| Living in Balance: Gender, Structural Inequalities, and Health Promoting Behaviors in Manitoba First Nation Communities
B. Elias, A. Leader, D. Sanderson,
The intent of this report is to describe health promoting behaviors, such as engaging in more physical activity, positive dietary changes, quitting smoking, and stop drinking for a time, as positive attributes that cluster in First Nation peoples. To understand the contribution that social determinants can make to positive health behaviors, this project investigates these health-promoting behaviors in relation to age, gender, socio-economic status, economic security, social conditions, and health behaviors. Reporting on health promoting behaviors in First Nation peoples illustrates that research which takes a positive approach can contribute to a more balanced understanding of health and health behaviors in First Nation communities.
This study examined characteristics that distinguish Manitoba First Nation women and men in terms of health behaviors (i.e., more physical activity, positive dietary changes,.quit smoking, and stop drinking for a time). Data used for this study was derived from the Manitoba First Nations Regional Health Survey. This survey was a general health survey, which included questions on health promoting behaviors, health risk history, structural material factors, and household social environment.
For this survey, the target population was all First Nation People living in a Manitoba First Nation community as of 1997. The sampling approach was a sentinel community design. All eight Tribal Councils and eight Independent Communities were represented in the selection process. Altogether, seventeen communities agreed to participate. In each community, households were then randomly selected from a community map and all adults and one child or youth under 18 years of age (proxy) were interviewed in each house.
The overall response rate was 81%, and a majority of the communities reported 100% completion of questionnaires. The total sample achieved was 1,948 adults and 870 children. Because more women (59%) than men (41%) answered the survey, the survey data was weighted using age and sex within each population-sampling unit (Tribal Council). After this adjustment, the sample reflected the age and sex distribution of the First Nation population.
The analysis for this paper was based on a sample of 1,870 adults representing a population of 32,030 Manitoba First Nation people. Descriptive analysis involved reporting percentages and chi-square tests of significance. A p-value of less than 0.05 was considered significant. Logistic regression modeling was used to adjust for significant characteristics. The Odds Ratio was used to summarize the association between the determinants of health, gender, and health promoting behaviors.
Three-quarters of First Nation people (75%) reported two or more positive health behaviors. Significantly more men than women (80% vs. 76%) stopped drinking. Men were also more likely to be physically active (27% vs. 16%), whereas women made appreciably more positive dietary changes (79% vs. 66%). There were little to no differences between women and men for quitting smoking or practicing two or more positive health behaviors.
Health promoting behaviors were important attributes of other health promoting behaviors. Individuals who stopped drinking had made positive dietary changes (X 2 =16.1, p=0.001) and were more likely to be physically active (X 2 =4.4, p=0.036). They were less likely, but not significantly so, to quit smoking (X 2 =3.79, p=0.052). People who made positive dietary changes were more likely to stop drinking (X 2 =4.4, p=0.036), quit smoking (X 2 =20.26, p=0.001) and to be more physically active (X 2 =8.8, p=0.003). Individuals who quit smoking made more positive dietary changes (X 2 =20.26, p=0.001). Individuals who were more physically active tended to quit drinking (X 2 =4.4, p=0.036) and to make positive dietary changes (X 2 =8.8, p=0.003).
First Nation individuals who stopped drinking were more likely to report dietary changes (OR 1.51). They were more likely to be middle aged (OR 1.51) or older (OR 1.94). They tended to smoke (OR1.51) and to have a history of substance use (OR 1.51), mental health (OR1.88) or drinking problems (OR 2.38). They were less likely to report overcrowding as a problem (OR 0.51), but twice as likely to live in homes where there is an addiction problem (OR 2.02).
First Nation people who made positive dietary changes were more likely to be physically active (OR 1.52) and twice as likely to have stopped drinking (OR 2.11). They.were two times more likely to be women (OR 2.03) and almost three times as likely to be older (OR 2.76) and to report higher education (OR 2.64). They were less likely to drink (OR 0.48), but more likely to be overweight (OR 1.32) and to have a mental health history (OR 1.70). They also tended not to disclose their household income (OR 1.78).
First Nations individuals who were more physically active than other community members were twice as likely to be older (OR 2.22). They tended to be men (OR 1.81). They were three times more likely to have higher education (OR 3.12) and were twice as likely to have some secondary education (OR 2.03). They tended to obtain a living from traditional land use activities or other economic sources (OR 1.81) and to make positive dietary changes (OR 1.45). They were less likely to be overweight (OR 0.54) or to experience economic insecurity (OR 1.51). First Nation people who quit smoking were twice as likely to have more education (OR 2.4), to be more economically secure (OR 1.66), and to live in households that were addiction free (OR 1.56).
First Nation individuals who reported two or more health promoting behaviors were more likely to be women (OR 1.35). They were two to four time more likely to have higher education (OR 2.11 and OR 3.81) and were more likely to be older (OR 1.56 and OR 2.36). Although they drank (OR 1.58) or had a history of substance use (OR 1.41), mental health problems (OR 1.58), or drinking problems (OR 1.92), they were more likely to report a number of health promoting behaviors.
In summary, individuals making changes were more likely to be women, older, more educated, and to have a history of drug, alcohol, or mental health problems. First Nation people who stopped drinking tended to be older and to have a history of drug and alcohol.problems. Individuals who quit smoking were more likely to have higher education and income status, whereas individuals who made dietary changes were older, well educated, and women. More physically active individuals were more likely to be men, highly educated, or engaged in traditional land use or other economic activities.
Positive health behaviors tend to cluster within individuals. They are associated with increased age and higher socioeconomic status. Gender differences were apparent in terms of dietary changes and physical activity. Many First Nation people with a history of drug, alcohol or mental health problems were actively practicing health-promoting behaviors. Education and economic security were critical determinants. Household environment, such as addiction problems and overcrowding were other major determinants associated with a few health promoting behaviors. Overall, this paper has demonstrated that structural inequalities are a major barrier to healthy living. However, Although social disparity does exist at the individual and household level, First Nation people are still determined to live a balanced way of life.
In conclusion, the results of this study have demonstrated that First Nation people are working at bringing balance to their lives. Health promotion programs could target younger people, men, women, and individuals in a poor social environment, but these programs have to rest on a First Nation understanding of how to acquire balance. The analysis suggests that elders and individuals that have achieved different levels of success could act as role models in these programs. Gender is also a factor, but very little is known as to how women differ from each other and the same can be said about men.
This paper has also demonstrated that promoting health is a complicated matter, which requires a multidimensional approach to advance a balanced way of life. Health promotion is also very much about self-governance. Although non-governmental bodies are eager to act on behalf of First Nations in the field of health promotion by creating opportunities to advance First Nation voices, such actions can still be interpreted as another form of cultural imperialism. Promoting First Nation health from a holistic view is an act of First Nation self-governance, which requires a First Nation perspective. This paper recommends that Manitoba First Nations through their health governance structure initiate negotiations with the federal government to address health risk factors from a social determinant perspective that is based on First Nation perspectives on wellness.For copies of this report, please contact:
Northern Health Research Unit
University of Manitoba
Faculty of Medicine
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