Assignment 2: It's Time For An Attitude Adjustment

ASSIGNMENT 2: IT'S TIME FOR AN ATTITUDE ADJUSTMENT

Let's Stop the Stigma

"Health promotion is one of the ways to take action on population health" (Public Health Agency of Canada, 2013). Recognized as a model that brings together political, social, economic, and physical aspects that affect health, the population health promotion model provides the forum for collective policy development.

"Multilevel interventions, implemented at the individual, physician, clinic, health-care organization, and/or community level, increasingly are proposed and used in the belief that they will lead to more substantial and sustained changes in behaviours related to prevention, detection, and treatment than would single-level interventions", (Cleary, Gross, Zaslavsky & Taplin, 2012).

The population-health promotion model is directed at an entire or sub-population, and not individuals, allowing for the outcomes "to include a sustainable and integrated health system, increased national growth and productivity, and strengthened social cohesion and citizen engagement"(Public Health Agency of Canada, 2013).

Canadian Association of Mental Health, 2018, states there's a link between physical and mental health. People living with chronic medical conditions like pain have a higher incidence of mood disorders. "People with a mental illness are twice as likely to have a substance use problem compared to the general population" (CAMH, 2018).

The purpose of this assignment is to bring to light the provincial crisis of opioid use and overdose deaths, while focusing on a population. The Indigenous People in British

Columbia, using the population health promotion model provides an understanding of the effects of the determinants of health for these people.

With many people overdosing on narcotics, such as fentanyl, in British Columbia, Dr. Perry Kendall, BC's medical health officer, has called the opioid overdose and death situation in BC is a public health emergency"(BCCDC, 2016). Many of the overdose statistics and deaths have affected the Indigenous population. The province of British Columbia has been working for several years to develop effective mental health and substance use strategies. Although there are many people in British Columbia and the world who experience mental health and substance use problems, it's estimated that in Canada in any given year, one fifth of Canadians are affected directly or indirectly by mental illness. Mental illness does not discriminate against culture, gender or age. Looking at the Indigenous population through the population health promotion model, the mental health and substance use concern is discussed.

Social Environments

The problems of social exclusion and racism for Aboriginal peoples go back to their first meetings the British colonizers. "Racism and its subsequent social exclusion continue to create barriers to Aboriginal participation and productivity on the national economy" (NCCAH, 2010, p. 23). Because of the history of trauma, in some communities, Indigenous children and youths are higher risk for mental health and substance use challenges. Overall, Indigenous youth between the ages of 10 and 19 are four and five times more likely to take their own lives compared to non-Indigenous youth" (Government of B.C., 2017).

Culture

"Oppressive and assimilationist colonial policies and practices, such as residential schools, threaten First Nations peoples' cultural identities and have contributed to high rates of suicide, depression, anxiety, substance use and despair" (FNHA, n.d.). "The Government of Canada recognizes that experiences with historical and intergenerational trauma, including the impact of colonization, loss of traditional culture and language, and experiences with Indian Residential Schools, have all contributed significantly to the elevated risk of mental health issues and substance use amongst Indigenous peoples", (Government of Canada, 2018).

Aboriginal people are tightly connected to their culture; a general understanding of their culture is lacking and the FNHA and other groups hope to change this through education. "...cultural diversity within the First Nation population is frequently not recognized nor respected in common practice. There is a misconception that First Nations are one homogeneous group who share the same culture, traditions, language, needs and desires" (Joseph, 2014).

Social and community networks have not welcomed First Nations people with open arms. Still today, years after the last residential school has been closed, and with the focus on healing, many native people continue to live on reservations, and stay within their own social circles. Their communities are primarily on designated land, they practice

traditional healing for illness, and raise children with traditional values. Although it's not spoken openly, there appears to be a prejudice and intolerance towards them in our society.

Working Conditions

Colonization did not allow Aboriginal people access to conditions and community resources that were necessary to maximize their socioeconomic status which resulted in higher unemployment, low literacy, lower levels of education, and poor housing situations. "Employment instability can drive individuals to social assistance, which then becomes the context for low income, stress, poor nutrition, and many other factors linked to poor health outcomes" (NCCAH, 2010).

"The key findings included Aboriginal people face significant earnings and income disparities compared to non-Aboriginal people in Canada; the gap is greatest for Registered Indians; even highly educated Aboriginal people face a considerable income gap relative to non-Aboriginal people" (Indigenous and Northern Affairs of Canada, 2013).

Physical Environments

Physical environments play a large role in determining the health of a population. The ongoing problem of affordable housing has resulted in overcrowding in many of the Aboriginal communities, which in turn has created additional health issues. Poor ventilation creating mouldy living environments, has caused chronic and acute health

conditions such as allergies and asthma. As well, there is a concern over food security as many communities are remote. Accessing fresh produce and traditional foods is difficult. These concerns have a large psychological impact on a population (NCCAH, 2010, p12).

Biology and Genetics, and Healthy Child Development

Creating supportive environments for Aboriginal people is paramount to improve health and reduce levels of disease and disability. Raising children up in physical environments where housing, food and water are substandard all contribute to frequent illness, chronic disease, future self-esteem and self-confidence issues. "FNHA Environmental Public Health Services works to identify and prevent environmental public health risks in First Nations communities that could impact the health of community members. Where public health risks are identified, recommendations are provided to reduce these risks" (FNHA, n.d.).

