Doctor of Philosophy(PhD) / The thesis explores the complexities of primary health care in a setting characterised as being both isolated and remote, and in the process identifies factors critical for developing successful PHC programs in such settings and more broadly. The four questions underpinning the study are 1) is a PHC approach relevant to the chosen small remote Australian community; 2) to what extent was a PHC approach being implemented; 3) what are the barriers and enablers to developing and implementing a PHC approach; and 4) what are the crucial factors for PHC programs in similar communities. The first chapter provides the background to the study, beginning with the range of descriptions of primary health care and the many themes needed to understand how it plays out in a small community. The Menindee community and some of the local health service players are introduced. Chapter Two explores complexity theory and complex adaptive systems and its relevance to organisations and managing change, particularly in complex environments. Chapter Three examines the evolution of primary health care, its philosophy, principles and elements as both a model of health care and of development. Chapter Four addresses social determinants, the life course and the long-term effects of inequity, before considering current factors that impact on health and health services. These include the beginning and end of the life course and those in the ‘middle’ where the effects of the obesity and diabetes epidemics are being played out at a younger age. The chapter concludes by noting common themes across the three chapters. Chapter Five describes the research design and methods. A case study using mixed methods was chosen and the theoretical framework provides an exploration of complexity and transdisciplinarity. What changed during the course of the study, questions of scope and its limitations are stated. Chapter Six is a quantitative analysis of the study community, which examines community demographics, the life course, a summary of adult and child health, and service use. These enable an understanding of the community profile, its uniqueness and its similarity to other communities that might benefit from a comprehensive PHC approach. The questions to be explored in the qualitative phase are identified. Chapter Seven is a qualitative study of the community in the midst of change. An individual interview guide approach was used and representatives from the community, local and regional health service providers were interviewed. Chapter Eight provides a synthesis of the two studies as they address themes from the complexity, PHC and social inequity literature. Five themes had particular significance to the study community: social determinants and Indigenous health; community size, resilience and change; chronic disease programs and prevention; vulnerable groups; and a complex adaptive systems perspective. The second section answers the four study questions. The thesis concludes with a discussion of PHC rhetoric and reality, the relevance of the study and its limitations, and issues requiring further research when considering primary health care in smaller communities.

The risk of developing type 2 diabetes is four fold higher in New Zealand(NZ) Polynesians compared to Caucasians. Hence diabetes is more prevalent in Maori (16.5% of the general population) and Pacific Island people (10.1%) compared to NZ Caucasians (9.3%). It is generally accepted that type 2 diabetes has major genetic determinants and heterozygous mutations in a number of genes have previously been identified in some subsets of type 2 diabetes and certain ethnic groups. The high prevalence of diabetes in NZ Polynesians, when compared with NZ Caucasians, after controlling for age, income and body mass index (BMI), suggest that genes may be important in this population. Therefore, the prevalence of allelic variations in the genes encoding amylin and insulin promoter factor-1 (IPF-1), and exon 2 of the hepatocyte nuclear factor-1α (HNF-1α) gene in NZ Polynesians with type 2 diabetes was determined. These genes are known to produce type 2 diabetes in other populations. The genes investigated were screened for mutations by PCR amplification and direct sequencing of promoter regions, exons and adjacent intronic sequences from genomic DNA. DNA was obtained from 146 NZ Polynesians (131 Maori and 15 Pacific Island) with type 2 diabetes and 387 NZ Polynesian non-diabetic control subjects (258 Maori and 129 Pacific Island). Sequences were compared to previously published sequences in the National Centre for Biotechnology Information database. Allelic variations in IPF-1 and exon 2 of the HNF-1α gene were not associated with type 2 diabetes in NZ Polynesians. However, in the amylin gene, two new and one previously described allele was identified in the Maori population including: two alleles in the promoter region (-132G>A and -215T>G), and a missense mutation in exon 3 (QlOR). The -215T>G allele was observed in 5.4% and l% of type 2 diabetic and non-diabetic Maori respectively, and predisposed the carrier to diabetes with a relative risk of 7.23. The -215T>G allele was inherited with a previously described amylin promoter polymorphism(-230A>C) in 3% of Maori with type 2 diabetes, which suggests linkage equilibrium exists between these two alleles. Both Q10R and -132G>A were observed in 0.76% of type 2 diabetic patients and were absent in non-diabetic subjects. Together these allelic variations may account for approximately 7% of type 2 diabetes in Maori. These results suggest that the amylin gene maybe an important candidate marker gene for type 2 diabetes in Maori.

