Exam Review

Question 1

What is the WHO definition of health?

Answer 1

After World War II, WHO created a definition for health that emphasized the aspects of health which are not only related to disease status. The definition is:

Health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.

Question 2

What is the functional definition of health?

Answer 2

The functional approach to defining health looks at what our health state allows us to do or not to do. The definition is:

Health is the capacity of people to adapt to, respond to, or control life’s challenges and changes.

Question 3

Define disease, illness, and sickness. Discuss the relationship between these terms.

Answer 3

Disease -  refers to a biological or physical malady affecting the body.

Illness - Refers to the perception of dysfunction by the afflicted individual.

Sickness - refers to the social acknowledgement of impairment or affliction.

Similar to the relationship between health and disease, the relationships between disease, illness, and sickness or not unidirectional. There can be disease without illness where increased blood pressure causes a heart attack or stroke when the person does not feel ill (hypertension). There can be illness without disease when the person feels ill but doctors cannot find anything wrong despite extensive testing (hypochondriac). Lastly there can be illness without sickness where the person feels ill but that feeling is not acknowledged by others (headache).

Question 4

Discuss the relationships between disease and health.

Answer 4

It is important to understand that there is a relationship between disease and health that must be properly considered. This is because someone can have a disease and be healthy (well-managed diabetic), have a disease and be unhealthy (late stage cancer), have no disease but be unhealthy (cannot sleep or eat well due to stress), or have no disease and be healthy.

Question 5

What is the main idea of the germ theory and who are the three key individuals involved in it?

Answer 5

The main idea of germ theory is that infections can come from germs so there must be sterilization methods for preventative measures.

Koch - Believed germs are present in those with disease and are absent in those without, germs can be isolated and cultured from those with disease, germs cause disease when introduced into a healthy host, and germs can be re-isolated from the newly diseased host.

Ignored the social context and potential genetic origins of many diseases.

Lister - Believed sepsis (infection) may be caused by pollen-like dust contaminating surgical wounds, anti-septic conditions like the application of carbolic acid should be used to prevent wound infections.

Caused surgical mortality to fall from 45% to 15% after intervention.

Pasteur - first postulated the germ theory of disease, discovered principles of microbial fermentation and sterilization, and described heat treatment methods for milk and wine (pasteurization).

Question 6

What are the genetic and lifestyle theories of disease?

Answer 6

Genetic - Linked to advantages in biology, shifting responsibility for disease to interplay between genetics and the environment. Genetic theories emphasize hereditary vulnerability and focus on the individual, rather than society.

Lifestyle- Behaviourally-driven by things like smoking, consuming alcohol, and eating fatty foods. Lifestyle theories emphasize individual behaviour change as the route to good health.

Question 7

What is multifactorial disease causation?

Answer 7

Multifactorial disease causation includes epigenetic‘s and environmental triggers. Epigenetics cover the idea of having a specific gene that raises your risk for disease. It is not completely deterministic. Environmental triggers are what cause the epigenetics but sometimes are not necessarily sufficient enough to cause disease.

Question 8

Explain wellness and well-being.

Answer 8

Wellness - The state of feeling well, not ill or sick.

Well-being - A broad concept that encompasses other areas of our lived experience. Examples include learning, financial security, social participation, work, leisure, housing, health, security, environment, and family life.

Question 9

What is a population? What is population health?

Answer 9

Populations are groups of individuals with a shared characteristic. They can be geographically or politically defined, but do not need to be.

Population health considers the health outcome of a group of individuals, including the distribution of such outcomes within the group. The field of population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two. The public health agency of Canada defines population health as an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups. They believe that the population health approach recognizes that health is a capacity or resource rather than a state. It is being able to pursue one’s goals, to acquire skills and education, and to grow.

Question 10

What is epidemiology?

Answer 10

Epidemiology provides important information to develop, implement, and evaluate approaches to prevent disease and improve quality of life in populations by studying distribution and determinants of disease in those populations.

Distribution - The focus of descriptive epidemiology that looks at how specific health outcomes are dispersed or patterned across a population. This is essential for developing hypotheses about the etiology of disease or other health problems and for planning health services.

Determinants - The focus of analytical epidemiology that looks at anything that influences the state of health in an individual or the distribution of health states in a population.

Question 11

What are the fundamental assumptions of disease?

Answer 11

1) Diseases do not distribute randomly in populations, but rather distribute in relation to the factors that determine health for the individuals in that population.

2) Factors that determine health status can be identified by studying distributions of health outcomes in populations.

Question 12

What are determinants of health?

Answer 12

Determinants of health are the range of personal, social, economic, and environmental factors which determine the health status of individuals or populations.

Question 13

Explain the Dahlgren and Whitehead model of determinants.

Answer 13

The Dahlgren and Whitehead model of the main determinants group factors to reveal over arching layers of influences on health.

Age, sex, and constitutional factors:

The factors closest to an individual are related to personal and biological features. These include age, sex, or genetic make up which can contribute directly to our susceptibility to diseases.

Individual lifestyle factors:

Factors associated with an individuals health practices and behaviours which are important but may not always be associated with an individuals freedom to choose, and can be influenced by larger factors at family, community, or more broad levels. These can include dietary and movement practices.

Social and community networks:

The extent to which people receive social support from peers, family, or other people in their community. Stronger levels of support are associated with better health outcomes. Being able to express one’s culture is also extremely important.

Living and working conditions:

Critical determinants of health which include education systems, work environment, housing, healthcare services, food, water, and sanitation services.

General socieconomic, cultural, and environmental conditions:

More broad conditions that influence health in direct and indirect ways. These include climate change, poverty, or affluence and how that supports it’s larger social and government system.

Question 14

What are social determinants of health?

Answer 14

Social determinants of health refer to social and economic factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. The social determinants of health refer to specific features of social and societal conditions that affect health, and how these can be altered by informed action. These circumstances are shaped by money, power, and resources.

Question 15

What are physical determinants of health?

Answer 15

Physical determinants of health refer to those factors in the physical environment which affect health risk and outcomes. These include air quality, water quality, soil contamination, occupational hazards, motor vehicle usage, and housing.

Question 16

What are examples of social and physical determinants of health?

Answer 16

Psychosocial factors - Knowledge, attitudes, belief, and ideas.

Biological factors - Genetic changes.

Environmental factors - Violence and genocide.

Health policy effects - Depending on the policies in place, there may be different accesses to healthcare.

Individual behaviours - Smoking and alcohol usage.

Question 17

Define root, underlying, and proximal determinants of health.

Answer 17

Root - broad factors in our natural environment, macro environment, and population level inequalities which seem distant to the diseased individuals themselves.

Underlying - factors in the middle of route and proximal causes which are aspects of our built environment and social context which influences health from a medium range.

Proximal - factors that are closer to an individual such as personal health behaviors, or whether a person is exposed to proximal factors like chemicals.

Question 18

Discuss risk factors of health.

Answer 18

The term risk factor is used when referring to health determinants that have been linked, by evidence, to specific health outcomes such that we can make a statement about level of risk they are associated with.

Intrinsic - Non-modifiable and biological characteristics

Disease-related - existing diseases that act as a risk for other diseases

Behavioural - Personal behaviours or lifestyle choices

Physical environment- exposure to contaminants or a lack of access to services

Social environment - interpersonal relationships and community networks

Some risk factors are more common than others and are associated with a more increased risk of mortality. These include high blood pressure, smoking, air pollution, high blood sugar, and obesity.

As populations experience economic growth, health risks transition from traditional to modern groupings which can be shown on a risk transition graph.

Question 19

What are health statics indicators?

Answer 19

Health status indicators are a specific way to measure and understand Health status in order to address key global health issues. The use of health status indicators are critical for three distinct reasons:

1) to determine the causes of illness, disability and death

2) to carry out disease surveillance

3) to make comparisons about health within and across countries

These typically include life expectancy at birth, neonatal mortality rate, infant mortality rate, under five mortality rate, and maternal mortality rate.

Question 20

How is population health measured?

Answer 20

Population health is often measured with vital statistics that collect data about mortality. The most common population health indicator is under five mortality. Although a blunt measure of health, death is an important aspect to consider but does not recognize suffering, disease burden, disability, or morbidity.

Question 21

Define health disparities/inequalities.

Answer 21

Health disparities refers to a type of difference in health that is closely linked with social or economic disadvantage. Common patterns of health disparities typically emerge within and across populations due to income and variation in health indicators.

Health inequalities involve how resources are shared equally amongst individuals, considering the differences in health that are not only unnecessary and avoidable but are also unfair and unjust.

Question 22

Define health inequity.

Answer 22

Health inequities are a form of inequality which can be understood as distinct according to the WHO definition which states that health and equities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work, and age.

Question 23

What is the difference between health equity and equality?

Answer 23

Equity: fair shares

Equality: equal shares

Question 24

What is a critical scholar?

Answer 24

A person who challenges aspects of existing structures that others accept without question.

Question 25

What should a critical scholar question when reading information?

Answer 25

Any Information: 1) How do we know this to be true? 2) Are there other ways to understand this? 3) Whose knowledge is this? 4) How do I judge the quality of the evidence in support of this knowledge? Health Information: 1) What definition are the authors using for health? 2) Are they considering a broad or narrow definition of health? 3) Is their definition grounded in a particular cultural understanding? Health Data: 1) What health indicators* are the authors using?

Question 26

Define the different health indicators.

Answer 26

Infant Mortality: The number of deaths of infants under the age of 1 per 1000 live births in a given year. Life Expectancy: The average number of years a newborn baby would be expected to live if the current mortality trends remained. Maternal Mortality: The number of women who die as a result of complications due to pregnancy and childbirth per 100,000 live births. Neonatal Mortality: The number of deaths of infants under 28 days of age in a given year per 1000 live births in that same year. Under-5 Mortality: The probability that a newborn infant will die before reaching the age of 5, expressed as a number per 1000 live births.

Question 27

Discuss life expectancy as a health indicator.

Answer 27

Life expectancy at birth is a narrow health indicator at a population level as it is only about the length of a person’s life and not the quality. However, it is a comparable statistic across geographies and this is why it is used. Life expectancy at birth across various regions as varies and is largely linked to levels of health development.

Question 28

Discuss under-5 mortality as a health indicator.

Answer 28

Under-5 mortality rate is another example of a key health indicator where the "per 1000 live births" is about comparability rather than specificity. This allows you to compare values across different regions with vastly different overall numbers of deaths by bringing values to a similar scale.

Question 29

Why can mortality statistics be flawed?

Answer 29

Health data is based on the assumption that vital statistics, the records of births and deaths, are taken everywhere. However, this is not always the case.

Question 30

What are the two categories of methodologies of collecting health evidence?

Answer 30

Quantitative: the process of collecting and analyzing data that is mainly expressed as numbers. This type of research consists of close-ended questions and allows you to test hypotheses. Qualitative: the process of collecting and analyzing data that is mainly expressed as words or images. This type of research consists of open-ended questions and enables you to explore ideas in-depth.

Question 31

What is critical appraisal?

Answer 31

Critical appraisal is the process of carefully and systematically assessing the outcome of scientific research to judge its trustworthiness, value, and relevance in a particular context. There are structured approaches to critically appraising all different types of studies as it is important to assess the quality of any evidence and knowledge base.

Question 32

What are environmental determinants of health?

Answer 32

Geography: include global location, country, region within a country, and urban/rural location. Natural Environment: encompasses air, water, soil, trees, and green space. It includes both biotic factors and abiotic factors. Built Environment: refers to housing, community structures, and things like roadways and other transportation structures you might be exposed to in your lives. Food Systems: include factors related to food sources, food distribution, levels of food security or insecurity, as well as concepts such as food deserts. Macro-Environmental Factors: political, economic, and national factors. This includes governance structures, climate change, war and conflict zones, and natural disasters.

Question 33

What is environmental health?

Answer 33

The natural environment is life’s foundational support system. Environment can be best understood as the space, objects, people, and nature that surround any living organism. Environmental Health: comprises those aspects of human health, including quality of life, that are determined by physical, chemical, biological, social, and psychosocial factors in the environment.

Question 34

What are environmental health burdens?

Answer 34

* Poor sanitation and lack of clean water * Air pollution * Inadequate housing/shelter * Changing land use and climate * Pollution and exposure to toxics There is a significant burden of disease associated with environmental factors. Environmental-associated diseases make up 8.4% of total burden of disease in low and middle income countries - Indoor Smoke: 3.7% - Unsafe Water/Sanitation: 3.2% - Urban Air Pollution: 1.5%

Question 35

What are the consequences of environmental health problems?

Answer 35

Unfortunately, there are consequences of physical environmental health problems that are not shared equally across a population. * A disproportionate burden lower SES status * A negative effect on economic productivity * A higher risk for young children

Question 36

What are air pollutants?

Answer 36

Ultra fine airborne pollutants in the atmosphere are a result of the smoke and fumes emitted through human activities. Due to their small size, these particles can easily enter and irritate children’s lungs, cross the blood-brain barrier to affect cognitive development, and cross the placenta affecting fetal development. Outdoor Air Pollution: worse in lower income urban communities. Outdoor air pollution includes environmental pollutants and industrial waste. Indoor Air Pollution: worse in lower income rural communities. Indoor air pollutants include solid biomass fuels used for heating and cooking

Question 37

What are the major urban air pollutants?

Answer 37

The air quality in urban centres and cities is indicated by certain air pollutants. Particulate Matter: block and inflame nasal and bronchial passages (

Question 38

What are the health risks of burning solid fuels indoors?

Answer 38

Burning solid fuels indoors creates many health risks the disproportionately impact women and children. * Incomplete combustion, leaving breathable particles, gases, and chemicals. * Smoke that can result in conjunctivitis, upper respiratory irritation, and acute respiratory infections. * Carbon monoxide, which can cause acute poisoning * Cardiovascular disease, pulmonary disease, cancer, and adverse reproductive outcomes. Issues in Birth: miscarriages, early delivery, and low birth weight. Child Mortality: 10% of mortality of children under 5 years old. Brain Development: harms development of healthy children’s brains.

Question 39

Discuss air pollution exposure and health inequities.

Answer 39

Certain populations remain at higher risk of air pollution than other populations. Urban Populations: increased exposure to industrial sites, smoldering dumps, and electrical generators. Rural Populations: increased exposure to unventilated homes and smoke-producing cook stoves. Refugees and Migrant Families: increased exposure to tents filled with wood smoke and lack of adequate housing, heating systems, and healthcare while in migration or resettlement.

Question 40

What factor exacerbate air pollution health inequities?

Answer 40

Lack of Access to Healthcare: makes children from low SES at even greater risk for adverse health effects caused by exposure to air pollution. Climate Change: air pollution contributes to greenhouse gas production and threatens economic livelihoods.

Question 41

What are the causes and consequences of unsafe water?

Answer 41

Causes: * Pollution, contamination, and toxic exposure * Inadequate sanitation and waste disposal * Poor hygiene practices Consequences: * Diarrheal illnesses such as gastroenteritis and cholera * Vector-borne diseases such as malaria, dengue and schistosomiasis

Question 42

What are water-related infections?

Answer 42

Water- Borne: transmitted through the ingestion of water (cholera). Water- Washed: result from poor personal hygiene due to an inadequate supply of clean water (HepA). Water-Based: transmitted through an aquatic intermediate host (Guinea worm). Water-Related Insect Vector: transmitted by insects that depend on water to reproduce (malaria or dengue).

Question 43

What was the plan for First Nations groups to get clean water?

Answer 43

The government will ensure that First Nation leaders have access to the tools and resources they need to deliver clean water to their residents.

Question 44

Discuss the water crisis in Kitigan Zibi Anishinabeg.

Answer 44

Kitigan Zibi Anishinabeg is situated about 130 kilometres north of Gatineau/Ottawa, adjacent to the town of Maniwaki. The municipal system of this community draws water from surface water, and has had issues with treating water to acceptable drinking water standards. The remaining residents are on individual wells and have been on a drinking water advisory since 1999 because of an unacceptable level of uranium in the groundwater. Kitigan Zibi Anishinabeg is one of 32 First Nation communities across Canada with drinking water advisories in September 2021.

Question 45

What global region has the most individuals lacking access to clean water?

Answer 45

East Asia and the Pacific

Question 46

What is the built environment?

Answer 46

The built environment refers to the infrastructure that makes up and includes housing, community structures, and transportation structures. Even within a single city or town, people’s exposures in this area can vary greatly.

