AN INTRODUCTION TO INDIGENOUS HEALTH AND HEALTHCARE IN CANADA BRIDGING HEALTH AND HEALING 2ND ED

AN INTRODUCTION TO INDIGENOUS HEALTH AND HEALTHCARE IN CANADA BRIDGING HEALTH AND HEALING 2 ND ED Vasiliki Douglas CONTENTS PART I INDIGENOUS CULTURE AND HEALTH 1. Introduction: First Nations, Métis and Inuit in Canada: Understanding the Issues 2. Western and Indigenous Ways of Knowing 3. Cultural Competency, Cultural Sensitivity and Cultural Safety 4. Historical Overview PART II INDIGENOUS HEALTH AND THE CANADIAN HEALTHCARE SYSTEM 5. Understanding the Determinants of Health and Canada’s Native Population 6. Diabetes, Diet and Nutrition 7. Chronic and Infectious Diseases 8. Women’s and Children’s Health 9. Mental Health 10. Hybridisation of Healthcare and the Way Forward for Indigenous Health Chapter 1 – Introduction: First Nations, Métis and Inuit in Canada: Understanding the Issues Test Questions 1. Why did the Canadian government devolve power to Indigenous governments after the Oka Crisis? a. Federal politicians wanted to evade responsibility for Indigenous affairs. b. It saved money by devolving costs onto other levels of government. c. Because Canadian politicians wanted to demonstrate their support for Indigenous selfgovernment. d. Possibly all of the above. 2. The Oka Crisis led to increased a. awareness of Indigenous issues in Canada among both Canadians and internationally. b. police surveillance of reserves in Eastern Canada. c. government repression of Indigenous peoples in Canada. d. anti-Indigenous sentiment among the non-Indigenous population. e. all of the above. 3. The Canadian Multiculturalism Act a. Entrenched biculturalism in the Canadian constitution b. Made assimilation part of Canada’s official cultural policy c. Established the concept of the cultural mosaic as an official part of Canadian identity d. Entrenched Indigenous culture as part of Canadian identity e. Made acculturation part of Canada’s concept of the cultural mosaic 4. When did the Government of Canada commit itself to multiculturalism? a. 1971 b. 1981 c. 1975 d. 1871 5. What are the implications of universal healthcare for the Canadian heath care system? a. There are no implications b. Everyone is treated for illness when they get sick c. Tertiary care services are very important d. If the health of a part of the population is allowed to suffer, the burden falls on everyone 6. The three founding nations of Canada are a. French, English and Métis. b. English, Scottish and the Indigenous peoples. c. French, English and the Indigenous peoples. d. French, English and American. 7. The Constitution Act of 1982 defined Indians as persons belonging to one of three groups a. Métis, Inuit, First Nations. b. Métis, Inuit, Status Indians. c. Status, Non-Status, Treaty. d. Status, Non-Status, Inuit. 8. The position of Indigenous peoples in Canada was entrenched in the constitution in a. 1867. b. 1982. c. 1992. d. 2016. 9. The range of individual and collective factors and conditions and their interactions that have been shown to be correlated with health status reflects the recognition that a. Health is a capacity or resource rather than a state b. Being able to pursue one’s goals, to acquire skills and education and to grow is a privilege rather than a right c. Factors within the healthcare system significantly affect health d. The correlation is specious 10. Health promotion is a way of a. improving population health. b. reducing the burden on the public healthcare system. c. an intrusion on the human rights of the population. d. a and b 11. What is population health? a. The overall health of a population b. The health of each individual in a population c. A statistical measure of average prescription drug consumption in a population d. All of the above e. None of the above 12. How does population health relate to individual health? a. Good population health means that every individual is healthy b. Poor population health means that every individual is in poor health c. Good population health facilitates individual health d. a and b e. None of the above 13. The approach that recognises there is a range of social, economic and physical environmental factors that contribute to health is a. social engineering. b. population health. c. affirmative action. d. harmful effects reductionism. 14. The Romanow Report identified two important long-term demographic trends a. Both the general population and the Indigenous population are increasing in numbers rapidly due to high birth rates b. The Indigenous population is increasing rapidly, but the general population is only increasing through immigration c. Both the Indigenous and the general population of Canada are in a state of long-term demographic decline d. None of the above 15. Why was the Royal Commission on Aboriginal Peoples (RCAP) created? a. Because the health of Canada’s Indigenous peoples is very poor b. To find ways to improve employment among the Indigenous population c. Because the government was embarrassed by the Oka Crisis d. All of the above 16. Why did both the RCAP report and the Romanow Report receive highly mixed receptions from the governments that commissioned them? a. Budget cutbacks meant that their recommendations were not followed b. Their recommendations were intrinsically unrealistic c. Federal-provincial quarrels over jurisdiction made them hard to implement in practice d a and c 17. The Ottawa Charter on Health Promotion a. identified the social and environmental roots of ill health. b. recognized that health is a by-product of a healthy environment. c. did not specifically mention the Canadian Indigenous population. d. all of the above. 18. What leads to a healthy population according to the Ottawa Charter on Health Promotion? a. Increased government spending b. Improved medical care c. Immunisations d. Improved determinants of health 19. What has changed in the healthcare environment in the last 25 years? a. Increased non-Western immigration to industrialised countries b. Increased population diversity c. More assertive populations, including ethnic minorities d. All of the above e. None of the above 20. Equity in health must be a central goal of healthcare professionals, citizens and their governments. An example of equity in health is a. locally produced and culturally appropriate health knowledge systems. b. treating everyone the same as you would treat yourself. c. implementing government developed health programs. d. health outcomes are omitted as part of the public infrastructure. 21. What does “Indian Status” mean? a. An individual is recognized by the Canadian government as the registered member of an official Indian Band b. An individual’s ability to publicly claim one is of Indigenous descent c. That an individual lives on a reserve or Indigenous community in the Canadian Arctic d. An individual is recognised as an Indian through quantum of status e. a and d 22. What distinguishes Status Indians from Non-Status Indians? a. Status Indians are officially recognised by the Canadian government as Indigenous b. Status Indians live on reserves, Non-Status Indians do not c. Status Indians have the right to vote, but Non-Status Indians do not d. All of the above 23. Non-Status Indians are a. not members of any First Nation. b. First Nations that are not recognised by the Canadian government. c. are the descendants of Europeans and First Nations. d. all of the above. 24. Non-Status Indians a. are one of the fastest-growing groups in the Indigenous population. b. are few in number and disappearing. c. mainly live on reserves. d. none of the above. 25. What was the title given to children born of one First Nations parent and one European parent? a. Métis b. Indian c. Status Indian d. First Nations 26. Métis are descendants of a. Viking colonists of Newfoundland who intermarried with the First Nations. b. a small First Nations on the Michigan Peninsula who worked for the Northwest Company. c. French, English and Scottish fur traders and their First Nations wives. d. French, English and Scottish farmers and their First Nations wives. e. none of the above. 