First Nations Wholistic Policy & Planning Model

First Nations Holistic Policy and Planning Model (Reading et al., 2007)

Our health outcomes, mortality, morbidity, and disease patterns are phenomena that are largely predetermined by factors outside our control long before we need medical care (First Nations Health Council, 2017). On the contrary, local and provincial health programs remain focused on “downstream strategies focused on behavior change” (Raphael, 2003). While individualized treatment is needed to treat individual health issues, the broader issues of population health require a multilevel approach that goes beyond individual treatment (First Nations Health Council, 2017). A literature review by the Canadian Council on Social Determinants of Health (2015) identified 36 models and frameworks on the determinants of health from various geographical and sectoral regions. One model that caught my interest is the First Nations Wholistic Policy and Planning Model, which in addition to highlighting key determinants of health in Canada’s Aboriginal communities, also sheds light on the impact of social exclusion as an element of a determinant of health and its impact on “Canada’s Aboriginal Peoples due to racism and discrimination alongside others such as historical conditions and colonialism” (Canadian Council on Social Determinants of Health, 2015). The model is unique in “identifying social determinants of First Nations health in order to address issues beyond the focus on health service delivery” (First Nations Health Council, 2017). The model was created to close the gap in health inequalities that’s prevalent in Aboriginal communities compared to other Canadian communities (First Nations Health Council, 2017). As a result, the community’s role is prominent and at the core of this model. Individuals are seen as an extension of their communities, and all treatment modalities are based on this premise (Reading et al., 2007). The Medicine Wheel has a longstanding reputation and is an accepted symbol of health and healing among the various tribes of Native Americans (Native Voice, n.d.). While It can be applied to many different contexts, in this model it plays a relatively central role, “with the four directions clearly articulated as spiritual, physical, emotional and mental” (Reading et al, 2007). In other words, each of the four elements is weighted the same as a determinant of health. Four cycles of the lifespan are also explicitly identified (child, youth, adult, elder). It’s interesting to note that age is not identified as a hierarchy in this model, rather the four generations are placed on the same plane highlighting the importance of a systemic approach that’s universal to all age groups. The importance of self-government forms the foundation of this model. The key four components of First Nations self-government include self-government/jurisdiction, fiscal relationship/accountability, collective and individual rights, capacity/negotiations (Canadian Council on Social Determinants of Health, 2015). Understanding that determinants of health extend beyond an individual’s choice of lifestyle and eating habits, the First Nations Wholistic Policy and Planning Model identifies 15 social determinants of health as follows (Canadian Council on Social Determinants of Health, 2015): · Historical Conditions and Colonialism · Community Readiness · Language, Heritage & Strong Cultural Identity · Self Determination & Non-Dominance · Legal & Political Equity · Environmental Stewardship · Social Services & Support · Lands & Resources · Lifelong Learning · Economic Development · Housing · Employment · Urban/Rural · Racism & Discrimination · On/Off Reserve While the role of a tight community is undoubtedly critical to the success of this model, hence why it is placed at its core, the success of such tight communities also relies on its relationships with other communities, which is well reflected in this model. The model is anchored on a tripod of social capital highlighting the importance of the relationship within, between, and outside the community, namely bonding, bridging, and linkages (Reading, 2007). In Summary, the First Nations Wholistic Policy and Planning Model is a multilevel approach aimed at identifying the various layers of determinants of health as it relates to the health of Canadian Aboriginal communities. Its elements include the use of a holistic and intersectoral approach, recognition of social exclusion, understanding the role of individuals and communities, recognizing the importance of upstream action, and identification of interactions between determinants (Canadian Council on Social Determinants of Health, 2015).

Recognition of social exclusion & its impacts as a determinant of health. Among the several contributing elements of health identified, social exclusion and its impact stand out as a prominent systemic problem in the Canadian health sector in the context of Aboriginal and non-Aboriginal populations. While “Social exclusion can stem from poverty, unemployment, homelessness, racism, and discrimination and results in lack of access to housing, education, transport and other factors vital to full participation in life” (Canadian Council on Social Determinants of Health, 2015), it can also greatly influence an individual’s interactions with the health care system in such domains as “lack of access to culturally and/or linguistically appropriate health care services and treatment options” (Canadian Council on Social Determinants of Health, 2015). Given Canada’s diversity, this is an area of great concern for both the Aboriginal communities, as well as other racial subgroups “for whom traditional healing options are not widely understood or accessible within Canada’s mainstream health care system” (Canadian Council on Social Determinants of Health, 2015). While some barriers of social exclusion are harder to overcome, there are many opportunities for quick wins where an individual’s interactions with the health care system can be improved. For example, having a translator on hand can greatly alleviate the unnecessary added distress for a newly arrived family who may be already dealing with the hardships of establishing themselves in a new country and dealing with a loved one’s illness.

Strict hospital visitor policies are another area that I have often witnessed cause families distress who may not be familiar with the Canadian health care system. For many cultures, it is considered emotionally healing to have a loved one at the bedside to help deal with the distress of being trapped in an unfamiliar environment while dealing with one’s illness. And some cultures take that even a step further and believe that having a physical presence to support the support person at the bedside is also important. This often leads to a clash between supportive friends and family members and the hospital staff who try to implement the hospital’s visitor policies. Given Canada’s great diversity, we need to first acknowledge that social exclusion is a gap in our health care industry and must take steps to close that gap because “Life is short where its quality is poor. By causing hardship and resentment, poverty, social exclusion, and discrimination cost lives.” (Wilkinson & Marmot, 2003, pp. 16)

REFERENCES

Canadian Council on Social Determinants of Health. (2015, May). A Review of Frameworks

on the Determinants of Health. http://ccsdh.ca/images/uploads/Frameworks_Report_English.pdf

First Nations Health Council. (2017). Social Determinants of Health Discussion Guide. http://fnhc.ca/wp-content/uploads/FNHC-Social-Determinants-of-Health-Discussion-Guide.pdf

Native Voice. (n.d.). Native Peoples’ Concepts of Health and Illness. Retrieved October 25, 2020, from https://www.nlm.nih.gov/nativevoices/exhibition/healing-ways/medicine-ways/medicine-wheel.html

Raphael, D., Barriers to addressing the social determinants of health: public health units and poverty in Ontario, Canada, Health Promotion International, Volume 18, Issue 4, December 2003, Pages 397–405, https://doi.org/10.1093/heapro/dag411

Reading, J., Kmetic, A., & Gideon, V. (2007, April). First Nations Wholistic Policy and Planning Model: Discussion Paper for the World Health Organization Commission on Social Determinants of Health. Assembly of First Nations. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.476.9397&rep=rep1&type=pdf

Wilkinson, R., & Marmot, M. (2003). Social Determinants of Health [OP]: The Solid Facts (Public Health) (2nd ed.). World Health Organization. Page 16, https://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf