The Determinants of
Aboriginal Health in Canada:
A Critical Population Health
Approach
Chantelle A.M. Richmond, Ph.D.
Department of Geography & The First Nations Studies Program
The University of Western Ontario
Introduction to the research
Aboriginal health has become a priority
among Canadian health researchers1,2
Focus on quantifying rates of disease and
mortality
 Less attention paid to the processes underlying
them
These observations have not transformed
into common understanding of the
underlying causes of inequality
 E.g. Environmental dispossession
1. Adelson, 2005; 2. Reading and Nowgesic, 2002
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Environmental Dispossession
 The processes through which Aboriginal
people’s access to the resources of their
traditional territories is reduced
 Directly – Physical displacement of communities
 Indirectly – Assimilationist policy
 Identities and cultures of Aboriginal peoples
are intimately bound to the quality of their
local environments
 Health and social effects of environmental dispossession are negative
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Objectives of today’s talk
1. To conceptualize the
determinants of health in rural
and remote First Nation and
Inuit communities
2. To examine how the process
of environmental
dispossession undermines
the quality of health
determinants
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A narrative approach
 Aboriginal Community Health Representatives
 Invited to NIICHRO’s AGM May 2005
 26 telephone interviews with CHR’s (June –
August 2005)
 Rural and remote Inuit and First Nations
communities from across Canada
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CHR’s identified 6 health determinants
1.
2.
3.
4.
5.
6.
Balance
Life control
Education
Material resources
Social resources
Environmental/
Cultural
connections
• Income and Social Status
• Social Support Networks
• Education
• Employment and Working
Conditions
• Social Environments
• Physical Environment
• Personal Health Practices &
Coping Skills
• Culture
• Healthy Child Development
• Gender
• Health Services
• Biology and Genetic Endowment
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Environment/ Cultural connections
“In my community, we are more northern and
we have traditional foods that we depend on.
We travel on the land, we socialize more
together on the land, and we know each
other, and that is good. We always go on
word of mouth, if somebody is going through
this or that, and this means everybody gets
involved. We are lucky to have that because I
know more southern communities are losing
that [connectedness] and its affecting them
and their health” (Debbie).
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Environmental/cultural connections
 CHR’s described reduced access to
environmental resources and shifting culture
(i.e., environmental dispossession) as a source
of serious decline in the quality of these health
determinants
 This process is leading to:
 Life imbalance, loss of life control, changing
forms of education, lacking material resources,
and social dysfunction
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Life Imbalance
“For a long time my community didn’t have
access to a lot of services, because the closest
town is about 80 kilometers away. We were
very self-reliant. More recently, as we are
relying on cars and outside resources, the
community has gotten away from things like
gardening or cutting wood, and all those other
healthier lifestyle practices that they used to do
a long time ago, that kept them active and
physically in shape (Michelle).”
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Loss of Life Control
“I think there is a lack of, a sense of um, self
esteem in people. A lot of times you see it from
residential school, like the impacts, and the lack
of parenting skills, and the addictions, and stuff
like that, that have resulted from that traumatic
experience and it seems people are not sure
how to move on (Meghan).”
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Changing Forms of Education
“No, the kids are not very active. Because they
always want to play those Nintendo games, and
all those computer games. And eating junk
food. Sitting inside your house I guess, and the
kids are always playing because the school
year is over right. So they are just sitting inside
(Nicole).”
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Lacking Material Resources
“The main employer is the band, and there are
only so many full time jobs. So the people in
those families are financially secure, whereas
other people have to rely on seasonal jobs for
their families, and then if you have a larger
family and you have a seasonal job, by the time
you start paying off your bills it is time for a
layoff again. It’s like a vicious cycle, and our
community members really struggle with that
(Michelle).”
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Social Dysfunction
“If you ask for help, people will usually come
around. But its different than in the past.
Money has become a factor in everything; its
not too often you have somebody helping an
elder out like just as a good deed, it will often
be because the person is getting money, or
because one of the band programs is paying
that person to help the elderly (Holly).”
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Key Findings
 Balance, life control, education, material
resources, social resources,
environmental/cultural connections are key
determinants of health
 Environmental dispossession, and its indirect
and direct affects, is significantly compromising
the quality of these health determinants
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Key Findings
 No mention of certain health determinants from
the Canadian list (e.g., child development,
gender, health services, biology/genetic
endowment)
 Is it possible that the CHR’s stories relate to a
more basic notion about health need in the First
Nation and Inuit context,
 Emphasis on the social determinants of health
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What does this mean for
research and policy?
1. Continued support for research into the social
determinants of Aboriginal health is essential
2. A need for critical approaches that look for the
‘causes of the causes’ of inequality


Seek to describe and understand what creates
disparities in health
Aboriginal health and social policy must take into account
the social context of places
3. Study post-colonial influences on health at local
level and make them central to research/ policy
questions
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Acknowledgements




NIICHRO
Dr. Nancy Ross
Dr. Kue Young
SSHRC Doctoral
Fellowship
 CIHR Global Health
Fellowship
QUESTIONS?
chantelle.richmond@uwo.ca
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