Okay. So I assigned a paper for this week that was called colonialism as a broader social determinant of health. I hope you had the chance to read it because I think it's actually a great application of the social determinants of health framework, both so that you understand how it works in its narrow sense but also what kind of thinking you need to do to be able to address some of the issues that I raised at the end of the last segment. So I realized that not all of you are necessarily going to be familiar with the history of indigeneous people in Canada. Unfortunately it has been a history that has been replicated many places so if you have read the paper then perhaps even if you're from other parts of the world you will, you will have heard about similar processes where you are. Basically since the time of English and French settlement here in Canada, there has been a long term there has been a long term process of colon, colonialism in Canada that has meant that indigenous peoples are largely controlled by the government. And in its earlier phases this was manifested in things like people being removed from their land. And and then later it morphed into things like un, large scale attempts at assimilation which had communities being disrupted, families being disrupted children being taken away from their families so that they could be schooled to be proper Canadians in a things that we call residential schools where a lot of, of very unfortunate and damaging and traumatizing practices took place, and then later on, even though the residential schools are no longer, they eventually went away, not as, not as long ago as you might think, but they did eventually go away. then what happened was a lot of child welfare involvement that had children being removed from their families and placed in non, non-aboriginal, non-indigenous families and, and really in a big picture through many processes at many different levels that are described in this paper indigenous people in Canada have been separated from each other, from their cultures, from their language, from their ways of life, from the ability to be educated and employed, etcetera, etcetera, etcetera. It goes on and on. And so I, I really liked his paper because like I said it, it talks about the social determinates of mental health but then also talks about this broader context that also contributes to that to those social determinants and it really reminded me of some of the work that I had refer to in the first lecture by Frantz Fanon who wrote about colonialism in the context of Algiers. And he talked about, he wrote about how the experience of colonialism has this incredibly damaging effect on the psyche of people who were colonized, the effects of systemic racism, the effects of the, the erasure of identity and that identity not being valued and in fact, that identity being denigrated, the effects of everyday violence and aggression against a group of people by people that have control over them that this has effects not only in the immediate moment but from many generations and I think this is, this is something that helped us understand what is happening with our indigenous people in Canada as well. So I, I thought that they were actually be a great way to sort of think about how social determinants of health play out. So, that's what we're going to be doing in this segment but if you are interested in writing about colonialism and its effect on mental health, then I would really recommend going to Frantz Fanon where I think it started it has certainly been taken up by others and two books that I would recommend and I'll put them in the resource list are Black Skin White Masks. I just realize that I have two copies of Black Skin White Masks. Oh, [LAUGH] it's that good I have two copies and then this other one the Wretched of the Earth. These are the ones that that I would recommend and there is lot of other writing but unfortunately its not available in English. So those of you that speak French probably have access to even more interesting stuff. With that let's turn to what what we learn about in this paper. So the Canadian document on social determinants of health clearly names aboriginal status as a social determnant. Aboriginal status refers to be identified as a person and recognized by the federal government of Canada as being of first nations maite or inuite origins. to get aboriginal status, people have to be registered with the government. So this is one of the ways, one of the very tangible ways in which colonialism continues to exist for indigenous peoples in Canada. Because of all the intrusion in indigenous communities and families, it's not always an easy thing to determine whether or not you have this status. And there are all kinds of privileges and problems that are associated with it. So that's a whole other discussion but in noting the use of the term aboriginal status here I want to signal that this may be referring to people who have the official government status or it may be more widely applicable to people who are socially associated with indigenous groups in Canada but don't necessarily have the government paperwork that demonstrates that. I've already cautioned you against reading the inclusion of aboriginal status here as a suggestion that being aboriginal predisposes people to ill health or poor health outcomes. again it is the social process and conditions associated with aboriginal status that are implicated in the health and health outcomes and this is what, I think your paper made so clear. The mental health outcomes of concern in indigenous in Canada's are the ones you see here. There are high rates of mental illness and suicide in aboriginal communities particular among young people. We also see a lot of alcohol and substance use problems and these are grouped under mental disorders. There's also a very commonly overlap between mental illness and substance use problems. I've also included family problems here because indigenous peoples are disproportionately represented in the caseloads of child welfare agencies. And the type of family disruptions that lead to and result from child welfare involvement has mental health consequences as well. Now [UNKNOWN] names familiar social determinants that are linked to those health outcomes. We see here low education and unemployment as an issue. Under housing and homelessness. We commonly see housing. And certainly dangerous physical environments. You may have noticed in the paper that she tells you that some of these reserve spaces are, are dangerous places to be in and that there are several of them that don't even have drinkable water available so we're talking about a very salient experience of danger and risk in those