27. Métis are one of the fastest growing Indigenous peoples in Canada because they a. have a very high birth rate. b. are growing through immigration. c. increasing numbers of Canadians are reclaiming their Métis heritage and selfidentifying as Métis. d. a and c 28. Where do the Inuit traditionally live? a. In the boreal forest b. In the Alpine regions of British Columbia c. In the circumpolar north d. In the sub-Arctic regions of Canada e. None of the above 29. The majority of First Nations and Inuit in the Northwest Territories and Nunavut live a. on reserves. b. as minorities in mixed communities with non-Indigenous peoples. c. in two major cities, Yellowknife and Iqaluit. d. in their own communities governed by elected local governments. e. none of the above. 30. Canada’s newest territory, Nunavut has a. a mostly Inuit population. b. both Inuit and Dene First Nations populations. c. a largely European population, with a large Inuit minority. d. no permanent population, only transient workers. e. none of the above. 31. Where do Canadian Inuit live? a. In the Canadian Arctic b. All over Canada c. In the Yukon Territory d. a and b 32. Which of these are recognized as Indigenous people in Canada? a. Status Indians b. Métis c. Inuit d. Sami e. a, b and c. 33. Which province or territory of Canada has the greatest linguistic and cultural diversity of Indigenous peoples? a. Québec b. Alberta c. The Northwest Territories d. British Columbia e. None of the above 34. What percentage of the population of Canada is Indigenous? a. 1% b. 25% c. 4.9% d. 7% e. None of the above 35. Which of the following is one of the fastest growing populations in Canada? a. Non-Indigenous peoples under 30 years b. First Nations under 30 years c. First Nations elders d. Non-Indigenous over 30 years 36. What is the median age of the Indigenous population of Canada in the 2016 census? a. 31 b. 45 c. 40 d. 22 37. Which Indigenous population is the youngest in Canada (in the 2006 Census)? a. Métis b. First Nations c. Inuit d. Québecois 38. What is the largest-growing Indigenous group in Canada? a. Status Indians b. Inuit c. Métis d. Non-Status Indians 39. The Government of Canada traditionally only recognised a single type of Registered First Nation level of governance. a. The Tribe b. The Band c. The Nation d. The Village 40. Indian Bands are governed by a. elected band Councils. b. hereditary chiefs. c. government appointees. d. none of the above. 41. Complete the following statement. In the 2016 Census, the First Nations birth rate was a. less than the Canadian rate for non-Aboriginals. b. more than twice the Canadian rate for non-Aboriginals. c. steadily declining. d. less than half of what it was 10 years age. 42. “First Nations” refers to the fact that a. Indigenous peoples were in Canada first, before Europeans. b. Indigenous peoples had their own governments, cultures and national traditions. c. the British and Canadian governments both recognised that Indigenous peoples were sovereign – that they were nations and negotiated with them on that basis. d. all of the above. 43. In Canada, Indian Reserves are a. where all Indigenous people live in Canada. b. land reserved for Indigenous people. c. the place where non-Status Indians live. d. inhabited by some First Nations, but not Inuit or Métis. e. none of the above. 44. Indian Reserves are inhabited by a. all Indigenous peoples in Canada. b. Métis and Status Indians. c. Inuit. d. many, but not all Status Indians. 45. The reserve system in Canada a. requires all First Nations to live on reserves, though neither Métis nor Inuit are required do so. b. consists of land held by First Nations directly under the Crown. c. recognises the political status of First Nations as sovereign entities. d. none of the above adequately detail the realities. 46. The Canadian government a. is obligated by its own laws to negotiate treaties with First Nations and Inuit. b. is not obliged to negotiate treaties at all. c. negotiates treaties out of a sense of fairness. d. b and c. 47. The Transfer Agreement of 1988 was developed with the goal of a. transferring responsibility for healthcare to the federal government. b. transferring responsibility for healthcare to First Nations groups. c. transferring land from First Nations groups to the provincial government. d. transferring government control from the provincial governments to First Nations communities. 48. Self-government initiatives grew during the 1980s and 1990s and were encouraged by a. the political fallout of the Oka, Gustafsen Lake and other incidents of violent and non-violent resistance. b. the increasing demand of dependence of many First Nations. c. the evolution of the healthcare system in the 1980s. d. none of the above. 49. The Charter of Rights and Freedoms recognises the a. right of Indigenous peoples to self-government. b. the language rights of Indigenous peoples. c. the right of Indigenous peoples to be treated fairly. d. all of the above. 50. Why should nurses care about Indigenous health? a. This is an important and rapidly increasing component of the population. b. Most nurses will be responsible for Indigenous patients at some point in their careers. c. Nurses and the nursing profession bear a responsibility for health promotion in the population, Indigenous and non-Indigenous. d. All of the above Type: T 51. What were the five reasons for the “disconnect” that the Romanow Report identified as preventing Indigenous peoples from benefiting from the Canadian healthcare system? Type: T 52. How would improving the health of the Indigenous population benefit all Canadians? Type: T 53. Why should nurses and other healthcare professionals care about Indigenous health? Answers to Test Questions 1. d 2. a 3. c 4. a 5. d 6. c 7. a 8. b 9. a 10. d 11. a 12. c 13. b 14. b 15. d 16. d 17. d 18. d 19. d 20. a 21. e 22. a 23. b 24. a 25. a 26. c 27. d 28. c 29. d 30. a 31. b 32. e 33. d 34. c 35. b 36. a 37. b 38. d 39. b 40. a 41. b 42. d 43. d 44. d 45. b 46. a 47. b 48. a 49. c 50. d Chapter 2 – Western and Indigenous Ways of Knowing Test Questions 1. Epistemology is a. a way of knowing about the world and how it works. b. a field of spiritual and metaphysical inquiry. c. defined as a way of thinking about human identity and the fundamental nature of human existence. d. a theory of mind used extensively in philosophy. 2. Ontology is a. the way we are, our state of being. b. the science of cranial topography. c. how we think about the world and how it works. d. a variety of factors enabling nurses to heal others through prayer. 3. Health is a. a matter of both physical and mental well-being. b. the absence of disease. c. how we live every day. d. all of the above. 4. Why are health and food security often a problem in Aboriginal communities? a. Traditional hunting and gathering can no longer feed everyone. b. Remote and impoverished communities lack the resources of prosperous urban areas. c. Government cutbacks have affected community health. d. All of the above. 5. Traditional Indigenous health views differ from traditional Western medicine in that a. Indigenous view is that health is holistic; Western view is that medicine is not holistic. b. Indigenous view is that health is earned; Western belief is that health is bought. c. Indigenous view is that health is a gift; Western belief is that health is holistic. d. both share the same philosophical underpinnings. 6. Culture influences health through a. the cultural stereotypes that society imposes upon individuals. b. the cultural roles individuals internalize and incorporate into their lives. c. providing a secure social identity with which to navigate society. d. all of the above. e. none of the above. 