Dr. Margo Greenwood, NCCAH Indigenous Perspectives in Mental Wellness Promotion: Opportunities for Public Health Action Dr. Margo Greenwood, NCCAH PMHP Forum – Feb 28-March 1, 2018

Declaration of real or potential conflicts of interest Presenter: Margo Greenwood I have no real or potential conflict of interest related to the material that is being presented today. Malcolm’s Lancet article (2009) good health is defined as “A balance of the mental, physical, spiritual, and emotional dimensions of self and the ability to live in harmony with family, community, nature, and the environment” AFN /Health Canada definition of mental wellness continuum is long “this balance is “enriched as individuals have a sense of purpose in their daily lives whether it is through education, employment, care giving activities, or cultural ways of being and doing; hope for the future and those of their families that is grounded in a sense of identity, unique Indigenous values, and having a belief in spirit; a sense of belonging and connectedness within their family and community and to culture; and finally a sense of meaning and an understanding of how their lives and those of their families and communities are part of creation and a rich history” ITK defines mental wellness as: “Self esteem and personal dignity flowing from harmonious physical, emotional, mental and spiritual wellness and cultural identity” (ITK, 2014)

Indigenous Concepts of Health and Wellness “ A balance of the mental, physical, spiritual, and emotional dimensions of self and the ability to live in harmony with family, community, nature, and the environment” (King, Smith, Gracey, Lancet, 2009) “Self esteem and personal dignity flowing from harmonious physical, emotional, mental and spiritual wellness and cultural identity” (ITK, 2014) Malcolm’s Lancet article (2009) good health is defined as “A balance of the mental, physical, spiritual, and emotional dimensions of self and the ability to live in harmony with family, community, nature, and the environment” AFN /Health Canada definition of mental wellness continuum is long “this balance is “enriched as individuals have a sense of purpose in their daily lives whether it is through education, employment, care giving activities, or cultural ways of being and doing; hope for the future and those of their families that is grounded in a sense of identity, unique Indigenous values, and having a belief in spirit; a sense of belonging and connectedness within their family and community and to culture; and finally a sense of meaning and an understanding of how their lives and those of their families and communities are part of creation and a rich history” ITK defines mental wellness as: “Self esteem and personal dignity flowing from harmonious physical, emotional, mental and spiritual wellness and cultural identity” (ITK, 2014)

Indigenous Children and Youth Disproportionate burden of ill-health Data limitations Culturally relevant indicators Jurisdictional barriers - surveillance Geographic and demographic representation Emphasis on disease and illness, not wellness and prevention BURDEN: Indigenous children and youth experience significant health and social disparities, with higher rates of injury, infant mortality, suicide, and chronic and infectious diseases STATS: Indigenous children aged 14 and under account for 28% of the total Indigenous population (compared to 16.5% of the non-Indigenous population), while Indigenous youth aged 15 to 24 represent 18.2% of the total Indigenous population (compared to 12.9% of the total non-Indigenous population). Inuit are the most youthful of the three Indigenous groups with a median age of 23, followed by 26 for First Nations, and 31 for Métis (Statistics Canada, 2013). DATA LIMITATIONS - limited by the quality and coverage of data, a lack of culturally relevant health indicators, and jurisdictional barriers associated with Indigenous status and geography; emphasis on Indigenous children’s disease and illness outcomes, rather than preventative and wellness measures; discrepancies in both geographic and demographic representation, with a dearth of research on youth in the Prairie and Atlantic provinces and the Northern Territories, as well as a significant under-representation of Métis and urban Indigenous youth health research

Mental Health Challenges and Strengths Vary immensely among communities and individuals Reflects distinctiveness of First Nations, Inuit and Metis worldviews and experiences Determinants of health intersect and manifest differently across lifespan and generations Knowledge Gaps Gender differences and transitions to adulthood LGBTQ2S populations Transgenerational impacts of residential schools Ongoing adversity

Beyond the Social Indigenous knowledges and ways of being as the primary frame of reference for understanding Indigenous health realities Colonialism as an “active and ongoing” force in lives of Indigenous peoples

Protective Factors Attributes or conditions at the individual, family, community of societal level than promote resilience and decrease risk factors Community Cultural continuity Self-government Band control of services Culture and language Identity Individual Self-reliance Self-confidence Community involvement Mentorship Kim and community relationships

Characteristics of Successful Mental Health Promotion Indigenous Concepts Holistic Incorporate Indigenous values, knowledges, cultural practices Indigenous Contexts Address underlying determinants Emphasize strengths and resilience Focus on protective factors Indigenous Processes Community-driven and owned Build capacity and leadership Meaningfully engage children, youth, families and communities

Public Health Roles Talk to Indigenous peoples and organizations to learn about their diverse perspectives on mental wellness (Boska et al, 2015) Learn about the social and cultural contexts of Indigenous communities (Boska et al, 2015) Commit to providing culturally-safe care Support Indigenous mental wellness workers Advocate for Indigenous heath equity Understand programs must be guided by local Indigenous knowledges Share knowledge on promising practices in Indigenous communites

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