MHST 632: Key Learning, Reflection, and Moving Forward

Reflecting on the Health Promotion 1 Foundations course, my ePortfolio primarily showcases my chosen health promotion topic, detailing the disproportionally greater risk of cardiovascular disease for Indigenous women in Canada compared to non-Indigenous women (Jaffer et al., 2021). Initially, my chosen topic was broader (focusing on Canadian women compared to Canadian men). As I grew to understand the concepts of intersectionality, I narrowed my topic to focus on Indigenous women while acknowledging the intersectionality beyond sex, including characteristics such as Indigenous heritage and rural geographical location (Jaffer et al., 2021).

The Social Determinants of Indigenous Peoples’ Health (SDIPH) model (Loppie & Wien, 2022) was applied to understand the unique factors contributing to this health disparity. The SDIPH model is visualized as a tree with stem, core, and root determinants and is summarized in Figure 1. This model effectively depicts the social, economic, and political contexts resulting from colonization that have ultimately created the cardiovascular health inequality that Indigenous women in Canada experience.

Figure 1

Note: From “Understanding Indigenous Health Inequalities through a Social Determinants Model,” by C. Loppie and F. Wien, 2022, National Collaborating Centre for Indigenous Health. (Understanding Indigenous health inequalities through a social determinants modhttps://www.nccih.ca/Publications/Lists/Publications/Attachments/10373/Health_Inequalities_EN_Web_2022-04-26.pdfel)

In addition to the SDIPH model, I briefly explored the Indigenous Ecological Systems Model (IESM). The IESM is adapted from Bronfenbrenner’s ecological model (Bronfenbrenner, 1979 as cited in Fish et al., 2022) and includes Indigenous perspectives on the interconnection between Indigenous Peoples and the various ecological levels they interact with while considering the unique historical and cultural contexts of Indigenous Peoples (Fish & Syed, 2022). In contrast to Bronfenbrenner’s ecological model (where the most concentric circle is the individual, followed by the microsystem, mesosystem, exosystem, macrosystem, and chronosystem), the IESM illustrates bidirectional relationships between the systems starting with the chronosystem (i.e., historical trauma) followed by the macrosystem (i.e., cultural factors), the individual, the microsystem, the mesosystem and lastly, the exosystem (Fish & Syed, 2022). As with the SDIPH model, the IESM also emphasizes the importance of historical and cultural contexts when discussing Indigenous health and wellbeing.

As I continue on my health promotion learning journey with a focus on Indigenous women’s health, I recognize my weakness as an outsider to Indigenous culture. Sourcing Indigenous perspectives on health and well-being may be difficult but not as challenging as understanding another culture’s perspective. In an effort to engage in critical allyship (Nixon, 2019), it will be necessary that throughout my journey and going forward, I am reflexive in my thoughts and actions. This includes reflecting on my actions that support systems of inequality; learning from and working in solidarity with Indigenous Peoples, communities, researchers, and organizations; and bringing awareness to privileges while supporting and engaging in action with Indigenous Peoples (Nixon, 2019).

Lastly, in anticipation of this course, I look forward to discovering how to perform program evaluations, as I suspect this aspect is valuable in securing ongoing funding for health interventions. I am also keen to learn about power struggles and imbalances. If I plan on working with Indigenous communities in the future, I suspect it will be necessary to recognize power dynamics while focusing on partnerships and collaboration. Going forward, I recognize that this course will be challenging. However, I look forward to deepening my understanding of the complexities of health promotion.

References

Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Harvard University Press.

Fish, J., Hirsch, G., & Syed, M. (2022). “Walking in two worlds”: Toward an indigenist ecological systems model for group therapy. The Counseling Psychologist, 50(5), 622–648. https://doi.org/10.1177/00110000221083028

Jaffer, S., Foulds, H. J. A., Parry, M., Gonsalves, C. A., Pacheco, C., Clavel, M.-A., Mullen, K. A., Yip, C. Y. Y., Mulvagh, S. L., & Norris, C. M. (2021). The Canadian Women’s Heart Health Alliance ATLAS on the epidemiology, diagnosis, and management of cardiovascular disease in women—Chapter 2: Scope of the problem. CJC Open, 3(1), 1–11. https://doi.org/10.1016/j.cjco.2020.10.009

Loppie, C., & Wien, F. (2022). Understanding Indigenous health inequalities through a social determinants model. National Collaborating Centre for Indigenous Health. https://www.nccih.ca/Publications/Lists/Publications/Attachments/10373/Health_Inequalities_EN_Web_2022-04-26.pdf

Nixon, S. A. (2019). The coin model of privilege and critical allyship: implications for health. BMC Public Health, 19(1), N.PAG. https://doi.org/10.1186/s12889-019-7884-9