Social determinants of self-reported health for Canada's indigenous peoples: a public health approach.

OBJECTIVE: In Canada, indigenous peoples suffer from a multitude of health disparities. To better understand these disparities, this study aims to examine the social determinants of self-reported health for indigenous peoples in Canada. STUDY DESIGN: This study uses data from Statistics Canada's Aboriginal Peoples Survey 2012. METHODS: Multinomial logistic regression models were used to examine how selected social determinants of health are associated with self-reported health among off-reserve First Nations and Métis peoples in Canada. RESULTS: Our analysis shows that being older, female, and living in urban settings were significantly associated with negative ratings of self-reported health status among the indigenous respondents. Additionally, we found that higher income and levels of education were strongly and significantly associated with positive ratings of self-reported health status. Compared with indigenous peoples with an education level of grade 8 or lower, respondents with higher education were 10 times (5.35-22.48) more likely to report 'excellent' and 'very good' health. Respondents who earned more than $40,000 annually were three times (2.17-4.72) more likely to report 'excellent' and 'very good' health compared with those who earned less than $20,000 annually. When interacted with income, we also found that volunteering in the community is associated with better self-reported health. CONCLUSIONS: There are known protective determinants (income and education) and risk determinants (location of residence, gender, and age) which are associated with self-reported health status among off-reserve First Nations and Métis peoples. For indigenous-specific determinants, volunteering in the community appears to be associated with self-perceived health status. Thus, addressing these determinants will be necessary to achieve better health outcomes for indigenous peoples in Canada. Next steps include developing indigenous-specific social determinants of health indicators that adequately measure culture, connection, and community.

Self-management of nutrition.

Eleven overweight subjects received a behavioral treatment program for weight loss and a nutritional self-management program during a 10-week treatment period. The nutritional self-management program was evaluated using a multiple-baseline across-groups design. The results indicated that caloric restriction without the nutritional self-management program did not result in the consumption of a well-balanced diet. Introduction of the nutritional self-management program led to improvement of nutritional consumption across six food groups. Self-control of caloric intake within certain food groups, i.e., fruit and vegetable, was better than for others. These findings are discussed in terms of the methodological difficulties involved in managing nutrition and the significance of nutritional self-management for health problems other than obesity.