7. The traditional ceremony most often used by those participating in the spiritual purification of the body, mind and soul with the intended purpose of prayer and healing of the individual holistically is called: a. smudging. b. sweat lodge. c. medicine wheel. d. midewiwin. 8. Smudging is a. a traditional practice among many First Nations and Métis peoples. b. the burning of traditional herbs to purify the body and soul. c. increasingly popular among Indigenous peoples across Canada. d. all of the above. 9. A shaking tent ceremony would be performed by a a. herbalist. b. medicine man. c. Shaman. d. witch doctor. 10. One therapeutic benefit of a sweat lodge is a. high temperature stimulates the body’s natural reactions to toxins. b. heat and scratching numerous lines on the skin drains the infection. c. the belief that the sucking horn removes the poison. d. the smell of herbs inhibits endorphin release. 11. The shape of the sweat lodge typically represents a. the shape of the Mother Earth. b. the Circle of Life. c. the womb of the Mother. d. the shape of the Turtle shell. 12. What is the social basis for traditional Inuit society? a. Consensus and group survival b. Individual profit and competition c. Material success of each family d. All of the above 13. The ritual most often used prior to any major ceremony or celebration, or to cleanse an individual, for the purpose of clearing away negative energy, to invite in peace and harmony is called: a. smudging b. medicine wheel c. sweat lodge d. midewiwin 14. Traditional Indigenous epistemology or “ways of knowing” is based on a. human culture and the natural world being distinct and separate from each other. b. modern medicine having the solution to all possible health problems. c. god-like animals punishing humans for their transgressions against nature. d. the holistic interaction of human beings with the natural world. 15. Modern culture perceives the world as a. divided into separate and mutually exclusive spheres of human and natural knowledge. b. a living, unified and interconnected whole in which everything influences everything else. c. a flat disc floating through space, with the sun orbiting around it. d. inanimate matter that can be manipulated for the benefit of human being. e. a and d. 16. Traditional Indigenous epistemology a. divides the world into human and non-human spheres of knowledge. b. believes in the existence of a “Great Spirit.” c. sees the natural and human world as a unified whole. d. believes that the non-human world exists for humans to exploit for their own benefit. 17. Indigenous patients may see their health in a. traditional terms. b. in terms of biomedicine. c. as a mixture of both ways of knowing. d. all of the above. 18. What was an important ingredient in Sophie Thomas’ anti-cancer medicine? a. Aspirin b. red Alder c. cedar root d. stinging Nettle e. all of the above 19. What do Sophie Thomas’ patients attribute her success to? a. Her herbal medicines b. Red willow bark c. Her capacity for caring for her patients d. All of the above 20. Sophie Thomas, a First Nations Elder, a. marketed and sold her cancer medicine using red alder to people looking for a cure. b. held that traditional healing beliefs can result in bad medicine when practiced by an individual. c. promoted avoidance of biomedicine among her band members. d. attributed the healing power of her medicine to the Creator. 21. All of the following concerning Indigenous holistic views of health are true except a. the mind, body, birthplace and spirit are all integral parts of health. b. prohibiting women from collecting herbal remedies and using spiritual rituals. c. giving sage as a gift of thanks to the Creator when collecting herbs from the environment. d. illness is a result of an imbalance in one of the four spheres of life. 22. Pre-modern cultures perceive the world as a. divided into separate and mutually exclusive spheres of human and natural knowledge. b. a living, unified and interconnected whole in which everything influences everything else. c. a flat disc floating through space, with the sun orbiting around it. d. inanimate matter that can be manipulated for the benefit of human beings. e. b and c. 23. Non-modern epistemology is defined as a. combining a pre-modern world view with the use of the tools and techniques of modern science, technology and biomedicine. b. a belief that rejects all aspects of modern science and medicine in favour of returning to pre-modern life. c. the philosophy that underlay the 1970’s Back to the Land movement. d. refusal to receive blood transfusions on religious grounds. e. none of the above. 24. A culturally sensitive nurse would recognise that First Nations a. are taught to suppress pain and not talk about self. b. cry and mourn loudly with the death of a community member. c. wear copper bracelets as a preventative measure for arthritis. d. value assertiveness as a communication style. 25. According to the Canadian Nurses Association, cultural competence is a. the application of knowledge, skill, attitudes and personal attributes required by nurses to provide appropriate care and services in relation to cultural characteristics of their clients. b. the knowledge that cultural differences as well as similarities exist without assigning values. c. use of culturally based care and health knowledge in sensitive, creative and meaningful ways. d. a manner which affirms respects and fosters the cultural expression of the recipient. 26. How does epistemological accommodation apply to the Canadian nursing context? a. It doesn’t apply at all. b. It allows both practitioners and patients to retain their own values while accommodating each other in the clinical setting. c. It explicitly gives practitioners permission to compromise professional standards in order to provide patient oriented care. d. It views the nurse as having an insignificant role in the Canadian healthcare system. 27. The medicine wheel has been adapted by different Indigenous groups into many forms with the colours to be taken to mean the following except a. North, South, East, West b. Spring, Summer, Fall, Winter c. Fire, Wind, Water, Earth d. Birth, Youth, Manhood, Death 28. What are the four colours of the medicine wheel? a. Black, Brown, Purple and Green b. Black, Blue, Red and White c. Yellow, Black, Red and White d. Green, Black, Brown and White 29. How old are medicine wheels? a. Visible in archaeological sites of up to 5,000 years old b. Invented by New Age spiritualists in the 20th century c. Adopted concomitant cultural practices important to many Indigenous peoples d. a and c 30. The medicine wheel is a. a useful way of representing Indigenous philosophy of health and well-being. b. falling into disuse. c. being taken up by peoples who have never used it before. d. a and c. 31. Tobacco ties a. represent a symbol of sacrifice and acknowledgement of a service. b. are an important part of many Indigenous cultures. c. are a small bag filled with tobacco. d. all of the above. 32. Herbs used in smudging often include a. cedar, tobacco, sweetgrass and white sage. b. rosemary, tobacco, basil and thyme, c. wild onion, savoury, rosemary and basil. d. spruce buds, pine needles, juniper and wild rose. 33. A talking stick can be a. a stick. b. a feather. c. a rock. d. a shell. e. all of the above. 34. The talking stick a. gives members of a talking circle the right to speak. b. organises meetings in a non-hierarchical way. c. represents democratic traditions in many Indigenous cultures. d. all of the above. 35.The person who holds the talking stick a. must remain quiet until it is passed on. b. is chosen as a leader at the meeting. c. has the right to direct the meeting without interruption. d. passes it on to the next person who may speak. 