physical environments. The other thing that I have here is trauma and violence because trauma and violence is something that we see affecting indigenous communities both from the inside and the outside and this create, creates environments that of course, have an effect on people's mental health. But this paper wants us to understand that looking at just these immediate social determinants is too shortsighted of view. It's actually a demonstration of how the social determinants can be limited in terms of not taking into account. The full range of determinants that effects specific populations. If we want to understand the determinants of mental health in indigenous communities, she suggested that you need to start with colonialism. You need to recognize that colonialism is this overarching, organizing policy that started in continuous to orchestrate the processes that eventually lead to those negative social determinants of health. Colonialism and its operation of things like systemic racism, cultural genocide. Here I'm referring to the assimilation processes that interrupted culture, language and family ties. community and family disruption as I've already mentioned and then also the removal of self determination. These are all strategies or tactics that are part of colonialism. And colonialism essentially puts control in other people's hands. It has consequences for those social determinants. So, if you look at all of these things, the systemic racism, the cultural, genocide, the disruption, and the lack of self-determination, all are connected to the things that we are identifying as social determinants of health here in this row. If we keep moving on, one of the consequences of having no self determination is that there are not appropriate services to address the problems that are promoting ill health. In the paper the author refers to an ecocentric approach that is consistent with indigenous perspectives. There are others of course but the removal of self determination has meant that this has not been available to indigenous peoples. What has been available are services that are inappropriate and at times actually harmful. When we get to the lecture on culture and mental health, I'll be, I'll be talking more about the work that indigenous people around the world have done to address the harm that has been inflicted by health and mental health services and the need to develop the services that are culturally safe. your paper does refer to this a bit in terms of how there has been an accepted discourse around the idea of the depressed Indian, the disordered Indian, the the addicted Indian. These are all parts of the type of, of harm, of harm that we see resulting from inappropriate services and frankly services that are actually dangerous in some ways to certain communities. In the absence of these culturally safe services or even a belief that there is a need for culturally sensitive services, it means that people do not get the help they need for either health problems or for the conditions that lead up to health problems like the ones that we see here. This isn't addressed in your article but I have added oppression related stress as a negative health code outcome that results from colonialism as well. Literature in this area has been mostly developed around racism in the context of the United States. and the thing is that what that literature talks about is how it's not just that the, the exposure to explicit, violent, and over racism that takes a toll on people. But the daily exposure to what they refer to as microaggressions, small acts and experiences, small everyday acts and experiences that reinforce your status as a person that is not valued or that is even held in contempt. These microaggressions have a cumulative effect that materializes in things like cardiovascular disease and mental illness. Indigenous people certainly face what we could call racism related stress but because it's in the context of this wider experience of colonialism, it's much bigger than just racism, so I name it as a pressure related stress here. I suppose you could also call it colonialism related stress. Finally, I want to mention that as well has having as well as these determinates having an effect on mental health they have an effect on physical health. Indigenous communities have higher rate of infection, injury, chronic disease. It's not surprising of course that things that negatively affect mental health also have an affect on physical health. This may be hinting at that false division between mind and body that I mentioned earlier. So, there are these physical health outcomes that take, to take into account. And they also have mental health consequences. As there is a lot of co-morbid anxiety and depression with physical illnesses. Another consideration is the mental health consequences for caregivers of people with mental and physical disorders. Caregivers can experience high levels of psychological distress, depression, anxiety, and their own physical health consequences as a result of it being in the caregiver role and of course we'll talk about that when we get to the lecture on families. So, why are some people mentally healthy and why is it harder for some other people to stay mentally healthy? I hope that thinking through the situation that's described in your paper helps you see that there's definitely a connection between the social environment that people are in and their health. It, it has to do with attitudes, it has to do with tensions. It has to do with the level of violence and trauma. It has to do with things like whether you have drinking water, and you, what you have to go through to get it. All of that has an effect on people's health. Both physical and mental. But what that paper also shows us so well is that there are broader issues that are also implicated. That it doesn't just stop or start at this place of well, if you have the right kind of housing, if you have the right kind of education, employment and all that, that if all these things are in place then your chances of being healthy are much better. That's certainly true but there are things that promote and undermine the ability to have those things in place. And that's what I think that paper demonstrates so beautifully and so unfortunately. So, we've talked now quite a bit about how the social context affects mental health. But how is it that, that social context somehow turns into something that affects the way that your brain is functioning or effects the way that you're feeling and behaving and, and thinking. what we're going to try to do is answer that question by looking at the bio physchosocial perspective and seeing if it can give us some answers. That's coming up next.
