While previous health research with Aboriginal populations focused almost exclusively on Aboriginal Peoples of First Nations descent living on reserves or in isolated rural communities in Canada, this study focusing on diabetes aimed to engage Aboriginal Peoples of First Nations and Métis descent living in an urban Ontario setting. Type 2 diabetes mellitus is a progressive metabolic disorder that affects Aboriginal Peoples of Métis and First Nations descent disproportionately compared to the rest of the Canadian population. To understand this disparity in diabetes incidence and to address issues with existing diabetes prevention and management strategies, this study: a) explores the perceptions surrounding Type 2 diabetes and its prevention from First Nations and Métis community people and health service providers and policy makers; and b) informs the existing diabetes prevention, management and care strategies in light of these perceived understandings. Primary data was collected through 40 in-depth one-on-one narrative interviews with First Nations and Métis people, health service providers and policy makers. Thematic codes that emerged through the narrative analysis of this data revealed that to fully understand the social determinants of diabetes in an urban First Nations and Métis people’s context required the application of intersectionality theory, since production of First Nations and Métis diabetes is socially determined and deeply intersectional. By combining the concepts of the social determinants of health and intersectional approaches, narrative analysis of the primary data revealed that diversities in socio-economic, cultural, legal and spatial contexts determine First Nations and Métis people’s life choices and have a strong bearing on their health outcomes. First Nations and Métis participants’ narratives revealed that dimensions of marginalization were reflected not only through inadequate material resources, but also through intersections of multiple factors such as colonial legacies, stereotyping, legal statuses, and the pan-Aboriginal nature of government policies and services. First Nations and Métis community members indicated that preventive programming aimed at avoiding or managing diabetes should be grounded in balancing and restoring the positive aspects of physical, mental, spiritual and emotional health and should also balance their diverse needs, lived realities, and social circumstances. The views of health service providers and policy makers captured in this thesis tended to reflect an understanding of diabetes causation grounded in both biomedical and intersecting social determinants of health. At the pragmatic level, however, the solution to this health issue presented by health service providers and policy makers addresses only the measurable individualistic biomedical risk factors of diabetes. Policy makers also discussed the need for developing qualitative indicators of the success of presently implemented health programs. Overall, the results of this study indicated that effective diabetes prevention and management strategies for urban First Nations and Métis people must recognize and address the diversities in their historical, socio-economic, spatial and legal contexts as well as their related entitlement to health services. A comprehensive diabetes prevention strategy should target the social determinants of health that are specific to urban First Nations and Métis people and must build on community strengths.

Courtesy stigma is the public disapproval evoked as a consequence of associating with a stigmatized individual or group. While there are few examples of research applying the concept of courtesy stigma to the professional associates of stigmatized persons, courtesy stigma has been shown to limit the social support and social opportunities available to family members who come to share some of the shame, blame and loss associated with their family member’s stigma(s). Research on the occupational health of persons performing frontline service work examines various sources of workplace demands and rewards, including the availability of public funding for the health and social service sectors, the devaluation of feminized forms of care-oriented work, and the downloading of responsibility for providing care to poorly paid or unpaid workers in the community and home. This research project blends the literatures on courtesy stigma and the occupational health of frontline service workers to understand the work experiences of those providing frontline social services to sex workers. A mixed methods design is used to study the workplace experiences of a small group of workers in a non-profit organization providing support and educational services to sex workers. The findings reveal that courtesy stigma is a discernable experience among this vulnerable group of service workers, affecting their work, community and family contexts. Courtesy stigma played a significant role in staff perceptions of others’ support for themselves and their work activities, leading to diminished opportunities for collaborative relationships, emotional exhaustion, altered service practices, and a low sense of workplace accomplishment. Thus, courtesy stigma forms part of the package of conditions that leads to high turnover, diminished workplace health, and a loss of service capacity in the frontline health and social service sector. The dissertation concludes with a consideration of the implications of the findings for the literatures on courtesy stigma and frontline service work, arguing that courtesy stigma is an underestimated determinant of occupational health for frontline service providers serving socially denigrated groups.

