Test Bank for An Introduction to Indigenous Health and Healthcare in Canada.

TEST BANK FOR AN INTRODUCTION TO INDIGENOUS HEALTH AND HEALTHCARE IN CANADA BRIDGING HEALTH AND HEALING 2ND EDITION

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CONTENTS PART I INDIGENOUS CULTURE AND HEALTH 1. Introduction: First Nations, Métis and Inuit in Canada: Understanding the Issues 2. Western and Indigenous Ways of Knowing 3. Cultural Competency, Cultural Sensitivity and Cultural Safety 4. Historical Overview PART II INDIGENOUS HEALTH AND THE CANADIAN HEALTHCARE SYSTEM 5. Understanding the Determinants of Health and Canada’s Native Population 6. Diabetes, Diet and Nutrition 7. Chronic and Infectious Diseases 8. Women’s and Children’s Health 9. Mental Health 10. Hybridisation of Healthcare and the Way Forward for Indigenous Health

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Chapter 1 – Introduction: First Nations, Métis and Inuit in Canada: Understanding the Issues Test Questions 1. Why did the Canadian government devolve power to Indigenous governments after the Oka Crisis? a. Federal politicians wanted to evade responsibility for Indigenous affairs. b. It saved money by devolving costs onto other levels of government. c. Because Canadian politicians wanted to demonstrate their support for Indigenous selfgovernment. d. Possibly all of the above.

2. The Oka Crisis led to increased

a. awareness of Indigenous issues in Canada among both Canadians and internationally. b. police surveillance of reserves in Eastern Canada. c. government repression of Indigenous peoples in Canada. d. anti-Indigenous sentiment among the non-Indigenous population. e. all of the above.

3. The Canadian Multiculturalism Act

a. Entrenched biculturalism in the Canadian constitution b. Made assimilation part of Canada’s official cultural policy c. Established the concept of the cultural mosaic as an official part of Canadian identity d. Entrenched Indigenous culture as part of Canadian identity e. Made acculturation part of Canada’s concept of the cultural mosaic

4. When did the Government of Canada commit itself to multiculturalism? a. 1971 b. 1981

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c. 1975 d. 1871

5. What are the implications of universal healthcare for the Canadian heath care system?

a. There are no implications b. Everyone is treated for illness when they get sick c. Tertiary care services are very important d. If the health of a part of the population is allowed to suffer, the burden falls on everyone

6. The three founding nations of Canada are

a. French, English and Métis. b. English, Scottish and the Indigenous peoples. c. French, English and the Indigenous peoples. d. French, English and American.

7. The Constitution Act of 1982 defined Indians as persons belonging to one of three groups

a. Métis, Inuit, First Nations. b. Métis, Inuit, Status Indians. c. Status, Non-Status, Treaty. d. Status, Non-Status, Inuit.

8. The position of Indigenous peoples in Canada was entrenched in the constitution in

a. 1867. b. 1982. c. 1992. d. 2016.

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9. The range of individual and collective factors and conditions and their interactions that have been shown to be correlated with health status reflects the recognition that

a. Health is a capacity or resource rather than a state b. Being able to pursue one’s goals, to acquire skills and education and to grow is a privilege rather than a right c. Factors within the healthcare system significantly affect health d. The correlation is specious

10. Health promotion is a way of

a. improving population health. b. reducing the burden on the public healthcare system. c. an intrusion on the human rights of the population. d. a and b

11. What is population health?

a. The overall health of a population b. The health of each individual in a population c. A statistical measure of average prescription drug consumption in a population d. All of the above e. None of the above

12. How does population health relate to individual health?

a. Good population health means that every individual is healthy b. Poor population health means that every individual is in poor health c. Good population health facilitates individual health d. a and b e. None of the above

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13. The approach that recognises there is a range of social, economic and physical environmental factors that contribute to health is a. social engineering. b. population health. c. affirmative action. d. harmful effects reductionism.

14. The Romanow Report identified two important long-term demographic trends

a. Both the general population and the Indigenous population are increasing in numbers rapidly due to high birth rates b. The Indigenous population is increasing rapidly, but the general population is only increasing through immigration c. Both the Indigenous and the general population of Canada are in a state of long-term demographic decline d. None of the above

15. Why was the Royal Commission on Aboriginal Peoples (RCAP) created? a. Because the health of Canada’s Indigenous peoples is very poor b. To find ways to improve employment among the Indigenous population c. Because the government was embarrassed by the Oka Crisis d. All of the above

16. Why did both the RCAP report and the Romanow Report receive highly mixed receptions from the governments that commissioned them?

a. Budget cutbacks meant that their recommendations were not followed b. Their recommendations were intrinsically unrealistic c. Federal-provincial quarrels over jurisdiction made them hard to implement in practice d a and c

17. The Ottawa Charter on Health Promotion

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a. identified the social and environmental roots of ill health. b. recognized that health is a by-product of a healthy environment. c. did not specifically mention the Canadian Indigenous population. d. all of the above.

