Coronary heart disease takes a large toll of middle-aged males thereby reducing the overall occupational fitness and potential of the workforce. Most of the risk factors for CHD (and other diseases) are self-determined and/or the result of preventable behaviour or alterable environment. The Multiple Risk Factor Hypothesis and the CHD risk factors are reviewed in detail in Chapter 2. It is more the interaction among risk factors within supposedly "normal" limits, rather than abnormally high levels of one or a few factors which results in the development of CHD, a phenomenon which obscures the issue of causation. It is hypothesized that the imbalance between the collective pathogenic effects of risk factors and the ability of the body to resist and/or repair such effects cause CHD. States such as sedentariness and obesity in which most of the risk factors tend to be clustered are important risk indicators. Moreover, since the overall risk profile is improved with reversal of these two states through regular aerobic activity and weight loss, the latter two are key interventions in CHD prevention. Risk factor screening to identify those at risk and subsequent modification of the risk status are useful manoeuvers for the prevention of CHD. As well as being secondary to the ravages of such diseases as CHD, occupational productivity is also reduced by poor levels of employee physical fitness. The recognition by employers of the potential success of CHD prevention programs and the increased productivity of the fit employee has led to the emergence of employer-sponsored occupational fitness programs. Such programs are based on a wholistic health-enhancement approach with regular aerobic physical activity as the core. The operative principles, contents (including the what and how of the all important assessment component) and benefits of such programs are reviewed in Chapter 3. A review of the state of health and fitness in the Canadian Forces and the experimental portion of the thesis make up Chapter 4. In spite of policies, orders and programs to ensure the health and fitness of Canadian Forces' personnel, the CF remains a fairly high-risk population. The cross-sectional study on the health and fitness of 2 83 CF personnel at National Defence Headquarters shows that Other Ranks constitute a higher-risk rank grouping than Officers, as do lower ranks in both of these two major rank groupings. Volunteers appear to be a self-selected sub-population which is healthier and fitter than average. Aerobic fitness (VO₂ max), obesity and resting heart rate emerge as the three key indicators of health and CHD risk status. Chapter 5 summarizes the thesis and contains conclusions and recommendations to the CF for future actions which are also applicable to most occupational settings. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Societies that foster high quality social environments and integration produce healthier populations. The mechanisms underlying the protective effect of social integration appear to be through various forms of social support. In the Canadian Aboriginal context, few authors have explored the relationship between health and social support. This gap in understanding is significant because Aboriginal frameworks of health point to the salience of larger social structures (i.e., family), yet patterns of population health point to distinctly social causes of morbidity and mortality (e.g., violence, alcoholism). An interesting paradox emerges: patterns of Aboriginal health suggest that social support is not working to promote health. This dissertation explores this paradox through a mixed-methods approach to describe the value of social support for Aboriginal health, and to critically examine the social-structural processes and mechanisms through which social support influences Aboriginal health at the community level. / Principal components analyses of the 2001 Aboriginal Peoples Survey (APS) identified social support as a consistent dimension of Metis and Inuit health, and multivariable logistic regression modelling of the 2001 APS identified social support to be a significant determinant of thriving health among Indigenous men and women (e.g., those reporting their health as excellent/very good versus good/fair/poor). The results also indicate a distinct social gradient in thriving health status and social support among Aboriginal Canadians. / Narrative analyses of 26 interviews with Aboriginal Community Health Representatives point to two key explanations for the health-support paradox: (i) social support is not a widely accessible resource; and (ii) the negative health effects of social support can outweigh the positive ones. The formation of health behaviours and cultural norms - which underpin social supports - are inextricably tied to the poor material circumstances that characterize Canada's Aboriginal communities. The thesis concludes with a critical examination of the processes through which environmental dispossession has influenced the determinants of Aboriginal health, broadly speaking. Effects are most acute within the material and social environments of Aboriginal communities. More research attention should focus on identifying the pathways through which the physical, material and social environments interact to influence the health of Aboriginal Canadians.

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