Living Conditions and Indigenous Health
It has become commonplace to acknowledge that health and well-being is impacted by social and economic conditions, but what exactly are these factors, how do they interrelate, why are they so powerful, and what can be done to improve health outcomes affected by them? These are the questions that co-authors Dr. Jeff Reading and Regine Halseth address in our new report Pathways to Improving Well-being for Indigenous Peoples: How Living Conditions Decide Health.
The report provides a broad overview of socio-economic determinants of health, including income, education, unemployment or working conditions, housing, community and social support, health care access, early childhood influences and education, healthy living, substance use (including alcohol, tobacco, and drugs), nutrition, and social exclusion. It draws on current research and health status data to document what is known about these determinants and their effects on the health of First Nations, Inuit, and Métis peoples in Canada. It also presents information on current interventions and their effectiveness.
The complexity of determinants involved in health issues is apparent in every part of the report. For instance, the section on housing notes that problems with housing quality, affordability, accessibility, and overcrowded living conditions can be linked with increased risks of respiratory ailments, gastrointestinal ailments, cancers, and tuberculosis. Besides the obvious links of housing quality to income and employment opportunities, northern and remote locations also involve higher transportation, construction, and operating costs. Insufficient funding for housing results in improperly constructed dwellings that contribute to health problems, and insufficient housing stock that leads to overcrowded conditions. In addition, legal barriers to home ownership on-reserve reduces incentive to maintain and renovate homes.
The report stresses that research and interventions must be sensitive to the ways that culture is implicated in health and wellness. For instance, culture is the foundation of individual and collective identity, so its erosion through colonial practices has had devastating effects for many Aboriginal people. At the same time, some cultural practices may be contributing to health problems. For instance, the use of wood-burning stoves and steam baths are part of daily life in many Aboriginal communities, but their use can contribute to poor indoor air quality and contribute to the development of chronic respiratory diseases.
The major message of the report is that, to be effective, research and intervention strategies must adopt a holistic “life course approach from a social determinants of health perspective.” This means that not only must the complex web of socio-economic determinants be considered, but also the interactions that operate throughout an individual’s life and across generations. These factors, the authors state, “influence the circumstances in which infants are born, children develop and grow, youth learn to make healthy life choices, and adults develop physical and mental health conditions.” Socio-economic determinants and their relationship to health across life stages should be of concern to all researchers and policy makers, not merely those within the health sector. Only in this way can meaningful and sustainable improvements be made to ensure that First Nations, Inuit, and Métis populations attain health status on par with other Canadians.