18. What leads to a healthy population according to the Ottawa Charter on Health Promotion? a. Increased government spending b. Improved medical care c. Immunisations d. Improved determinants of health

19. What has changed in the healthcare environment in the last 25 years?

a. Increased non-Western immigration to industrialised countries b. Increased population diversity c. More assertive populations, including ethnic minorities d. All of the above e. None of the above

20. Equity in health must be a central goal of healthcare professionals, citizens and their governments. An example of equity in health is

a. locally produced and culturally appropriate health knowledge systems. b. treating everyone the same as you would treat yourself. c. implementing government developed health programs. d. health outcomes are omitted as part of the public infrastructure.

21. What does “Indian Status” mean?

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a. An individual is recognized by the Canadian government as the registered member of an official Indian Band b. An individual’s ability to publicly claim one is of Indigenous descent c. That an individual lives on a reserve or Indigenous community in the Canadian Arctic d. An individual is recognised as an Indian through quantum of status e. a and d

22. What distinguishes Status Indians from Non-Status Indians? a. Status Indians are officially recognised by the Canadian government as Indigenous b. Status Indians live on reserves, Non-Status Indians do not c. Status Indians have the right to vote, but Non-Status Indians do not d. All of the above

23. Non-Status Indians are

a. not members of any First Nation. b. First Nations that are not recognised by the Canadian government. c. are the descendants of Europeans and First Nations. d. all of the above.

24. Non-Status Indians

a. are one of the fastest-growing groups in the Indigenous population. b. are few in number and disappearing. c. mainly live on reserves. d. none of the above.

25. What was the title given to children born of one First Nations parent and one European parent?

a. Métis

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b. Indian c. Status Indian d. First Nations

26. Métis are descendants of

a. Viking colonists of Newfoundland who intermarried with the First Nations. b. a small First Nations on the Michigan Peninsula who worked for the Northwest Company. c. French, English and Scottish fur traders and their First Nations wives. d. French, English and Scottish farmers and their First Nations wives. e. none of the above.

27. Métis are one of the fastest growing Indigenous peoples in Canada because they

a. have a very high birth rate. b. are growing through immigration. c. increasing numbers of Canadians are reclaiming their Métis heritage and selfidentifying as Métis. d. a and c 28. Where do the Inuit traditionally live?

a. In the boreal forest b. In the Alpine regions of British Columbia c. In the circumpolar north d. In the sub-Arctic regions of Canada e. None of the above

29. The majority of First Nations and Inuit in the Northwest Territories and Nunavut live

a. on reserves. b. as minorities in mixed communities with non-Indigenous peoples. c. in two major cities, Yellowknife and Iqaluit.

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d. in their own communities governed by elected local governments. e. none of the above.

30. Canada’s newest territory, Nunavut has

a. a mostly Inuit population. b. both Inuit and Dene First Nations populations. c. a largely European population, with a large Inuit minority. d. no permanent population, only transient workers. e. none of the above.

31. Where do Canadian Inuit live?

a. In the Canadian Arctic b. All over Canada c. In the Yukon Territory d. a and b

32. Which of these are recognized as Indigenous people in Canada?

a. Status Indians b. Métis c. Inuit d. Sami e. a, b and c.

33. Which province or territory of Canada has the greatest linguistic and cultural diversity of Indigenous peoples?

a. Québec b. Alberta c. The Northwest Territories d. British Columbia e. None of the above

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34. What percentage of the population of Canada is Indigenous?

a. 1% b. 25% c. 4.9% d. 7% e. None of the above

35. Which of the following is one of the fastest growing populations in Canada? a. Non-Indigenous peoples under 30 years b. First Nations under 30 years c. First Nations elders d. Non-Indigenous over 30 years

36. What is the median age of the Indigenous population of Canada in the 2016 census? a. 31 b. 45 c. 40 d. 22

37. Which Indigenous population is the youngest in Canada (in the 2006 Census)? a. Métis b. First Nations c. Inuit d. Québecois

38. What is the largest-growing Indigenous group in Canada?

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a. Status Indians b. Inuit c. Métis d. Non-Status Indians

39. The Government of Canada traditionally only recognised a single type of Registered First Nation level of governance.

a. The Tribe b. The Band c. The Nation d. The Village

40. Indian Bands are governed by

a. elected band Councils. b. hereditary chiefs. c. government appointees. d. none of the above.

41. Complete the following statement. In the 2016 Census, the First Nations birth rate was

a. less than the Canadian rate for non-Aboriginals. b. more than twice the Canadian rate for non-Aboriginals. c. steadily declining. d. less than half of what it was 10 years age.

42. “First Nations” refers to the fact that

a. Indigenous peoples were in Canada first, before Europeans.

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b. Indigenous peoples had their own governments, cultures and national traditions. c. the British and Canadian governments both recognised that Indigenous peoples were sovereign – that they were nations and negotiated with them on that basis. d. all of the above.

43. In Canada, Indian Reserves are

a. where all Indigenous people live in Canada. b. land reserved for Indigenous people. c. the place where non-Status Indians live. d. inhabited by some First Nations, but not Inuit or Métis. e. none of the above.

44. Indian Reserves are inhabited by a. all Indigenous peoples in Canada. b. Métis and Status Indians. c. Inuit. d. many, but not all Status Indians.

45. The reserve system in Canada

a. requires all First Nations to live on reserves, though neither Métis nor Inuit are required do so.

b. consists of land held by First Nations directly under the Crown. c. recognises the political status of First Nations as sovereign entities. d. none of the above adequately detail the realities.

