Chapter 4: The Chief Public Health Officer's report on the state of public health in Canada 2008 – Social support and connectedness

Social and Economic Factors that Influence Our Health and Contribute to Health Inequalities

Social support and connectedness

Family, friends and a feeling of belonging to a community give people the sense of being a part of something larger than themselves. Satisfaction with self and community, problem-solving capabilities and the ability to manage life situations can contribute to better health overall.98 The extent to which people participate in their community and feel that they belong can positively influence their long-term physical and mental health.

Four out of five Canadians report that in times of crisis, they rely on someone (e.g. friends, family members) as a confidante, for advice and for care. Relying on individuals or communities for assistance during these times is considered essential for good mental health and coping skills.2 In terms of feeling a sense of community, about 62% of Canadians report this.321 Generally, people living in rural Canada are more likely to report feeling a part of their community than people living in urban areas, as are people with higher incomes.

Social cohesion is a measure of social connectedness that is based on how much people participate in their community and how satisfied they are with their lives in those communities. A frequently used measure of social cohesion is voter turnout.311 Participation in the political system suggests that individuals believe their participation in the democratic process matters and that they are invested in the community by caring about the outcome. Young adults do not vote as often as their older counterparts; however, they are more likely to participate in politically related activities such as petitions, meetings and boycotts.322 Overall, fewer Canadians participate in elections than in the past. Generally, those who do participate are more likely to vote in national and provincial/territorial elections than in municipal elections.323 The trend is reversed for First Nations voters, whose rate of participation in national elections is relatively low but is high for First Nations community elections.324

Levels of social connectedness are also shaped by how safe a person feels and the level of violence to which he or she is exposed or perceives a threat – both of which can impact mental and physical health.167 One measure of safety in a community is the crime rate. Canadians perceive that crime rates are increasing.325 Previous victims, in particular, believe this and feel unsafe during daily activities. In reality, the overall crime rate has decreased about 30% since peaking in 1991, and the violent crime rate in Canada has remained unchanged. Currently, the rate of violent offences is approximately 951 per 100,000 population, and is higher in rural areas (1,067 incidents per 100,000 population), than in urban areas (830 per 100,000 population).327, 328 In Canada’s territories, the rate of violent victimization is almost three times higher and the rate of physical assault is almost four times higher than reported in the provinces.329

Often violence and maltreatment occur in places where individuals should expect to feel the safest. The disturbing problem of family violence continues, and involves a range of abusive behaviours on the part of someone in a relationship of trust and/or dependency. About 8% of women and 7% of men report having experienced an incidence of violence with a current or previous partner.330 Women report experiencing more serious forms of violence than men, and are also more likely to incur injuries as a result of the violence. Reported spousal abuse among Aboriginal women and men off reserve is much higher than the national average (e.g. 21% compared to 7% for physical and sexual abuse in 2004).331 Approximately 4% of seniors living in their own homes reported experiences of abuse or neglect, most commonly material abuse involving the misuse of the victim’s money or property by a caretaker.332

Children are also victims of violence and maltreatment. In 2003, there were more than 235,000 investigations of maltreatment involving children from birth to 15 years in Canada. For nearly half of the investigations (49%), reports of maltreatment were substantiated by an investigating agency. At least one parent was the alleged perpetrator in 82% of child maltreatment investigations in Canada (excluding Quebec).333 Children who witness family violence often exhibit negative behaviours, physical aggression, emotional disorders, hyperactivity and destructive behaviours.331, 334 In addition, a survivor of child abuse is seven times more likely to become dependent on substances and ten times more likely to commit suicide.335

Rates of violence experienced by youth are four times higher than for children. Among 14- to 17-year-olds who reported being assaulted, over 50% were assaulted by a close friend, co-worker or an acquaintance, 20% were assaulted by a stranger and 16% by a family member.336 And most often the violent acts occur in a public place. At younger ages (between 11 and 15 years old), 25% of males and 21% of females reported being bullied as a result of their race, ethnicity or religion.337