Personal Health and Practices and Coping Skills

Education around developing personal skills and strategies to deal with daily challenges is part of the First Nations Health Authority Wellness program, providing education, tools and initiatives (FNHA, n.d.). Governments at various levels must work together to bridge the gaps so that all people, Aboriginal and non-Aboriginal must have the same access to job opportunities, services, and resources to improve health and overall quality of life. "Poverty has been associated with an increased risk of chronic disease, injury, poor infant development, a range of mental health issues, (stress, anxiety, depression, lack of self-esteem), and premature death" (NCCAH, 2010). Breaking the social stigma when dealing with mental health and substance use makes it difficult for many to seek treatment. More work must be done to eradicate the prejudice and preconceived ideas (Government of B.C., 2017).

Education

Education disparities exist for Aboriginal men and women, according to Indigenous and Northern Affairs, Government of Canada, (2013). "Although Aboriginal incomes rise with increased education, it was found that even highly educated Aboriginal people still face a considerable income gap relative to their British-origin counterparts" (Indigenous and Northern Affairs, Government of Canada, (2013). Income and Social Status for the Indigenous population, according to Indigenous and Northern Affairs, Government of Canada, (2013), have been evident for many years. The fallout from poor education, is poor literacy and knowledge about healthy food and living choices.

"Insufficient education also diminishes the skills one might have to offer the labour market often resulting in lower paying jobs. The ensuring poverty and social exclusion both experienced by Aboriginal peoples, increases the risk of family instability, which often manifests in divorce and single parenthood" (NCCAH, 2010, p.15).

Gender

When addressing gender, substance use can start early for girls and young women, especially if their boyfriends are using alcohol and drugs. Men generally die prematurely due to chronic conditions, and although women live longer they are burdened with mental illnesses such as depression and anxiety, (Public Health Agency of Canada, 2013). Poverty for Aboriginal people is a significant concern in Canada with about 40% of native children affected in off-reserve settings, and native women are twice as likely to be in poverty conditions as opposed to non-native women.

Along with an analysis and understanding of the determinants of health, comes strategies to ensure the desired health outcomes are achieved (Public Health Agency of Canada, 2013). The FNHA (n.d.) has developed wellness strategies to help First Nations people work through a 'wellness journey' which includes 'wellness champions' that provide a supportive environment and an extensive counselling program. "Funded initiatives include a broad focus on health promotion and chronic disease prevention and management, including healthy eating, food security, physical activity, tobacco prevention and cessation, chronic disease screening and management, and injury prevention" (FNHA, n.d.).

Federal, Provincial, and local governments need to continue to support Aboriginal people in BC and across Canada. Evidence shows that there are many aspects outside of healthcare that affect one's health. The Population Health Promotion Model "promotes participation of all Canadians in developing strategies to improve health" (Public Health Agency of Canada, 2013). BC Ministry of Health, Aboriginal Agencies and other stakeholders have worked collaboratively to deal with the mental health and substance use concerns. The BC Mental Health and Substance Use Strategy 2017-2020 continues to support current efforts as well provide an improved coordination of services with the various health partners. With the increased focus on preventing mental illness and promoting mental health, BC's Mental Health and Substance Use Strategy will focus on three main areas of wellness, access, and partnerships, (Government of B.C.,2017).

According to Government of B.C. Ministry of Health (2017), research suggests that health promotion early on in one's life is a wise investment. The goal is preventing mental illness and substance use, promote mental wellness, interventions at early stages of illness, especially for children and young adults.

Wellness, Access and Partnerships are the three pillars of BC's Mental Health and Substance Use Strategy. The Wellness pillar focuses on promoting the health of communities and families helps to address the bigger social determinants of health. Strengthening communities helps to create positive physical environments and increase positive mental health. Reducing the opportunities for mental health and substance use through education, providing school-based programs to support students, and skill development for parents. Proper housing for those dealing with mental health and substance use concerns is an investment by the Government of B.C., with housing units in many communities. The Access pillar ensures improved navigation to services by those seeking it. Often emergency room visits can be averted when a person is looking

for supports through community access versus going to the hospital for help. British Columbia wants to bridge the gap for the most vulnerable by providing more consistent access programs, treatment and services. Partnerships is the final pillar of the mental health strategy. "Key to partnerships will be the inclusion of individuals and families dealing with mental health and/or substance use challenges." (Government of B.C.,2017, p.23).

In conclusion, the Province of British Columbia and its stakeholders recognize the challenges of the Indigenous Peoples. Though initiatives such as BC's Mental Health and Substance Use Strategy, help for vulnerable populations such as First Nations, Metis, and Inuit is available in a way that is welcoming and non-judgmental. I feel that in order for us to build a caring relationship, we need to base it on trust and humility; we need to understand that past events shape lives for generations to come. This happens through "recognizing the role of history and society and past traumatic experiences, and their impacts in shaping health, wellness and health care experiences" (Government of B.C.,2017, p.24).