46. The Canadian government

a. is obligated by its own laws to negotiate treaties with First Nations and Inuit.

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b. is not obliged to negotiate treaties at all. c. negotiates treaties out of a sense of fairness. d. b and c.

47. The Transfer Agreement of 1988 was developed with the goal of a. transferring responsibility for healthcare to the federal government. b. transferring responsibility for healthcare to First Nations groups. c. transferring land from First Nations groups to the provincial government. d. transferring government control from the provincial governments to First Nations communities.

48. Self-government initiatives grew during the 1980s and 1990s and were encouraged by

a. the political fallout of the Oka, Gustafsen Lake and other incidents of violent and non-violent resistance.

b. the increasing demand of dependence of many First Nations. c. the evolution of the healthcare system in the 1980s. d. none of the above.

49. The Charter of Rights and Freedoms recognises the

a. right of Indigenous peoples to self-government. b. the language rights of Indigenous peoples. c. the right of Indigenous peoples to be treated fairly. d. all of the above.

50. Why should nurses care about Indigenous health?

a. This is an important and rapidly increasing component of the population. b. Most nurses will be responsible for Indigenous patients at some point in their careers.

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c. Nurses and the nursing profession bear a responsibility for health promotion in the population, Indigenous and non-Indigenous. d. All of the above

Type: T 51. What were the five reasons for the “disconnect” that the Romanow Report identified as preventing Indigenous peoples from benefiting from the Canadian healthcare system?

Type: T 52. How would improving the health of the Indigenous population benefit all Canadians?

Type: T 53. Why should nurses and other healthcare professionals care about Indigenous health?

Answers to Test Questions 1. d 2. a 3. c 4. a 5. d 6. c 7. a 8. b 9. a 10. d 11. a 12. c 13. b 14. b 15. d 16. d 17. d 18. d

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19. d 20. a 21. e 22. a 23. b 24. a 25. a 26. c 27. d 28. c 29. d 30. a 31. b 32. e 33. d 34. c 35. b 36. a 37. b 38. d 39. b 40. a 41. b 42. d 43. d 44. d 45. b 46. a 47. b 48. a 49. c 50. d

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Chapter 2 – Western and Indigenous Ways of Knowing Test Questions 1. Epistemology is

a. a way of knowing about the world and how it works. b. a field of spiritual and metaphysical inquiry. c. defined as a way of thinking about human identity and the fundamental nature of human existence. d. a theory of mind used extensively in philosophy.

2. Ontology is

a. the way we are, our state of being. b. the science of cranial topography. c. how we think about the world and how it works. d. a variety of factors enabling nurses to heal others through prayer.

3. Health is

a. a matter of both physical and mental well-being. b. the absence of disease. c. how we live every day. d. all of the above.

4. Why are health and food security often a problem in Aboriginal communities? a. Traditional hunting and gathering can no longer feed everyone. b. Remote and impoverished communities lack the resources of prosperous urban areas. c. Government cutbacks have affected community health. d. All of the above.

5. Traditional Indigenous health views differ from traditional Western medicine in that

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a. Indigenous view is that health is holistic; Western view is that medicine is not holistic. b. Indigenous view is that health is earned; Western belief is that health is bought. c. Indigenous view is that health is a gift; Western belief is that health is holistic. d. both share the same philosophical underpinnings.

6. Culture influences health through a. the cultural stereotypes that society imposes upon individuals. b. the cultural roles individuals internalize and incorporate into their lives. c. providing a secure social identity with which to navigate society. d. all of the above. e. none of the above.

7. The traditional ceremony most often used by those participating in the spiritual purification of the body, mind and soul with the intended purpose of prayer and healing of the individual holistically is called: a. smudging. b. sweat lodge. c. medicine wheel. d. midewiwin.

8. Smudging is

a. a traditional practice among many First Nations and Métis peoples. b. the burning of traditional herbs to purify the body and soul. c. increasingly popular among Indigenous peoples across Canada. d. all of the above.

9. A shaking tent ceremony would be performed by a

a. herbalist. b. medicine man.

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c. Shaman. d. witch doctor.

10. One therapeutic benefit of a sweat lodge is a. high temperature stimulates the body’s natural reactions to toxins. b. heat and scratching numerous lines on the skin drains the infection. c. the belief that the sucking horn removes the poison. d. the smell of herbs inhibits endorphin release.

11. The shape of the sweat lodge typically represents

a. the shape of the Mother Earth. b. the Circle of Life. c. the womb of the Mother. d. the shape of the Turtle shell.

12. What is the social basis for traditional Inuit society? a. Consensus and group survival b. Individual profit and competition c. Material success of each family d. All of the above

13. The ritual most often used prior to any major ceremony or celebration, or to cleanse an individual, for the purpose of clearing away negative energy, to invite in peace and harmony is called:

a. smudging b. medicine wheel

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c. sweat lodge d. midewiwin 14. Traditional Indigenous epistemology or “ways of knowing” is based on

a. human culture and the natural world being distinct and separate from each other. b. modern medicine having the solution to all possible health problems. c. god-like animals punishing humans for their transgressions against nature. d. the holistic interaction of human beings with the natural world.

15. Modern culture perceives the world as

a. divided into separate and mutually exclusive spheres of human and natural knowledge. b. a living, unified and interconnected whole in which everything influences everything else. c. a flat disc floating through space, with the sun orbiting around it. d. inanimate matter that can be manipulated for the benefit of human being. e. a and d.

16. Traditional Indigenous epistemology

a. divides the world into human and non-human spheres of knowledge. b. believes in the existence of a “Great Spirit.” c. sees the natural and human world as a unified whole. d. believes that the non-human world exists for humans to exploit for their own benefit.

17. Indigenous patients may see their health in

a. traditional terms. b. in terms of biomedicine. c. as a mixture of both ways of knowing. d. all of the above.

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18. What was an important ingredient in Sophie Thomas’ anti-cancer medicine?

a. Aspirin b. red Alder c. cedar root d. stinging Nettle e. all of the above 19. What do Sophie Thomas’ patients attribute her success to?

a. Her herbal medicines b. Red willow bark c. Her capacity for caring for her patients d. All of the above

20. Sophie Thomas, a First Nations Elder,

a. marketed and sold her cancer medicine using red alder to people looking for a cure. b. held that traditional healing beliefs can result in bad medicine when practiced by an individual.

c. promoted avoidance of biomedicine among her band members. d. attributed the healing power of her medicine to the Creator.

21. All of the following concerning Indigenous holistic views of health are true except

a. the mind, body, birthplace and spirit are all integral parts of health. b. prohibiting women from collecting herbal remedies and using spiritual rituals. c. giving sage as a gift of thanks to the Creator when collecting herbs from the environment. d.

illness is a result of an imbalance in one of the four spheres of life.

22. Pre-modern cultures perceive the world as

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a. divided into separate and mutually exclusive spheres of human and natural knowledge. b. a living, unified and interconnected whole in which everything influences everything else. c. a flat disc floating through space, with the sun orbiting around it. d. inanimate matter that can be manipulated for the benefit of human beings. e. b and c.

23. Non-modern epistemology is defined as

a. combining a pre-modern world view with the use of the tools and techniques of modern science, technology and biomedicine. b. a belief that rejects all aspects of modern science and medicine in favour of returning to pre-modern life. c. the philosophy that underlay the 1970’s Back to the Land movement. d. refusal to receive blood transfusions on religious grounds. e. none of the above.

24. A culturally sensitive nurse would recognise that First Nations a.

are taught to suppress pain and not talk about self.

b.

cry and mourn loudly with the death of a community member.

c.

wear copper bracelets as a preventative measure for arthritis.

d.

value assertiveness as a communication style.

25. According to the Canadian Nurses Association, cultural competence is a. the application of knowledge, skill, attitudes and personal attributes required by nurses to provide appropriate care and services in relation to cultural characteristics of their clients. b. the knowledge that cultural differences as well as similarities exist without assigning values. c. use of culturally based care and health knowledge in sensitive, creative and meaningful ways.

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d. a manner which affirms respects and fosters the cultural expression of the recipient.

26. How does epistemological accommodation apply to the Canadian nursing context? a. It doesn’t apply at all. b. It allows both practitioners and patients to retain their own values while accommodating each other in the clinical setting. c. It explicitly gives practitioners permission to compromise professional standards in order to provide patient oriented care. d. It views the nurse as having an insignificant role in the Canadian healthcare system.

27. The medicine wheel has been adapted by different Indigenous groups into many forms with the colours to be taken to mean the following except

a. North, South, East, West b. Spring, Summer, Fall, Winter c. Fire, Wind, Water, Earth d. Birth, Youth, Manhood, Death

28. What are the four colours of the medicine wheel?

a. Black, Brown, Purple and Green b. Black, Blue, Red and White c. Yellow, Black, Red and White d. Green, Black, Brown and White

29. How old are medicine wheels?

a. Visible in archaeological sites of up to 5,000 years old b. Invented by New Age spiritualists in the 20th century c. Adopted concomitant cultural practices important to many Indigenous peoples d. a and c

30. The medicine wheel is

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a. a useful way of representing Indigenous philosophy of health and well-being. b. falling into disuse. c. being taken up by peoples who have never used it before. d. a and c.

31. Tobacco ties a. represent a symbol of sacrifice and acknowledgement of a service. b. are an important part of many Indigenous cultures. c. are a small bag filled with tobacco. d. all of the above.

32. Herbs used in smudging often include

a. cedar, tobacco, sweetgrass and white sage. b. rosemary, tobacco, basil and thyme, c. wild onion, savoury, rosemary and basil. d. spruce buds, pine needles, juniper and wild rose.

33. A talking stick can be

a. a stick. b. a feather. c. a rock. d. a shell. e. all of the above.

34. The talking stick

a. gives members of a talking circle the right to speak. b. organises meetings in a non-hierarchical way. c. represents democratic traditions in many Indigenous cultures. d. all of the above.

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35.The person who holds the talking stick

a. must remain quiet until it is passed on. b. is chosen as a leader at the meeting. c. has the right to direct the meeting without interruption. d. passes it on to the next person who may speak.

36. Biomedicine is the

a. application of the mechanistic philosophy of modern science and technology to the human body in order to keep it in proper working order. b. use of vaccinations to prevent infectious diseases. c. refusal to view the body as a machine that can be repaired. d. holistic view of health as a spiritual, physical and emotional whole. e. none of the above.

37. What is biomedicine?

a. The application of biological science to human health b. A curative, technological approach to physical illness c. A totalitarian ideology d. All of the above

Type: F 38. The four spheres that Indigenous people believe illness to be a result of an imbalance of one or more amongst them:

,

,

,

Type: T 39. Provide three therapeutic benefits identified with use of a sweat lodge.

Type: T 40. Describe one traditional Indigenous health practice and give examples of how this practice may contribute to improving the health of Indigenous people.

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Type: T 41. What nursing interventions promote the creation of supportive environments that will enhance the capacity of individuals and communities to make healthy choices?

Answers to Test Questions 1. a 2. a 3. d 4. d 5. a 6. b 7. b 8. d 9. c 10. a 11. c 12. a 13. a 14. d 15. e 16. c 17. d 18. b 19. d 20. d 21. b 22. b 23. a 24. a 25. a 26. b 27. c 28. c 29. c 30. d

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31. d 32. a 33. e 34. d 35. d 36. a 37. d 38. physical, emotional, intellectual, spiritual

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Chapter 3 – Cultural Competency, Cultural Sensitivity and Cultural Safety Test Questions 1. What are the advantages of cultural competency? a. It is straightforward to learn and be certified in. b. Most Indigenous patients recognise the value of cultural competency training. c. It ensures that all patients are treated equally according to their individuality. d. It developed in recent years with the growth of holistic nursing.

2. Which organisations routinely use cultural competency for nursing practice?

a. The American military b. The Canadian Government c. Professional nursing associations in Canada d. All of the above

3. Which organisation is one of the major proponents of cultural competency?

a. The European Union b. People’s Republic of China c. The Government of Nova Scotia d. The United States Military

4. Cultural safety borrows from what common practice? a. sharps safety b. patient-centred care c. public health d. homeopathy

5. Where did cultural safety originate?

a. Canada b. Australia

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c. The United States d. New Zealand

6. What concept is cultural safety based on?

a. Sharps safety b. Patient-centred care c. Public health d. Homeopathy 7. Who is the focus of cultural safety?

a. The nurse, constantly evaluating his or her behaviour b. The healthcare system, which benefits from greater efficiency c. The patient, whose personal sense of security is the focus d. All of the above

8. According to the Canadian Nurses Association, cultural competence is

a. the application of knowledge, skill, attitudes and personal attributes required by nurses to provide appropriate care and services in relation to cultural characteristics of their clients. b. the knowledge that cultural differences as well as similarities exist, without assigning values. c. use of culturally based care and health knowledge in sensitive, creative and meaningful ways. d. a manner which affirms respects and fosters the cultural expression of the recipient.

9. The Kahnawake Schools Diabetes Prevention Project (KSDPP) is an example of

a. cultural imperialism. b. cultural assimilation through education. c. culturally safe health promotion.

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d. application of cultural competency to diabetes education.

10. The Inuulitsvik Maternities provide culturally safe care by

a. allowing family members to accompany expectant mothers when they are evacuated to Southern hospitals for birth. b. having decisions on evacuation made by a community board, using medical advice. c. giving pregnant women the option of natural childbirth techniques. d. encouraging spouses to attend births at the clinic.

11. How should we, as nurses, treat our Indigenous patients?

a. As Indigenous, with their own unique values and beliefs b. No differently than any of our other patients c. As individuals, according to how they want to be treated d. a and c

12. What are the disadvantages of cultural sensitivity?

a. It is very hard to put into practice. b. It is not useful in the clinical setting. c. It is not very well defined. d. It is very hard to teach to students.

13. Unintentional rudeness on the part of the nurse is an example of

a. assertiveness. b. cultural blindness. c. advanced competence. d. cultural sensitivity.

14. Which of the following statements best defines cultural sensitivity? a.

The process of passing on a culture from one generation to the next

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b.

A form of inclusion whereby an individual is given the opportunity to belong

c.

The belief that one’s culture is the norm, but other cultures have value too

d.

A reality that a variety of injustices have been committed against different groups

15. A culturally sensitive nurse would recognise that First Nations

a. are taught to suppress pain and not talk about self. b. cry and mourn loudly with the death of a community member. c. value assertiveness as a communication style. d. vary widely in their reaction to pain and suffering.

16. How does epistemological accommodation apply to the Canadian Nursing context? a. It doesn’t apply at all. b. It allows both practitioners and patients to retain their own values while accommodating each other in the clinical setting. c. It explicitly gives practitioners permission to compromise professional standards in order to provide patient oriented care. d. None of the above.

17. Professional standards are less important in nursing Indigenous patients than cultural safety and epistemological accommodation.

a. True b. False

18. Official multiculturalism policy sees Indigenous peoples as no different than any other ethnic minority in Canada.

a. True b. False

19. Indigenous people have the right to treatment that respects their cultural values.

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a. True b. False

20. Nurses should apply the principles of cultural safety only to the Aboriginal population in Canada. a. True b. False

21. Lack of culturally safe nursing care of Indigenous patient can be fatal. a. True b. False

Type: T 22. Provide THREE examples of how nurses can foster incorporation of epistemological accommodation of traditional Indigenous healing practices into the biomedical system.

