Title: Social Capital and Wellness Amongst First Nations in Coastal British Columbia
1Social Capital and Wellness Amongst First Nations
in Coastal British Columbia
- Ralph Matthews, Ph.D.,
- Professor of Sociology,
- The University of British Columbia,
- And Professor Emeritus of Sociology,
- McMaster University
- Chris Buse, BA
- The University of British Columbia
- Presentation to a Symposium on Aboriginal
Experiences of Aging - Saskatoon, Saskatchewan, September 17-19, 2008
2Present Data on Health from Two Studies
- Coastal Communities Project (CCP)
- Working with Six First Nation Communities and Six
Adjacent Civic Communities in Coastal B.C. - Issues of Environment, Resource Management,
Education, Governance, and Health. - Funded through the SSHRC Community-University
Research Alliance (CURA) Program. - Resilient Communities Project (RCP)
- Social Capital and Economic Development 23
Coastal Communities in British Columbia. - Funded through the SSHRC Initiatives on the New
Economy Program.
31.I Coastal Communities Project
Investigating Health in Old Massett
- Old Massett Band Council (Haida Gwaii) wished to
have a community interview study carried out on a
range of issues. - Appointed Councilors who worked with us on
designing it. - All interviews conducted by members of the Band.
- Health and health care was one of the topics
covered. - Focus was on
- Who consulted for health care assistance.
- Asked about use of traditional healing versus
western medicine.
4The Social and Cultural Basis of Wellness and
Healing
- When asked who they had consulted in the past 12
months about a physical or mental health issue
and how frequently, many of the consultations
identified medical advice was obtained from
family, friends and non-medical personnel (see
Table 1). - When asked about using traditional healing
methods, 40 percent of males and 34 percent of
females had done so. - (32 percent of females and 7 percent of males did
not indicate receiving advice regarding any
health problems)
5Table 1 Old Massett Persons Contacted and
Frequency of Contact Regarding Health
6Traditional Healing
- Most respondents received traditional healing
from family and friends. - Traditional healing methods were applied to a
range of health issues from arthritis, to common
colds, to cancer. - Respondents were least likely to seek traditional
healing for broken bones and for eye and tooth
problems. - All but one respondent who sought traditional
healing declared it to have been successful. - Interviewers were sometimes provided with
detailed descriptions for the preparation of
traditional medicines knowledge that we regard
as the cultural knowledge of the Haida people. - Throughout coastal B.C. we have been consistently
informed about traditional healers from the
northwest of the USA (notably Montana, Utah) who
complete a circuit of First Nation communities in
the Pacific Northwest utilizing/selling a variety
of traditional medicines.
7Indigenous Healing and Wellness in Social Context
- The point of beginning our discussion with our
Old Massett data is to demonstrate that - Health care and healing always occurs in a social
context. - This is particularly the case when dealing with
indigenous persons health care where an
awareness of the social and cultural context is
critically necessary in order to understand
virtually all aspects of health care. - The social and cultural context retains strong
elements of traditional knowledge and healing,
operating where more western healing and
healthcare processes take place. - Let us turn now to a more quantitative
investigation of that social context using the
findings of the Resilient Communities Project
(RCP) to examine the relationships involved.
8II. The Resilient Communities Project (RCP)
Examining Health in Social Context
- Five year Study Multi-stage project involving
- Background Data.
- Statistical data analysis of pre-existing data.
- Mailed Questionnaire.
- Sent to 4,386 households in 23 communities.
- N.B. Five mailings 60.0 response rate.
- Interviews (Semi-Structured).
- 93 local residents from six communities.
- 78 leaders from six communities.
- All households on two First Nation reserves.
9Measuring Social Capital in the RCP
- Social Capital seen as an attribute of the access
that people have to resources through their
contact with other persons within their social
network. - Refers to embedded social relations entrenched in
social ties (Granovetter 1985). - We define social capital as resulting in the
social ties that people have with one another. - Embodied through strength of ties between
individuals or groups that foster norms of trust,
reciprocity, social participation and civic
engagement (Putnum 2000 Burt 2001 Coleman 1990) - The RCP measures social capital in terms of the
extent to which people have strong ties (i.e.
friends and relatives) and weak ties
(acquaintances) with people who reside inside or
outside their communities, and who have potential
access to important social and economic resources
(measured with a Position Generator).