BACKGROUND: Indigenous populations in the United States (US) experience worse health outcomes and higher disease prevalence compared to the US all race population. The World Health Organization (WHO), Canadian research on Indigenous-specific determinants, the Harvard Project on American Indian Economic Development, and the Native Nation's Institute have all identified governance as a determinant that impacts community health and development. This dissertation explored the active and potential role of Indigenous nations' governance, since the Native nation building era commenced in the 1970s, in protecting and promoting family and community health. OBJECTIVES: The dissertation aims were to: (1) describe the state of population data for US Indigenous nations and benefits of engaging with data, data sovereignty, and data governance for US Indigenous nations, (2) outline the history and current state of tribal public health relative to other US public health systems, and (3) elucidate the assumptions and applicability of the social determinants of health framework to Indigenous health contexts. METHODS: This mixed-methods study integrated retrospective quantitative and primary quantitative and qualitative data from case studies with six reservation-based American Indian tribes with qualitative data collected in a focus group and two consensus panels of public health practitioners and scholars. RESULTS: The results by aim were: (1) self-determination with regard to health and other population data offers Indigenous nations opportunities to create and access relevant and reliable data to inform policy and resource allocations, (2) the federal government and others have not invested in tribal public health authority infrastructures in ways similar to investments made in federal, state, and local public health authorities, resulting in tribal public health systems falling below other public health authorities in function and capacity, and (3) underlying Euro-Centric assumptions imbedded in the social determinants of health framework reduce its applicability in Indigenous health contexts. CONCLUSIONS: This study contributes to understanding the roles of Indigenous nation self-determination and sovereignty in defining health to align with Indigenous philosophies of wellness. Guided by Indigenous-specific determinants of health, tribes can set community-based, culture-informed methods and metrics for establishing, monitoring, and assessing public health policies and programs to support healthy communities and families. RECOMMENDATIONS: Indigenous nations, in partnership with researchers and other governments as appropriate, should develop framework(s) for tribal health that include broad, shared, and nation-specific definitions of health, healthy families and communities, and health determinants. Federal, state, and local governments should partner with Indigenous nations to improve tribal public health infrastructures and to support tribal data sovereignty and data governance through building tribal data capacity, aligning data with tribal self-conceptions, and forming data sharing agreements.

Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-04-15T12:16:38Z No. of bitstreams: 1 Tese Sandra Pachecoseg.pdf: 58529 bytes, checksum: adf998666b216ae5bb687367b4c566af (MD5) / Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-05-26T10:59:33Z (GMT) No. of bitstreams: 1 Tese Sandra Pachecoseg.pdf: 58529 bytes, checksum: adf998666b216ae5bb687367b4c566af (MD5) / Made available in DSpace on 2013-05-26T10:59:33Z (GMT). No. of bitstreams: 1 Tese Sandra Pachecoseg.pdf: 58529 bytes, checksum: adf998666b216ae5bb687367b4c566af (MD5) Previous issue date: 2007 / O objeto central da tese é o perfil antropométrico das crianças na faixa etária de 0 a 5 anos do povo indígena Kiriri, assim como suas condições de saúde e práticas alimentares cotidianas. O percurso metodológico para a apreensão dessas três dimensões privilegiou o método da observação participante com registro etnográfico, ao abrigo do qual foram utilizadas também técnicas de caráter quantitativo. Das 365 crianças de 0 a 5 anos residentes na Terra Indígena Kiriri, 306 (83,83%) participaram do estudo. Os resultados evidenciaram, notadamente, uma elevada prevalência de processos crônicos de Desnutrição pelo Indicador Altura/Idade (19,9%), cuja prevalência está muito além da aceitável pela Organização Mundial de Saúde, que é de 2,3 % (OMS, 1995). Do ponto de vista nutricional, a alta relevância de Desnutrição crônica representa reduzida garantia de segurança alimentar infantil, não só ao nível doméstico mas também comunitário, assim como precárias condições de prevenção e manutenção da saúde. Visando melhor conhecer e descrever a situação nutricional na Terra Indígena Kiriri, os indicadores Peso/Estatura, Peso/Idade e Estatura/Idade foram cruzados com variáveis consideradas importantes no quadro multicausal da Desnutrição. As variáveis selecionadas foram sexo, idade, escolaridade materna e aleitamento. Em relação às variáveis sexo e aleitamento, não se observou associação entre elas e a ocorrência de Desnutrição. Destacada a questão do déficit de crescimento, observou-se que das 60 (20,3%) crianças que apresentaram Desnutrição pelo indicador Estatura/Idade, aproximadamente 87,0% possuem mães com escolaridade até a 4ª série. Constatou-se, também, que crianças entre 24 e 59 meses de idade representam 57,4% do total de crianças desnutridas. Em uma perspectiva comparativa entre os dois Grupos em que está dividida, hoje, a população indígena, a Desnutrição tem uma distribuição geográfica específica, sendo que no Grupo liderado pelo cacique Lázaro, a prevalência da Desnutrição crônica é maior (24,6%) do que no Grupo liderado pelo cacique Zenito (13,0%). Um estudo focal foi realizado entre as famílias com crianças Desnutridas no grupo local de Mirandela, de modo a melhor compreender alguns fatores envolvidos na determinação do Déficit de crescimento. As formas de cuidado e cura que conformam o sistema de saúde local foram observadas numa perspectiva relacional, identificando-se um campo complexo onde diferentes demandas são articuladas a órgãos oficiais e conhecimentos locais, de modo a atender às necessidades materiais, relações de poder e prestígio, motivações históricas, etc. As observações sobre as práticas alimentares Kiriri demonstram uma dieta alimentar baseada no feijão e farinha de mandioca, e complementada por tubérculos e cereais (batata-doce, pão, arroz e farinha de milho). De modo geral, a marca dessa alimentação cotidiana é a monotonia. Entre as carnes, a preferência incide sobre a de boi. Atenção foi, igualmente, dirigida para as técnicas culinárias, a cozinha, a comida e o comer. A observação do sistema alimentar Kiriri se constitui em elemento fundamental para o respeito à sua especificidade cultural e elaboração de políticas públicas que contribuam para o equacionamento do seu problema de (in) segurança alimentar. / Salvador

