6.5 Social determinants of health

Social determinants of health significantly impact Indigenous populations across the Americas. These non-medical factors, shaped by the distribution of resources, contribute to persistent health disparities and inequities experienced by Indigenous communities compared to non-Indigenous populations.

Economic stability, education access, social context, healthcare quality, and environmental factors all play crucial roles. Addressing these determinants is essential for improving Indigenous health outcomes and reducing disparities in the Americas.

Social determinants overview

• Social determinants of health refer to the non-medical factors that influence health outcomes and are the conditions in which people are born, grow, work, live, and age
• These determinants are shaped by the distribution of money, power and resources at global, national and local levels
• In the context of Indigenous Issues Across the Americas, social determinants play a significant role in the persistent health disparities and inequities experienced by Indigenous populations compared to non-Indigenous populations

Economic stability factors

Poverty and low income

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• Poverty is a major driver of health inequities and is associated with a wide range of adverse health outcomes, including increased risk of chronic diseases, mental health problems, and premature mortality
• Low income limits access to healthy food, safe housing, and quality healthcare, creating barriers to maintaining good health
• Indigenous populations across the Americas experience disproportionately high rates of poverty compared to non-Indigenous populations, contributing to health disparities

Unemployment and job insecurity

• Unemployment and job insecurity can lead to financial stress, which has been linked to poor mental and physical health outcomes
• Limited job opportunities and discrimination in hiring practices contribute to higher rates of unemployment among Indigenous populations
• Precarious employment, such as seasonal or part-time work, can also lead to income instability and difficulty accessing benefits like health insurance

Lack of affordable housing

• Affordable, safe, and stable housing is essential for maintaining good health, as it provides a foundation for meeting basic needs and accessing healthcare
• Indigenous communities often face a shortage of affordable housing options, leading to overcrowding, homelessness, and increased exposure to environmental hazards
• Inadequate housing conditions, such as lack of running water or proper sanitation, can contribute to the spread of infectious diseases and exacerbate chronic health conditions

Education access and quality

Low high school graduation rates

• Education is a key determinant of health, as it influences employment opportunities, income, and health literacy
• Indigenous students often face barriers to completing high school, such as underfunded schools, discrimination, and cultural disconnection
• Lower educational attainment is associated with poorer health outcomes, including higher rates of chronic diseases and shorter life expectancy

Barriers to higher education

• Access to higher education can provide opportunities for better employment, higher income, and improved health outcomes
• Indigenous students may face financial, cultural, and geographic barriers to pursuing higher education, such as limited funding for scholarships, lack of culturally relevant programs, and the need to leave their communities
• Addressing these barriers and increasing representation of Indigenous students in higher education can contribute to reducing health inequities

Underfunded schools in communities

• Schools in Indigenous communities often receive inadequate funding, resulting in limited resources, overcrowded classrooms, and reduced educational quality
• Underfunded schools may struggle to provide essential services, such as school meals, counseling, and health screenings, which can impact student health and well-being
• Investing in equitable funding for schools in Indigenous communities can help improve educational outcomes and promote better health

Social and community context

Discrimination and racism

• Discrimination and racism can have profound impacts on mental and physical health, contributing to chronic stress, anxiety, and depression
• Indigenous populations often experience systemic racism and discrimination in healthcare settings, leading to mistrust, delayed care-seeking, and poorer health outcomes
• Addressing discrimination and racism at individual, institutional, and societal levels is crucial for promoting health equity and improving the well-being of Indigenous communities

Social exclusion and isolation

• Social exclusion and isolation can lead to feelings of loneliness, depression, and reduced access to social support networks
• Indigenous communities may experience social exclusion due to geographic remoteness, language barriers, and cultural differences
• Strengthening social connections and building inclusive communities can help mitigate the negative health impacts of social exclusion and isolation

Adverse childhood experiences

• Adverse childhood experiences (ACEs), such as abuse, neglect, and household dysfunction, can have long-lasting impacts on health and well-being
• Indigenous children may be at higher risk of experiencing ACEs due to the legacy of colonialism, intergenerational trauma, and socioeconomic disparities
• Addressing ACEs through trauma-informed care, family support services, and community-based interventions can help promote resilience and improve health outcomes

Health care access and quality

Lack of health insurance coverage

• Health insurance coverage is a critical factor in accessing timely and affordable healthcare services
• Indigenous populations often have lower rates of health insurance coverage compared to non-Indigenous populations, due to factors such as unemployment, poverty, and eligibility barriers
• Expanding access to health insurance, including Medicaid and Medicare, can help reduce financial barriers to healthcare for Indigenous communities

Limited access to health services

• Indigenous communities, particularly those in rural or remote areas, may face limited access to healthcare facilities and providers
• Long distances to healthcare facilities, lack of transportation, and shortages of healthcare professionals can create barriers to accessing necessary services
• Investing in telemedicine, mobile health clinics, and community health worker programs can help improve access to care in underserved Indigenous communities

Poor quality of care in facilities

• Indigenous patients may experience poor quality of care in healthcare facilities due to factors such as cultural insensitivity, language barriers, and provider bias
• Poor quality of care can lead to misdiagnosis, inadequate treatment, and mistrust in the healthcare system
• Improving cultural competency training for healthcare providers, increasing representation of Indigenous professionals in healthcare, and incorporating traditional healing practices can help enhance the quality of care for Indigenous patients

Neighborhood and built environment

Overcrowded and substandard housing

• Overcrowded and substandard housing conditions can contribute to the spread of infectious diseases, exacerbate chronic health conditions, and impact mental health
• Indigenous communities often experience higher rates of overcrowding and poor housing quality due to limited affordable housing options and underfunded housing programs
• Investing in the construction and maintenance of safe, affordable housing can help improve health outcomes and reduce health disparities

Lack of transportation infrastructure

• Lack of reliable transportation infrastructure can create barriers to accessing healthcare services, healthy food options, and employment opportunities
• Indigenous communities, especially those in rural or remote areas, may have limited public transportation options and poor road conditions
• Improving transportation infrastructure, such as expanding public transit networks and investing in road maintenance, can help increase access to essential services and resources

Exposure to environmental toxins

• Exposure to environmental toxins, such as air pollution, contaminated water, and hazardous waste, can have detrimental effects on health
• Indigenous communities may be disproportionately impacted by environmental toxins due to factors such as proximity to industrial sites, inadequate environmental regulations, and limited access to clean water
• Strengthening environmental protections, promoting clean energy initiatives, and involving Indigenous communities in decision-making processes can help reduce exposure to environmental toxins and promote environmental justice

Food insecurity and nutrition

Lack of access to healthy foods

• Access to healthy, affordable food options is essential for maintaining good health and preventing chronic diseases
• Indigenous communities, particularly those in food deserts or remote areas, may have limited access to fresh produce and other nutritious foods
• Investing in community gardens, farmers' markets, and food assistance programs can help improve access to healthy food options in Indigenous communities

Reliance on processed, low-nutrient foods

• Reliance on processed, low-nutrient foods can contribute to the development of chronic diseases such as obesity, diabetes, and heart disease
• Indigenous populations may have higher rates of consumption of processed foods due to factors such as limited access to healthy options, food insecurity, and the influence of Western diets
• Promoting traditional Indigenous food systems, increasing nutrition education, and improving the affordability of healthy foods can help reduce reliance on processed foods

Higher rates of obesity and diabetes

• Indigenous populations often experience higher rates of obesity and diabetes compared to non-Indigenous populations
• Factors such as limited access to healthy foods, physical inactivity, and genetic predisposition can contribute to the development of these chronic conditions
• Implementing culturally appropriate diabetes prevention and management programs, increasing access to physical activity opportunities, and addressing social determinants of health can help reduce the burden of obesity and diabetes in Indigenous communities

Unique challenges for Indigenous peoples

Intergenerational trauma and stress

• Intergenerational trauma refers to the cumulative emotional and psychological wounding experienced by Indigenous communities as a result of historical and ongoing oppression, violence, and cultural suppression
• This trauma can be passed down through generations, contributing to higher rates of mental health problems, substance abuse, and chronic stress
• Addressing intergenerational trauma through culturally sensitive mental health services, community healing programs, and the revitalization of Indigenous cultural practices can help promote resilience and well-being

Geographic isolation and remoteness

• Many Indigenous communities are located in geographically isolated or remote areas, which can create unique challenges in accessing healthcare, education, and other essential services
• Limited infrastructure, long distances to services, and harsh environmental conditions can exacerbate health disparities and limit opportunities for economic and social development
• Investing in telemedicine, distance education programs, and community-based services can help mitigate the impacts of geographic isolation on Indigenous health and well-being

Disruption of traditional practices

• The disruption of traditional Indigenous practices, such as language, spirituality, and land-based activities, can have profound impacts on health and well-being
• Colonization, forced assimilation policies, and the loss of land and resources have contributed to the erosion of Indigenous cultural practices and identity
• Supporting the revitalization of Indigenous languages, cultural practices, and traditional knowledge systems can help promote cultural continuity, resilience, and improved health outcomes for Indigenous communities