Understanding Social Determinants of First Nations Health Using a Four-Domain Model of Health and Wellness Based on the Medicine Wheel: Findings from a Community Survey in One First Nation.

Tracey George,Samantha Wells,Christopher J. Mushquash,Sharon Bernards,Melody Morton Ninomiya,Sara Plain,Julie George,Bryan Tanner

doi:10.3390/ijerph19052836

Abstract

We examined the explanatory roles of social determinants of health (SDOH) for First Nations people using a four-domain model of health and wellness based on the Medicine Wheel (i.e., physical, mental, emotional, and spiritual health), including colonial-linked stressors (i.e., historical trauma, childhood adversities, racial discrimination) and cultural resilience factors (i.e., cultural strengths, traditional healing practices, social support). Data were collected in partnership with a First Nation in Ontario, Canada in 2013 through a community survey (n = 194). For each outcome (physical, mental, emotional, and spiritual health), a modified Poisson regression model estimated prevalence ratios for the SDOH, adjusting for age, sex, education, and marital status. Negative associations were found for historical trauma with physical, mental, emotional, and spiritual health; for childhood adversities with mental health; and for racial discrimination with physical, mental, and emotional health. Positive associations were found for cultural strengths with physical, mental, and emotional health and for social support with physical, mental, emotional, and spiritual health. We observed negative associations between use of traditional healing practices and mental and emotional health. Our findings suggest that these SDOH may play important roles in relation to wellness through associations with the domains of health modelled by the Medicine Wheel.

Highlights

In the last twenty years, researchers have increasingly examined the roles that social determinants of health (SDOH) play in shaping health outcomes for First Nations peoples [1–4]
Among the cultural resilience factors, each cultural strength identified within the community was associated with a higher likelihood of reporting good or better physical, mental, and emotional health
We considered the health impacts of stressors stemming from colonialism and culture resilience factors in light of a wellness-oriented four-domain model of health based on the Medicine Wheel

Summary

Introduction

In the last twenty years, researchers have increasingly examined the roles that social determinants of health (SDOH) play in shaping health outcomes for First Nations peoples [1–4]. Justified by discriminatory laws, such as the 1876 Indian Act, First Nations communities have been exposed to several discriminatory and traumatic events and policies at the behest of the Canadian government, including forced resettlement, land seizure, suppression of language and cultural practices, residential and day schooling, racialized policing, and racist family separation policies, such as the 60s scoop. In many communities, these traumatic events have caused immense disruption in First. In addition to shaping health outcomes directly, historical trauma has been linked to increased exposure to additional life stressors, including adverse experiences during childhood as well as increased exposure to racial discrimination as an adult [13]

Methods

Results

Discussion

Conclusion