This thesis is a subset of a larger “parent” project under the direction of my supervisor, Dr. Cecilia Benoit. The purpose of the larger project is to seize an unique research opportunity that has emerged with the development and implementation of the HerWay Home (HWH) program, a community-based initiative for pregnant and early parenting women who face substance use and other challenges in the Greater Victoria Area. My research has capitalized on the pre-implementation phase of the HWH program between 2010-2011. Thirteen in-person semi-structured interviews were conducted with women who would likely be clients for the HWH program, based on their pregnancy experiences, substance use concerns and other life challenges. The goal of this research has been to explore these women’s pregnancy and postpartum narratives and investigate what, in their view, should be crucial components of the HWH intervention in the short and longterm. My findings indicate that, consistent with the literature on pregnant and early parenting women facing substance use and other life challenges, a range of complex, intertwined disadvantages exist in their lives that translate into multiple barriers to accessing continuous health and social care during their pregnancy and after the birth of their child. An adapted model of the Health Lifestyle Theory is used to frame the analysis of the data collected from this research. The results from this research support the argument that the life choices of the participants are constrained by structural life chances and socially determined inequities that systematically disadvantage and disempower them. The findings also reveal an implicit sense of agency in the women’s narratives, as well as key specifics about what they view as the main gaps in care and their desired program services. The findings will be relayed to HWH organizers, and used to inform the development and implementation of the program’s services. / Graduate

Best Practices: Does it mean the same thing in the Aboriginal community as it does in the Health Authorities when it comes to diabetes care? / Population Health

The present thesis entitled "Health and social situation of unemployed persons living in Český Krumlov" deals with the issue of unemployment in the context of a human life situation. The five chapters the theoretical section define issues of health and its determinants with emphasis on the social determinants of health, and also deal with the characteristics of unemployment from an economic and social health point of view, the definition of the competencies of the Labour Office and other employment services, as well as with specific information about Český Krumlov including unemployment statistics relating to its territory. The practical part is based on quantitative research study. To collect data for this survey, interviewing method (a questionnaire) was used. A specific questionnaire was created, which contained mostly closed questions in the form of scales with a bilateral scale used for measuring the living situations of people questioned. Research tool focused on the subjective evaluation of the respondents in the areas of financial, social and health situation. The research sample consisted of individuals registered as jobseekers with the Labour Office in Český Krumlov. That means I used a deliberate choice through institutions. The selection was conducted by direct addressing potential respondents upon arriving at the Labour Office workplace in Český Krumlov. The questionnaires were distributed personally, so the return was 96.7%. After elimination of incomplete or logically incorrectly completed questionnaires, a total of 353 questionnaires were collected using the afformentioned procedure. The aim was to describe the health and social situation of unemployed persons living in Český Krumlov region and determine whether there is a relationship between social and health situation of the unemployed, and the relationship between unemployment length records and social situation of the unemployed. In line with the objectives of the work, two basic research questions were established in the following wording: "Does the subjective assessment of selected characteristics of the social situation reflect in the subjective evaluation of selected aspects of health of the unemployed?" And "Does the length of registration reflect in the subjective evaluation of the social situation of the unemployed?" To the research questions, the hypotheses were determined, which assumed that increasing the value of one variable will increase the value of the other variable. As the characteristics of the social situation for the first research question were chosen: duration of the records, perception of unemployment, living with a partner and financial situation. Health was due to the characteristics of the social situation assessed from three aspects - overall, mental and physical. The results of this research thus show that three out of four selected characteristics are reflected in the health of unemployed people in at least two respects. In terms of social situation, the results confirmed that the duration of the unemployment records are deteriorating financial situation and also the tolerance of the people around towards the unemployed from the perspective of the job seekers. These findings not only correspond with the current knowledge in this area, but also point out that the health and social problem of unemployment is still relevant even today, when the existential threat to the unemployed is averted. The diploma thesis could thus serve the Labour Office in Český Krumlov in the basic orientation about the health and social status of their registered candidates. Furthermore, it could be an incentive for local nonprofit organizations to establish cooperation with the unemployed if needed. The thesis could also enrich the existing research dealing with this issue in one of the regions with the highest unemployment rates in the country.

A discriminação étnico-racial é um evento estressor capaz de produzir múltiplos danos físicos e mentais. Apesar do crescente interesse científico mundial e de ser tema estratégico para a saúde coletiva, permanece pouco estudado no Brasil, especialmente quando comparado aos EUA, responsável por expressiva produção acadêmica nessa área. Acerca das comunidades remanescentes de quilombo, são ainda mais escassos os dados disponíveis na literatura sobre a sua situação de saúde, sendo nula a investigação abrangendo discriminação étnico-racial entre esses indivíduos. Buscando contribuir para essas questões, a presente pesquisa analisou as frequências de discriminação entre os adultos quilombolas do município de São Lourenço do Sul/RS, por intermédio da escala Experiences of Discrimination, além de verificar as condições sociodemográficas e de saúde dessa população, mensurados pelos questionários da Pesquisa Nacional de Saúde adaptados para esse trabalho. Foram realizadas 103 entrevistas, sendo a amostra composta por 55,3% de mulheres, 71,8% com idades entre 18 e 59 anos e 72,8% da raça/cor preta. A prevalência de discriminação étnico-racial percebida em algum momento da vida foi de 59,2%, resultado superior ao encontrado em outros estudos importantes acerca do tema no país. As frequências com que os entrevistados reportaram ter sofrido discriminação nos contextos cotidianos investigados variaram de 1,9% ao pedir crédito ou empréstimo bancário até 28,2% ao frequentar a escola. Os itens acerca de agravos em saúde revelaram alta (64,1%) frequência de doenças crônicas, sendo a hipertensão arterial sistêmica (45,6%) a doença mais prevalente. Foram baixos os índices de tabagismo e de uso abusivo de álcool. Os resultados desse estudo permitem concluir que a prevalência de discriminação racial nas comunidades remanescentes de quilombo do município de São Lourenço do Sul foi alta e o local no qual ela foi percebida com maior frequência foi o ambiente escolar. É de suma importância que se reconheça a existência da prática do racismo dentro da sociedade brasileira para que se sistematizem ações para transformar essa realidade. / The ethnic-racial discrimination is a stressor event related to multiple physical and mental damages. However, despite the growing scientific interest in a global scale, it remains little studied in Brazil, especially when compared to the USA, responsible for expressive academic production in this area. Concerning the remaining communities of quilombo, the data available in the literature about their health status is even scarcer, with no research covering ethnic-racial discrimination on these individuals. In order to analyze these questions, the present study investigated the frequencies of discrimination among quilombola adults in the city of São Lourenço do Sul / RS, through the scale “Experiences of Discrimination”, beside verifying the sociodemographic and health conditions of this population, measured by questionnaires of the National Health Survey adapted for this work. A total of 103 interviews were conducted, with 55.3% of women, 71.8% between 18 and 59 years old, and 72.8% of blacks. The prevalence of ethnic-racial discrimination perceived at some point in life was 59.2%, a result superior to that found in other important studies on this matter in the country. The frequencies with which respondents reported discrimination in the daily contexts of the questionnaire ranged from 1.9% when applying for credit or bank loan up to 28.2% when attending school. The items about health problems revealed a high (64.1%) frequency of chronic diseases, with systemic arterial hypertension (45.6%) being the most prevalent disease. The rates of smoking and alcohol abuse were low. The results of this study allow us to conclude that the prevalence of racial discrimination in the remaining communities of quilombo in the municipality of São Lourenço do Sul was high and the place where it was most frequently perceived was the school environment. It is extremely important to recognize the existence of the practice of racism within Brazilian society to systematize actions to change this reality.