10Role of Trust in Relation to Social Capital
- Trust can be seen as both a precondition for the
cooperation that allows social capital relations
to form. - Trust is also the result or outcome of these
social relations. - In the context of healthcare and wellness trust
provides or produces - access to resources
- allows for greater efficiency in healthcare
services delivery and traditional healing - Networks of social support
- Higher trust higher levels of wellness (Rose
2000).
11Measuring Trust in the RCP
- Respondents were asked to indicate support or
disagreement with 12 statements concerning trust.
- Statements ranged from global measures (e.g.
Most people can be trusted), to community
specific measures (e.g. Business leaders in this
community can be trusted). - Factor Analysis of our Trust variables
identified two distinct factors comprising seven
of the 12 statements. - We have labeled these Generalized Trust and
Institutional Trust.
12Trust Factors - Component Loadings
13Measuring Health and Wellness in the RCP
- General Well-Being / Wellness
- All things considered, how satisfied are you
with your life as a whole these days? - (Dissatisfied to Satisfied on a 10 point scale)
- Physical Well-Being
- How would you describe the state of your health
compared to other persons your age? - Poor Fair Good Very Good Excellent
- Psychological Well-Being
- How much of the time, over the past two weeks,
have you Been a nervous person Felt calm and
happy Felt down-hearted and blue Been a happy
person Felt so down in the dumps that nothing
could cheer you up? - All Most Some Little or None of the time.
- Calculated a 16 point scale constructed from the
questions above
14Other Variables in Our Analysis
- Age
- In years as of 2004
- Income
- Measured in five categories
- Education
- Measured in four categories
- Ethnic Status
- First Nation versus Non-First Nation
15Age Distribution of RCP First Nation Population
16Traditional Indicators of Health
Health and Wellness
17Summary of Findings Comparison First Nation and
Non-First Nations Respondents
- F.N. persons have significantly lower household
incomes, significantly lower educational levels. - F.N. persons have significantly higher formal and
informal social participation (i.e. the basis of
social capital) - Formal (17 point index) scheduled formal
meetings for sports teams, arts and crafts, FN
ceremonies, etc. - Informal (15 point index) going out for
drinks, movies, etc. - F.N. have significantly lower levels of trust
- Note contradiction with most social capital
literature that sees trust as being directly
associated with social participation. - F. N. persons have significantly lower of levels
of all three measures of wellness and health - i.e. General wellness Physical Health Mental
Wellness.
18Income
19Education
20Physical Health Differences
21Means Comparison F. N. versus Non-F. N. All
Social Capital and Trust Variableswith All
Wellness and Health Variables
22Review of our Findings regarding the Context of
Trust
- Many studies of the social determinants of health
emphasize the role of social capital (i.e.
networks and involvement in social relations) in
health. - We have used measures of involvement in formal
and informal groups as our proxy measure of this.
- We see significant differences between F.N. and
non-F.N. persons in terms of their involvement in
formal and informal groups (i.e. F.N. persons are
more likely to be involved in both formal and
informal groups). - Many studies of social capital demonstrate that
the more people are involved in community formal
and informal activities within their community,
the more likely they are to trust community
members. - We see that there are significant differences
between First Nation and Non-First Nation persons
in terms of trust. - First Nation persons are likely to have less
trust than non-First Nation persons. - The more First Nation persons are involved in
formal and informal groups/activities in their
community the LESS likely they are to trust
members of their community. - Now let us look at the relationship between
trust, wellness and other social variables.
23Building a Model of Wellness and Its Relationship
to Trust
- Statistical models set up to explain the
relationship between Trust and Wellness - Bi-variate statistics illustrate trust
disparities and relationship directionality. - In other studies, trust is rarely modelled as the
primary explanatory variable of health it is
generally something to be controlled. - Hypothesis not formally tested amongst F.N.
populations in Canada. - Three measures general wellness physical
health mental health - Wellness is argued as a more stable measure of
health and well-being going beyond physical
health and attempting to encompass a greater
social depiction of an individuals life.