Question 47

What aspects of housing can impact health?

Answer 47

Internal Housing Conditions: include biological, chemical, and physical hazards (physical design). Area Characteristics: include social benefits and location. Housing Tenure: includes psychological benefits and financial dimensions.

Question 48

How do living spaces impact health?

Answer 48

Pollutants: outdoor air pollutants can have an impact on an individual’s health in both urban and rural settings. Building Materials: modern building and furnishing materials contain chemicals that can lead to short-term or long-term health outcomes. Mold/Bacteria: humidity can create mold and bacteria in bathrooms, leading to respiratory ailments such as asthma and allergic reactions. Cleaning Products: chemicals from cleaning products used in the kitchen release VOCs that can irritate the eyes, nose, and throat, causing difficulty breathing or nausea. Fumes: carbon monoxide fumes from attached garages can cause confusion, vomiting dizziness, weakness, headaches, and in concentrated doses can be lethal. Gases: radon seeping through foundation and cracks in the home can lead to lung cancer. Cigarettes: primary, secondary, and even tertiary smoke can lead to lung cancer and other respiratory illness, especially when smoked inside. Solvents: chemical fumes from paints and solvents release VOCs. Irritants: animal hair and dander can cause asthma attacks and allergic reactions. Fireplaces: combustion gases from fireplaces and wood burning stoves can trigger respiratory illnesses.

Question 49

What is residential segregation?

Answer 49

Residential segregation refers to the spatial separation of two or more social groups within a specified geographic area, such as a municipality, a county, or a metropolitan area. It shows the extent to which groups defined by racial, ethnic, or national origin live in different neighbourhoods and has been associated with many human health outcomes.

Question 50

Discuss homelessness.

Answer 50

Unsheltered Homelessness: individuals who, at some point in their life, have lived in a homeless shelter, on the street or in parks, in a makeshift shelter, or in an abandoned building. (2.6% male and 2.3% female) Hidden Homelessness: individuals who had to temporarily live with family or friends, or anywhere else, because they had nowhere else to live. (15% population)

Question 51

What factors contribute to core housing need?

Answer 51

Lack of Affordability: occurs when tenants pay more than 30% of their income on housing (76.1%). Lack of Suitability: occurs when tenants live in overcrowding conditions (4.3%). Lack of Adequacy: occurs when a tenant’s home lacks a full bathroom or requires significant repair (4.5%).

Question 52

How is life course perspective important when considering housing?

Answer 52

A life course perspective provides a reminder to consider determinants of health as they differ by different ages in a person’s life. Young children spend large proportion of their time at home, and housing plays an important role in child development. Children are more vulnerable to exposure to physical, chemical, and biological harms because of their specific behaviours, and the impacts might be more severe because of the lack of maturity.

Question 53

What aspects of a neighbourhood impact a person's health?

Answer 53

Physical Features: include air, water, and grocery stores. Availability of Healthy Environments: decent and secure housing, non-hazardous work, and safe play areas. Services Provided: education, transport, and health. Socio-Cultural Features: political, economic, ethnic, history, norms, values, crime, and support networks. Reputation of an Area: how neighbourhoods are perceived by insiders and outsiders and can affect investment, self-esteem & morale, and who moves in and out.

Question 54

Discuss food deserts.

Answer 54

Certain neighbourhoods are structured in a way that there is no easy access to healthy food sources, and in which unhealthy foods exist as the closest and easiest options for residents. This is often a very intentional tactic used by businesses.

Question 55

What is the macro-environment?

Answer 55

The macro-environment considers things such as a country’s governance structures, whether there is war or conflict, whether people have experienced natural disasters, and the ever present impacts of climate change.

Question 56

Discuss natural disasters and complex humanitarian emergencies.

Answer 56

Global health is significantly impacted by natural disasters and complex humanitarian emergencies. Natural Disasters: any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area. CHEs: characterized by extensive violence and loss of life, displacements of populations, widespread damage to societies and economies, and the need for large-scale, multi faceted humanitarian assistance.

Question 57

What affects the management of complex humanitarian emergencies?

Answer 57

* Population Migration * Corruption * Disruption of Supply Chains * Collapse of State or National Level Institutions * Breakdown of Law and Order

Question 58

Discuss climate change.

Answer 58

Climate change is the single biggest health threat facing humanity. Some of the most significant impacts of climate change include rising temperatures, more extreme weather, rising sea levels, and increasing CO2 levels. Though the extent of the impact is unknown, climate change will have a significant impact on global health as it affects food, air, water, vector-borne diseases, and drought. Whether people live in rural villages, big cities, or islands and coastal towns, their health is threatened by climate change.

Question 59

Which health issues are becoming more prevalent due to climate change?

Answer 59

* Lyme disease * Eco-anxiety * Symptoms of environmental allergies * Asthma exacerbation/respiratory issues

Question 60

How can you reduce environmental health risks?

Answer 60

Outdoor Air Pollution: minimizing automobile usage, adopting cleaner transportation options, using less energy and material goods, and avoiding the burning of garbage. Indoor air pollution: use of indoor stoves with efficient fuels and a reduction of chemical use in household products. Water: implementation of appropriate water systems and promotion of proper hand washing practices. Sanitation: implementing low-cost sanitation systems and encouraging lifestyle modifications to improve sanitation on an individual level. Housing: encouraging the construction of homes that are well suited to the climate of an area. This includes ensuring appropriate construction approaches and components, and avoiding the use of harmful chemicals in material goods or cleaning products. Climate: encouraging major reductions in greenhouse gas emissions through transition to clean energy sources and supporting changes in social norms towards a reduction in overconsumption of resources.

Question 61

How does governance impact health?

Answer 61

A country's political system has a direct relationship to the availability, number, and type of services that are available. The health system, resource allocation, taxation, benefits, and pensions are all examples. People’s physical, mental, and emotional health can be affected in countries where freedom of movement or expression are limited, or where specific members of the population are not given equal freedoms or opportunities. In regards to the connection between governance and health, democracy plays a very pertinent role. Overall it is more likely for health rates to be more negative if a country does not have a free democracy

Question 62

How does war impact health?

Answer 62

War can be defined as a state of armed conflict between different nations or states. Living in a place that is undergoing war directly impacts physical health as well as mental and emotional health. Security of a person is at the base of Maslow’s hierarchy of needs and is a basic human right. People who experience trauma associated with war, can have immediate, medium-term, and long-term health impacts. PTSD is one type of negative health impact. In addition, people can also face increased risks of conditions such as heart disease, heart attack, high blood pressure and stroke, sleep problems, weight gain, and memory and concentration impairment due to the long-term impact of stress.

Question 63

What are social determinants of health?

Answer 63

Broadly, the SDOH are social factors that influence health outcomes. SDOH are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. SDOH account for between 30-55 per cent of health outcomes. * Social relationships and supports * Social norms * Social policies * Societal features * Political and economic systems * Income and social protection * Early childhood development * Education * Working life conditions * Access to health services

Question 64

What are lifestyle factors?

Answer 64

Lifestyle factors are the changeable ways of life and habits that have a serious impact on human health. They refer to the behaviours, actions, and lifestyle choices that individuals make that affect their health. It is true that lifestyle factors are connected to individual choice but it is imperative to understand that SDOH can have immense influence on the choices that people have and make. From a lifestyle perspective: * Don’t smoke * Follow a balanced diet * Keep physically active * Manage stress by making time to relax * Drink alcohol in moderation * Cover up in the sun * Practice safer sex * Take up cancer screening opportunities * Be safe on the roads * Learn the First Aid ABCs (Airway, Breathing, Circulation/Compression)

Question 65

What is culture?

Answer 65

Culture is a shared set of beliefs, ideas, values, and behaviours. Culture forms the basis of a group’s identity, as members of a cultural group will typically share a common ideology and cosmology. Culture can also be described as an ideology linked to behaviour. It is transmitted across generations and through cohorts. It is malleable, dynamic, and responsive to external stimuli.

Question 66

What is ethnicity?

Answer 66

Ethnicity is related to culture, but is not an identical concept as individuals with the same ethnicity may have different cultures.

Question 67

Does culture have to engage active cognition?

Answer 67

Culture does not have to engage the active cognition of people in order for it to have an influence on their lives. Marriage rites, funeral rites, and food habits are all cultural elements which are often embodied through indirect learning. People may be aware of this, but they don't have to be.

