Aboriginal Families, Diversity Aboriginal Families, Diversity and Livelihoodand Livelihood

Obesity and Healthy Occupation Obesity and Healthy Occupation Panel PresentationPanel Presentation

Gaye HansonGaye Hanson

June 14, 2008June 14, 2008CAOT Annual ConferenceCAOT Annual Conference

Whitehorse, YukonWhitehorse, Yukon

Discovering the Difference Discovering the Difference ……““We go looking for culture and cultural meaningWe go looking for culture and cultural meaningonly to find issues of equity and power.only to find issues of equity and power.Our hidden expressions and lack of complianceOur hidden expressions and lack of complianceare really a reflection of limitationsare really a reflection of limitationsimposed on us by a system, a societyimposed on us by a system, a societythat says it values difference and diversitythat says it values difference and diversitybut what it really wants is conformity...”but what it really wants is conformity...”

Rani SrivastavaRani Srivastava““Guide to Clinical Cultural Competence” 2007Guide to Clinical Cultural Competence” 2007

OverviewOverview• Aboriginal PeopleAboriginal People

• CultureCulture

• Values and BeliefsValues and Beliefs

• Cultural Sensitivity and Cultural Cultural Sensitivity and Cultural CompetenceCompetence

• Issues and RisksIssues and Risks

• Life Giving Forces and Policies to SupportLife Giving Forces and Policies to Support

• Research Questions and ChallengesResearch Questions and Challenges

• Moving Into the FutureMoving Into the Future

Aboriginal PeopleAboriginal People• First NationFirst Nation• InuitInuit• MétisMétis• Other Aboriginal PeopleOther Aboriginal People• Other dimensions of diversity – Other dimensions of diversity –

gender, age, geography, income, gender, age, geography, income, education, occupation, socio-economic education, occupation, socio-economic status, degree of acculturation, access status, degree of acculturation, access to traditional lands, language, cultural to traditional lands, language, cultural teachings etc. teachings etc.

CultureCulture

• Culture includes, but is not restricted to, Culture includes, but is not restricted to, age or generation; gender; sexual age or generation; gender; sexual orientation; occupation and socioeconomic orientation; occupation and socioeconomic status; ethnic origin or migrant experience status; ethnic origin or migrant experience religious or spiritual belief; and disability. religious or spiritual belief; and disability. Dianne Wepa, “Cultural Safety in New Zealand”, 2005Dianne Wepa, “Cultural Safety in New Zealand”, 2005

• Culture is what we do every day, every Culture is what we do every day, every week and every year – it is embodied in week and every year – it is embodied in our way of seeing the world, seeing other our way of seeing the world, seeing other human beings, assessing “goodness” or human beings, assessing “goodness” or risk and understanding our past, present risk and understanding our past, present and future. We all have a culture.and future. We all have a culture.

Values and Beliefs Values and Beliefs • Within health care, issues of culture and Within health care, issues of culture and

diversity have largely been viewed from a diversity have largely been viewed from a negative standpoint – with a focus on cultural negative standpoint – with a focus on cultural differences and the resulting problems.differences and the resulting problems.(Srivastava, 2007)(Srivastava, 2007)

• It would be more effective to recognize that It would be more effective to recognize that barriers do not result from the clients’ culture barriers do not result from the clients’ culture but rather values and beliefs inherent in the but rather values and beliefs inherent in the biomedical culture, and from insufficient biomedical culture, and from insufficient training as well as barriers in the health care training as well as barriers in the health care system.system.(Tripp-Reimer, Choi, Kelly & Enslein, 2001) (Tripp-Reimer, Choi, Kelly & Enslein, 2001)

Cultural SensitivityCultural Sensitivity

• Cultural sensitivity builds on cultural Cultural sensitivity builds on cultural awareness, cultural knowledge and awareness, cultural knowledge and cultural understanding.cultural understanding.

• Culturally sensitive care is that which Culturally sensitive care is that which demonstrates the recognition of demonstrates the recognition of cultural differences and provides cultural differences and provides accommodation when possible. accommodation when possible. Cultural insensitivity would be seen Cultural insensitivity would be seen when unique cultural characteristics, when unique cultural characteristics, needs and desires are not identified needs and desires are not identified as part of health care. as part of health care.

Cultural Competence Cultural Competence

• Cultural Competence is the human Cultural Competence is the human relational capacity to seek and find relational capacity to seek and find compassionate understanding within, compassionate understanding within, between and among people of differing between and among people of differing cultural backgrounds and perspectives.cultural backgrounds and perspectives.Hanson, 2006Hanson, 2006

• Cultural competence is a verb which Cultural competence is a verb which describes behaviors grounded in a describes behaviors grounded in a person’s thoughts, feelings, awareness, person’s thoughts, feelings, awareness, knowledge, skills and relational style.knowledge, skills and relational style.

