The Social Ecological Model of Health and Indigenous Canadians

As we have explored the definition of health in previous units, it is safe to say that health encompasses mental, physical, social and other realms that are influenced by the many determinants of health. There are many health models that exist to provide a framework for evaluating various health influences and how they interact with and affect each other at many different levels and often simultaneously. This blog post will explore further the social-economic model, the social determinants of health and apply them to the indigenous population of Canada and some the health inequities and inequalities that they experience.

The Social-Ecological Model is a theory based framework that is widely accepted in public health and looks at how people relate through relationships with family, individuals, groups, their environment and community. This model allows for understanding of the influences these relationships have on health and to identify and understand interventions to overcome these influences. (Golden, McLeroy, Green, Earp, & Lieberman, 2015)

The initial theory developed by Urie Bronfenbrenner was illustrated by a series of nesting circles that place the individual at the center surrounded by a various systems with those believed to have the strongest influences at the center. (Kilanowski, 2017) These circles incorporate multiple determinants of health and represent the spheres of influence that allow for a multi-level approach to interventions for changing behavior. White (2015) noted that “an approach that incorporates complementary interventions at several levels is more likely to achieve and sustain success over time than a single intervention” (p. 6).

According to White (2015), the social ecological model includes the following spheres of influence: individual, relationship, community, society and global influence. The individual level identifies personal and biological factors such as age, gender, education, income, and personal or family history. The relationship level looks at relationships, social networks and support systems that may increase or reduce a risk of experiencing a particular outcome. The third sphere of influence is community which looks at the settings where social relationships occur such work and school. The society or organization sphere looks at broader societal influences that help create a climate where health behavior is encouraged. The fifth sphere of influence is Global Influence or policy/enabling environment such as local, provincial, national or global policy or laws that have health implications. To summarize, “the essence of the SE Model is that while individuals are often viewed as responsible for what they do, their behavior is largely determined by their social and economic environment” and “barriers to healthy behaviors are often shared across their community, even a society as a whole; as these are lowered or removed, behavior change becomes more achievable and sustainable” (White, 2015. p, 6).

Canada’s Indigenous population consists of three groups: First Nations, Metis, and Inuit peoples. First Nations make up the largest of the three groups and are located on reservations, and other rural and urban communities below the Arctic. The second largest group, the Metis, live in Ontario and the western provinces and were the descendants of French and English fur traders that married Indian wives. The Inuit live in communities throughout Canada’s Arctic. It is well known in the literature that Indigenous Canadians have a lower life expectancy than the national average, and experience higher rates of chronic disease as well as higher rates of suicide, family violence and other self-destructive and violent behaviors. (Kolahdooz, Nader, Yi, & Sharma, 2015; Richmond, Ross, & Egeland, 2007)

Some of the social determinants of health that contribute to these disparities include: education, employment and income, housing environments, personal health behaviors, social support networks and culture. Understanding many of the social determinants of health that contribute to health disparities amongst the Indigenous population requires consideration of Canadian history after the 1867 Indian Act that resulted in significant trauma, emotional distress and mistrust as a result of colonization and the implementation of the residential school system. (Kolahdooz, Nader, Yi, & Sharma, 2015; Richmond, Ross, & Egeland, 2007)

Applying the social ecological framework to the health disparities of Indigenous Canadians allows an opportunity to look at many levels that relate to those disparities and the interactions between individual, environmental, community and global levels.

Factors at the individual that contribute to the health of Indigenous Canadians include: non-modifiable factors (such as age, sex, and genetics), early life events, knowledge, attitudes and beliefs, culture and language.

At the interpersonal or relationship level things to take into consideration would include: the importance of family and social support networks including nature and Creator and how many of the health disparities can be linked to the systemic forces that contributed to the populations losing some of their connections to their culture, traditions and social support networks. (Richmond, Ross, & Egeland, 2007)

Community level factors would take into consideration things like: household income, physical household environment, food security, community events, school environment, safe play grounds and access to health clinics.

The society level of the framework would include local and national policy related to the health of Indigenous Canadians such as the residential school system and the most recently the Government of Canada undid the Department of Indigenous and Northern Affairs Canada to create two new ministries: Indigenous Services and Crown-Indigenous Relations and Northern Affairs to improve services and close the socioeconomic gap while working towards the self-determination of Indigenous Canadians. (Philpott, 2018).

Global Influence often include larger influences such as the United Nations Sustainable Develop Goals and Indigenous Peoples in Canada. (Odulaja, & Halseth, 2018).

References

Golden, S.D., McLeroy, K.R., Green, L.W., Earp, J.L., & Lieberman, L.D. (2015). Upending the social ecological model to guide health promotion efforts toward policy and environmental change. Health Education & Behavior, 42(1), 8S-14S.

Kilanowski, J.F. (2017). Breadth of the socioecological model. Journal of Agromedicine, 22(4), 295-297. DOI: 10.1080/1059924X.2017.1358971

Kolahdooz, F., Nader, F., Yi, K.J., & Sharma, S. (2015). Understanding the social determinants of health among Indigenous Canadians: priorities for health promotion policies and actions. Global Health Action, 8: 27968. DOI:10.3402/gha.v8.27968.

Odulaja, O.O., Halseth, R. (2018). The United Nations sustainable development goals and Indigenous peoples in Canada. Retrieved from https://www.nccih.ca/495/The_United_

Nations_Sustainable_Development_Goals_and_Indigenous_Peoples_in_Canada.

nccih?id=241

Philpott, J. (2018). Canada’s efforts to ensure the health and wellbeing of Indigenous peoples. The Lancet, 391(10131), 1650-1651. DOI: https://doi.org/10.1016/S0140- 736(18)30179-X.

Richmond, C.A., Ross, N.A., & Egeland, G.M. (2007). Social support and thriving health: A new Approach to understanding the health of Indigenous Canadians. American Journal of Public Health, 97(9), 1827-1833.

White, F. (2015). Primary health care and public health: foundations of universal health systems. Medical Principles and Practice, 24(2). DOI: 10.1159/000370197.