Question 68

How does culture impact health?

Answer 68

Culture is closely related to an individual’s health behaviours for a few main reasons. For instance, malaria is so prevalent in some parts of Africa that the disease is part of the cultural context and may be viewed as normal by some families. * Nutrition and eating practices * Gender roles and activities * Tobacco or alcohol use * Social and sexual relationships and practices * Hygiene practices * Marriage rites * Funeral practices Negatively Impacting Health: * Food preferences - undercooked meats/fishes and unpasteurized milk * Settlement patterns - increase risk for the spread of infectious diseases * Historical racism/Structural violence between cultural groups Positively Impacting Health: * Sardinian Inverse Transhumance - cattle grazing patterns that were adaptive to avoid peak malaria mosquito concentrations * Vietnamese Stilt Houses - built to prop the house above the mosquito flight ceiling to protect people against malaria

Question 69

Discuss social connectedness.

Answer 69

Social connection is conveyed through feelings of inclusion and support felt between people in relationships and communities. Stronger social connections are associated with better physical and mental health outcomes. Perception of Health: people with a strong sense of community belonging were more likely to report very good or excellent general and mental health. Health Behaviours: people with higher levels of social connectedness reported healthier lifestyle behaviours like walking more, eating healthier, or engaging in more moderate amounts of screen time. Health Improvements: declines in health were associated with low levels of community belonging. Those who felt their health declined over the course of a year were less likely to report a sense of community belonging.

Question 70

What is SES and socioeconomic position?

Answer 70

Socioeconomic Status: an individual's/group's position within a hierarchical social structure. Socioeconomic Position: the social and economic factors that influence what positions individuals or groups hold within society.

Question 71

How is SES measured?

Answer 71

Individual Indicators: a person’s level of education, their annual income or family income, and their occupation. Area-Level Indicators: the proportion of a population with at least a high school level education, the proportion of a population working in manual labour positions, or the average family income in a specific census subdivision. Childhood: * Parental education and occupation * Household income * Household conditions Young Adulthood: * Education Professional Life: * Occupational social class * Unemployment * Income * Wealth, deprivation * Household conditions * Partner’s SES * Assets transfer when starting a family Retirement: * Wealth, deprivation * Household conditions * Assets transfer occurring at death

Question 72

How does SES relate to health?

Answer 72

SES: income levels have been directly associated with other aspects of individual identity such as gender and race. SES is measured and conceptualized via a number of indicators including education, occupation, income as well as subjective SES level, and also disparities in SES levels across communities. Pathways: SES is largely connected to health outcomes via two pathways; the environmental resources and constraints that allow access to material senses, and psychological pathways that affect how people see themselves and their abilities, experiences, extent of control, and health compared to others. Outcomes: intermediate variables affect access to quality and effective medical care, exposures to pathogens and environmental carcinogens, health-related behaviours, and the responses to stress. These all are connected to health outcomes associated with physical and cognitive functioning, disease onset, or mortality.

Question 73

What are the different ways to explain when SES matters?

Answer 73

There are critical periods in a person’s life when socio-economic influences can make even more impact than others. When considering the life course, there are three basic ways to think about SES influences, and these happen simultaneously. Critical Period Explanation: notes that early life influences during sensitive periods of brain development influence later life outcomes. Pathway Explanation: notes that early experiences can set individuals on different health trajectories. Cumulative Explanation: notes that day to day exposures to adversity may build to cause adverse health outcomes over time.

Question 74

How does childhood SES impact health?

Answer 74

The extent that lower SES adversely impacts neuroplasticity will dictate the extent that allostatic control systems become impaired later in life.

Question 75

Discuss ACEs.

Answer 75

Adverse childhood experiences and adverse community environments are known as “the pair of ACEs”. People who grow up with “the pair of ACEs” are much more likely to face negative health outcomes and/or premature death. Adverse Childhood Experiences: * experiencing violence, abuse, or neglect * witnessing violence in the home or community * having a family member die by suicide Adverse Community Environments: refers to situations where social supports are not available and safety might not be assured.

Question 76

How is income a SDoH?

Answer 76

Income is one of the many indicators often considered as part of SES, but it is a key social determinant of health in its own right. SDOH Associated With Income: * Educational achievement * Housing * Access to clean water, sanitation, and hygiene * Access to health services * Safer work environments

Question 77

How does living location impact health?

Answer 77

Location is connected to longevity because where a person lives impacts the choices, opportunities, and resources they have available to them.

Question 78

Discuss education as a SDoH.

Answer 78

Education is an indicator that measures the capture of knowledge and is linked to an individual’s literacy, capacities, and potential assets. Education level is an important health determining factor on its own. Higher levels of educational achievement are associated with improved health outcomes across the globe and this has intergenerational effects. Education sometimes refers to the individual’s parents and other times the educational attainment of the individual themselves. Education attainment is a very good indicator in many populations because there is less memory bias than other indicators, it is not affected by current health status, and it may be relatively easily defined, remembered, and accurately recalled.

Question 79

Discuss occupation as a SDoH.

Answer 79

Information about an individual’s occupation may capture aspects of their lives including class, labour exposures, experience of employment, stress levels, and levels of social value. Weaknesses of Occupation as a Social Indicator: * There are gender patterns in many jobs. * Occupational measures don’t always capture unemployed or retired persons, persons in transient jobs, or students. * Occupational realities may differ between societies and there may be quite a bit of variation within any one occupation.

Question 80

What causes health inequalities?

Answer 80

Levels of Power and Resources: different access to resources, power, and influence affects the degree of personal control over one's life. Levels of Exposure to Health Hazards: poor housing or working conditions that are unsafe. Impacts of Health Hazards: even when everyone is exposed to the same health risks, their health may not be affected in the same way. Impacts of Being Sick: illness and chronic disease can have a more serious impact for some groups in society. Experiences in Early Childhood: disadvantage early in a person’s life can accumulate and lead to poor health in adulthood.

Question 81

Discuss the social staircase.

Answer 81

Bottom: individuals at the bottom often have lower quality of food, less education, insufficient housing, and very little power over their circumstances. People on the lowest step also have double the chance of dying prematurely or having a serious illness than those on the highest step. Middle: individuals at the middle will have sufficient resources and power over their circumstances. People on the middle step are still more likely to have a shorter life span and be less healthy compared to those on the top step. Top: individuals at the top step have higher quality food, greater access to education, good housing, and power over their circumstances. People on the top step are generally healthier than everyone else and tend to live longer.

Question 82

What are the populations that face inequities?

Answer 82

* Priority * Marginalized * Vulnerable * Hard/difficult to reach * Targeted * Disadvantaged * Under-served * Who would benefit most from intervention * Disenfranchised * Disempowered * Underprivileged * At-risk * High-risk * Equity seeking/equity deserving

Question 83

What are three areas for addressing SDoH?

Answer 83

Improve daily living conditions: change the circumstances in which people are born, grow, live, work and age. Policy and Resources: tackle inequitable distribution of power, money, and resources through economic policies and better governance. Problem Solving and Action: measure and understand the problem to expand the knowledge base, develop a workforce that is trained in understanding SDOH, and raise public awareness about SDOH.

Question 84

What are aspects of identity?

Answer 84

Many aspects of identity are related to physical attributes or how a person looks. There are also aspects related to things like the languages, accents, the kinds of food you eat, or the family events and traditions you participate in.

Question 85

What is the relationship between identity and health?

Answer 85

Some of the features of identity have direct associations with specific health outcomes, such as the fact that Marfan Syndrome is more common among tall, lean people. However, many of the pathways between identity factors and health have to do less with genetic or biological aspects and more with individual experiences.

Question 86

What factors associate with privilege?

Answer 86

* Sexual orientation * Class/Socioeconomic status (SES) * Geographic region * Religion * Gender identity * Employment * Physical ability * Physical appearance * Handedness * Language * Nation of origin * Ethnicity * Families' relation to education, money, housing and neighbourhoods * Families' languages of origin

Question 87

What are health behaviour factors associated with privilege?

Answer 87

* Smoker or non-smoker * Substance use practices * Current body mass index * Exercise behaviours * Diet behaviours * Sleep behaviours * Current stress management practices * Participation in healthy leisure/activities * Active involvement in your community

Question 88

What is oppression?