36. Biomedicine is the a. application of the mechanistic philosophy of modern science and technology to the human body in order to keep it in proper working order. b. use of vaccinations to prevent infectious diseases. c. refusal to view the body as a machine that can be repaired. d. holistic view of health as a spiritual, physical and emotional whole. e. none of the above. 37. What is biomedicine? a. The application of biological science to human health b. A curative, technological approach to physical illness c. A totalitarian ideology d. All of the above Type: F 38. The four spheres that Indigenous people believe illness to be a result of an imbalance of one or more amongst them: _______, _______, ________, ________ Type: T 39. Provide three therapeutic benefits identified with use of a sweat lodge. Type: T 40. Describe one traditional Indigenous health practice and give examples of how this practice may contribute to improving the health of Indigenous people. Type: T 41. What nursing interventions promote the creation of supportive environments that will enhance the capacity of individuals and communities to make healthy choices? Answers to Test Questions 1. a 2. a 3. d 4. d 5. a 6. b 7. b 8. d 9. c 10. a 11. c 12. a 13. a 14. d 15. e 16. c 17. d 18. b 19. d 20. d 21. b 22. b 23. a 24. a 25. a 26. b 27. c 28. c 29. c 30. d 31. d 32. a 33. e 34. d 35. d 36. a 37. d 38. physical, emotional, intellectual, spiritual Chapter 3 – Cultural Competency, Cultural Sensitivity and Cultural Safety Test Questions 1. What are the advantages of cultural competency? a. It is straightforward to learn and be certified in. b. Most Indigenous patients recognise the value of cultural competency training. c. It ensures that all patients are treated equally according to their individuality. d. It developed in recent years with the growth of holistic nursing. 2. Which organisations routinely use cultural competency for nursing practice? a. The American military b. The Canadian Government c. Professional nursing associations in Canada d. All of the above 3. Which organisation is one of the major proponents of cultural competency? a. The European Union b. People’s Republic of China c. The Government of Nova Scotia d. The United States Military 4. Cultural safety borrows from what common practice? a. sharps safety b. patient-centred care c. public health d. homeopathy 5. Where did cultural safety originate? a. Canada b. Australia c. The United States d. New Zealand 6. What concept is cultural safety based on? a. Sharps safety b. Patient-centred care c. Public health d. Homeopathy 7. Who is the focus of cultural safety? a. The nurse, constantly evaluating his or her behaviour b. The healthcare system, which benefits from greater efficiency c. The patient, whose personal sense of security is the focus d. All of the above 8. According to the Canadian Nurses Association, cultural competence is a. the application of knowledge, skill, attitudes and personal attributes required by nurses to provide appropriate care and services in relation to cultural characteristics of their clients. b. the knowledge that cultural differences as well as similarities exist, without assigning values. c. use of culturally based care and health knowledge in sensitive, creative and meaningful ways. d. a manner which affirms respects and fosters the cultural expression of the recipient. 9. The Kahnawake Schools Diabetes Prevention Project (KSDPP) is an example of a. cultural imperialism. b. cultural assimilation through education. c. culturally safe health promotion. d. application of cultural competency to diabetes education. 10. The Inuulitsvik Maternities provide culturally safe care by a. allowing family members to accompany expectant mothers when they are evacuated to Southern hospitals for birth. b. having decisions on evacuation made by a community board, using medical advice. c. giving pregnant women the option of natural childbirth techniques. d. encouraging spouses to attend births at the clinic. 11. How should we, as nurses, treat our Indigenous patients? a. As Indigenous, with their own unique values and beliefs b. No differently than any of our other patients c. As individuals, according to how they want to be treated d. a and c 12. What are the disadvantages of cultural sensitivity? a. It is very hard to put into practice. b. It is not useful in the clinical setting. c. It is not very well defined. d. It is very hard to teach to students. 13. Unintentional rudeness on the part of the nurse is an example of a. assertiveness. b. cultural blindness. c. advanced competence. d. cultural sensitivity. 14. Which of the following statements best defines cultural sensitivity? a. The process of passing on a culture from one generation to the next b. A form of inclusion whereby an individual is given the opportunity to belong c. The belief that one’s culture is the norm, but other cultures have value too d. A reality that a variety of injustices have been committed against different groups 15. A culturally sensitive nurse would recognise that First Nations a. are taught to suppress pain and not talk about self. b. cry and mourn loudly with the death of a community member. c. value assertiveness as a communication style. d. vary widely in their reaction to pain and suffering. 16. How does epistemological accommodation apply to the Canadian Nursing context? a. It doesn’t apply at all. b. It allows both practitioners and patients to retain their own values while accommodating each other in the clinical setting. c. It explicitly gives practitioners permission to compromise professional standards in order to provide patient oriented care. d. None of the above. 17. Professional standards are less important in nursing Indigenous patients than cultural safety and epistemological accommodation. a. True b. False 18. Official multiculturalism policy sees Indigenous peoples as no different than any other ethnic minority in Canada. a. True b. False 19. Indigenous people have the right to treatment that respects their cultural values. a. True b. False 20. Nurses should apply the principles of cultural safety only to the Aboriginal population in Canada. a. True b. False 21. Lack of culturally safe nursing care of Indigenous patient can be fatal. a. True b. False Type: T 22. Provide THREE examples of how nurses can foster incorporation of epistemological accommodation of traditional Indigenous healing practices into the biomedical system. Type: T 23. Briefly discuss the advantages and disadvantages of the three standard models of intercultural nursing care: cultural sensitivity, cultural competency and cultural safety. Type: T 24. What nursing interventions promote the creation of supportive environments that will enhance the capacity of Indigenous individuals and communities to make healthy choices? Answers to Test Questions 1. a 2. c 3. d 4. a 5. d 6. a 7. c 8. a 9. c 10. b 11. d 12. b 13. d 14. c 15. d 16. b 17. b 18. a 19. a 20. b 21. a 22. a. Culturally relevant care: In traditional culture, physical and spiritual health are closely linked, therefore the nurse can recognize the importance of spiritual ceremonies to be practiced (e.g., smudging in hospital room). Discuss/incorporate traditional healing practices with the patient (i.e., herbs and teas), and so consider integrating them into the nursing care so long as they don’t interfere with or contraindicate the pharmaceutics/treatments prescribed. May also conduct research into determining the possible interactions between them – the herbs and teas and the drug therapies prescribed – and so compare Western medical practices with the traditional ones in order to develop an understanding of such possible interactions. Remember to include families in developing nursing care. b. Encourage/welcome traditional healers to come into the hospital; also, to advocate/provide a place/space for traditional healing ceremonies (e.g., smudges) to take place. c. Holistic approach to healthcare by considering the possible incorporation of the use of the medicine wheel into the nursing care plan if appropriate. This demonstrates consideration of Indigenous views of holistic health being that of a balance of the mind, body, soul and spirit. d. Privacy and time for family and visitors with patient provided for prayers, meditation, or other traditional methods of healing in the acute care setting without interruption. In providing time for privacy and time/opportunity for connecting oneself with the spiritual world, this may improve a patient’s will to live and may serve as a source of strength. 