A Trickle Down without Treatment

When looking at the many factors determining the overall health of an individual it is important to understand and consider a multitude of contributing factors. Using the social ecological model of health highlighting these various determinants can help to illustrate how the Indigenous population living on remote reservations, as well as in larger cities face health inequality on every level. The social ecological model identifies five factors, which influence a person's risk for disease; these factors are individual, interpersonal, institutional, community and public policy (McDaniel, 2020).

Social Ecological Model

The individual level comprises biological, demographic, economic and behavioral factors. The interpersonal level of the social economical model are the formal or informal social networks such as the social support systems a person has available to them. Also included are a person's relationships with family, working groups and friends. Institutional factors are characterized by the availability of hospitals or health clinics in the area and other medical organizations within proximity to the individual. This includes physicians, nurses and other available health care practitioners working within those organizations. The next level to consider pertains to community factors which may impact the health of an individual. This includes such issues as whether an individual lives in an urban or rural area and if they are migratory workers. Other considerations include summer and winter temperatures and the elevation, forestation, and pollution of the specific geographical location (McDaniel, 2020). All of these determinants influence the health of individuals. The last level of influence this model describes public policy. This considers your local, provincial, national laws and regulations. All of which have influence on a person’s health and behaviours. Although this appears to be the furthest away from the individual, these policies affect every other level (McDaniel, 2020).

For example, when looking at the health of Canadian Indigenous people this model can be adapted to show how it translates to health. For this blog, I will look at one aspect of indigenous health, oral care, and how there are multiple levels of influence affecting it. Prior to working on remote northern reservations, this was not something I understood to be important. Not that oral care was not important but the lack of oral care in our norther communities which I have now come to realize is the result of a myriad of different things. An example of this would be the lack of consistent access to dentistry for these communities. Depending on the population, there may only be a dentist present for 5 days a month. Some lucky communities also get a dental hygienist for one to two weeks per month. Those select communities which have the providers then have to fly in distilled and clean water for all of the procedures due to the lack of clean drinking water. This is information, which I gained through my years of work and based on witnessed averages.

Individual

The individual level of this model, applies to the biological and personal characteristics of the Indigenous population by the way of their perception of risk. This is demonstrated in the way that this population believe oral disease and decay are inevitable and therefore do not consider themselves at risk (Grimm, 2018). As a result, they do not feel the need for corrective behavioral modification. There is also a deeply rooted cultural appreciation for holistic and natural medicine within this population (Grimm, 2018). The other key piece to this is the individual having clean water at their home to brush and clean their teeth with. As an example in a remote reserve in Ontario called Pikangikum, see image representing the community above, only 109 of the 500 homes have indoor plumbing. Those that have indoor plumbing and access to water remain on a boil water advisory (habitat.ca) Knowing and understanding this information will assist health care practitioners when trying to assist with teaching, understanding and modifying behaviours to promote better oral care and hygiene.

Interpersonal

Moving to the interpersonal level of this model it is important to consider the behaviours that are modeled by the persons parents or grandparents. The elders in the Indigenous community have profound influence on the younger generation (Grimm, 2018). As mentioned previously the perception is that oral disease is expected combined with the lack of the basic hygiene necessity of clean water does not set the new generation up for success. Therefore, we could assume, these healthy oral care behaviours are not being modeled in the home or within the family unit without a great deal of effort. Health care practitioners would be wise to consider an education initiative at this community level. The habitat for humanity group has been helping the community with programs building cisterns since 2018 and thus should improve the uptake of education and oral hygiene practices moving forward (Habitat.ca). Gathering with the elders to discuss the importance and share the knowledge and necessary skills would be of great benefit. By empowering the most valued influential members of the community the knowledge will be shared with the younger generations and better accepted than it would coming from persons outside the community(Grimm, 2018) .

Institutional and Community

Continuing through this model we are brought to the institutional and community levels. In the province of Ontario, the northern most communities have only one nursing station. This station is tasked with providing healthcare to the community it serves (CTV News, 2020). I have personally worked in over 15 of these stations with just one of them having road access. Some have a dental office within the station and others have a space where, when the dentist is coming, the equipment is brought out and sectioned off by room dividers. Further to this lack of infrastructure is the lack of rapport built between practitioner and client as the dentists that go into the community are often different each time. For a population where there is evidence to show oral care is a much-needed resource it would be beneficial to support a policy that provides continuity of care for this service. The leadership within the community also have influence over the social norms and values. Providing education and tools to the community leaders could further influence the behaviours of the people there (Grimm, 2018). Though the education seems simple, as there are many resources required to teach and promote proper oral hygiene. The one link that continues to be key in bringing this change is that of clean water with which to brush teeth and clean.

Public Policy

The need for clean drinking water on our northern reserves leads to public policy. Our prime minister had made a promise that by 2021 all boil water advisories will be eradicated. However, at this time there are still 22 drinking water advisories in effect on first nations reserves (CTV News, 2020). There is much arguing currently within the government between policy makers and the indigenous representation. This lack of clean water appears to derail all teaching, education and work occurring at the other levels in the model, for it is a fundamental part to having good oral care. The work needed to plan, promote, fund and implement process for clean drinking water in all these communities needs to be done in collaboration between the policy makers and the indigenous leaders (CTV News, 2020). Using oral care as the example here provides a small glimpse into the overall bigger picture affecting the health of our indigenous people. The issue is lack of clean drinking water. Unfortunately, many persons in Canada are unaware this problem exists within our own country.

References

CTV News. (2020, December 2). Feds break promise to eliminate all drinking water advisories in 2021, vow work will continue. Retrieved from www.ctvnews.ca.

Grimm, S. (2018). Ecological model of Health: Understanding the Increased Risk of Oral Disease in Aboriginal Populations in Canada. Retrieved from wordpress.com: www.shandelgrimm.wordpress.com

Habitat.ca. (2018, June 21). Clean drinking water in Pikangikum. Retrieved from www.habitat.ca

McDaniel, J. T. (2020). Emergency room visits for chronic obstructive pulmonary disease in Illinois counties: An epidemiological study based on the Social Ecological Model. chronic illness, 69-82.