Made available in DSpace on 2016-06-02T19:48:19Z (GMT). No. of bitstreams: 1 4116.pdf: 4607966 bytes, checksum: 70dbbda1bb0ba6357c93fab3715b286b (MD5) Previous issue date: 2012-01-09 / Financiadora de Estudos e Projetos / This study aimed primarily to examine the workers conceptions about the process of nursing care in an institution of attention to indigenous health care. The starting point was the reference of the work process and its relation to the use of technologies in health care production. It was also considered the National Policy for the Health of Indigenous Peoples, particularly the distincted attention that should permeate the work process at the institution being studied. The empirical material was obtained from document analysis, systematic observations, guided by the flowchart Merhy Analyzer and by ten interviews with the nursing staff. A thematic analysis of categorical data was conducted and it revealed a fragmented labor process, focused on procedures and cast by institutional and bureaucratic rules. In the process of nursing work there is a clear gap from thinking to acting because planning the Schedule is a job for the responsable worker and the nursing station performs it. The worker s reports showed a sense of equality among human beings in the caring process. Therefore, it was also learned that in some situations, there is an establishment of asymetric relationship showing a certain denial of what is said. The assisted Indians in Support House are perceived by respondents as a retracted and suspicious individual. The care process should be based on a relationship based on trust. To approach the Amerindian, the nursing worker needs to undertake, especially light Technologies, empathy and affection. However, work in live action, hence the use of relational technologies, can be captured by the rigidity of the bureaucratic organizational structure. The act is cast and creative potential of workers is not valued. The caring process presents a special care, the monitoring, which is the activity of nursing staff to accompany the Indians to specialized health services outside the home support. Although the National Policy advocates a distincted attention, the work process in the institution being studied, seemed not to potentiate nor favors a care where it is considered the indigenous peculiarities of self-health care. / Este estudo teve como objetivo principal analisar as concepções de trabalhadores da enfermagem sobre o processo de cuidar em uma instituição de atenção à saúde indígena. Partiu-se do referencial do processo de trabalho e a sua relação com o emprego das tecnologias da saúde na produção do cuidado. Considerou-se também a Política Nacional de Atenção à Saúde dos Povos Indígenas, particularmente a atenção diferenciada, que deve permear o processo de trabalho na instituição estudada. O material empírico foi obtido a partir de análise documental, de observação sistemática, orientada pelo Fluxograma Analisador de Merhy e de dez entrevistas com trabalhadores de enfermagem. Realizou-se análise categorial temática dos dados. A análise realizada permitiu identificar um processo de trabalho fragmentado, centrado em procedimentos e engessado pelas normas institucional-burocráticas. No processo de trabalho da enfermagem, há uma divisão clara entre o pensar e o agir, pois o trabalhador responsável pelas atividades do agendamento planeja e o pessoal do posto de enfermagem executa. Os relatos dos trabalhadores evidenciaram uma noção de igualdade entre os seres humanos no processo de cuidar. No entanto, apreendeu-se também, que há, em algumas situações, o estabelecimento de relações assimétricas, mostrando que há uma certa negação do que se afirma. Os indígenas assistidos na Casa de Apoio são percebidos pelos entrevistados como um indivíduo retraído e desconfiado. O processo de cuidar deve ter como base o cultivo de relações de confiança. Para se aproximar do ameríndio, o trabalhador de enfermagem necessita empreender, principalmente as tecnologias leves, empatia e afeto. Todavia, o trabalho vivo em ato, consequentemente o uso das tecnologias relacionais, pode ser capturado pela rigidez da estrutura burocrático-organizacional. O agir é engessado e a potência criativa dos trabalhadores parece não ser valorizada. O processo de cuidar apresenta uma particularidade, o acompanhamento, que se refere à atividade dos trabalhadores de enfermagem em acompanhar os indígenas nos serviços de saúde especializados fora da Casa de Apoio. Apesar de a política nacional voltada ao indígena preconizar a atenção diferenciada, o processo de trabalho na instituição de estudo parece não potencializar e nem favorecer um cuidado em que se considerem as particularidades indígenas de auto-cuidado à saúde.