Type: T 23. Briefly discuss the advantages and disadvantages of the three standard models of intercultural nursing care: cultural sensitivity, cultural competency and cultural safety.

Type: T 24. What nursing interventions promote the creation of supportive environments that will enhance the capacity of Indigenous individuals and communities to make healthy choices?

Answers to Test Questions 1. a 2. c 3. d

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4. a 5. d 6. a 7. c 8. a 9. c 10. b 11. d 12. b 13. d 14. c 15. d 16. b 17. b 18. a 19. a 20. b 21. a 22. a. Culturally relevant care: In traditional culture, physical and spiritual health are closely

linked, therefore the nurse can recognize the importance of spiritual ceremonies to be practiced (e.g., smudging in hospital room). Discuss/incorporate traditional healing practices with the patient (i.e., herbs and teas), and so consider integrating them into the nursing care so long as they don’t interfere with or contraindicate the pharmaceutics/treatments prescribed. May also conduct research into determining the possible interactions between them – the herbs and teas and the drug therapies prescribed – and so compare Western medical practices with the traditional ones in order to develop an understanding of such possible interactions. Remember to include families in developing nursing care. b. Encourage/welcome traditional healers to come into the hospital; also, to advocate/provide a place/space for traditional healing ceremonies (e.g., smudges) to take place. c. Holistic approach to healthcare by considering the possible incorporation of the use of the medicine wheel into the nursing care plan if appropriate. This demonstrates consideration of Indigenous views of holistic health being that of a balance of the mind, body, soul and spirit.

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d. Privacy and time for family and visitors with patient provided for prayers, meditation, or other traditional methods of healing in the acute care setting without interruption. In providing time for privacy and time/opportunity for connecting oneself with the spiritual world, this may improve a patient’s will to live and may serve as a source of strength.

23. Possible answers:

Cultural sensitivity: Advantages: 1. It is easy to learn.

2. It is easy to practice.

Disadvantages: 1. It is largely ineffective in addressing problems in patient care.

2. It gives the healthcare provider a false sense of accommodation, while not actually doing anything concrete for the patient.

Cultural competency: Advantages: 1. Its checklist approach to learning about other cultures is facile to implement.

2. Enrolling in education and training courses in preparation to being culturally competent in the healthcare environment prepares healthcare professionals is relatively straightforward.

3. It is easy to test for cultural competency and maintain standards of culturally appropriate care.

4. It can be effective in delivering culturally appropriate care to traditional Indigenous patients.

5. It can give the healthcare provider confidence that they are providing appropriate care to members of cultural minorities.

6. Being aware of personal prejudices and biases and cultivating ways of not displaying them outwardly.

7. Developing health information written in appropriate literacy levels in both official bilingual languages (English and French) and in the language and cultural norms of the targeted Indigenous population.

Disadvantages: 1. Its checklist approach tends to ignore the nuances and variations between individuals.

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2. It assumes that cultures are static, when they are changing and evolving continually – which can leave cultural competency training rapidly out of date.

3. Cultural competency can give healthcare providers a false sense of confidence that their care is appropriate, when it may not be.

Cultural safety: Advantages: 1. It places the focus of appropriate care on the patient whose personal sense of security is the focus and not the healthcare provider.

2. It ensures that individual cultural preferences are respected.

3. It encourages the healthcare provider to provide appropriate care to all patients, irrespective of their cultural background in order to maintain their safety.

4. It encourages the healthcare provider to become a patient advocate – for the safety of the patient is foremost.

5. Making culturally welcoming environments in clinics and healthcare institutions by exhibiting the Indigenous cultural representations and portrayals.

6. Listening attentively to Indigenous clients and not assuming your skills and knowledge are best.

7. Adopting open attitudes, behaviour, and skills that enable a healthcare professional to work respectfully and effectively with Indigenous people and communities while presenting as knowledgeable and affirming.

Disadvantages: 1. It is difficult to learn.

2. Practicing cultural safety requires the healthcare provider to be alert to the individual cultural matrix of each patient 3. Cultural safety must be accommodated with the professional practice standards of the healthcare provider.

24. Possible nursing interventions – cultural safety:

i. People make healthier choices when they feel supported. Listening and learning from Indigenous people about their traditional culture/medicine will allow for a deeper relationship to develop with members of the community. In doing so, the nurse will have a better understanding of how to effectively and appropriately provide healthcare to the community. ii. Creating space for spiritual and cultural beliefs to be incorporated into nursing care so that respect and a genuine interest towards their beliefs are demonstrated.

