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Understanding how proximal, intermediate, and distal determinants of Indigenous peoples’ health in Canada, relate to the physical and mental health of First Nations, Métis, and Inuit, can shed light on how to allocate health-related resources to address well documented health disparities in these groups. This dissertation contributes to the literature by addressing two population-level quantitative research questions pertaining to Indigenous peoples’ physical and mental health, and a qualitative case study examining what factors maintain and improve Indigenous community health workers’ mental wellness and access to mental health supports. First, this thesis establishes a link between being Indigenous and health-related quality of life using multivariate regressions, as well as decomposition techniques. Second, the relationship between having an ancestor who survived the Residential School System, and five physical and mental health outcomes, controlling for determinants of health are estimated using multivariate ordered logistic and logistic regressions. Third, given that Indigenous self-government is an important determinant of health and wellbeing, an explanatory single-case study design is used to explore what factors maintain and improve, or create barriers to mental wellness and access to mental health supports for Indigenous community health workers in an Indigenous-governed health system. These chapters build on each other, and use a variety of methodological approaches, to identify if and to what degree observable determinants of health account for the physical and mental health of Indigenous peoples living in Canada. Substantively, this thesis evaluates empirically, the relationship between determinants of health and health outcomes for Indigenous peoples. Findings could be used to advocate for adequate and sustained investment in programs and services responsive to the contexts and needs of Indigenous men and women living in Canada. Methodologically, novel applications of statistical/econometric methodologies, furthers understanding of quantitative relationships examined with respect to Indigenous peoples’ physical and mental health at the population-level. In terms of a theoretical contribution, this dissertation contributes by lending further insight into the empirical relationships between determinants of Indigenous peoples’ health and health outcomes, and by introducing a framework for conceptualizing factors that strengthen mental wellness of Indigenous community health workers in remote Northern contexts in Canada. / Thesis / Doctor of Philosophy (PhD) / First Nations, Métis, and Inuit make up 4.3% of the Canadian population and together represent the three distinct identities of Indigenous peoples living in Canada. Indigenous peoples’ experiences of colonization have had impacts on their physical and mental health. Additionally, experiences of colonization have also affected many determinants of Indigenous peoples’ health ranging from access to food and clean drinking water, to the availability of appropriate education, social, and healthcare services. The following chapters explore how certain experiences of being Indigenous in Canada are associated with physical and mental health outcomes, taking into consideration determinants of health. Even after controlling for all of the things known to be related to Indigenous peoples’ physical and mental health, and that are typically used to explain any differences in health between groups, there is still a difference in health outcomes between Indigenous and non-Indigenous peoples in Canada. There is also still a difference in physical and mental health outcomes between Indigenous adults with and without an ancestor who attended the Residential School System. The effects of colonization also influence Indigenous community health workers’ mental wellness, and access to mental health supports while living and working in a remote, Northern community.

This thesis discloses findings from a scoping review of Social and Structural Determinant of Health (SSDOH)-related academic and grey literature from neurosurgery and fields with neurosurgical overlap. The purpose of this thesis is to identify which social determinants have been assessed, for which surgical procedures they were evaluated, and what disparities were found. To identify studies to include or consider for this systematic review, the review team worked with a medical librarian to develop detailed search strategies for each database. Studies were screened by title and abstract independently by two reviewers. Disagreements between reviewers were resolved by a third reviewer, blinded to the decisions of the primary reviewers. The scoping review of the SSDOH in neurosurgical outcomes identified 99 studies from the year 1990 to 2020. Identified studies were targeted predominantly toward spine surgery patients, evenly distributed in analyses of gender, race and economic stability. The relatively low volume of neurosurgical papers focused on the SSDOH and emphasis on one subspecialty demonstrates the need for an expanded interest in the SSDOH in neurosurgery. / Urban Bioethics

The purpose of this study is to describe findings of the 2006 Aboriginal Peoples Survey that was conducted by Statistics Canada. They collected data on the living conditions and lifestyles of Aboriginal peoples living off-reserve in Canada. The thesis describes diabetes, co-morbidities, and social determinants of health that affect this population through the lens of intersectionality and Dr. Nancy Krieger's Eco-Social theory. / Graduate / 0766 / 0573

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This thesis evaluates the utility of �social capital� for public health in four dimensions (communication, explanation, practice and measurement) and at two levels (macro and micro), using interviews with public health workers and a theoretical analysis of social capital. It concludes that the concept is potentially useful for public health but that there are limitations to its utility, arising from the presence of two competing discourses or world views identified in the social capital literature: the rational choice discourse and the political economy discourse. This thesis argues that although social capital is widely perceived to have rhetorical leverage in macro-level policy debates, its contested meaning draws into question the value of any consensus built on the glossing over of different world views. The concept has no value for communication at the micro level. The rational choice theory of social capital appears useful for explaining the social determinants of health although it does not adequately account for the power structures which shape and constrain access to social capital, and it undervalues many aspects of social relationships. The political economy approach is more useful in these respects but is far more complex and difficult to quantify. It is unclear whether either of these theories adds much value to the existing literature which social capital tends to eclipse. The concept has limited value for public health practice, as the dual world views embedded in it can be used to support widely varying policy directions. It is also limited by its inability to describe the dynamics of change or to identify levers for initiating change. The meaningfulness of social capital indicators is compromised by the reductionism of the rational choice paradigm. The political economy discourse renders the development of quantitative indicators far more problematic but may be useful for informing qualitative research.