23. Possible answers: Cultural sensitivity: Advantages: 1. It is easy to learn. 2. It is easy to practice. Disadvantages: 1. It is largely ineffective in addressing problems in patient care. 2. It gives the healthcare provider a false sense of accommodation, while not actually doing anything concrete for the patient. Cultural competency: Advantages: 1. Its checklist approach to learning about other cultures is facile to implement. 2. Enrolling in education and training courses in preparation to being culturally competent in the healthcare environment prepares healthcare professionals is relatively straightforward. 3. It is easy to test for cultural competency and maintain standards of culturally appropriate care. 4. It can be effective in delivering culturally appropriate care to traditional Indigenous patients. 5. It can give the healthcare provider confidence that they are providing appropriate care to members of cultural minorities. 6. Being aware of personal prejudices and biases and cultivating ways of not displaying them outwardly. 7. Developing health information written in appropriate literacy levels in both official bilingual languages (English and French) and in the language and cultural norms of the targeted Indigenous population. Disadvantages: 1. Its checklist approach tends to ignore the nuances and variations between individuals. 2. It assumes that cultures are static, when they are changing and evolving continually – which can leave cultural competency training rapidly out of date. 3. Cultural competency can give healthcare providers a false sense of confidence that their care is appropriate, when it may not be. Cultural safety: Advantages: 1. It places the focus of appropriate care on the patient whose personal sense of security is the focus and not the healthcare provider. 2. It ensures that individual cultural preferences are respected. 3. It encourages the healthcare provider to provide appropriate care to all patients, irrespective of their cultural background in order to maintain their safety. 4. It encourages the healthcare provider to become a patient advocate – for the safety of the patient is foremost. 5. Making culturally welcoming environments in clinics and healthcare institutions by exhibiting the Indigenous cultural representations and portrayals. 6. Listening attentively to Indigenous clients and not assuming your skills and knowledge are best. 7. Adopting open attitudes, behaviour, and skills that enable a healthcare professional to work respectfully and effectively with Indigenous people and communities while presenting as knowledgeable and affirming. Disadvantages: 1. It is difficult to learn. 2. Practicing cultural safety requires the healthcare provider to be alert to the individual cultural matrix of each patient 3. Cultural safety must be accommodated with the professional practice standards of the healthcare provider. 24. Possible nursing interventions – cultural safety: i. People make healthier choices when they feel supported. Listening and learning from Indigenous people about their traditional culture/medicine will allow for a deeper relationship to develop with members of the community. In doing so, the nurse will have a better understanding of how to effectively and appropriately provide healthcare to the community. ii. Creating space for spiritual and cultural beliefs to be incorporated into nursing care so that respect and a genuine interest towards their beliefs are demonstrated. iii. Providing support by inquiring about and arranging for the presence of friends, family, or community members in the clinical setting is reassuring to Indigenous people. iv. Providing culturally appropriate educational material (e.g., human immunodeficiency virus [HIV], sexually transmitted disease [STD] pamphlets, etc.), preferably from an analogous Indigenous health organisation that highlights the communities’ participation in designing and incorporating traditional medicine and food and healthy lifestyle choices (e.g., exercise programs), is reverential. In so doing, Indigenous peoples can relate to and understand more effectively the intended healthcare message, and this can ideally lead to increased implementation of mutually identified healthcare goals. v. Using appropriate language and terminology in the clinical setting that may be understood and be relevant to Indigenous people. vi. Providing culturally appropriate health information about risks and preventative measures to encourage the end of high-risk behaviour. vii. Providing a judgement-free environment and demonstrating an open-mindedness so that individuals feel comfortable and accepted, thus increasing their likelihood to asking further questions and for seeking additional information and counselling. viii. Maintaining a long-term residence in the community to establish relationships with members and to gain the trust of people. Chapter 4 – Historical Overview Test Questions 1. An example of assimilation as it applies to Indigenous people is a. residential schools. b. development of the Métis culture. c. participation of Indigenous people in the fur trade. d. use of traditional medicine in the biomedical system. 2. The Indian Act, 1876, reflected the official ideology of assimilation, which a. explicitly saw government policy as the peaceful absorption of the Indigenous population. b. paved the way for extensive settlement on the Prairies. c. was based explicitly on a “divide and conquer” philosophy. d. none of the above. 3. All of the following are true except a. Indigenous people were relatively disease free in the pre-Contact period b. Indigenous people were embattled by disease in the pre-Contact period c. Indigenous people were in close contact with mammals in the pre-Contact period d. Indigenous people were well nourished in the pre-Contact period 4. Pacific Coastal First Nations depended on which of the following staple food “species”? a. Bison b. Cod c. Salmon d. Caribou 5. How do we know about the pre-Contact history of North American Indigenous peoples? a. Explorer’s accounts b. Archaeology c. Oral history d. All of the above 6. Which of the following pre-Contact Indigenous populations were primarily agricultural? a. Cree b. Iroquois c. Blackfoot Confederacy d. Beothuk 7. Which of the following foods were domesticated by First Nations farmers before Contact? a. beans, maize, squash b. chocolate and tobacco c. wheat and barley d. a and b 8. Where did First Nations practice agriculture in Canada? a. Southern Québec and Southern Ontario b. Canadian Prairies c. Canadian Arctic d. Boreal Forest 9. Which large herd animal formed part of the staple diets of Indigenous hunter-gatherers at Contact? a. Whale b. Caribou c. Bison d. Woolly mammoth e. a, b and c 10. Village life in pre-Contact British Columbia was supported by a. an abundant supply of salmon. b. hunting mountain caribou. c. whaling. d. farming. 11. Traditionally, the Inuit diet was composed of a. a mixture of wild greens and meat. b. mostly meat and fish, supplemented by some seasonal plants. c. produce from their farms. d. salmon fishing. 12. Pre-Contact Indigenous peoples were a. well nourished. b. often faced with starvation. c. much less well nourished than their European contemporaries. d. faced with cycles of abundance and starvation. 