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iii. Providing support by inquiring about and arranging for the presence of friends, family, or community members in the clinical setting is reassuring to Indigenous people. iv. Providing culturally appropriate educational material (e.g., human immunodeficiency virus [HIV], sexually transmitted disease [STD] pamphlets, etc.), preferably from an analogous Indigenous health organisation that highlights the communities’ participation in designing and incorporating traditional medicine and food and healthy lifestyle choices (e.g., exercise programs), is reverential. In so doing, Indigenous peoples can relate to and understand more effectively the intended healthcare message, and this can ideally lead to increased implementation of mutually identified healthcare goals. v. Using appropriate language and terminology in the clinical setting that may be understood and be relevant to Indigenous people. vi. Providing culturally appropriate health information about risks and preventative measures to encourage the end of high-risk behaviour. vii. Providing a judgement-free environment and demonstrating an open-mindedness so that individuals feel comfortable and accepted, thus increasing their likelihood to asking further questions and for seeking additional information and counselling. viii. Maintaining a long-term residence in the community to establish relationships with members and to gain the trust of people.

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Chapter 4 – Historical Overview Test Questions 1. An example of assimilation as it applies to Indigenous people is

a. residential schools. b. development of the Métis culture. c. participation of Indigenous people in the fur trade. d. use of traditional medicine in the biomedical system.

2. The Indian Act, 1876, reflected the official ideology of assimilation, which

a. explicitly saw government policy as the peaceful absorption of the Indigenous population. b. paved the way for extensive settlement on the Prairies. c. was based explicitly on a “divide and conquer” philosophy. d. none of the above.

3. All of the following are true except

a. Indigenous people were relatively disease free in the pre-Contact period b. Indigenous people were embattled by disease in the pre-Contact period c. Indigenous people were in close contact with mammals in the pre-Contact period d. Indigenous people were well nourished in the pre-Contact period 4. Pacific Coastal First Nations depended on which of the following staple food “species”?

a. Bison b. Cod c. Salmon d. Caribou

5. How do we know about the pre-Contact history of North American Indigenous peoples?

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a. Explorer’s accounts b. Archaeology c. Oral history d. All of the above

6. Which of the following pre-Contact Indigenous populations were primarily agricultural?

a. Cree b. Iroquois c. Blackfoot Confederacy d. Beothuk

7. Which of the following foods were domesticated by First Nations farmers before Contact?

a. beans, maize, squash b. chocolate and tobacco c. wheat and barley d. a and b

8. Where did First Nations practice agriculture in Canada?

a. Southern Québec and Southern Ontario b. Canadian Prairies c. Canadian Arctic d. Boreal Forest 9. Which large herd animal formed part of the staple diets of Indigenous hunter-gatherers at Contact?

a. Whale b. Caribou c. Bison d. Woolly mammoth

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e. a, b and c

10. Village life in pre-Contact British Columbia was supported by

a. an abundant supply of salmon. b. hunting mountain caribou. c. whaling. d. farming.

11. Traditionally, the Inuit diet was composed of

a. a mixture of wild greens and meat. b. mostly meat and fish, supplemented by some seasonal plants. c. produce from their farms. d. salmon fishing.

12. Pre-Contact Indigenous peoples were

a. well nourished. b. often faced with starvation. c. much less well nourished than their European contemporaries. d. faced with cycles of abundance and starvation.

13. Hunter-gatherers consumed a diet that was

a. superior to most other Indigenous and European diets. b. inferior to Indigenous farmers’ diets, but superior to European diets. c. about the same as both other Indigenous and European diets. d. inferior to all other Indigenous and European diets.

14. The harsh environment of the Inuit left them

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a. more secure than most Indigenous peoples, because their isolation left them free from competition. b. living a marginal existence that was often threatened by the environment. c. more numerous as a people due to the invigorating effects of their environment. d. sparsely populated and poorly nourished.

15. Pre-Contact Canadian Indigenous peoples

a. engaged in frequent warfare amongst themselves b. were an isolated, impoverished population c. had population densities too low to support systematic and large-scale warfare d. had high enough population densities to repel European colonists

16. Northern Plains First Nations depended on which of the following staple food species?

a. Bison b. Mule deer c. Elk d. Moose

17. Inuit depended on which of the following staple food species?

a. Bison b. Cod c. Salmon d. Caribou

18. The trade centres of the Northern plains were the hub for disease contact and concomitant spread of many epidemics. Which one of the following diseases fulfils the criteria for depopulating epidemics in the Northern plains?

a. Influenza b. Measles c. Small pox

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d. Tuberculosis

19. Infectious diseases

a. led to frequent epidemics among the North American Indigenous peoples before Contact. b. were rare, but serious threats to Indigenous populations. c. were endemic among the Iroquois farmers of Eastern Canada. d. appear to have been unknown before Contact.

20. What factor allowed tuberculosis (TB) to flourish among Indigenous people during the 20th century period?

a. Lack of racial immunity b. Relocation to reserves c. Genetic susceptibility d. Poor water quality 21. Virgin soil epidemics are characterised by

a. mortality among the old and young. b. excessive morbidity. c. acquired immunity. d. high mortality in all age groups.

22. A virgin soil epidemic is

a. a plant disease striking untilled land. b. epidemic disease infecting a population with no prior immunity. c. chronic disease in a population with poor determinants of health. d. paediatric disease causing at least 50% mortality.

23. A virgin soil epidemic is one that

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a. a population has no acquired resistance to. b. infects the earth and remains active in it. c. infects only children before the age of adolescence. d. is spread through sexual contact.