Este trabalho pretende compreender como se dá o Processo de Nascimento entre a população indígena Pankararu de Pernambuco, tratando principalmente dos cuidados e itinerários a ele associados, a partir da experiência de algumas mulheres indígenas. Para isso, será feito o exercício de olhar primeiramente o contexto e cultura indígena locais, considerando suas relações com os encantados e a sociedade envolvente, principalmente com os sistemas oficiais de saúde disponibilizados pelo Estado. No contexto Pankararu, o nascimento envolve tanto os conhecimentos e práticas biomédicas e indígenas, como a utilização de remédios do mato, passar pelo atendimento pré-natal, a realização do parto domiciliar ou hospitalar, além do batizado em casa. Para esta pesquisa foi utilizado o método etnográfico por meio da observação participante e de entrevistas semiestruturadas que viabilizaram apreender alguns dos saberes locais dessa população, relacionados ao parto e nascimento. O principal resultado desta investigação foi a revelação de como tem sido a assistência e experiência dessas mulheres com relação à sua saúde reprodutiva, considerando a demanda de contracepção, a ocorrência de partos em casa e nos hospitais, o trabalho das parteiras indígenas e o resguardo para controle da dona-do-corpo. / This work tries to understand the Process of Birth in the Pankararu indigenous population, in Pernambuco, focussing primarily on its associated cares and itineraries, based on the experience of some indigenous woman. To achieve this, an exercise of looking at the local indigenous context and culture will be conducted, considering the relations with the encantados and the absorbing society, mainly with the official health systems made available by the State. In the Pankararu context, birth involves both biomedical and indigenous knowledges and practices, the use of remédios do mato (medicinal herbs), frequenting prenatal care, giving birth at the hospital or at home and a home baptism. For this research, the ethnographic method was used, through participant observation and semi structured interviews that made it feasible to grasp some of the local knowledge of this population about labour and birth. The primary result of this investigation was the revelation of how the assistance has been received by these women and their experience regarding their reproductive health, taking into account the demand for contraception, the occurrence of home and hospital deliveries, indigenous midwives and the resguardo (postpartum restrictions period) for dona-do-corpos control.

Introdução - O estado nutricional tem repercussões importantes durante as mudanças pelas quais passa o corpo da mulher no processo de ser mãe, desde a concepção, gestação, parto e puerpério, continuando após este período. Porém, o estado nutricional da mulher é muito priorizado antes, durante e até um ano após a gestação - mais em função da influência que este pode ter sobre o peso ao nascer e as condições de amamentação da criança, do que pelos benefícios potenciais para a própria mãe. Por isso, há escassez de estudos sobre o estado nutricional de mães fora do período gravídico-puerperal. Objetivo - Descrever e analisar o estado nutricional e o acesso a serviços de saúde materna das mulheres, mães de crianças menores de cinco anos, no município de Jordão, Acre - Brasil no ano de 2005. Método - Trata-se de um estudo transversal de base populacional com 267 mulheres mães de crianças menores de cinco anos participantes da pesquisa Situação Nutricional do Município do Jordão (SINJORDÃO). Foram coletadas informações sobre características demográficas, socioeconômicas, antropométricas, de morbidade e condições de saúde. O estado nutricional foi classificado de acordo com o IMC adotando como ponto de corte os sugeridos pela Organização Mundial de Saúde (1995): Baixo peso (IMC < 18,5); Eutrófico (18,5 IMC < 25); Sobrepeso ( 25 IMC < 30) e Obesidade (IMC 30). A determinação de hemoglobina sangüínea foi feita por punção digital com uso de hemoglobinômetro portátil Hemocue, adotando-se Hb <12,0 g/dL para diagnóstico de anemia. Para análise estatística utilizou-se o teste de quiquadrado, adotando-se p<0,05. Resultados - O percentual de baixo peso foi de 3,4 por cento e não houve diferença estatística para nenhuma das variáveis avaliadas, a de sobrepeso (SP) foi de 27,7 por cento e a de obesidade (OB) foi de 6 por cento. Somando estas duas últimas categorias (SP+OB), o excesso de peso foi maior entre as indígenas (41,4 por cento p = 0,011), quem recebia benefícios sociais (50 por cento p = 0,005), casadas (35,5 por cento p = 0,038), não fumantes (38,3 p = 0,056) e quem pariu acompanhada de profissional de saúde (39 por cento p = 0,05). A anemia foi encontrada em 26,1 por cento das mulheres e foi maior entre as que não fizeram pré-natal (32,9 por cento p = 0,008), tiveram internação após o parto (57,1 por cento p = 0,007) e as que amamentaram exclusivamente menos de trinta dias (29,2 por cento p = 0,038). Apenas 45,5 por cento fez pelo menos uma consulta no pré-natal, e apenas 44,2 por cento tiveram parto em instituições de