Answer 88

Oppression is a mixture of institutional power and prejudice that manifests and creates disadvantages for specific groups. It is reinforced by individual beliefs, interpersonal interactions, institutional biases, and societal norms. Societal/Cultural: * Ideas about what is “right” Institutional: * Legal system * Education system * Public policy * Hiring practices * Media images Interpersonal: * Actions * Behaviours * Language Individual: * Feelings * Beliefs * Values

Question 89

What is race?

Answer 89

Race is a social construct and conceptual categorization based on physical characteristics of people in groups. Some of these physical characteristics can include skin colour, hair colour, hair texture, and facial and bodily features. Humans as a species share 99.9% of their DNA with each other and it is now widely accepted that race is socially constructed, and not biologically based. Facts Regarding Racial Categories: * There is greater genetic variability within racial categories than across racial groups. * There are changing conceptions of racial identity over time and location * Racial categorization was used to enforce power differentials between groups.

Question 90

What is racism?

Answer 90

Racism is the false belief in the superiority of one group of people over another based on race. Effects: * Unfairly disadvantages some individuals. * Unfairly advantages other individuals. * Saps strength of society by wasting resources. Personally-mediated/Interpersonal: intentional or unintentional racial prejudice and discrimination between one individual and another through commission or omission that is condoned by societal norms. Internalized: one's intrinsic value and talents are accepted by members of the stigmatized racial group about themselves. They don't believe in themselves or those who look like them. It entails accepting restrictions on one's own full humanity, aspirations, ability to make decisions, and capacity for self-expression. Institutionalized: fixed into organizational or societal structures including rules, regulations, laws, and norms. It is expressed through discriminatory situations and practices in a multitude of institutional domains including education, political representation, criminal justice, housing, employment, and healthcare. Institutionalized racism influences the distribution of resources.

Question 91

What is the difference between prejudice and descrimintation?

Answer 91

Prejudice: differential assumptions about the abilities, motives, and intentions of others according to their race. Discrimination: differential actions toward others according to their race.

Question 92

What is racial equity and inequity?

Answer 92

Racial Equity: just and fair inclusion into a society in which all people can participate, prosper, and reach their full potential. Racial Inequity: can result from any forms of racism but especially structural racism that is embedded in historical, political, cultural, social, and economic systems and institutions. Racial inequity produces adverse outcomes for Black, Indigenous, and People of Colour in areas such as health, wealth, career, education, infrastructure, and civic participation

Question 93

What is white supremacy?

Answer 93

White supremacy is a system that assumes the practices of whiteness are the right way of organizing human life. It is the presumed superiority of white racial identities.

Question 94

What is anti-Indigenous racism?

Answer 94

A specific and targeted form of racism that originates from settler colonialism. It is the permanent occupation of a territory and removal of Indigenous peoples with the express purpose of building an ethnically distinct national community. Anti-Indigenous racism includes a history of assimilation, cultural genocide, and myths of Canada as a place of immigrant and settler founding.

Question 95

What is anti-black racism?

Answer 95

Anti-Black racism is a specific and targeted form of racism towards Black people. Anti-Black racism includes legacies of colonialism, immigration, forced settlements, a history of slavery in Canada, and common practices and particular laws that result in an absence of opportunities and outcomes for Black people.

Question 96

What is the pathway to racial inequity?

Answer 96

Unjust differences in health outcomes and opportunities to be healthy exist between socially derived racial groups. This roots from causes associated with colonial and racist ideologies, stereotypes, prejudice, and experiences of racial discrimination. Colonial and Racist Ideology: white supremacy, settler colonialism, and structural racism Stereotypes Based on Race: negative, exaggerated beliefs reinforced by oppressive power relations. Prejudice: thinking based on stereotypes, reinforced by oppressive power relations. Racial Discrimination: action or inaction made possible implicitly or explicitly by oppressive power relations. Racial Health Inequity: inequitable social or health outcomes and experiences.

Question 97

What is racial segregation?

Answer 97

Racial segregation is a specific example of how racism can affect people’s environments and health. It is the physical separation of races by enforced residence in different areas. Segregation was imposed by legislation, and supported by economic institutions and the ideology of white supremacy. * Access to quality education and employment * Challenging to adhere to good health * Poverty and wealth * Access to necessary social infrastructure * Exposure to environmental toxins * Access to quality health care

Question 98

What is redlining?

Answer 98

Redlining is one example of structural racism. This is the practice of discriminating in the approval of loan or insurance applications.

Question 99

Why are health outcomes different between black and white people?

Answer 99

Differential health outcomes by racial groups are due to diverse socioeconomic influences, differential exposures and environments in childhood, and experiences of racism which influence health in the short and long-term. There are also differential exposures to health promoting environments and supports across the lifespan for people of different groups.

Question 100

How does race influence health outcomes?

Answer 100

Components of Race: race is a fixed measure, although it is context-specific and can change over time. Experiences of racism are context and time specific, associated with a multitude of cultural, social, economical and political realms. These factors influence stress levels, health practices and resources. Health Effects: biological processes are impacted and cause healthy or unhealthy states of physical and mental health.

Question 101

What is racialization?

Answer 101

Racialization is the process by which racial or ethnic identities are assigned to groups of people who could be perceived as socially different.It may be based on skin colour, origin, religion, language, or other characteristics and can lead to marginalization of the group from society.

Question 102

How does racialization increase health disparities?

Answer 102

* Less use of preventive health care. * Lower use of mental health services. * Less appropriate care of diabetes and cardiovascular disease risk factors.

Question 103

What does discrimination cause?

Answer 103

* Subclinical carotid artery disease * Coronary artery calcification * Accelerating aging * Higher consumption of alcohol * Higher levels of psychological stress * High levels of depressive symptoms * Low birth weight

Question 104

How do racial disparities cause very preterm births?

Answer 104

VPT is defined as birth before 32 weeks of gestation. VPT birth is an example of racial disparity in health outcomes. The association between racial disparities and VPT birth can be attributed to multiple different causal factors. Traditional Conceptual Framework: one’s race influences preterm births, which is mediated through SES, behaviours, and genetics (not adequately represented by this framework). Alternative Conceptual Framework: represents the complexities of VPT birth more adequately by suggesting that three primary proximate biologic pathways mediate the racial disparity in VPT birth: uteroplacental vascular dysfunction, placental and maternal HPA dysfunction, and maternal-fetal inflammation.

Question 105

What do anti-racist actions include?

Answer 105

* Individual transformation * Organizational change * Community change * Movement-building * Anti-discrimination legislation, and * Racial equity policies in health, social, legal, economic, and political institutions

Question 106

What are the impacts of decolonial practice?

Answer 106

* Makes Indigenous self-determination and resurgence a priority * Provides Indigenous peoples with the tools to understand how racism distorts interactions with each other and acts on opportunities for solidarity * Questions settler privilege * Equips white people to act against structural racism and settler colonialism * Analyzes the ways in which anti-racism can reinforce colonial and racist practices

Question 107

What does achieving racial equity mean?

Answer 107

Achieving racial equity means that opportunities and outcomes for health and well-being are no longer assigned based on race. The impact of anti-racism is measured by the extent to which the material and symbolic well-being of racialized peoples is improved.

Question 108

What are the types of migrants?

Answer 108

“Migrant” is a term that applies to an individual who leaves home and moves from one place to another. Immigrant: a person who has settled permanently in another country. Refugee: a person who has fled their own country because they are at risk of serious human rights violations and persecution. The risks to their safety and life were so great that they felt they had no choice but to leave and seek safety outside their country. Asylum Seeker: a person who has left their country and is seeking protection from persecution and serious human rights violations in another country, but who hasn’t yet been legally recognized as a refugee and is waiting to receive a decision on their asylum claim.

Question 109

Discuss the health of migrants.

Answer 109

The well-being of people in situations of migration has many determinants. These relate to the different phases of migration including the pre-migration, movement, arrival, integration, and return phases. Individuals also have other aspects of their identity that intersect with migration status and affect health. Pre-Migration Phase: * “Pre-migratory events and trauma * Epidemiological profile compared to the destination * Linguistic, cultural, and geographic proximity to destination Movement Phase: * Travel conditions for irregular migration flows * Duration of journey * Traumatic events, such as abuse * Single or mass movement Arrival and Integration Phase: * Separation from family/ partner * Discrimination and social exclusion * Abuse and exploitation * Legal status * Language and cultural values * Duration of stay Return Phase: * Level of home community services * Remaining community ties * Duration of absence * Behavioural and health profile as acquired in host community

Question 110

What are challenges that migrants have?

