Residential Schools and the Destabilization of the Social Determinants of Health: An Introduction
By: Émilie Lebel
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.
This article is part of a series exploring how residential schools have destabilized the social determinants of Indigenous health. Each feature amplifies the voice of a knowledge keeper to examine the ongoing legacy of these institutions in communities today.
What does health even mean?
The formalized concept of health, as it is known today, was established in 1948 by the World Health Organization (WHO), which offered this definition: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Simply put, being healthy encompasses much more than not being sick. What’s more, health is larger than the physical body, and includes both the mental and social dimensions of an individual’s life. Because of the breadth of the definition, mainstream visions of health have become more holistic and begin to draw closer to those embraced by Indigenous Peoples in Canada. This broader view also allows for a more comprehensive grasp of the factors that influence health outcomes. Think of it as a two-way street: by acknowledging that health is physical, mental, and social, we may begin to accept that mental, physical, and social factors can all impact health.
The Social Determinants of Health
Health is determined by factors like genetics, age, and gender – but only in part.
It is also heavily influenced by social and economic circumstances. These categories are referred to as the “social determinants of health” or SDH. They encompass one’s living conditions, as well as the systems that impact our daily lives.
According to the WHO (2022), SDHs encompass:
1. Income and social protection
3. Unemployment and job insecurity
4. Working life conditions
5. Food insecurity
6. Housing, basic amenities and the environment
7. Early childhood development
8. Social inclusion and non-discrimination
9. Structural conflict; and
10. Access to affordable health services of decent quality
In other words, the SDH are non-medical conditions which affect the choices we make, shape our foreseeable health conditions, and determine their potential gravity. Each individual SDH is significant, but equally important is their cascading effect – meaning that one tends to lead to another. For example, individuals with low incomes may be forced to live in sub-standard housing with mold or pests, which in turn can influence respiratory or mental health.
Another example can be seen among the Inuit living in Nunavut. They have limited access to essential services in Inuktitut, which in turn leads to mis-diagnoses, worsened health prognosis, and even avoidable death (Kotierk in Greenwood, de Leeuw, Stout, Larstone, and Sutherland, 2022). In essence, the social determinants of health may be the most relevant factors to consider when examining health disparities as they account for 30 to 55% of the observed variance in health outcomes, according to the WHO’s latest data.
Essentially, the data shows us that socioeconomic forces can have a greater impact on our health than healthcare itself.
Health Inequality and Inequity
Health inequality refers to the unequal distribution of health determinants across various groups, and how these lead to differences in respective health statuses. For example, more remote communities often face limited access to care, which impacts the overall health trends of those populations. When it comes to inequality, the SDH can be understood as a roadmap for public health initiatives: they show how these key experiences tend to cascade in vulnerable populations and go on to influence the health of members of those communities.
In Canada, First Nations, Inuit, and Métis peoples are disproportionally more likely than the average Canadian to experience unsatisfactory health services, low educational attainment, poor and unstable income, food insecurity, poverty, poor basic amenities (e.g., housing), and discrimination. Consequently, Indigenous peoples by contrast to national averages have lower life expectancy; higher infant mortality; higher rates of chronic conditions such as arthritis, obesity, diabetes, and cancer; higher rates of communicable diseases such as HIV, tuberculosis and Hepatitis C; higher rates of suicide, drug overdoses; and lower self-reported mental health (Greenwood & al., 2022; Pan-Canadian Health Inequalities Reporting Initiative, 2018; Fayed, A King, M King, et al., 2018). These rates vary greatly among the many diverse First Nations, Inuit and Métis groups and communities, yet all fall short of what could be expected within the broader population of Canada.
Moreover, these health trends in Indigenous populations are more than unequal; they are also inequitable.
Health inequity means unfair and avoidable differences in health outcomes between different groups. In other words, certain groups face the systemic accumulation of detrimental experiences, which alters their health and quality of life. “This unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics.” (Commission on Social Determinants of Health, 2008)
“Poor Policies and Programs”: Residential Schools
According to the Pan-Canadian Health Inequalities Reporting Initiative (2018), “[t]he colonial structure, which sought to assimilate Indigenous peoples into the dominant Euro-Canadian culture, has been largely responsible for destabilizing the determinants of Indigenous health.”
One of these structures of assimilation is, of course, the residential school system. These schools, operational from 1831 to 1996, aimed to disrupt children’s ties to their families, culture, spirituality, and communities in a stated effort to “civilize Indians.” (Greenwood & al., 2022).
In his 1922 pamphlet, The Story of a National Crime, Dr. Peter H. Bryce denounced the poor conditions within the schools. He condemned their astounding incidence of tuberculosis and high mortality rates, which he attributed to these deplorable conditions. What’s more, these institutions systematically shaped the social determinants of Indigenous health. Indeed, “Indigenous Peoples’ health inequities are embedded in histories of dispossession from their homelands and the destruction of their social systems.” (Delormier et al., 2017 as cited in Greenwood et al, 2002)
These effects were profound and foundational to the health inequities observed today in First Nations, Métis, and Inuit communities. The next instalments in this series will delve further into some of these social determinants and the lived realities of three individuals rising from this destabilization.
Bryce, P. H. The Story of a National Crime: An Appeal for Justice to the Indians of Canada. Ottawa: James Hope and Sons, 1922.
Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health: Commission on Social Determinants of Health final report. Geneva, Switzerland: World Health Organization.
Greenwood, M., de Leeuw, S., Stout R., Larstone, R. & Sutherland, J., editors. Introduction to Determinants of First Nations, Inuit, and Métis Peoples’ Health in Canada. Toronto (ON): Canadian Scholars Press; 2022.
Pan-Canadian Health Inequalities Reporting Initiative. (2018). Key Health Inequalities in Canada; A National Portrait. Canada: Public Health Agency of Canada.
ST Fayed, A King, M King, et al. (2018). In the eyes of Indigenous people in Canada: exposing the underlying colonial etiology of hepatitis C and the imperative for trauma-informed care. Canadian Liver Journal 1.3. doi: 10.3138/canlivj.2018-0009.
The Truth and Reconciliation Commission of Canada (2015). Canada’s Residential Schools: The Legacy; The Final Report of the Truth and Reconciliation Commission of Canada, Volume 5. Montreal & Kingston: McGill-Queens University Press.
World Health Association (2022). Social determinants of health. Consulted on https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
Downie, G & Lemire, J. (N.D.). The Secret Path. https://www.secretpath.ca
Greenwood, M., de Leeuw, S., Stout R., Larstone, R. & Sutherland, J., editors. Introduction to Determinants of First Nations, Inuit, and Métis Peoples’ Health in Canada. Toronto (ON): Canadian Scholars Press; 2022. https://canadianscholars.ca/book/introduction-to-determinants-of-first-nations-inuit-and-metis-peoples-health-in-canada/
Jean, Michel. Tiohtiáke. Montréal: Libre Expression; 2021.
Maurice, Jacqueline Marie. The Lost Children : A Nation’s Shame. Professional Women Publishing; 2014.
Pan-Canadian Health Inequalities Reporting Initiative. (2018). Key Health Inequalities in Canada; A National Portrait. Canada: Public Health Agency of Canada. https://www.canada.ca/en/public-health/services/publications/science-research-data/key-health-inequalities-canada-national-portrait-executive-summary.html