1. Aboriginal Families, Diversity and Livelihood Obesity and Healthy Occupation Panel Presentation Gaye Hanson June 14, 2008 CAOT Annual Conference Whitehorse, Yukon

2. Discovering the Difference … “We go looking for culture and cultural meaning only to find issues of equity and power. Our hidden expressions and lack of compliance are really a reflection of limitations imposed on us by a system, a society that says it values difference and diversity but what it really wants is conformity...” Rani Srivastava “Guide to Clinical Cultural Competence” 2007

3. Overview Aboriginal People Aboriginal People Culture Culture Values and Beliefs Values and Beliefs Cultural Sensitivity and Cultural Competence Cultural Sensitivity and Cultural Competence Issues and Risks Issues and Risks Life Giving Forces and Policies to Support Life Giving Forces and Policies to Support Research Questions and Challenges Research Questions and Challenges Moving Into the Future Moving Into the Future

4. Aboriginal People First Nation First Nation Inuit Inuit Métis Métis Other Aboriginal People Other Aboriginal People Other dimensions of diversity – gender, age, geography, income, education, occupation, socio-economic status, degree of acculturation, access to traditional lands, language, cultural teachings etc. Other dimensions of diversity – gender, age, geography, income, education, occupation, socio-economic status, degree of acculturation, access to traditional lands, language, cultural teachings etc.

5. Culture Culture includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience religious or spiritual belief; and disability. Culture includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience religious or spiritual belief; and disability. Dianne Wepa, “Cultural Safety in New Zealand”, 2005 Culture is what we do every day, every week and every year – it is embodied in our way of seeing the world, seeing other human beings, assessing “goodness” or risk and understanding our past, present and future. We all have a culture. Culture is what we do every day, every week and every year – it is embodied in our way of seeing the world, seeing other human beings, assessing “goodness” or risk and understanding our past, present and future. We all have a culture.

6. Values and Beliefs Within health care, issues of culture and diversity have largely been viewed from a negative standpoint – with a focus on cultural differences and the resulting problems. Within health care, issues of culture and diversity have largely been viewed from a negative standpoint – with a focus on cultural differences and the resulting problems. (Srivastava, 2007) It would be more effective to recognize that barriers do not result from the clients’ culture but rather values and beliefs inherent in the biomedical culture, and from insufficient training as well as barriers in the health care system. It would be more effective to recognize that barriers do not result from the clients’ culture but rather values and beliefs inherent in the biomedical culture, and from insufficient training as well as barriers in the health care system. (Tripp-Reimer, Choi, Kelly & Enslein, 2001)

7. Cultural Sensitivity Cultural sensitivity builds on cultural awareness, cultural knowledge and cultural understanding. Cultural sensitivity builds on cultural awareness, cultural knowledge and cultural understanding. Culturally sensitive care is that which demonstrates the recognition of cultural differences and provides accommodation when possible. Cultural insensitivity would be seen when unique cultural characteristics, needs and desires are not identified as part of health care. Culturally sensitive care is that which demonstrates the recognition of cultural differences and provides accommodation when possible. Cultural insensitivity would be seen when unique cultural characteristics, needs and desires are not identified as part of health care.

8. Cultural Competence Cultural Competence is the human relational capacity to seek and find compassionate understanding within, between and among people of differing cultural backgrounds and perspectives. Cultural Competence is the human relational capacity to seek and find compassionate understanding within, between and among people of differing cultural backgrounds and perspectives. Hanson, 2006 Cultural competence is a verb which describes behaviors grounded in a person’s thoughts, feelings, awareness, knowledge, skills and relational style. Cultural competence is a verb which describes behaviors grounded in a person’s thoughts, feelings, awareness, knowledge, skills and relational style.