Cultural Competence (2)Cultural Competence (2)Connected concepts:Connected concepts:• Cultural competence requires a basic Cultural competence requires a basic

understanding of core concepts such as understanding of core concepts such as culture, race, ethnicity, gender, diversity, culture, race, ethnicity, gender, diversity, marginalization, and minority. marginalization, and minority. Srivastava, 2007Srivastava, 2007

• It goes beyond awareness, sensitivity, It goes beyond awareness, sensitivity, knowledge and skills to application; knowledge and skills to application; although a basic level of knowledge about although a basic level of knowledge about the cultural groups you are working with, the cultural groups you are working with, including, in the case of Aboriginal people, including, in the case of Aboriginal people, the history of colonization, acculturation, the history of colonization, acculturation, residential schools and related residential schools and related intergenerational effects is needed.intergenerational effects is needed.

Cultural Competence (3)Cultural Competence (3)Levels and building blocks:Levels and building blocks:

• Intrapersonal Intrapersonal

• InterpersonalInterpersonal

• TeamTeam

Cultural Competence (4)Cultural Competence (4)Levels and building blocks:Levels and building blocks:

• Organizational – Governance, structure, Organizational – Governance, structure, funding, policies, procedures, training, funding, policies, procedures, training, incentives, supports and resources that incentives, supports and resources that invest in building cultural competence invest in building cultural competence at all levels.at all levels.

• Systemic – Public awareness, Systemic – Public awareness, legislation and regulatory legislation and regulatory environments that support cultural environments that support cultural competence.competence.

Issues and Risks Issues and Risks • Poverty, unemployment, under employmentPoverty, unemployment, under employment• Food securityFood security• Isolation, marginalization, shameIsolation, marginalization, shame• Spiritual and cultural impactsSpiritual and cultural impacts• Emotional challenges, grief, addictions Emotional challenges, grief, addictions • Access to appropriate educationAccess to appropriate education• Physical health burdens and chronic illnessPhysical health burdens and chronic illness• Genetic predispositionGenetic predisposition• Access to health careAccess to health care

Life Giving ForcesLife Giving Forces• Hope – being able to envision a future you Hope – being able to envision a future you

want to livewant to live• Self determination, Self governmentSelf determination, Self government• Self efficacy, pride in contribution to Self efficacy, pride in contribution to

communitycommunity• Pride, language and culturePride, language and culture• Own institutions, programs and servicesOwn institutions, programs and services• Own professionalsOwn professionals• Rebuilding family and communityRebuilding family and community• Deeper understanding of healing Deeper understanding of healing

Policies to Support LG Policies to Support LG ForcesForces• Self government, self governanceSelf government, self governance

• Consultation, collaboration, Aboriginal Consultation, collaboration, Aboriginal relations capacity and expertiserelations capacity and expertise

• Co-management arrangements Co-management arrangements

• Culturally competent policyCulturally competent policy

• Healthy public policyHealthy public policy

• Responsive, culturally competent care Responsive, culturally competent care systems and practitioners that contribute systems and practitioners that contribute to capacity NOT dependency to capacity NOT dependency

Research QuestionsResearch Questions

• How do we better understand the dynamic How do we better understand the dynamic interplay of characteristics, influences and interplay of characteristics, influences and choices that lead to weight issues – choices that lead to weight issues – individual, family, community and society?individual, family, community and society?

• How do we support positive livelihood and How do we support positive livelihood and personal / family / community change?personal / family / community change?

• Where are the points of change and Where are the points of change and effective strategies at all levels – spiritual, effective strategies at all levels – spiritual, emotional, intellectual and physical?emotional, intellectual and physical?

Research ChallengesResearch Challenges

• Community based research takes Community based research takes time and funds to support time and funds to support relationship buildingrelationship building

• Sensitive issue, burden of shame and Sensitive issue, burden of shame and angeranger

• Biomedical approach – lacks a more Biomedical approach – lacks a more comprehensive perspectivecomprehensive perspective

Moving Into the FutureMoving Into the Future• Government to Government arrangementsGovernment to Government arrangements• Co-management and collaborative Co-management and collaborative

governance of health systemgovernance of health system• Overcoming jurisdictional issuesOvercoming jurisdictional issues• Action on determinants of healthAction on determinants of health• Improved, culturally competent, more Improved, culturally competent, more

comprehensive collaborative care comprehensive collaborative care • Focus on relationships at all levelsFocus on relationships at all levels• Improved access to OT and related Improved access to OT and related

servicesservices

Contact InformationContact Information

Gaye HansonGaye HansonPresident, Hanson and AssociatesPresident, Hanson and Associates

42 Tamarack Drive42 Tamarack DriveWhitehorse, YukonWhitehorse, Yukon

Y1A 4W2Y1A 4W2P (867)633-6753P (867)633-6753F (867)633-6777F (867)633-6777C (867)333-2411C (867)333-2411

gaye@hansonandassociates.cagaye@hansonandassociates.ca