13. Hunter-gatherers consumed a diet that was a. superior to most other Indigenous and European diets. b. inferior to Indigenous farmers’ diets, but superior to European diets. c. about the same as both other Indigenous and European diets. d. inferior to all other Indigenous and European diets. 14. The harsh environment of the Inuit left them a. more secure than most Indigenous peoples, because their isolation left them free from competition. b. living a marginal existence that was often threatened by the environment. c. more numerous as a people due to the invigorating effects of their environment. d. sparsely populated and poorly nourished. 15. Pre-Contact Canadian Indigenous peoples a. engaged in frequent warfare amongst themselves b. were an isolated, impoverished population c. had population densities too low to support systematic and large-scale warfare d. had high enough population densities to repel European colonists 16. Northern Plains First Nations depended on which of the following staple food species? a. Bison b. Mule deer c. Elk d. Moose 17. Inuit depended on which of the following staple food species? a. Bison b. Cod c. Salmon d. Caribou 18. The trade centres of the Northern plains were the hub for disease contact and concomitant spread of many epidemics. Which one of the following diseases fulfils the criteria for depopulating epidemics in the Northern plains? a. Influenza b. Measles c. Small pox d. Tuberculosis 19. Infectious diseases a. led to frequent epidemics among the North American Indigenous peoples before Contact. b. were rare, but serious threats to Indigenous populations. c. were endemic among the Iroquois farmers of Eastern Canada. d. appear to have been unknown before Contact. 20. What factor allowed tuberculosis (TB) to flourish among Indigenous people during the 20th century period? a. Lack of racial immunity b. Relocation to reserves c. Genetic susceptibility d. Poor water quality 21. Virgin soil epidemics are characterised by a. mortality among the old and young. b. excessive morbidity. c. acquired immunity. d. high mortality in all age groups. 22. A virgin soil epidemic is a. a plant disease striking untilled land. b. epidemic disease infecting a population with no prior immunity. c. chronic disease in a population with poor determinants of health. d. paediatric disease causing at least 50% mortality. 23. A virgin soil epidemic is one that a. a population has no acquired resistance to. b. infects the earth and remains active in it. c. infects only children before the age of adolescence. d. is spread through sexual contact. 24. Introduced epidemic diseases caused Indigenous populations to suffer mortality rates as high as a. 20% b. 10% c. 40% d. 95% 25. Decolonizing Indigenous health can mean a. devolving more services to Indigenous health authorities. b. including Indigenous rituals and beliefs in the medical system. c. abolishing the medical system and returning to traditional healing altogether. d. any of the above. 26. Jordan’s Principle states that a. the first agency to come into contact with a First Nation’s child in need of care, is obligated to pay for that care. b. provincial Medicare programs are primarily responsible for Non-Status First Nations healthcare. c. Health Canada must provide primary care services to all Indigenous children. d. municipal governments are responsible for emergency services for the Urban Indigenous population in Manitoba. 27. The creation of Jordan’s principle a. was named after the Indigenous physician who advocated for health promotion and provision of non-insured benefits b. was named after the politician who developed the patchwork of federal, provincial and local jurisdictions that permitted Indigenous patients “to fall through the cracks.” c. was implemented at the federal and provincial level. d. was named after a 5-year-old boy who died in Winnipeg while the federal and provincial governments argued. 28. The fur trade spread quickly across Canada because a. it was created by Europeans to help Indigenous peoples develop new markets for their furs. b. it exploited existing Indigenous trade routes. c. European explorers mapped new trading routes and introduced Indigenous peoples to them. d. European steam ships and trains transported goods quickly. 29. The fur trade created a network of European trading posts that covered Canada and which also a. opened and exploited new trade networks. b. brought the Indigenous population into a global economy. c. obtained the permission of existing Indigenous people to prepare the way for further European economic and political penetration. d. provided the Indigenous population with opportunities to travel. 30. Early Contact Indigenous societies were able to quickly a. adapt to and adopt European technology. b. use their existing technology to defeat European armies that invaded them. c. develop advanced weapons that were adopted by Europeans themselves. d. withdraw from European traders into isolation. 31. The predominant pattern of disease among Indigenous people following Contact was a. infectious diseases. b. injuries. c. chronic diseases. d. suicide. 32. Of all the impacts of European Contact on the Americas, epidemic diseases were a. the most insignificant. b. the most devastating. c. as important as the new trading opportunities that Contact brought. d. less important than the new weapons, especially firearms, that Europeans brought. 33. Which of the following were introduced to the Americas by European explorers and traders? a. Smallpox b. Rubella c. Tuberculosis d. Common Cold e. a, b and d 34. How far did the 1775 to 1782 smallpox extend across North America? a. Through the English Thirteen Colonies on the East Coast and Mexico b. No further north than Mexico and the French colonies in Louisiana c. Everywhere in North America except the Arctic and the Northwest Coast of British Columbia d. All of the above 35. The spirochete that causes syphilis was a. present in Indigenous populations and caused frequent outbreaks of syphilis before Contact. b. brought to the Americas by Europeans. c. brought to Europe as a venereal disease by Europeans and then reintroduced to the Americas in this new form. d. brought to the Americas by sailors trading in the Far East. 36. The Royal Proclamation of 1763 a. recognized Indigenous title to land in British North America. b. banned the Potlatch and the Ghost Dance. c. granted the Hudson’s Bay Company the right to trade in North America. d. seized the traditional lands of the Cree in Northern Ontario and Northern Québec. 37. The Royal Proclamation of 1763 a. seized First Nations land for the King of England. b. was a military treaty between the Iroquois Confederacy and the English. c. recognized Indigenous title to most of Canada. d. has never been recognised by Canadian governments. 38. The Royal Proclamation of 1763 a. brought the fur trade into the global market. b. encouraged Indigenous peoples to work for the Hudson’s Bay Company. c. recognised Indigenous title and sovereignty to land in North America. d. followed the United States’ example of settler and Indigenous relations. 39. Why is the Royal Proclamation of 1763 important today? a. It created the Province of Canada. b. It recognised Indigenous title to most of Canada. c. It regulates transfer of land between First Nations and settlers. d. It sharply reduced amount of potential conflict between settlers and First Nations. 40. The Canadian government began providing medical services to the Indigenous population a. after the Second World War. b. as soon as it signed land claims treaties which guaranteed them. c. since Confederation. d. a and b. 41. Until recently the Indian Act had as its official goal a. assimilation of the Indigenous population into the general population of Canada. b. keeping the Status Indian population segregated on their reserves. c. forcing Inuit, Métis and Non-Status Indians to become Status Indians. d. none of the above. 