preventing all injuries in other settings Overlap of settings (work and home and/or local environment) important to understand in Indigenous context 20 20 10 Age, Gender, Place, Indigenous Identity and Injury Epidemiology of severe trauma among status Indigenous Canadians: a population-based study (Karmali et al., 2005) Karmali et al., 2005 Brussoni et al. 2016 21 21 Key Findings: • Indigenous Canadians had nearly a 4fold greater risk of severe trauma than the non-Indigenous population • Motor vehicle crashes accounted for the overwhelming majority of cases of severe injury or death in both populations • Status First Nations were almost 5 times more likely than the reference population to be involved in such events Possible explanations could involve: • environmental factors (e.g., road conditions on reserves) • physical factors at the time of the event (e.g., vehicle maintenance, seatbelt use) • social factors (e.g., driving behaviours as a result of law enforcement practices against speeding, numbers of car occupants, lifestyles involving need for frequent highway travelling) 22 Karmali et al., 2005 22 11 Identity, Age and Injury among Indigenous Populations (FNIGC, 2012) http://www.itk.ca/health/InjuryPrevention-Index.php • Injury prevalence varies by identity, sex and age 23 23 Factors Associated with Injury in First Nations -socio-economic status -education -location of residence -access to health services -location of residence = lifestyle and livelihood BUT…Are these “Indigenous 24 factors” ? (AFN/FNIGC, 2007) 24 12 Indigenous Identity, Place and Injury In the NWT from 2000-2009, INJURY: • • • • Was one of the most serious public health concerns Was the leading cause of death for those aged 1-44 308 people died from injury Was the second leading cause of hospitalizations 4822 people were hospitalized due to injury Of injury related deaths: 33% were intentional (purposefully inflicted) 67% were unintentional injuries Most of these were preventable ! http://www.hss.gov.nt.ca/en/services/injury-prevention 25 25 Indigenous Identity, Place and Injury Dene Metis Inuit Non-Aboriginal Yellowknife Regional Centre Small Community • Injury rates vary by Indigenous identity and geography….why? 26 http://www.hss.gov.nt.ca/en/services/injury-prevention 26 13 Injury and Indigenous Identity Dene Metis Inuit Non-Aboriginal • Where you live, what you do, what risks you choose to take / must you take, all influence the chance of benefit / injury 27 GNWT, 2004 27 Preventing Injuries from Mechanical Hazards The Haddon Matrix Applied to Motor Vehicle Related Injuries Factors Phases Human (host) Vehicle (agent) Environment Pre-injury Prevent distracted driving Ensure braking capacity Ensure visibility of hazards Time of Injury Use seat belt Avoid sharp or pointed surfaces Provide barriers that prevent head-on crashes Post-injury Medical treatment to prevent hemorrhage Maximize rapidity of energy reduction Facilitate emergency medical response • Active strategies – those requiring initiative • Passive strategies – little or no action is required 28 28 14 Preventing Injuries from Mechanical Hazards The Haddon Matrix Applied to Motor Vehicle Related Injuries Factors Phases Human (host) Pre-injury Prevent distracted driving Vehicle (agent) Time of Injury f Ensure braking yo te g ju ry capacity s tra f in tiv e n c e o c e f f a Use seat belt or c hsharp s t e Avoid in g pointed surfaces Mo im iz m in Post-injury Prevent hemorrhage Maximize rapidity of energy reduction Environment Ensure visibility of hazards Provide barriers that prevent head-on crashes Facilitate emergency medical response • Most effective strategies to minimizing chance of injury is action at the pre-injury environment level 29 29 Preventing Injuries from Mechanical Hazards • • • • • Motor vehicle deaths 5x US average 2nd leading cause of hospitalization for Navajo 14% adults-seatbelts, 7% children used car safety seats Seat-belt program implemented in 1988 Involved school education, public info, car seat loan program, incentives (prizes), law enforcement • Program incorporated cultural norms and teachings • Seat belt use 90%, child seat use 40%; 28% reduction in hospitalizations 