Answer 110

Health Services: migrants many not have the ability to maintain health records or monitoring of existing conditions. Finances: financial challenges make accessing health or other services that require payment difficult. Living and Working Conditions: poor living and working conditions are other potential health challenges for migrants. Migration of Healthcare Workers: health worker migration can leave whole communities and regions with a need for trained personnel and thus a gap in services available.

Question 111

What is the healthy immigrant effect?

Answer 111

When immigrants arrive to Canada they are, on average, in better health than their Canadian born counterparts but that the health of immigrants and non-immigrants equalizes over time.

Question 112

What are Indigenous Peoples?

Answer 112

Indigenous Peoples are those who inhabited a country or region prior to the arrival of later settlers and immigrants. There are about 5000-6000 different Indigenous groups in 70 countries.

Question 113

What is the nomenclature for Indigenous groups?

Answer 113

In Canada it is common practice to refer to First Nations, Inuit, and Métis as the three broad groups of Indigenous Peoples, each with unique histories, languages, cultures, and spiritual beliefs. Amendments were made in 1982 to section 35 of the Canadian Constitution formally recognizing Indigenous Peoples in Canada as: * First Nations * Treaty Indians * Non-treaty Indians * Inuit * Métis

Question 114

What is the Indian Act?

Answer 114

The Royal Proclamation decreed that the British government had the right to negotiate treaties and purchase lands previously occupied by Indigenous Peoples. The Indian Act was introduced in 1876 and revised in 1951. It created a paternalistic wardship system, created reserves, and created the Treaty System. It also legally defined who was and was not an “Indian” according to the Canadian government. The Indian Act was an important part of colonization.

Question 115

What is colonization?

Answer 115

Colonization is the process of establishing a colony or group of settlers in a new land or territory, whether previously inhabited or not, during which the settlers are both partially or fully subject to and accountable to their mother country of origin. It can also be described as the policy or practice of acquiring full or partial political control over another country, occupying it with settlers, and exploiting it economically.

Question 116

What was medicine central to colonial enterprise?

Answer 116

The field of medicine played a major role in colonization and thus ideas of colonial medicine and colonization have been persistent and pervasive. * An altruistic desire to spread the benefits of western medicine. * The sense that western medicine is needed in communities elsewhere. * The desire to keep colonial settlements healthy. * The desire to keep the local workforce in colonial areas healthy. The federal government in Canada established Indian Hospitals for the treatment of First Nations and Inuit peoples in the 20th century. These hospitals lacked Indigenous medicines, midwives, and holistic approaches to illness and treatment.

Question 117

What did colonization bring?

Answer 117

Canadian colonization started around 1535, bring diseases such as smallpox, measles, and tuberculosis, which were unknown in Indigenous populations. Another major aspect associated with European contact was the creation of the residential school system, which began around 300 years post-contact.

Question 118

Discuss the residential school system.

Answer 118

A major part of colonization in the 1800s and 1900s was the residential school system which functioned from 1880 to 1996, and was compulsory for all Indigenous children from 1884 to 1948. Starting in 1880, Indigenous children were removed from their homes and families and sent to residential schools that were run by Christian churches, operating in partnership with the Canadian government. Aims: to remove and isolate children from the influence of their home, families, traditions, and cultures, and to assimilate into the dominant culture, converting children to Christianity and European culture. Here, native language and culture was suppressed in an intentional process of forced assimilation and many children died, were abused, neglected, and/or forced to stay at school. In May of 2021, 215 unmarked graves were found in Kamloops B.C. At least 4,100 students died while attending residential schools across Canada.

Question 119

What were the impacts of colonization?

Answer 119

Overall, the social, spiritual, physical, and mental health of Indigenous Peoples has been negatively impacted by colonization that resulted in systemic marginalization and disempowerment. Impacts: * Multiple Forms of Violence * Loss of Livelihoods and Ways of Life * Loss of Culture and Language * Land Appropriation * Negative Health Impacts * Oppression * Structural Anti-Indigenous Racism The specific colonial history of any particular Indigenous group has unique aspects that should not be generalized.

Question 120

What health concerns are related to colonization?

Answer 120

Changes to Traditional Lifestyle and Diet: * CVD including heart attack and stroke * obesity * diabetes Poverty and Poor Living Conditions: * TB * exposures to toxins * injuries * diseases of contaminated water Trauma, Social Exclusion, and Injustice: * substance abuse * family violence * mental health concerns * suicide Food Insecurity/Sovereignty: Indigenous groups face higher rates of food insecurity than the non Indigenous population, and are unable to eat culture meals.

Question 121

How do you break the cycle for negative outcomes of Indigenous people?

Answer 121

Breaking the cycle includes addressing stereotypes, discrimination, poor access and poor outcomes, and building structures for Indigenous self-determination, Indigenous systems for knowledge and practices, anti-racism, and cultural safety. Colonialism: systems of oppression and a set of intentionally created beliefs about the inferiority of Indigenous Peoples. Healthcare System: built on colonialism, with a history of segregation, racism, and discrimination. Stereotypes: beliefs that Indigenous patients are less “worthy” of care, are alcoholics, are irresponsible, and/or are unfairly advantaged. Discrimination: Indigenous Peoples may experience harm, poorer quality of care, and even death. Discrimination can include abusive interactions, denial of service, and/or a lack of respect for cultural protocols. Less Access: unwelcoming environments, geographic barriers, and a mistrust of providers. Poor Outcomes: health care made worse by racism negatively impacts the health and wellbeing of Indigenous Peoples. Break the Cycle: involves self-determination and Indigenous leadership, cultural safety, active anti-racism, and advocacy for Indigenous rights in health care. This will lead to Indigenous systems, knowledge, practices, and substantive equality to reach positive health outcomes.

Question 122

What are the key DoH for Indigenous people?

Answer 122

* Financial Security/Insecurity * Housing Conditions * Water Safety * Food Security/Insecurity * Experiences of Discrimination and Injustice * Loss/Strength of Language, Culture, and Heritage * Connection to the Land * Self-Determination * Level of Access to Services

Question 123

Discuss the web of being.

Answer 123

Social determinants for Indigenous Peoples’ health can be mapped using the Web of Being. Distal Determinants: include self-determination, language, culture and heritage, land resources, racism, poverty, dislocation, residential schools, and social exclusion. Intermediate Determinants: include health systems, location, education systems, early childhood, environmental stewardship, justice, social services, racism and social exclusion, community infrastructure, and cultural ways. Proximal Determinants: include employment, income, social support networks, personal access to the land, food security, education, and gender. This also includes lifestyle behaviours such as diet or smoking status, as well as the physical environment including housing and access to services.

Question 124

Are DoH the same across all Indigenous communities?

Answer 124

Métis, First Nations, and Inuit have many similar but some unique DOH. The differences in DOH across groups can be attributed to the unique experiences of colonization and discrimination depending on the specific group as well as their geography and culture. For example, some Inuit were subjected to forced relocation to the high Arctic as part of the Canadian government’s desire to assert ownership in these regions, or were encouraged to settle in specific areas, while the Métis were often denied physical spaces for their communities. Remote Communities: rely more heavily on hunting, fishing, and foraging and can be affected more significantly by food insecurity and high imported food costs. They may have limited opportunities for higher education or various occupations within the community. Housing quality and quantity may also be limited. Reserve Communities: conditions of public services are lower quality or limited. Space for housing and community development is often limited. But in a positive sense, there is often formal governance that can help advocate for community needs. Urban Communities: there may only be certain cultural, social, and language supports available within their urban setting. They may have differing access to traditional food or land, that may otherwise be more accessible in remote or reserve communities. In a positive sense, there exist more opportunities for diverse educational or occupational experiences.

Question 125

Discuss self-determination for indigenous people.

Answer 125

Self–determination is the key DOH for Indigenous Peoples. Self-determination and autonomy have been denied or taken away from Indigenous Peoples as part of colonization. Ongoing discrimination and oppression can also restrict self-determination. “Lack of control over important dimensions of living in itself contributes to ill health. Indigenous Peoples want to exercise their own judgment and understanding about what makes them healthy, their own skills in solving health and social problems.”