42. Bill C31, an amendment to the Indian Act enacted by Parliament a. clarified Indigenous rights to land and resources. b. reinstated to First Nations bands the right to govern. c. proclaim Indigenous peoples as a nation or tribe. d. restored Indian status to women and their children. 43. After Confederation, the Canadian government sought to a. exterminate the Indigenous population of Canada. b. suppress Indigenous resistance through military force. c. assimilate the First Nations population through a variety of approaches. d. keep the Indigenous population separate and distinct from the non-Indigenous population. 44. Modern relations between the First Nations peoples and the Canadian government are a legacy of a. the 1876 Indian Act. b. the War of 1812. c. the Northwest Rebellion. d. all of the above. 45. Residential schools were created to a. preserve Indigenous traditions and language. b. force Indigenous children to learn to assimilate into the non-Indigenous population. c. provide a place for homeless orphans to go to school. d. make jobs for unemployed schoolteachers. 46. Residential school had a major negative impact on the health and well-being of many Indigenous people. An example of a loss experienced by children who attended residential school is a. identity. b. English language. c. physical abuse. d. alcohol misuse. 47. Residential schools a. were the foremost instrument of state assimilation policy as applied to the Indigenous population. b. reflected official policy of segregation of Indigenous and non-Indigenous populations. c. were only attended by a minority of Indigenous children. d. were only for Indigenous children. 48. The Canadian residential school system left a legacy of a. successfully preparing graduates for the workforce. b. systematic abuse and neglect of Indigenous children. c. model education widely imitated in other school systems in Canada. d. high-quality education, but primitive facilities and inedible food. 49. In Canada, Indian Reserves are a. where all Indigenous people live in Canada. b. land reserved for Indigenous people. c. the place where Non-Status Indians live. d. inhabited by some First Nations, but not Inuit or Métis. 50. Before 1982, Status Indian men who married a Non-Status woman a. granted their wife and their children Indian status. b. lost Indian Status themselves. c. kept Indian Status, but could not grant it to either their wife or children. d. passed Indian Status on to their children, but not to their wives. 51. Before 1982, Status Indian women who married a Non-Status man a. transferred their Status rights to their husband and children. b. kept Indian Status, but could not transfer it to their husband and children. c. kept Indian Status, as did their children, but could not transfer it to their husband. d. were stripped of Indian status, as were their descendants. 52. Which of the following statements best defines ethnocentrism? a. A form of rejection whereby an individual is denied the opportunity to participate in the dominant culture. b. The belief that one’s culture is superior to any other culture. c. A reality that a variety of injustices have been committed against different groups. d. A form of inclusion whereby an individual is brought in to participate in the dominant culture. 53. The concept of enfranchisement put forwards in 1869 for Indigenous people meant that a. Indigenous women were now given the vote. b. Indigenous women who married non-Indigenous men lost their status. c. Indigenous women were seen as equal to Indigenous men. d. Indigenous men who gained voting rights lost their status. 54. What has been a major factor in preserving and promoting health among the Indigenous population? a. Low smoking rates b. Traditional diet and lifestyle c. Modern medical treatment d. Improved education for health life choices Type: F 55. The heartland of pre-Contact Indigenous agriculture lay in __________________, ___________________ and _________________. (3 marks) Type: F 56. Some imported diseases that travelled the Atlantic with explorers and settlers to the Americas include ________________, ________________, ______________, ______________ and ________________. (5 marks) Type: F 57. Infectious diseases of particular concern in Indigenous communities include _____________, ________________ and ___________________. (3 marks) Type: F 58. Generations of Indigenous farmers in southern North America, Central America and the Andean Highlands domesticated a wide range of crops, many still significant today, which include _________________, ________________, ________________, _________________, ________________ and _______________ from wild ancestors. (6 marks) (answers may include other crops including: melons, squash, avocados, vanilla and tobacco) 59. Pre-Contact Northern populations were in close contact with mammals. As a result of this contact diseases such as tuberculosis may have infected pre-Contact Indigenous people of the Arctic. a. True b. False 60. Indigenous people were relatively disease free in the pre-Contact period. a. True b. False 61. The Indian Act is clear that status Indians do not own property on reserves. a. True b. False 62. Traditionally, Indigenous peoples participated in government and spiritual ceremonies. a. True b. False 63. All Indigenous people are First Nations. a. True b. False 64. Only Status Indians have the right to live on reserves. a. True b. False 65. First Nations without status cannot live on reserves and receive no special government assistance. a. True b. False 66. Without status it is impossible to claim and be Indigenous. a. True b. False 67. Inuit have Indian status. a. True b. False 68. Métis have Indian status. a. True b. False 69. A treaty Indian is a member of a Prairie First Nation that has signed a land claims treaty with the Canadian government. a. True b. False 70. Most First Nations in British Columbia are treaty Indians. a. True b. False 71. Treaty Indians receive different and better services than other First Nations, even those with Indian status. a. True b. False 72. The term First Nations is now preferred over Indian. a. True b. False 73. Treaties are direct government to government agreements between two sovereign governments. a. True b. False 74. Indian reserves are granted by the Canadian government, not inhabited by right. a. True b. False 75. The Canadian government has been slowly devolving governmental functions to Indigenous governments, without introducing constitutional amendments to do so. a. True b. False 76. The Charter of Rights and Freedoms places the individual rights of Canadians (including Indigenous Canadians) above the treaty rights of Indigenous peoples. a. True b. False 77. The Canadian constitution entrenches the treaty rights of the Indigenous peoples of Canada and requires Canadian governments to respect them. a. True b. False 78. The Canadian government assigns every Registered Indian a Band Number to identify their eligibility for government services. a. True b. False Answers to Test Questions 1. a 2. a 3. b 4. c 5. d 6. b 7. d 8. a 9. e 10. a 11. b 12. a 13. a 14. b 15. c 16. a 17. d 18. c 19. d 20. b 21. d 22. b 23. a 24. d 25. d 26. a 27. d 28. b 29. b 30. a 31. a 32. b 33. e 34. c 35. c 36. a 37. c 38. c 39. c 40. d 41. a 42. d 43. c 44. d 45. b 46. a 47. a 48. b 49. d 50. a 51. d 52. b 53. d 54. b 55. Southern Canada (Ontario/Québec), Central America (including Mexico), South America (Peru, Chile) 56. small pox, tuberculosis, measles, influenza, rubella 57. upper respiratory infections, tuberculosis, sexually transmitted diseases (HIV [human immunodeficiency virus], HPV [human papillomavirus], chlamydia, etc.) 58. maize/corn, potatoes, tomatoes, chillies, beans, cocoa/chocolate 59. b 60. a 61. a 62. a 63. b 64. a 65. a 66. b 67. b 68. b 69. b 70. b 71. b 72. a 73. a 74. a 75. a 76. b 77. a 78. a Part II Indigenous Health and the Canadian Healthcare System Chapter 5 – Understanding the Determinants of Health and Canada’s Native Population Test Questions 1. What are the determinants of health? a. Factors in people’s physical, social, economic and biological environment that affect their health b. Key pharmaceuticals that are used to treat important chronic diseases c. Collective impact of public health agencies on each Canadian’s health. d. Components of a standard medical risk scoring sheet for maternal health 2. Individuals and communities reporting high levels of health have a greater sense of a. control. b. financial resources. c. spirituality. d. self-preservation. 