30 Berger et al., 2009 30 15 Preventing Injuries from Mechanical Hazards • Where does the strategy enacted in Navajo Territory fit in the Haddon Matrix? Factors Phases Host (human) Agent (vehicle?) Environment Pre-injury Time of Injury Post-injury 31 31 Preventing Injuries from Mechanical Hazards • Where does the strategy enacted in Navajo Territory fit in the Haddon Matrix? Factors Phases Host (human) Agent (vehicle?) Environment Pre-injury Education Car seat loan program Increased law enforcement presence Time of Injury Seat-belt use Post-injury 32 32 16 BUT... Health Benefits of Interactions with Mechanical Elements of the Environment • Physical activity • Transportation and mechanisms of traditional activities – work (socio-economy, health) – traditional activities and livelihoods (physical, cultural, mental, spiritual health, identity, socio-economy) Literatures / Sources Caring for Country Traditional Foods and Nutrition Therapeutic Landscapes Indigenous knowledge narratives 33 33 Healthy Country = Healthy People Participation in Indigenous Cultural and Natural Resource Management = Physical health and well-being • More frequent exercise • Lower obesity, diabetes, renal disease, CVD, psychological stress • Better nutritional status (e.g. omega-3 fatty acids; iron) • Improved socio-economic well-being • Food sources and other valued resources • Decreased health costs • “Sustainable livelihoods” Burgess et al., 2009 and Weir et al., 2011 34 34 17 Practice Activity – In Pairs or Groups of 3 • Complete the Haddon Matrix to identify things that could be done to minimize the risk of harm from falling through the ice associated with winter seasonal hunting of a culturally important species in a northern Ontario First Nation…and therefore preserve the benefits of this activity Factors Phases Host (human) Pre-injury Public education about safe travel and ice conditions Time of Injury Carry whistle or signaling device when winter traveling Post-injury Have well trained volunteer Search and Rescue team and protocols in community Agent (ice) Ice monitoring and reporting online for community Environment Signs on shoreline of dangers of thin ice near areas with current Have emergency routes along common hunting trails marked with trail markers 35 35 Recommended Readings AFN. 2007. First Nations Regional Longitudinal Health Study. FNIGC. 2012. First Nations Regional Longitudinal Health Study (Phase 2). Burgess et al. , Healthy, country, healthy people: the relationship between Indigenous health status and “caring for country”, MJA (190)10: 567-572 Government of the Northwest Territories (GNWT) Health and Social Services. 2004. Injury in the Northwest Territories (Summary report). Yellowknife: Department of Health and Social Services. Karmali et al. 2005. Epidemiology of severe trauma among status Aboriginal Canadians: a population based study. CMAJ, 172 (8): 1007-1111 Mathers et al. 2001. The burden of disease and injury in Australia. Policy and Practice, Bulletin of the World Health Organization, 79(1): 1076-1084 Runyan, CW. 2003. Back to the future – Revisiting Haddon’s conceptualization of injury epidemiology and prevention. Epidemiologic Reviews, 25: 60-64 Weir et al. 2011. The Benefits Associated with Caring for Country, Literature Review prepared for the AIATSIS, Canberra, Australia. Williams, AF. 1999. The Haddon matrix: its contribution to injury prevention and control. In McClure, Roderick (Ed.) Third National Conference on Injury Prevention and Control, 9-12 May 1999, Brisbane, Queensland. Yassi et al (2001. pgs 92-102) 36 36 18 Reminders 1. Academic Integrity Module should be completed online 2. Assignment #1 Article Critique – due if you have not already handed it in and/or have an extension, marking has started 3. Last Days of Okak video questions due from Seminar last week, if you don’t have an extension 4. Assignment #2 Science and Studies Assignments are now posted and you can start working on them (due Nov 21st) - extensions available upon request following the 7+7 policy 5. Adjusted Schedule to accommodate visiting knowledge holder / teacher on Nov 28 – see updated syllabus 6. Final Exam – Wed Dec 20th 3-6pm ENW103 37 37 19