Question 126

What is reconciliation?

Answer 126

Reconciliation is the ongoing process between Indigenous Peoples and non-Indigenous Peoples where a mutually respectful framework for living together and producing holistically healthy, sustainable, and strong Indigenous nations within a strong Canada is strived for. 2008: a formal apology from the federal government was issued for the residential school system. 2015: the Truth and Reconciliation Commission report was released. 2016: the Indigenous population has been growing in number, and on average, is much younger than the overall Canadian population. Many efforts toward truth, reconciliation, and revitalization support Indigenous communities across Canada. 2019: the government launched an investigation into the deaths and disappearances of murdered or missing Indigenous women and girls 2021: there was documentation of thousands of unmarked graves of Indigenous children at former residential school sites across Canada.

Question 127

What are the guidance tools for health researchers who work with Indigenous peoples?

Answer 127

* Truth and Reconciliation Commission Calls to Action * United Nations Declaration on the Rights of Indigenous Peoples * Community-Specific Protocols * Ownership, Control, Access & Possession Principles * Tri-Council Policy Statement (Chapter 9)

Question 128

What is the Truth and Reconciliation Commission report?

Answer 128

Between the years 2008 and 2014, the Truth and Reconciliation Commission heard stories from thousands of residential school survivors across Canada and released a report based on what was learned. The report states that the Indigenous policies of the past 100 years were “cultural genocide”. Within the report, 94 Calls to Action provide instruction to guide governments and communities on the road to reconciliation.

Question 129

What is UNDRIP?

Answer 129

UNDRIP is the United Nations Declaration on the Rights of Indigenous Peoples report; a human rights instrument that can be used as a guide to set and compare standards for the survival, dignity, and wellbeing of Indigenous Peoples. The UNDRIP was assumed by the UN General Assembly in 2007, despite the fact that efforts to create policies dealing with the protection of Indigenous Peoples have been ongoing for several decades. The UNDRIP focuses on the rights of Indigenous Peoples to live with self-worth; to sustain and fortify their own institutions, cultures, and traditions; and to continue working on their self-determined development, in conjunction with their own needs and desires. A significant number of the rights in the Declaration require advanced and improved approaches to global issues, such as decentralization, development, and multicultural democracy. Accomplishing total respect for diversity will require countries to take on participatory approaches to Indigenous issues, which will need efficacious consultations and the building and fostering of partnerships with Indigenous Peoples.

Question 130

What are specific ways the interact with the Indigenous community?

Answer 130

Engaging respectfully with Indigenous Elders and communities is an important part of reconciliation. There are specific ways to engage and interact with Indigenous Elders and communities and these can vary by specific group and geography. Interacting with Indigenous Elders: the exchange of tobacco, when asking an Elder to share traditional knowledge or to engage in some aspect of ceremony. Interacting with Indigenous Communities: to ask a community to participate in an event or project, an advisory group must review a request and have the project led by members of the community.

Question 131

What are the OCAP principles?

Answer 131

The OCAP principles of ownership, control, access, and possession are sanctioned by the First Nations Information Governance Committee. They outline stewardship principles that require First Nation ownership of, control of, access to, and possession of its own knowledge including data or any information collected about or with Indigenous communities.

Question 132

What is the Tri-council policy statement?

Answer 132

The Tri-Council Policy Statement - Ethical Conduct for Research Involving Humans has a chapter that specifically outlines basic principles for engaging in research with Indigenous communities. Chapter 9 states that when proposing research involving Indigenous participants, researchers should advise their research ethics board on how they have appropriately engaged, or intend to engage with, the relevant Indigenous community.

Question 133

What are sex and gender?

Answer 133

Sex: a set of biological attributes in humans and animals, including physical and physiological features like chromosomes, gene expression, hormone levels and function, and reproductive anatomy. Sex has often been described in the binary terms of women and men. Gender: a social construct and refers to the identities, roles, behaviours, and expressions of girls, women, boys, men, and gender diverse people. Gender influences how individuals view themselves and one another, as well as how they behave and interact. From a societal perspective, gender is also associated with how power and resources are distributed.

Question 134

What is the gender binary?

Answer 134

The gender binary is defined as the categorization of gender into two separate forms of masculine and feminine, by cultural beliefs, societal norms, or both. However, it does not consider the real diversity of sex and gender identities because it does not include intersex people whose biological characteristics do not fit into the binary medical categories of male or female. It also does not consider non-binary, genderqueer or gender non-conforming identities. The gender binary system that has been the normative conceptualization within many western societies in the past is not a universal concept.

Question 135

Discuss gender identity.

Answer 135

Gender identity is the profound and personal feeling of being male or female, neither, or both. This feeling usually appears very early in childhood. Gender Identity and Sex: gender identity is personal and people identify in many different ways. The majority of people are cisgender, but some people have gender identities that do not match the sex to which they were assigned at birth. Non-binary, genderqueer or gender non-conforming people feel that they belong to a gender outside of the categories of men and women and as such, do not identify with these categories. Gender Identity Continuum: gender identity exists on a continuum and can change over time; it is not limited to a binary. * Cisgender * Transgender * Genderfluid * Genderqueer * Gender non-binary * Gender non-conforming * Two-Spirit Gender Identity and Sexual Orientation: distinct concepts as a person can identify as a woman, for example, and have a sexual preference for women, men, neither, or both.

Question 136

Discuss gender expression.

Answer 136

Gender expression is the manner in which individuals express and present their gender via their conduct or behaviour, their actions, their style and clothing choices, and how these expressions are understood by other people, according to gender norms and traditions. There is no association between sexual orientation, gender identity, gender expression, and biological characteristics.

Question 137

What are gender roles?

Answer 137

Gender roles are the “behavioural norms typically applied to males and females in societies, that influence individuals’ everyday actions, expectations, and experiences, for example, how we dress or talk, what we aspire to do and what we feel are valuable contributions to make as a woman or a man”. Health and Well-Being: norms and social expectations of proper roles for men and women, have shown to have an impact on general health and well-being. Social Institutions: family, culture, media, education, the law, and political and religious institutions that have standards, values, and representations of masculinity and femininity can make it harder for both men and women to fulfill or take on particular duties and obligations since they do not fit the established standard, leading to increased strain and stress. Attitudes and Behaviours: gender roles influence attitudes and behaviours in many areas including relationships, parenting, schooling, work, and health practices. Gender roles can also create economic and cultural pressures that differentially affect the health of people of different genders. Different Exposures: norms and values around gendered work roles, the division of paid and unpaid labour, and the occupations of people of different gender identities can result in different exposures and vulnerabilities. These, result in varying health needs, behaviours, and outcomes.

Question 138

What are gender relations?

Answer 138

Gender relations describe how people interact with or are treated by people in the world around them, based on their ascribed gender.

Question 139

What is institutionalized gender?

Answer 139

Institutionalized gender refers to ways in which social institutions frame gender experiences, roles, and relationships

Question 140

Discuss gender as a cultural concept.

Answer 140

Gender is a cultural concept, and views of it are not universal. For example, numerous Indigenous communities recognize a third or more genders within their societies. “Two-Spirit” is a term used within some Indigenous communities, and it encompasses cultural, spiritual, sexual and gender identity. There is a long history of sexual and gender diversity in Indigenous cultures and Two-Spirited people have often held revered roles such as healers and counsellors Hijra of Bangladesh: individuals that predominantly reside within the Indian subcontinent. This group is officially recognized as a third gender, neither female or male. Many Hijra live in organized all-Hijra communities, led by a guru. Kathoey of Thailand: an identity used by individuals in Thailand, whose identities in English can be best described as ‘transgender women’ or ‘traditionally female presenting gay men’. Many Thai people perceive Kathoey as belonging to a separate sex, this includes some transgender women.

Question 141

What is transgender?

Answer 141

Transgender people are those whose psychological self differs from the social expectations for the physical sex which they were assigned at birth. Transgender is not a sexual orientation; transgender people may have any sexual orientation. It is important to acknowledge that while some people may fit under this definition of transgender, they may not identify as such. Being discriminated against, and being the target of hate, violence, and exclusion are common experiences for many transgender people. Self-Esteem: low self-esteem Depression: 60% clinically depressed. Suicide: 32% attempting suicide associated with depression, low self-esteem, forced sex, drug and alcohol treatment, and gender-based discrimination. Health Needs: difficulty addressing their trans health needs with health care professionals who are under-prepared and inadequately trained.