This research aimed to explore the nutritional vulnerability of homeless adult men. Using a mixed methods approach, risk factors for chronic illness, food security status, dietary intake adequacy, and how the study participants navigate the food supply system to obtain food were investigated. This study assessed differences in nutrition vulnerability between participants that use solvents and those that do not. The findings reveal that all participants were nutritionally vulnerable. A majority was overweight or obese; nearly all experienced food insecurity; and most did not meet the daily food intake guidelines established by Canada’s Food Guide. Daily efforts by participants to obtain food from charitable meal programs helped to meet physiological needs, as well as social, economic, safety and security needs. Participants using solvents had different nutritional and food experiences than non-solvent users. This was identified by a higher prevalence of severe food insecurity and social exclusion compared to non-solvent using homeless participants. This study provides important information to program planners and policy-makers necessary in order to help meet the food and nutritional needs of adult homeless populations. Findings may be translated into policies and programs aimed at improving accessibility to healthy foods.

Upstream social determinants of health (SDH) have become widely acknowledged as lying at the root of poor health outcomes in Canada and globally. Conditions of social disadvantage restrict access to both social and physical resources, limiting the opportunity to actively pursue a healthy lifestyle. The Commission on the Social Determinants of Health maintains that educating the public about the SDH is a key step towards population health equity. Educating adolescents may be the most efficient and effective route of SDH knowledge dissemination, as youth are in a stage of peak learning, and are also easily reached through health education curriculum delivered in secondary school. However, health curriculum in Ontario is lacking in SDH content, placing a much greater emphasis on individual, lifestyle behaviors, such as diet, physical activity, and sax sex practices. Identifying a gap in SDH knowledge within this population, and evaluating the benefits of SDH education, is required to advocate for health curriculum revision to include SDH material. This project is designed as both a research study and SDH educational intervention. Concept mapping exercises were used to determine students’ knowledge of the determinants of health and the SDH. The impact of short term SDH education on student retention of SDH material was also evaluated. Student concept maps indicated that students attributed their health primarily to physical determinants versus social determinants; 44% of maps contained no SDH content. Statistical analyses prior to delivering the SDH lessons indicated that students’ SDH knowledge varied by their relative socioeconomic status (SES). Post-lesson analyses indicated however that student SDH knowledge increased significantly, and final levels of SDH knowledge following the SDH lessons was unaffected by socio-demographic variables. Findings suggest that 1) there is an SDH knowledge gap in the adolescent population, 2) an inequity in adolescent SDH knowledge exists across socio-economic factors, and 3) that SDH education can potentially eliminate the inequity in SDH knowledge. Current Ontario health curriculum requires revision to include SDH material. Designing curricula to have an optimal influence on both student learning and adolescent health requires greater communication and collaboration from both educational institutions and health agencies in Canada / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2012-09-27 08:49:09.739

The susceptibility of individuals to illness and disease is greatly influenced by context specific social determinants of health (SDH), yet there is a dearth of literature pertaining to SDH among refugees, particularly those residing in urban areas. The purpose of this study was to identify and generate empirical evidence on SDH among female refugees in Malaysia. It focused specifically on Rohingya refugees, a stateless and persecuted Muslim minority from Myanmar. Intersectionality formed the theoretical foundation of the study, which utilized a qualitative research design and employed an exploratory, applied research approach. Document review provided background and contextual information for primary data, which were collected using semi-structured interviews and analysed using thematic analysis. The study was undertaken in affiliation with the United Nations High Commission for Refugees (UNHCR) and had two primary outputs: it provided UNHCR with information and recommendations to inform context-specific program and policy development, and it generated rich empirical findings that contribute to the nascent evidence base on SDH in the context of forced migration. Results indicate that key factors affecting the health and wellbeing of Rohingya women include: their journey from Myanmar to Malaysia, income, employment, food security, transportation, the physical environment, UNHCR, security issues, education, religion, healthcare, and social capital/the social safety net. These interacted, overlapped and compounded each other, forming a ‘web of interrelated factors’ that affected participants’ health. Findings provide insight into the instrumental role of the sociopolitical context in structuring the lives of urban refugee women, and emphasize the importance of extending current discourse beyond refugee women’s needs and vulnerabilities to consider their resilience and agency in situations of significant hardship. / Graduate / 0573

This research aimed to explore the nutritional vulnerability of homeless adult men. Using a mixed methods approach, risk factors for chronic illness, food security status, dietary intake adequacy, and how the study participants navigate the food supply system to obtain food were investigated. This study assessed differences in nutrition vulnerability between participants that use solvents and those that do not. The findings reveal that all participants were nutritionally vulnerable. A majority was overweight or obese; nearly all experienced food insecurity; and most did not meet the daily food intake guidelines established by Canada’s Food Guide. Daily efforts by participants to obtain food from charitable meal programs helped to meet physiological needs, as well as social, economic, safety and security needs. Participants using solvents had different nutritional and food experiences than non-solvent users. This was identified by a higher prevalence of severe food insecurity and social exclusion compared to non-solvent using homeless participants. This study provides important information to program planners and policy-makers necessary in order to help meet the food and nutritional needs of adult homeless populations. Findings may be translated into policies and programs aimed at improving accessibility to healthy foods.