9. Cultural Competence (2) Connected concepts: Cultural competence requires a basic understanding of core concepts such as culture, race, ethnicity, gender, diversity, marginalization, and minority. Srivastava, 2007 Cultural competence requires a basic understanding of core concepts such as culture, race, ethnicity, gender, diversity, marginalization, and minority. Srivastava, 2007 It goes beyond awareness, sensitivity, knowledge and skills to application; although a basic level of knowledge about the cultural groups you are working with, including, in the case of Aboriginal people, the history of colonization, acculturation, residential schools and related intergenerational effects is needed. It goes beyond awareness, sensitivity, knowledge and skills to application; although a basic level of knowledge about the cultural groups you are working with, including, in the case of Aboriginal people, the history of colonization, acculturation, residential schools and related intergenerational effects is needed.

10. Cultural Competence (3) Levels and building blocks: Intrapersonal Intrapersonal Interpersonal Interpersonal Team Team

11. Cultural Competence (4) Levels and building blocks: Organizational – Governance, structure, funding, policies, procedures, training, incentives, supports and resources that invest in building cultural competence at all levels. Organizational – Governance, structure, funding, policies, procedures, training, incentives, supports and resources that invest in building cultural competence at all levels. Systemic – Public awareness, legislation and regulatory environments that support cultural competence. Systemic – Public awareness, legislation and regulatory environments that support cultural competence.

12. Issues and Risks Poverty, unemployment, under employment Poverty, unemployment, under employment Food security Food security Isolation, marginalization, shame Isolation, marginalization, shame Spiritual and cultural impacts Spiritual and cultural impacts Emotional challenges, grief, addictions Emotional challenges, grief, addictions Access to appropriate education Access to appropriate education Physical health burdens and chronic illness Physical health burdens and chronic illness Genetic predisposition Genetic predisposition Access to health care Access to health care

13. Life Giving Forces Hope – being able to envision a future you want to live Hope – being able to envision a future you want to live Self determination, Self government Self determination, Self government Self efficacy, pride in contribution to community Self efficacy, pride in contribution to community Pride, language and culture Pride, language and culture Own institutions, programs and services Own institutions, programs and services Own professionals Own professionals Rebuilding family and community Rebuilding family and community Deeper understanding of healing Deeper understanding of healing

14. Policies to Support LG Forces Self government, self governance Self government, self governance Consultation, collaboration, Aboriginal relations capacity and expertise Consultation, collaboration, Aboriginal relations capacity and expertise Co-management arrangements Co-management arrangements Culturally competent policy Culturally competent policy Healthy public policy Healthy public policy Responsive, culturally competent care systems and practitioners that contribute to capacity NOT dependency Responsive, culturally competent care systems and practitioners that contribute to capacity NOT dependency

15. Research Questions How do we better understand the dynamic interplay of characteristics, influences and choices that lead to weight issues – individual, family, community and society? How do we better understand the dynamic interplay of characteristics, influences and choices that lead to weight issues – individual, family, community and society? How do we support positive livelihood and personal / family / community change? How do we support positive livelihood and personal / family / community change? Where are the points of change and effective strategies at all levels – spiritual, emotional, intellectual and physical? Where are the points of change and effective strategies at all levels – spiritual, emotional, intellectual and physical?

16. Research Challenges Community based research takes time and funds to support relationship building Community based research takes time and funds to support relationship building Sensitive issue, burden of shame and anger Sensitive issue, burden of shame and anger Biomedical approach – lacks a more comprehensive perspective Biomedical approach – lacks a more comprehensive perspective

17. Moving Into the Future Government to Government arrangements Government to Government arrangements Co-management and collaborative governance of health system Co-management and collaborative governance of health system Overcoming jurisdictional issues Overcoming jurisdictional issues Action on determinants of health Action on determinants of health Improved, culturally competent, more comprehensive collaborative care Improved, culturally competent, more comprehensive collaborative care Focus on relationships at all levels Focus on relationships at all levels Improved access to OT and related services Improved access to OT and related services

18. Contact Information Gaye Hanson President, Hanson and Associates 42 Tamarack Drive Whitehorse, Yukon Y1A 4W2 P (867)633-6753 F (867)633-6777 C (867)333-2411 gaye@hansonandassociates.ca