The focus of the presented diploma thesis is to evaluate the knowledge of seniors in the field of healthy nutrition. It is furthermore important to find out, whether the seniors have enough relevant information about rational nutrition and which sources they would like to use to gather information about healthy nutrition. Socio-economic aspects, which lead to senior nutrition, are also monitored. A quantitative research strategy and an in-depth interview were used to fulfil the aim of the thesis. The research group of twenty-two seniors was chosen by a method of purposeful sampling. The criteria for choosing seniors were an age between 65 74 years, old age pension, living alone and a responsibility for their own nutrition. The results of this thesis could be helpful to health insurance companies, municipal authorities, senior clubs or non-profit organizations which could create an environment for active education of seniors in the field of healthy nutrition. The seniors could learn to prepare tasteful high-nutrition meals. The seniors in their early phase of old age are the most endangered with obesity amongst all age groups. It is caused by the socioeconomic aspects they were influenced by during their lives. Their dietary habits started to form in the post-war period with the lack of food. They spent their working lives in the era of socialism, in which the selection of food was also restricted. In the nineteen-nineties, the seniors were in their mid-age and their dietary habits were already established. Theoretical knowledge in the field of rational nutrition is substantial, but the seniors are often not willing or lack the ability to create nutritionally balanced and tasteful meals. Therefore, the seniors would benefit from an interactive means of education with the possibility of learning necessary skills and contacting a nutrition specialist with their questions.

abstract: The health situation of indigenous peoples is comparable to that of the world's poorest populations, but with the additional burdens of social and cultural marginalization, geographic and cultural barriers to accessing health services, and, in some areas, appropriation of land and natural resources. Cultural transmission (the transfer of beliefs, ideas, and behaviors from one culture to another) from outsider health institutions should presumably aid in closing this health gap by transferring knowledge, practices, and infrastructure to prevent and treat disease. This study examines the biosocial construction of the disease ecology of tuberculosis (TB) in indigenous communities of the Paraguayan Chaco with varying degrees of cultural transmission from outside institutions (government, religious, and NGOs), to determine the influence of cultural transmission on local disease ecologies. Using a biocultural epidemiological framework for the analysis of human infectious disease ecology, this study employed an interdisciplinary, mixed methods approach to examine the interactions of host, pathogen, and the environment in the Paraguayan Chaco. Three case studies examining aspects of TB disease ecology in indigenous communities are presented: (1) The effective cultural transmission of biomedical knowledge to isolated communities, (2) Public health infrastructure, hygiene, and the prevalence of intestinal parasites: co-morbidities that promote the progression to active TB disease, and (3) Community-level risk factors for TB and indigenous TB burden. Findings from the case studies suggest that greater influence from outside institutions was not associated with greater adoption of biomedical knowledge of TB. The prevalence of helminthiasis was unexpectedly low, but infection with giardia was common, even in a community with cleaner water sources. Communities with a health post were more likely to report active adult TB, while communities with more education were less likely to report active pediatric TB, suggesting that healthcare access is the major determinant of TB detection. More research is needed on the role of non-indigenous community residents and other measures of acculturation or integration in TB outcomes, especially at the household level. Indigenous TB burden in the Chaco is disproportionately high, and better understanding of the mechanisms that produce higher incidence and prevalence of the disease is needed. / Dissertation/Thesis / Doctoral Dissertation Social Science and Health 2014