3. The determinant of health that has the greatest impact on health is a. education. b. income. c. drugs and alcohol. d. healthcare. 4. Which of the following are considered to impact the health of a population? i. Access to healthcare services iii. Income ii. Drinking water iv. Leisure activities a. None of the above b. i, ii and iii c. All of the above d. i and iii 5. In Canada, higher income and social status usually correlate with a. better health. b. higher alcohol consumption. c. consumption of fatty foods. d. purchases of Mediterranean food products. 6. Which Indigenous population has the lowest levels of income in Canada? a. Métis b. On-reserve First Nations c. Off-reserve First Nations d. Inuit 7. Social support networks provide individuals with a. a network of friends and supporters to help them weather adverse circumstances. b. peer pressure that can lead to unwise personal health decisions. c. a strong sense of control and mastery over life. d. all of the above. 8. How can we measure the strength of social support networks? a. By measuring physical response to staged family crisis scenarios b. Through participation in family and community events c. By estimating the maximum number of interpersonal relationships possible in the community d. Through use of psychological evaluation 9. Canadians with low levels of education are more likely to a. smoke less. b. have excellent health. c. obtain job satisfaction. d. have poorer health. 10. When compared with the non-Indigenous population, Indigenous rates of post-secondary trades certification are a. much lower. b. about the same. c. much higher. d. not calculated. 11. Canadians with low education are more likely to a. smoke less. b. have excellent health. c. obtain job satisfaction. d. have poorer health. 12. The Indigenous unemployment rate is a. lower than the Canadian average. b. roughly the same as the Canadian average. c. a little higher than the Canadian average. d. much higher than the Canadian average. 13. What are the most important years in an individual’s development? a. Birth to age 6 b. Birth to age 12 c. Ages 12 to 16 d. Ages 18 to 30 14. An individual’s genetic endowment a. will determine their health throughout their life. b. can influence their health, but seldom determines it. c. has no effect on individual health. d. refers to modern biomedical gene selection techniques. 15. Public health services include a. vaccinations. b. mammograms. c. open heart surgery. d. a and b. e. none of the above. 16. Gender roles a. are biologically invariant. b. are socially assigned and culturally embedded. c. may be changed through surgical and pharmaceutical intervention. d. have important implications for health. e. b and d. 17. Traditional Indigenous health views differ from traditional Western medicine in that a. Indigenous view is that health is holistic; Western view is that medicine is not holistic. b. Indigenous view is that health is earned; Western belief is that health is bought. c. Indigenous view is that health is a gift; Western belief is that health is holistic. d. both share the same philosophical underpinnings. 18. Culture influences health through a. the cultural stereotypes that society imposes upon individuals. b. the cultural roles individuals internalize and incorporate into their lives. c. providing a secure social identity with which to navigate society. d. all of the above. 19. When compared with the general Canadian population, the incidence of cancer mortality among First Nations is a. less of a problem. b. more of a problem. c. increasing. d. the same. 20. Contaminants in the physical environment can cause a. cancer. b. respiratory disease. c. birth defects. d. a and c. e. all of the above. 21. The Gaia Theory a. sees human beings as an integral part of the planetary ecosystem. b. is a mystical belief that the Earth itself is alive and takes the form of an ancient goddess. c. has been discredited by recent scientific research. d. all of the above. 22. Gaia Theory considers the Earth to be a. a unified interconnected whole. b. easily described by a number of unrelated individual scientific theories. c. a living goddess and the spiritual mother of the world. d. a simple piece of inanimate matter. 23. What is population health? a. The overall health of a population b. The health of each individual in a population c. A statistical measure of average prescription drug consumption in a population d. All of the above 24. What is the relationship between the determinants of health and population health? a. The determinants of health are the means by which population health can be measured b. There is no relationship c. The determinants of health measure individual health, while population health uses statistical measures d. b and c 25. Health Canada, from http://www/ population health approach as a tool for population health promotion and public policy specifically to a. consider gathering information on health inequities among population groups. b. improve the health of the population. c. reflect on the capacity of people to come to terms with life’s challenges. d. discount the range of social, economic and physical factors that contribute to health. 26. How does population health relate to individual health? a. Good population health means that every individual is healthy. b. Poor population health means that every individual is in poor health. c. Good population health facilitates individual health. d. a and b. 27. Vaccination rates among the First Nations population are a. lower than among the non-Indigenous population. b. higher than among the non-Indigenous population. c. non-existent. d. 100%. 28. What has been a major factor in preserving and promoting health among the Aboriginal population? a. Low smoking rates b. Traditional diet and lifestyle c. Modern medical treatment d. Improved education for health life choices 29. The design and implementation of health policies and programs can promote or violate human rights. a. True b. False 30. Health status improves with each step up in income and social status. a. True b. False 31. Canadians with low levels of education are more likely to have poorer health. a. True b. False 32. Education and literacy increases opportunities for jobs and income security. a. True b. False 33. High levels of trust and group membership are factors of social environment that are associated with reduced mortality rates. a. True b. False 34. Personal health practices such as immunisation and mammograms are showing positive results in disease prevention. a. True b. False 35. The mind, body, birthplace and spirit are all integral parts of health according to Indigenous people. a. True b. False 36. The Gaia Theory is an example of how scientific epistemology can reflect aspects of the traditional Indigenous world view. a. True b. False 37. Indigenous people experience health problems that are linked with their historical position in the Canadian social system. a. True b. False Type: MT Matching (13 Marks) Directions: Match the following descriptions of the Determinants of Health in Column A with the appropriate term from Column B. Fill in your answers a, b, c, d, e, etc. Items from Column B may be used more than once. Each question is worth 1 mark. Column A Column B 38. The capacity