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Reconceptualizing determinants of health: Barriers to improving the health status of First Nations peoples

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Abstract

Comparing the key determinants of health articulated by the Public Health Agency of Canada (the Agency) with the spiritual and cultural knowledge systems of First Nations peoples, as expressed by the Four Worlds International Institute for Human and Community Development (Four Worlds) and their 14 determinants of well-being and health, reveals differing philosophical perspectives. The key determinants of health can be interpreted as lacking a holistic and inclusive approach to public health services. As a result, many public health programs in Canada marginalize, ignore and suppress the needs of First Nations communities and people. Incorporating the Four Worlds guiding principles and its 14 health determinants model within the context of Canadian public health services geared towards First Nations populations provides the opportunity to develop a deeper understanding of social determinants of health. Therefore, when implementing public health initiatives to address the health status of First Nations people in Canada, it is important that the Agency incorporate the guiding principles of the Four Worlds: Development Comes from Within; No Vision, No Development; Individual and Community Transformations Must Go Hand in Hand; and Holistic Learning is the Key to Deep and Lasting Change. Reconceptualizing the key determinants of health to encompass the worldview expressed by the Four Worlds acknowledges the cultural wisdom of First Nations people and offers the potential to develop more inclusive public health services.

Résumé

Une comparaison entre les grands déterminants de la santé définis par l’Agence de la santé publique du Canada («l’Agence») et les systèmes de connaissances spirituelles et culturelles des Premiers Peuples, comme exprimés par l’organisme Four Worlds International Institute for Human and Community Development («Four Worlds»), et leurs 14 déterminants du bien-être et de la santé, révèle des perspectives philosophiques différentes. Les grands déterminants de la santé peuvent être interprétés comme étant insuffisamment inspirés par une approche holistique et inclusive en ce qui a trait aux services de santé publique. Par conséquent, de nombreux programmes de santé publique au Canada marginalisent, négligent et suppriment les besoins des communautés des Premières nations et de leurs membres. Dans le contexte des services de santé publique du Canada axés sur les populations des Premières Nations, intégrer les principes directeurs de Four Worlds et son modèle des 14 déterminants de la santé offre la possibilité d’approfondir notre compréhension des déterminants sociaux de la santé. En conséquence, lorsque l’Agence met en oeuvre des initiatives de santé publique pour améliorer l’état sanitaire des Premiers Peuples au Canada, il est important qu’elle intègre les principes directeurs de Four Worlds: «le développement vient de l’intérieur»; «pas de vision, pas de développement»; «les transformations individuelles et collectives doivent aller de pair»; et «l’apprentissage holistique est la clé d’un changement profond et durable». Repenser les grands déterminants de la santé pour qu’ils englobent la vision du monde exprimée par Four Worlds reconnaîtrait la sagesse culturelle des Premiers Peuples et offrirait la possibilité de mettre au point des services de santé publique plus inclusifs.

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Authors and Affiliations

  1. MERCURi Research Group, School of Public Health, University of Saskatchewan, Health Sciences Building, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada

    Robert Nesdole MEd, Debora Voigts MEd & Rein Lepnurm MHA, PhD

  2. College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada

    Rose Roberts BSn, PhD

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  1. Robert Nesdole MEd
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  2. Debora Voigts MEd
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  3. Rein Lepnurm MHA, PhD
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  4. Rose Roberts BSn, PhD
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Correspondence to Robert Nesdole MEd.

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Nesdole, R., Voigts, D., Lepnurm, R. et al. Reconceptualizing determinants of health: Barriers to improving the health status of First Nations peoples. Can J Public Health 105, e209–e213 (2014). https://doi.org/10.17269/cjph.105.4308

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