Therefore, it is most important in our
considerations. - Literature suggests that trust may have
implications for health. (Veenstra 2000 Hardin
2002 Rose 2000 Kawachi 1999).
24F.N. Findings Its all about Generalized Trust
- Generalized Trust is a significant predictor of
all three health measures (Higher Trust Better
Health). - Institutional trust suppresses original trust
relationship controlling for it makes
Generalized Trust/Health association stronger
(Has no effect on health and wellness on its
own). - Social participation has little to no effect on
the trust/health association, and little to no
influence on wellness more generally. - This seems contradictory to evidence presented in
the social capital literature. - We would expect higher social participation to
produce better health. - Variance the proportion of health and wellness
explained by trust is high
25F.N. Findings Traditional Predictors of Health
- Age is not a significant predictor of health and
wellness - Education
- Importance of H.S. Diploma, but results are not
statistically significant - Achieving more than a H.S. Diploma does not seem
to produce greater levels of wellness as
indicated in the literature - Income
- Income is not as important to this relationship
as trust is, and for the most part, income is not
significantly associated with health contradicts
traditional literature on health - a threshold effect is present that is,
individuals occupying the lowest income category
are worse off, but occupying successively higher
income categories is not necessarily better for
health or wellness - Variance
- Age and Education do not explain health and
wellness outcomes - Income accounts for a little less than half of
health and wellness (still not as much as
generalized trust)
26Physical Health
27Mental Wellness
28Wellness
29Limitations
- Small sample size
- Social Participation What gives?
- RCP data may not be asking the right questions
- Does not adequately address social activity
around family ties or family relations - To look at health, wellness, and healing, we need
to analyze social relationships, not just social
participation - Data need to reflect the way in which First
Nation respondents engage in activities family
may play a more important role than First Nation
community activities
30Policy Directions Towards a CHED Model
- CHED Model Community Health and Economic
Development - Developed by Glen Timbers, Director of United
Church Health Services, Bella Coola, BC. - A service delivery model that focuses on the
community basis of health and the development of
trust particularly with F. N. communities. - Building Community requires meaningful
participation from members - Sees health and wellness as a community based
phenomenon related to the economic and social
well-being of a community. - The CHED Model is centred around the development
of community based generalized trust. Our
findings show that this is a dominant factor in
self-reported physical and mental health and
general well-being, particularly for First Nation
communities.
31Central Coast Health and Well-Being Charter
- Central Coast Health and Well-being Charter
- Agreement to work on local strategies to improve
service delivery, to strengthen community bonds
and to promote relationships, spirit and service
networks of communities. -
- CHED depends on leadership, learning and
development systems social and recreational
activities unique history, location and social
attributes work and economic activity
infrastructure and environment health services
governance and coping systems - Signed by Five First Nation Band Communities and
all non-First Nation Communities.
32Policy Directions Towards a CHED Model
- Healing and wellness are social processes
requiring social considerations - Wellness is a resource for daily life
- Health services need incorporate and respect
traditional medicines/values as an integral part
of the economic, social, and spiritual community - Addressing trust may be more beneficial to health
than palliative care - Community Involvement
- Needed to influence regional authorities,
independent community service providers, and
provincial/federal governments - Band Unity via Trust Building Community Gardens
- Cross-cultural issues are important when dealing
with healing and wellness
33Towards a CHED Model Trust and Community
34References
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Coast Health and Well-being Charter. Charter
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Nuxalk Nation, Heiltsuk Nation, Kitasoo Nation,
Bellac Coola General hospital Board, RW Large
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Vancouver, BC UBC Press.
35THANK YOU!
- For more information
- Websites
- Resilient Communities Project
- www.resilientcommunitiesproject.ca
- Coastal Communities Project
- www.coastalcommunitiesproject.ca
- E-MAIL ralph.matthews_at_ubc.ca