Question 142

What is non-binary?

Answer 142

The term “non-binary” refers to someone who does not identify within the traditional gender binary. This means that their gender identity is neither man/woman nor boy/girl. Furthermore, there are many different terms that are used to describe someone not identifying within the traditional gender binary. For the first time in 2021, the Canadian Census included a question on gender and the precision of "at birth" on the sex question, which allowed for all cisgender, transgender, and non-binary individuals to report their gender.

Question 143

What is sexuality?

Answer 143

Sexuality is defined as one’s own sexual feelings, thoughts, attractions, and behaviours towards other people. It includes the idea that individuals can find other people physically, sexually, and/or emotionally attractive.

Question 144

What does 2SLGBTQIA+ stand for?

Answer 144

2S - Two Spirit L - Lesbian G - Gay B - Bisexual T - Transgender Q - Queer or Questioning I - Intersex A - Asexual + - Members of other LGBTQIA+ communities and allies.

Question 145

Discuss sexuality and mental health.

Answer 145

Compared to the overall population, those who identify as 2SLGBTQIA+ may be more likely to experience sadness, anxiety, substance misuse, homelessness, self-harm, and suicidal thoughts. This is especially true for young people who identify with these components of their identity, who may also be enduring victimization and bullying at school as they come to terms with their sexuality. The majority of 2SLGBTQIA+ community members do not suffer from these negative outcomes Mental Stressors: * Feeling different from other people * Feeling unsupported or misunderstood * Feeling worried about coming out, and then being rejected or isolated * Feeling pressure to deny or change their sexuality or gender expression * Being bullied Being the victim or target of homophobia or sexuality-based discrimination can make it difficult to enjoy life fully. This kind of discrimination can affect sleep, appetite, concentration, and relationships.

Question 146

What are additional challenges facing the 2SLGBTQIA+ community?

Answer 146

Increased Vulnerability: stigmatization and discrimination can eventually result in a higher chance of anxiety, depression, and emotional suffering. Societal Pressure: people can feel coerced into aligning with societal norms and conventional ideas about being female or male. People who do not meet these normative expectations can be victims of physical abuse, intimidation, and ridicule. Discrimination: members of these communities continue to experience harassment, discrimination, prejudice, and violence at school, work, and within varying social situations.

Question 147

Discuss the differences in health by sex, gender, and sexuality.

Answer 147

Biological Factors: hormonal and genetic influences and experiences of going through gender transformative medical procedures can lead to differences in health by sex, gender, and sexuality. Social and Structural Factors: roles and expected norms of behaviour for different genders and sexual orientations in society may lead to differences in health. Social and structural factors include experiences of sexism, homophobia, transphobia and other forms of discrimination, as well as different levels of access to resources and services. Nutrition: girls are often fed less nutritious food than boys, leading to negative long-term effects. Gender-Based Violence and Sexual Abuse: women, girls, and non-binary people are more likely to experience gender-based violence and sexual abuse. Female Genital Mutilation: the surgical alteration of female genitals has affected more than 200 million women and girls alive today worldwide. Complications associated with FGM include shock, infection, hemorrhaging, long-term urinary retention, infertility, obstructed labour, and negative mental and emotional health. Sex-Selective Abortion or Infanticide: up to 1.2 million missing female births may be due to sex-selective abortion or infanticide.

Question 148

What are gender based health challenges?

Answer 148

Mental Health: * Depression is higher among women, girls, and people from sexual and gender diverse groups than among men and boys. Expected Gender Norms of Behaviour: * Women and girls are more likely to acquire respiratory diseases from cooking with poor ventilation. * Men and boys are more likely to experience motor vehicular-related injuries and mortality. There are at least 19 conditions that disproportionately and negatively affect women. Cisgendered women live longer than cisgendered men, but the poor health of women also impacts families and society because of the roles they have. Alzheimer’s Disease: more common cause of death for females than males. Iron Deficiency: higher rate of iron deficiency among females, which is related to menstruation and dietary iron deficiency.

Question 149

Discuss hypertension and sex.

Answer 149

There are some sex differences that are associated with different health outcomes, like hypertension. The prevalence of hypertension tends to decrease as income increases for women, whereas for men it tends to fluctuate as income changes, with no clear pattern. Hypertension increases after menopause in women as the protective effects of hormones are lost, while men experience higher blood pressure after adolescence. Men and women also respond differently to treatment for hypertension. Women are significantly less likely to have their blood pressure controlled.

Question 150

How does SES's impact on health vary by gender?

Answer 150

Men who experienced a drop in SES were four times more likely to develop poor mental health, including depression, than men who had improved their SES. Women have no apparent difference between those who experienced upward or downward changes in their SES.

Question 151

How does imigration's impact on health vary by gender?

Answer 151

Lower Rates of Depression: * Immigrant Men with Low Incomes * Immigrant Women with Middle/High Incomes Higher Rates of Depression: * Immigrant Men with Middle/High Incomes * Immigrant Women with Low Incomes

Question 152

What are risk factors of gender based violence?

Answer 152

Gender-based violence and sexual abuse are more common among women and people of diverse sex and gender groups. Common forms of abuse include physical violence, sexual violence, and mental and economic harm. Risk Factors: * Low SES * Young age of male partner * Gender inequality * Paternalistic cultural norms * Legal structures which act against overall sexual and gender diversity at a societal level

Question 153

Discuss violence against women.

Answer 153

* Societal sexism such as gender stereotypes. * Discriminatory laws and a lack of political participation or inclusion. * Healthcare services do not cover the needs of women. * Care work that they provide goes underpaid. * Direct physical, psychological, and sexualized violence and abuse.

Question 154

What is gender mainstreaming and sex and gender-based analysis?

Answer 154

Gender mainstreaming: a process of working towards systematic and consistent consideration of sex, gender, and sexuality in the development, implementation, and evaluation of studies, policies, and programs in the interest of advancing health equity. Sex and Gender-Based Analysis: a valuable tool for analyzing how sex, which is rooted in biology, and gender, which is rooted in social roles that are shaped by the environment and experiences, influence an individual’s health and well-being.

Question 155

What steps have already been taken to recognize gender and sexual diversity?

Answer 155

Canadian Census Modifications: modifications to the Canadian census in 2021 with respect to sexual and gender-based classifications. Human Rights Act and Criminal Code Amendments: in 2017, the Canadian government amended the Canadian Human Rights Act and the Canadian Criminal Code to protect individuals from discrimination and hate crimes based on gender identity and expression.

Question 156

What are the common mortality statistics?

Answer 156

Nearly half of child mortality is neonatal (45%) and rates are higher among equity deserving groups.

Question 157

What are the statistics of health inequities in Canada?

Answer 157

Time-Inappropriate Mammography: rural women are 1.32x more likely to have a time inappropriate mammography TB: 25x higher for Indigenous communities Diabetes: 3x higher for those on reserve or in Northern communities

Question 158

Discuss indicator statistics.

Answer 158

Life expectancy at birth: lower for Sub-Saharan Africa, South Asia, and North Africa Under-5 Mortality: higher for Sub-Saharan Africa, South Asia, and North Africa Vital Statistics: only 1/4 children in the poorest 20% of families have their births registered

Question 159

Who has the most deaths relating to air pollution?

Answer 159

Asia

Question 160

Discuss SDOH Statistics

Answer 160

Life Expectancy: 18 year difference between high and low income Premature Death: 15 million deaths in low-middle income countries Disease: relative gaps have increased Under-5 Mortality: 8x higher in Africa than Europe

Question 161

What are the statistics between race and health outcomes?

Answer 161

Diabetes: 2.1x higher for Black Active: 40.8% black and 54.2% white Alcohol/Smoking: black is lower than white

Question 162

What are the statistics of food insecurity among Indigenous populations?

Answer 162

Non-Indigenous: 11.1% Off-reserve: 28.2% On-reserve: 50.8%

Question 163

What are statistical mental health differences by gender?

Answer 163

Poor Mental Health: 65% transgender vs 11% cisgender Suicide Considerations: 45% transgender vs 16% cisgender Covid Mental Health: 21% male, 26% female, 68% non-binary