A discriminação étnico-racial é um evento estressor capaz de produzir múltiplos danos físicos e mentais. Apesar do crescente interesse científico mundial e de ser tema estratégico para a saúde coletiva, permanece pouco estudado no Brasil, especialmente quando comparado aos EUA, responsável por expressiva produção acadêmica nessa área. Acerca das comunidades remanescentes de quilombo, são ainda mais escassos os dados disponíveis na literatura sobre a sua situação de saúde, sendo nula a investigação abrangendo discriminação étnico-racial entre esses indivíduos. Buscando contribuir para essas questões, a presente pesquisa analisou as frequências de discriminação entre os adultos quilombolas do município de São Lourenço do Sul/RS, por intermédio da escala Experiences of Discrimination, além de verificar as condições sociodemográficas e de saúde dessa população, mensurados pelos questionários da Pesquisa Nacional de Saúde adaptados para esse trabalho. Foram realizadas 103 entrevistas, sendo a amostra composta por 55,3% de mulheres, 71,8% com idades entre 18 e 59 anos e 72,8% da raça/cor preta. A prevalência de discriminação étnico-racial percebida em algum momento da vida foi de 59,2%, resultado superior ao encontrado em outros estudos importantes acerca do tema no país. As frequências com que os entrevistados reportaram ter sofrido discriminação nos contextos cotidianos investigados variaram de 1,9% ao pedir crédito ou empréstimo bancário até 28,2% ao frequentar a escola. Os itens acerca de agravos em saúde revelaram alta (64,1%) frequência de doenças crônicas, sendo a hipertensão arterial sistêmica (45,6%) a doença mais prevalente. Foram baixos os índices de tabagismo e de uso abusivo de álcool. Os resultados desse estudo permitem concluir que a prevalência de discriminação racial nas comunidades remanescentes de quilombo do município de São Lourenço do Sul foi alta e o local no qual ela foi percebida com maior frequência foi o ambiente escolar. É de suma importância que se reconheça a existência da prática do racismo dentro da sociedade brasileira para que se sistematizem ações para transformar essa realidade. / The ethnic-racial discrimination is a stressor event related to multiple physical and mental damages. However, despite the growing scientific interest in a global scale, it remains little studied in Brazil, especially when compared to the USA, responsible for expressive academic production in this area. Concerning the remaining communities of quilombo, the data available in the literature about their health status is even scarcer, with no research covering ethnic-racial discrimination on these individuals. In order to analyze these questions, the present study investigated the frequencies of discrimination among quilombola adults in the city of São Lourenço do Sul / RS, through the scale “Experiences of Discrimination”, beside verifying the sociodemographic and health conditions of this population, measured by questionnaires of the National Health Survey adapted for this work. A total of 103 interviews were conducted, with 55.3% of women, 71.8% between 18 and 59 years old, and 72.8% of blacks. The prevalence of ethnic-racial discrimination perceived at some point in life was 59.2%, a result superior to that found in other important studies on this matter in the country. The frequencies with which respondents reported discrimination in the daily contexts of the questionnaire ranged from 1.9% when applying for credit or bank loan up to 28.2% when attending school. The items about health problems revealed a high (64.1%) frequency of chronic diseases, with systemic arterial hypertension (45.6%) being the most prevalent disease. The rates of smoking and alcohol abuse were low. The results of this study allow us to conclude that the prevalence of racial discrimination in the remaining communities of quilombo in the municipality of São Lourenço do Sul was high and the place where it was most frequently perceived was the school environment. It is extremely important to recognize the existence of the practice of racism within Brazilian society to systematize actions to change this reality.

This dissertation thesis titled ``Social Determinants of Health in Selected Romany Communities{\crqq} adverts to the issues of relationship between the health condition and social and economic factors, as well as other external or culture-conditioned influences affecting them. I have based my work on the concept of ten social determinants of health by Wilkinson and Marmot (2005). The theoretical section adverts to the interrelation of particular determinants in the Roma communities and the specific role of stress affecting all determinants. Thereat, I have based my study on generally available findings, primarily those acquired from research surveys, against which I have compared the results of my research section. The objective of this presented thesis is to describe the influence of social determinants of health in the wider context of everyday living in selected Roma communities. In doing so, I have primarily focused on impediments to the full participation of the described target population in the living of the majority society due to social exclusion. The target population consists of five multi-generation Romany families from two separate locations. Two families enjoy a higher stratification status (including a representative of the Romany elite) and three live in socially excluded locations. Having considered the specifics of the target population and orientation on the common day of the respondents, I have opted for socio-ethnographic field research, i.e. a qualitative by a research method, with the prevailing technique being participative observation and interviews. Processed research data is presented, alongside discussions, in subchapters following upon the topics of the theoretical part of my thesis, i.e. particular groups of health determinants. The results indicate that it is not only the underprivileged socio-economic conditions that take a share in the worsened health condition of persons living in socially excluded locations but these also involve therefrom originating stressors, which are often specific (symbolic element of social exclusion, alternative sources of livelihood). I also attribute a special meaning to culture-conditioned norms and opinions that, in some cases, bear a negative influence on the health condition via behavioral factors (such as a low number of Roma mothers lactating their children or attitude to the abuse of habit-forming substances). Apart from the identification of the influence proportions breakdown by social determinants of health in Roma communities, I see the benefit of my thesis in its qualitative nature, predestining it for utilization in a wider, longitudinal quantitative research of the target Romany group.