References

BCCDC. (2018). Analysing patterns of health care utilization among people who overdose from illegal drugs in British Columbia. BCCDC Public Knowledge Summary Retrieved from https://www.bccdc.ca/resource-gallery/Documents/Educational%20Materials/Epid/Other/20180307_BCCDC%20Public%20Knowledge%20Summary_Analyzing%20patterns.pdf

BCCDC. (2017). BC overdose action exchange II. Retrieved from https://www.bccdc.ca/resource-gallery/Documents/bccdc-overdose-action-screen.pdf

BCCDC. (n.d.). Public health emergency BC. Retrieved from https://www.bccdc.ca/about/news-stories/stories/public-health-emergency-in-bc

CAMH (n.d.) Mental Illness and Addiction: Facts and Statistics. Retrieved from https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics

Ellis, E. (2015). B.C. has higher rates of hospital stays due to mental illness than the rest of Canada. Vancouver Sun. Retrieved from https://www.vancouversun.com/health/higher+rates+hospital+stays+mental+illness+than+rest+Canada/10865534/story.html

FNHA (n.d.). Overdose data and First Nations in BC. Retrieved from https://www.fnha.ca/newsContent/Documents/FNHA_OverdoseDataAndFirstNationsInBC_PreliminaryFindings_FinalWeb.pdf

FNHA. (n.d.) Wellness and the First Nations Health Authority. Retrievedfrom https://www.fnha.ca/wellness/wellness-and-the-first-nations-health-authority/

Government of B.C. (2017). B.C.'s Mental Health and Substance Use Strategy 2017-2020. Retrieved from https://www.health.gov.bc.ca/library/publications/year/2017/mental-health- substance-use-strategy.pdf

Government of Canada. (2018). Strengthening Canada's approach to substance use issues. Canadian Drug and Substances Strategy. Retrieved from https://www.canada.ca/en/health-canada/services/substance u se/canadian-drugs-substances-strategy/strengthening-canada-approach substance-use-issue.html

Joseph, B. (2014). Respecting First Nations Cultural Diversity. Retrieved From https://www.ictinc.ca/blog/respecting-first-nations-cultural-diversity

Indigenous and Northern Affairs Canada. (2013). Aboriginal Income Disparity in Canada. Retrieved from https://www.aadncaandc.gc.ca/eng/1378411773537/1378411859280

National Collaborating Centre for Aboriginal Health (2010). Social determinants.Retrieved from https://www.ccnsa-nccah.ca/docs/determinants/FS-PovertySDOH-EN

PMC, E., Cleary, P., Gross, C., Zaslavsky, A., & Taplin, S. (2012). Multilevel Interventions: Study Design and Analysis issues. - Abstract - Europe PMC.Retrieved from https://europepmc.org/abstract/MED/2262359

Public Health Agency of Canada. (2013). Population health: focus on the health of populations. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health-approach/what-population-health-approach.html#health

Shepert, E. (2018). Over fifty per cent of overdose deaths in BC involve mental illness, report finds. Retrieved from https://www.vancouverisawesome.com/2018/09/27/overdose-deaths-mental-illness-bc/

Simms, C. (2016). Canada's First Nations: the social and political determinants ofhealth. The BMJ. Retrieved from https://blogs.bmj.com/bmj/2016/04/01/canadas-first-nations-the-social-and-political-determinants-of-health/

Students Exploring Inequality in Canada. Current Crisis. (2014, December 6). Retrieved from https://inequalitygaps.org/case-studies/our-most-recent-crop/aboriginal-education-in-canada/current-crisis/

Sources: Statistics Canada, Census of Population, 1996, 2001 and 2006

This chart shows the highest level of education for on-reserve Aboriginals compared to the rest of Canada. A high school diploma is by far the highest with over 40% whereas less than 5% of on-reserve Aboriginals have a university degree. As R.J Kowalchuk demonstrates, many people living on-reserve do not even graduate high school.

Video Series : Stopping The Stigma

BC,Northern Health. "Stop Stigma. Save Lives: The Impact of Empathy." YouTube, 29 Mar. 2017, youtu.be/nTMR9ii3xeI?list=PL9krkje3uygKuMA_BrwmiZXrCWdFqAL-n.

BC, Northern Health. "Stop Stigma. Save Lives: Preventing Overdoses." YouTube, YouTube, 29 Mar. 2017, www.youtube.com/watch? v=VkuFL9V19hw&list=PL9krkje3uygKuMA_BrwmiZXrCWdFqAL- n&index=2.

BC. Northern Health. Stop Stigma. "Save Lives: Experiences of Stigma" [Video file]. (2017, March 29). Retrieved from https://www.youtube.com/watch?v=NtxaFXThrzA&list=PL9krkje3uygKuMA_BrwmiZXrCWdFqAL-n&index=3

BC. Northern Health. (2017, March 29). "Stop Stigma. Save Lives: Labels Stick & Labels Hurt"[Video file]. Retrieved from https://www.youtube.com/watch?v=3Dhkb2tdXU4&list=PL9krkje3uygKuMA_BrwmiZXrCWdFqAL-n&index=