Cite

Concluding Thoughts: Understanding and Dismantling

By: Émilie Lebel

Émilie Lebel

Contributing Writer

Émilie is an emerging freelance writer specialising in health and social justice. Her knowledge base includes an Honours Bachelor of Health Sciences & Psychology (uOttawa, 2013), a Master of Health Sciences in Occupational Therapy (uOttawa, 2015), and a certificate in Concurrent Disorders (University of Toronto & CAMH, 2022) along with years of experience in community mental health and acquired brain injuries.  Emilie is passionate about effective positive social change – which she works to spark through education and meaningful discourse.

As an occupational therapist, I witness every day the impacts of the social determinants of health on those around me. Some cases have resonated profoundly and stayed with me, anchoring my true understanding.

One such experience took place in 2015, in the last months of my training. I was given the opportunity to have a placement at Mamisarvik Healing Centre, a branch of Tungasuvvingat Inuit, in Ottawa. At the time, the centre provided a culturally safe eight-week program for Inuit adults living with trauma and/or substance misuse. I took part in the daily programming, listened, learned…and was dumbfounded.

The extent of my ignorance astounded me. How could this be my first encounter with the residential school system, the Sixties Scoop, or events such as the slaughter of the dogs – where RCMP officers killed Inuit sled dogs? This, I realized, stemmed from growing up as a white, non-Indigenous person whose education whitewashed Canada’s treatment of First Nations, Métis and Inuit peoples. Truth be told, the history lessons I followed through elementary school in Quebec then high school in Ontario painted a much more balanced – rosy, even – view of the colonisation of Canada. I knew better than to believe this version of events and, for a long time, I thought that was enough; but it wasn’t. My skepticism was not a substitute for knowledge. It still involved looking the other way.

Along with the shock, these teachings were made more powerful by the individuals who shared their stories and exposed the ongoing struggles caused by these events.

One by one, participants detailed the countless ways in which their lives, their families, and their communities continued to be affected by these policies.

Yes, this is our history. But it still defines lives now.

Past Policies, Current Relevance

Health is heavily influenced by social and economic circumstances, known as the social determinants of health, which, in turn, are impacted by systemic forces and political decisions.

Understanding SDHs helps clarify the likely repercussions of systems and policies. For instance, cutting funds to schools in vulnerable neighbourhoods – or to programs such as free breakfast – does not support childhood development and feeds the cycle of struggle for families. Or, policies that enable poor working conditions may place workers at higher risk of accidents, chronic stress, and persistent fatigue – not to mention the lack of support following injuries or disease onset.

This series examined how government policies, such as the residential school system and the Sixties Scoop, have directly resulted in the systemic destabilization of the social determinants of health for Indigenous people and Indigenous communities. As the final report of the Truth and Reconciliation Commission states, “[h]ealth disparities of such magnitude have social roots.” Learning about this insidious process and its reverberations – for example, listening to knowledge holders such as Chantal Batt, Dr. Jaqueline Marie Maurice, and Selina Legge – is essential to comprehending why things are as they are today.

As the TRC’s final report stated, “[m]any students were permanently damaged by residential schools. Separated from their parents, they grew up knowing neither respect nor affection. A school system that mocked and suppressed their families’ cultures and traditions destroyed their sense of self-worth. Poorly trained teachers working with an irrelevant curriculum left students feeling branded as failures. Children who had been bullied and abused carried a burden of shame and anger for the rest of their lives. Overwhelmed by this legacy, many succumbed to despair and depression. Countless lives were lost to alcohol and drugs. Families were destroyed, children were displaced by the child welfare system.”

As a result, notes the Pan-Canadian Health Inequalities Reporting Initiative (2018), “[c]ompared with non-Indigenous people, First Nations, Inuit, and Métis populations experienced inequalities across most health outcome and health determinant indicators. These health inequalities reflect a history of colonialization, forced assimilation, and disrupted relationships with traditional lands that has led to increased poverty, precarious, and underemployment; barriers to social and economic development; and discrimination within housing, education, and health care sectors.” This destabilization has led to chronically higher rates of homelessness, poverty, ill-health, addiction, and family breakdown.  In fact, explains Dr Maurice, the systemic barriers experienced within healthcare, education, and child services “make it next to impossible to succeed even if you have that potential.”

“I understand now, when I pass the Indigenous people on the streets,” Legge says. “I know why they’re there. There’s a lot of people still left in the streets, in the systems, in the prisons (…) with their addictions and their traumas.”

Intergenerational & Historical Trauma

The inequity observed today appears to be more than the sum of its parts. Indeed, the ramifications are greater than what could be predicted by looking only at the traditional social determinants of health. Researchers Loppie Reading and Wien concluded in 2009 that “[t]his unexplained residual, as it is called, suggests there must be ‘something else’ out there that contributes to unequal health outcomes for Aboriginal people, something that has not yet been identified or satisfactorily measured.” Loppie Reading and Wien argue that it is necessary to look beyond traditional SDHs to truly capture reality: “[This unexplained residual] lends some indirect support for the notion that the effects of historical trauma (e.g., lack of self-determination) may indeed be a determinant of health for Aboriginal populations.”

Recent research by Mutuyimana and Maercker (2023), proposes this definition: “[h]istorical trauma is psychological and emotional injuries shared collectively across generations resulting from past collective traumatic experiences or events, manifesting in perceived discrimination and oppression, learned mistrust, exhaustion and feelings of humiliation, cultural-related syndromes and historical thoughts of loss, associated with various clinical psychological disorders and risk behaviours within a group that share a similar social, historical, and political backgrounds.” Similar to intergenerational trauma, historical trauma is broader and includes non-clinical consequences of trauma, such as cultural loss, in addition to its clinical consequences (e.g., disorders). Though it is yet to be accurately captured or measured, its grip on Indigenous peoples is indisputable.

Consequently, as we aim to support wellness and reduce the health impacts of harmful policies, we must be trauma informed. In their textbook on the determinants of First Nations, Inuit, and Métis Peoples’ health in Canada, Greenwood, de Leeuw, Stout, Larstone and Sutherland explain that “[f]or Indigenous people to experience cultural safety in healthcare, practitioners must recognize that ‘trauma is a public health issue that impacts every health care service system in Canada.’ Trauma- and violence-informed care understands, identifies, and responds to the effects of trauma. It minimizes the risk of re-traumatizing patients and contributes to support and healing.” To be sure, without accounting for the effects of trauma, efforts to support healing will fall short of their intended outcome.

Confronting Inequities

“It’s surprising that Canada doesn’t own up to its history,” reflects Batt, “but this is new history. People didn’t necessarily know that residential schools existed on the fringe of communities.”

Now there is increased knowledge of these schools and their impact on current lives. So, we must gather momentum and progress to the next step: own up to this history by confronting its legacy of inequities. As per the TRC’s 19^th call to action: “[w]e call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess long-term trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services.”

The Commission on Social Determinants of Health (2008) states that “[w]here systematic differences in health are judged to be avoidable by reasonable action they are, quite simply, unfair…Putting right these inequities – the huge and remediable differences in health between and within countries – is a matter of social justice.”

The SDHs guide us to where such ‘reasonable action’ may have the strongest effects on corrosive health and social problems.  By restructuring and investing in SDHs such as education, social protection, childhood development, social inclusion, and access to culturally appropriate services, we may begin to redress these imbalances and seek justice.

And importantly, we must undertake this process using the lens of historical trauma, and understanding why things are as they are, how we got here, and what else is needed. As the TRC’s final report states, “[w]e must learn from the failure of the schools to ensure that the mistakes of the past are not repeated in the future.”