Section 3 - Includes both lecture content and content from readings. PDF

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Summary

Race, Culture, and HealthCulture Is a shared concept  Is socially constructed  Is embedded in everyday life  Is expressed with and interacts with related dimensions  Has been historically Eurocentric  Is an aspect of CHN care that requires us to recognize our assumptions and act on themCultura...

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Community – Section 3 Content

Race, Culture, and Health Culture      

Is a shared concept Is socially constructed Is embedded in everyday life Is expressed with and interacts with related dimensions Has been historically Eurocentric Is an aspect of CHN care that requires us to recognize our assumptions and act on them

Cultural Diversity in Canada     

Canada is one of the most diverse nations in the world This diversity challenges dominant societal notions of culture Media perpetuates discrimination Cultural discrimination  socioeconomic discrimination Health of new immigrants decreases on entry to Canada

Cycle of Oppression

Cultural Safety   

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Cultural safety is on a continuum Self-reflection is key for cultural humility We are all bearers of culture

Community – Section 3 Content

Racism and White Settler Privilege in Nursing 

A critical look at: o Education o Research o Practice o Leadership

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Who is teaching? Whose ideas are being taught? Who is dominant and who is discriminated against? Whose theories are predominant? What issues are researched? Who are the decision-makers? Who influences care, and the profession?

Anti-Oppression, Anti-Racism and CHNs

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Culture (like racism) is socially constructed, shared, embedded in everyday life, individually focused and historically Eurocentric Canada is one of the most diverse countries in the world – this is both a great strength and great risk “White Settler Privilege” in nursing perpetuates racism

Community – Section 3 Content

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By being aware of sensitive to and reflective about culture (ours and others) CHNs can move toward cultural competency so that our clients experience cultural safety CHN practice with a cultural lens involves seeing, understanding and mapping, then confronting oppression and privilege in order to change it Indigenous Health

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Indigenous people (First Nations, Metis and Inuit) 1.4 million – 4.3% of Canadian population Due to historical factors, colonization and residential schools, which caused multigenerational trauma, many Indigenous people have adverse situations in relation to the social determinants of health which impact their health negatively. Challenges include income, education, physical environment, employment, food insecurity, health services, unhealthy coping behaviours

Indigenous Peoples are Diverse (Algonquin or Anishina* or Anishna* or Athapaskan or Athabaskan or Atikamekweet or Blackfoot or Cayuga or Chipewyan or Cree or Dene or Dakelh or Dunne-za or Gitskan or Gitsxan or Gwich* or Haida or Haisla or Haudenosaunee or Heiltsuk or Huron or Iroquois or Kaska or Ktunaxa or Kwakwaka* or Malis or Mikmaq or Micmac or Mohawk or Nakoda or Nipissing or Nisga* or Nlaka* or Nuu chah nulth or Nuxalk or Ojibw* or OjiCree or Okanagan or Oneida or Onondaga or Oweenkeno or Passamaquoddy or Potawatomi or Salish or Sec wepmc or Seneca or Six Nations or Saulteaux or Sekani or Stlatlimc or Tagish or Tahltan or Tasttine or Tlingit or Tsilhqot* or Tsimshian or Tsuu* or Tuscarora or Tutchone or Wakashan or Wetsuweten or Wyandot).ab,ti. Summary   

Colonization, assimilation and loss of culture has had a major impact on the health of Indigenous people Truth and Reconciliation Commission has changed the way CHNs work with Indigenous people Cultural safety approach is key to CHN practices, as are the Integration of Traditional Knowledge in Indigenous healing Rural and Remote Health

Rural and Remote Characteristics   

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What is the difference between “rural” and “remote” for you? Definitions of rural and remote are contested Stats Can o “individuals in towns or municipalities outside the commuting zone of larger urban centres” o = reliance on obesogenic foods o Countered by increased reliance on hunting and fishing

CHNs in Rural and Remote Communities Pros    

Primary health care More independent Wider roles, e.g. multitasking generalist Interprofessional working is important (via telehealth)

Cons   

Less educated Lower RN:Patient ratio Not always equipped for advocacy / community development role

Summary     

Rural and remote communities differ from urban ones, and from each other SDOH are linked directly to each community’s geography, economy and populations Access to care, technology, nutritious food and clean water are health inequities commonly experienced by rural/remote populations Specific health issues are a reflection of unique community circumstances CHNs are community members with a role in advocacy but can be challenged by lack of numbers and skillset Gender, Sexuality and Health

Sex and Gender      

Sex = traditionally female and male, but sex characteristics exist on a continuum Gender = “socially constructed roles, behaviours, activities, and attributes that a given society considers appropriate for men and women” pg. 364 (WHO, 2013 para 3. quoted in Dosani and Mansell, 2015). Gender roles Gender identity Masculine and feminine Transgender

Women’s and Men’s Health Women’s Health  The Women’s Health Movement arose from paternalistic attitudes in the medical and health care system  These affected women’s reproductive rights and violence against women  The movement expanded to include all health issues impacting women’s lives  CHNs do primordial and primary prevention to assist individuals and groups to think critically about gender and health

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Community – Section 3 Content

Men’s Health  Men may respond differently than women to illness  they tend to deny illness and attempt to self-manage for long periods before seeking medical treatment  CHN need to look at the ways to increase men’s access (and willingness to access) health care Lesbian, Gay, Bisexual, Transgender, Queer, and 2-Spirit (LGBTQ2S) Clients        

1.7% of adults 18-59 identify as gay or lesbian; 1.3% identify as bisexual; likely underestimated Historically Canada has been heterosexist with homophobia present in society Health challenges experienced due to stigmatization/discrimination “Coming out” can be stressful Negative health behaviours may result from societal attitudes and stressors Addressing diverse sexual identity and orientation in your practice facilitates therapeutic relationship development and may increase clients positive experiences with health care providers It is important to consider the attitudes, values, beliefs and of yourself and others. As well as to work with the LGBTQ2S community to reduce stigma and foster respect What are YOUR assumptions and beliefs? How will these influence the care you provide?

Defining and Addressing Gender Inquity Gender Inequity  when individuals are not provided the same opportunities in society because of their gender or genderidentity Gender Lens  look at the program / policy / intervention and see if it impacts men, women, boys, and girls in different ways Gender Based Analysis Process 1. Access 2. Inclusion 3. Benefits 4. Equity 

GBA should be included when planning community health –based interventions or strategies

Gender Bias Arises From 1) overgeneralization, 2) gender and sex insensitivity and 3) double standards Emma Watson – HE for She (11.47 min) Gender Equality   

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Canada holds at 16 out of 144 countries on gender gap index Top countries ahead of Canada: Iceland, Norway, Finland Sweden, Ireland Four Categories Assessed 1. Economic participation and opportunity 2. Education attainment 3. Health and survival 4. Political empowerment In 2011 in Canada, women were paid 72% of what men were paid for the same work. The Global Gender Gap Report

Community – Section 3 Content

Canada’s Commitment to Gender Equality These sites are for interest  Canada Just Gave Women a Pay Rise March 08, 2018  Canadian History of Women’s Rights  Government of Canada – Rights of Women  Ontario Ministry of the Status of Women Summary      

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Health outcomes and processes (e.g. blood pressure, acceptance of a program) may be influenced by sex and gender The ways in which gender is normalized and expressed in society create different expectations and opportunities for men women boys and girls CHNs have a role to work to change values, beliefs and perspectives about women’s/human rights What are your attitudes, values and beliefs towards LGBTQ2S community? This focuses on primordial prevention – changing practices and developing healthy public policy – to reduce stigma and foster respect Governments use GBA to ensure programs and policies are equitable...