saúde. Conclusão - Este trabalho mostrou que as mulheres mães de crianças com 5 anos ou menos, o acesso ao serviço de saúde é muito abaixo do esperado para a região Norte. Apesar de viverem em situação sócio-econômica precária, vivenciam a transição nutricional. Foi possível observar que entre as mulheres menores de cinco anos no Jordão, Acre, o baixo peso se apresenta de forma normal, não sinalizando como problema de Saúde Pública, ao contrário do excesso de peso e da anemia, que apesar de ainda não se configurar com a gravidade que se encontra de modo geral no Brasil, apresenta uma tendência a agravar conforme se promovem mudanças na ordem econômica / Introduction - the nutritional state has important repercussions during the changes for which it passes the body of the woman in the process of being mother, since the conception, gestation, childbirth and puerperium, continuing this period after. However, the nutritional state of the women is very prioritized before, during and up to one year after the gestation, more in function of the influence that this can have on the birthweight and the conditions of breast-feeding of the child, more than for the potential benefits for the mother. Therefore, the scarcity of studies on the nutritional state of mothers is of the childbearing year. Objective - To describe and to analyze the nutritional state and the access the health services materna of the women five year mothers of lesser children, in the city of Jordão, Acre - Brazil in the year of 2005. Method - Cross-sectional study with population base of 267 women, mothers of children under five year old, participants of the research Nutritional Situation of the City of Jordão (SINJORDÃO). Information on demographic, socioeconomic, and anthropometrical characteristics have been collected, as well as related morbidity and conditions of health. The nutritional state was classified in accordance with the IMC adopting as cut point the suggested ones for the World-wide Organization of Health (1995): Low weight (IMC < 18,5); normal range (18,5 IMC < 25); Overweight (25 IMC < 30) and Obesity (IMC 30). The determination of hemogloblin was made by digital punch with use of portable hemoglobinometer Hemocue, adopting itself Hb>12,0g/dL. Findings. The prevalence of underweight was 3,4 per cent, with no statistical association with any variables; overweight (OW) was present in 27,7 per cent, and obesity (OB) in 6 per cent. Adding these two last cathegories (OW+OB), weight excess was higher in indigenous (41,4 per cent p = 0,011), those receiving social benefits (50 per cent p = 0,005), married women (35,5 per cent p = 0,038), non-smokers (38,3 p = 0,056), those who delivered with a trained practitioner (39 per cent p = 0,05). The prevalence of anemia was 26,1 per cent, higher in those who had no antenatal care, (32,9 per cent p = 0,008), were re-hospitalized (57,1 per cent p = 0,007) and those who breastfed exclusively for less than 30 days (29,2 per cent p = 0,038). Conclusions: Regardless of their poor economic status, they already live the nutritional transition. Among women with children under 5 years old in Jordão Acre, low birth weight is within the expected rate, not as a public health problem. On the contrary, weight excess and anemia, although not as high as the rest of the country, is already a trend, following the changes in the cash transfer programs, indicating the need for specific programs of nutritional education. This study shows that women with children under 5 years old, have limited access to health services, much below those in the Northern region

The Labrador Innu lived for millennia in the Quebec-Labrador Peninsula as nomadic hunters. Commencing in the 1950s, successive policies imposed on the Innu by federal and provincial governments brought significant disruptions to their traditional way of life. Today, the Labrador Innu are settled in the communities of Sheshatshiu and Natuashish in the province of Newfoundland and Labrador, Canada. They have maintained their language and culture, anchored in their understanding of territory and their relationship with their ancestral land, and have increasingly asserted their self-determination, including in research. The Innu articulated a Healing Strategy in 2014 after extensive community consultations. The Strategy states that a contemporary return to culture would provide healing to individuals and communities. Healing is important due to the social suffering experienced through sudden forced settlement and schooling in a non-Innu system. These abrupt changes altered the social fabric that had sustained Innu society for millennia. As part of the Strategy, the Innu decided to undertake a study to articulate their concept of wellbeing (minuinniuin) and their process of healing. Wellbeing and healing are intrinsic concepts for Innu; however, these concepts need to be uncovered for health and service providers, and policy makers. Having lived in Labrador and worked for the Innu, I was invited to be part of this community-initiated research. The Grand Chief of the Innu Nation directed that the research involve Innu