Improving Social Connectedness

Santropol Roulant

Santropol Roulant is a Montréal-based not-for-profit organization founded in 1995 to provide inexpensive, nutritious meals to seniors and others living with a loss of autonomy.338 It was initially conceived as a youth employment initiative to provide meaningful work experience to young people in the community while meeting the dietary needs of vulnerable populations, but has since grown to serve an even greater purpose.339 In addition to preparing and delivering meals, the volunteers and staff also provide friendship and caring. Young people seem to make a special impact on the meal recipients with their youthful energy and outlook. The connections being made are unique – forged from a genuine interest between generations, with sometimes differing linguistic and cultural backgrounds, instead of through family or obligation.340 With urban isolation on the increase among seniors, this new approach to community is an important part of what Santropol Roulant delivers. Other Santropol activities include the creation of a roof-top garden to provide fresh organic fruits and vegetables to its kitchen, and a roof-top garden guide and start-up kits that are available to individuals and groups interested in making their own urban garden.341, 342 It is hoped that rooftop gardening will help reconnect people in their area to healthy foods, the environment and to the greater community.343

Santropol Roulant currently relies on over 100 volunteers to run its program each week.344 Given the soaring costs of hospitalization ($700 per day to treat a malnourished patient), the potential savings to taxpayers from this service is estimated at $2.4 million over the last five years.345

Loneliness and isolation can have adverse impacts on the health of many Canadians, particularly some seniors. More than 6% of Canadians over the age of 65 reported not having any friends compared to 3% of those aged 55 to 64. Those seniors who reported having no friends are also less likely to report being in excellent or very good health.123

Social exclusion is experienced when some people or groups have limited control and access to social, economic, political and cultural resources.145 Aboriginal Peoples have a long history of unequal access to and control over education and health care, as well as lands and natural resources, which has resulted in social disconnection.216

Health can be influenced by historical and cultural experiences that not only affect individuals but whole communities.216 For example, residential schools had a significant impact on the health and well-being of many First Nations adults and consequently their children and grandchildren.281, 346 Almost half of residential school survivors report that the experience negatively affected their mental and physical health through isolation from family, separation from community, and a loss of identity and language.347 Among their children, 43% believe the residential school experience had a negative effect on their parents’ parenting skills.161

Connectedness Through Self-Determination

The Eskasoni Primary Care Project

The Eskasoni project began with the decision of one community of nearly 3,000 Mi'kmaq people on Cape Breton Island, Nova Scotia to manage their own health care.350 Overseeing the project was a collaborative effort involving a Tripartite Steering Committee made up of representatives from the Eskasoni Band Council, the Nova Scotia Department of Health, the First Nations and Inuit Health Branch of Health Canada, and Dalhousie University's Department of Family Medicine.8 The approach sought to break down barriers to accessing health care and allow involved community members to become proficient at planning, executing and evaluating their own health programming. The first step was the building of a new health centre to bring programs and services under one roof and to streamline recordkeeping. Physician services were then revamped to replace the one-doctor, fee-for-service approach with a multi-doctor, multi-discipline approach based on salaried positions. The results – better quality of care, lower health care costs, greater accessibility to services, and high client and staff satisfaction – have been well worth the investment: 96% of all pregnancies are now followed from pre- to post-natal care within the community; costs for prescription drugs have decreased, despite a population increase; and referrals from physicians to a nutritionist/health educator for managing diabetes have increased by 850%.351, 352 In addition, 73% of centre users report receiving an appointment with their family doctor within 24 hours or less and 90% within 48 hours. Annual visits to the family doctor are also down from a high of 11 visits per year to approximately 4. Trips to the out-patient/emergency department at the regional hospital are down 40%. With fewer trips off reserve for care, medical transportation costs were reduced by $200,000 in the three-year period after the centre opened.351

In 2004, the five Cape Breton Bands (Eskasoni, Potlotek, Wagmatcook, We'koqma'q and Membertou First Nations) came together through the Tui'kn Initiative to build upon and expand the Eskasoni model of primary health care to all Cape Breton First Nations communities.

High rates of suicide among First Nations people, particularly among youth, are linked to social exclusion and disconnection from their traditions and culture. However, research suggests that it is a mistake to assume these challenges are systemic within First Nations communities and points to protective factors that can reduce these risks. Research from British Columbia has revealed that 90% of Aboriginal youth suicides in the province occur in just 10% of First Nations communities. Suicide rates in these communities sometimes reach 800 times the Canadian average, while more than half of the First Nations communities in the province have not had any suicides in many years. Further research on language groups and community identity suggest that cultural preservation and continuity, as well as living in communities with self-government, settled land claims, and access to self-managed education, health, cultural and policing services all have positive impacts on the health of the local population. The British Columbia studies found that communities with some level of self government and/or multiple community control factors present had the lowest rates of suicide.348, 349

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