researchers and utilize Innu ways-of-knowing and knowledge as fully as possible. Innu knowledge, like all Indigenous knowledges, is specific to the place where Innu live and to their experiences. Indigenous concepts of health and wellbeing, connections to land, and cultural identity are wholistically connected and culture-specific. The main objective of this dissertation is to articulate the Labrador Innu understanding of wellbeing and their distinctive process of healing. This qualitative study involves interviews and focus groups with 39 participants older than 16 years of age. This is a dissertation by articles. It consists of a general introduction to Indigenous health inequities, a literature review, a description of the methods, and the results as three separate manuscripts. It concludes with a summary of findings and implications. The first manuscript focuses on the process of developing an Innu framework for health research involving a partnership between Innu and non-Innu researchers. An Innu community-based participatory research (CBPR) framework for health research is proposed where Innu knowledge is foundational to the study. The framework is based on the metaphor of Innu and non-Innu canoeing together in one canoe. Within the space that joins all researchers, Indigenous knowledges are uncovered. This CBPR framework is used in the following two manuscripts. The second manuscript describes the contemporary process of healing of the Labrador Innu. Healing practices have been developed to deal with the historical and contemporary effects of colonialism and Innu people consider them effective. Healing is grounded in self-determination, culture, and non-reliance on bio-medicine. Five stages of healing are described: being “under the blanket”; finding spiritual strength; extending hands out; finding strength and power; and helping others. The findings highlighted the enablement of healing through spiritualities, support from Elders, return to culture, and resistance to negative stereotypes. The third manuscript aims to understand Innu views of wellbeing, and the influence of the land on health and wellbeing. Findings highlight that the experience of being on the land with family and community, learning cultural knowledge, and enacting Innu identity play a major role in enhancing wellbeing. For the Innu, the land sustains wellbeing by emplacing knowledge systems and cultural identity. The work presented in this dissertation contributes to the literature on Labrador Innu population health by highlighting that access to and experience of land build up health and wellbeing by providing and facilitating togetherness, fostering a relationship to all living beings, and enacting culture and a positive Innu identity. The findings add new knowledge to Indigenous health studies literature, particularly Innu health studies – holding promise for reducing health inequities. Implications for research, practice, and policy are also addressed.

This study investigates key components for effective Indigenous adult language learning and resulting health and wellness benefits following a Dene research paradigm with Grounded Theory applications. Eight colleagues in the Master’s of Indigenous Language Revitalization (MILR) program at the University of Victoria participated in open ended discussions on their experiences in learning their Indigenous languages as adults. These Indigenous adults reclaiming their ancestral languages report experiencing benefits related to health and overall well-being. Physical fitness and healthy weight loss, emotional healing and a greater sense of identity all surfaced for my colleagues while working towards or achieving fluency in their languages. The main methods of successful language learning used were the Master-Apprentice Program, Total Physical Response and Accelerated Second Language Acquisition. Tips for learning the languages are included. / Graduate / 2021-04-13

This Degree Project studies health promotion and strengths-based approaches in an Indigenous Australian context. The study focuses on an Indigenous Australian organisation called the Deadly Choices and their health-related promotion. The study is informed by postcolonial theory as well as cultural identity theory, and it was conducted through a textual analysis by analysing Deadly Choices’ Facebook posts and Twitter tweets both qualitatively and quantitatively. The study set out to determine what kind of features and what style language could contribute to the notion of a strengths-based approach and thus could empower Indigenous people to become change agents themselves.  The aim of the study was to understand if there are certain repetitive, identifiable features that construct the basis for a strengths-based approach and thus contribute to the matters of empowerment and decolonising health promotion in the context of Deadly Choices. In total 151 samples were analysed. I was able to conclude that Deadly Choices uses a strengths-based approach to an extent, but they tend to focus on only the resilience approach rather than the more prominent sociocultural approach.