24. Introduced epidemic diseases caused Indigenous populations to suffer mortality rates as high as

a. 20% b. 10% c. 40% d. 95%

25. Decolonizing Indigenous health can mean

a. devolving more services to Indigenous health authorities. b. including Indigenous rituals and beliefs in the medical system. c. abolishing the medical system and returning to traditional healing altogether. d. any of the above.

26. Jordan’s Principle states that a. the first agency to come into contact with a First Nation’s child in need of care, is obligated to pay for that care. b. provincial Medicare programs are primarily responsible for Non-Status First Nations healthcare. c. Health Canada must provide primary care services to all Indigenous children. d. municipal governments are responsible for emergency services for the Urban Indigenous population in Manitoba.

27. The creation of Jordan’s principle

a. was named after the Indigenous physician who advocated for health promotion and provision of non-insured benefits

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b. was named after the politician who developed the patchwork of federal, provincial and local jurisdictions that permitted Indigenous patients “to fall through the cracks.” c. was implemented at the federal and provincial level. d. was named after a 5-year-old boy who died in Winnipeg while the federal and provincial governments argued.

28. The fur trade spread quickly across Canada because

a. it was created by Europeans to help Indigenous peoples develop new markets for their furs. b. it exploited existing Indigenous trade routes. c. European explorers mapped new trading routes and introduced Indigenous peoples to them. d. European steam ships and trains transported goods quickly.

29. The fur trade created a network of European trading posts that covered Canada and which also

a. opened and exploited new trade networks. b. brought the Indigenous population into a global economy. c. obtained the permission of existing Indigenous people to prepare the way for further European economic and political penetration. d. provided the Indigenous population with opportunities to travel.

30. Early Contact Indigenous societies were able to quickly

a. adapt to and adopt European technology. b. use their existing technology to defeat European armies that invaded them. c. develop advanced weapons that were adopted by Europeans themselves. d. withdraw from European traders into isolation.

31. The predominant pattern of disease among Indigenous people following Contact was

a. infectious diseases.

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b. injuries. c. chronic diseases. d. suicide.

32. Of all the impacts of European Contact on the Americas, epidemic diseases were

a. the most insignificant. b. the most devastating. c. as important as the new trading opportunities that Contact brought. d. less important than the new weapons, especially firearms, that Europeans brought.

33. Which of the following were introduced to the Americas by European explorers and traders?

a. Smallpox b. Rubella c. Tuberculosis d. Common Cold e. a, b and d 34. How far did the 1775 to 1782 smallpox extend across North America? a. Through the English Thirteen Colonies on the East Coast and Mexico b. No further north than Mexico and the French colonies in Louisiana c. Everywhere in North America except the Arctic and the Northwest Coast of British Columbia d. All of the above

35. The spirochete that causes syphilis was

a. present in Indigenous populations and caused frequent outbreaks of syphilis before Contact. b. brought to the Americas by Europeans. c. brought to Europe as a venereal disease by Europeans and then reintroduced to the Americas in this new form.

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d. brought to the Americas by sailors trading in the Far East.

36. The Royal Proclamation of 1763

a. recognized Indigenous title to land in British North America. b. banned the Potlatch and the Ghost Dance. c. granted the Hudson’s Bay Company the right to trade in North America. d. seized the traditional lands of the Cree in Northern Ontario and Northern Québec.

37. The Royal Proclamation of 1763

a. seized First Nations land for the King of England. b. was a military treaty between the Iroquois Confederacy and the English. c. recognized Indigenous title to most of Canada. d. has never been recognised by Canadian governments.

38. The Royal Proclamation of 1763

a. brought the fur trade into the global market. b. encouraged Indigenous peoples to work for the Hudson’s Bay Company. c. recognised Indigenous title and sovereignty to land in North America. d. followed the United States’ example of settler and Indigenous relations.

39. Why is the Royal Proclamation of 1763 important today?

a. It created the Province of Canada. b. It recognised Indigenous title to most of Canada. c. It regulates transfer of land between First Nations and settlers. d. It sharply reduced amount of potential conflict between settlers and First Nations.

40. The Canadian government began providing medical services to the Indigenous population

a. after the Second World War. b. as soon as it signed land claims treaties which guaranteed them.

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c. since Confederation. d. a and b.

41. Until recently the Indian Act had as its official goal

a. assimilation of the Indigenous population into the general population of Canada. b. keeping the Status Indian population segregated on their reserves. c. forcing Inuit, Métis and Non-Status Indians to become Status Indians. d. none of the above.

42. Bill C31, an amendment to the Indian Act enacted by Parliament

a. clarified Indigenous rights to land and resources. b. reinstated to First Nations bands the right to govern. c. proclaim Indigenous peoples as a nation or tribe. d. restored Indian status to women and their children.

43. After Confederation, the Canadian government sought to

a. exterminate the Indigenous population of Canada. b. suppress Indigenous resistance through military force. c. assimilate the First Nations population through a variety of approaches. d. keep the Indigenous population separate and distinct from the non-Indigenous population.

44. Modern relations between the First Nations peoples and the Canadian government are a legacy of

a. the 1876 Indian Act. b. the War of 1812. c. the Northwest Rebellion. d. all of the above.

45. Residential schools were created to

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a. preserve Indigenous traditions and language. b. force Indigenous children to learn to assimilate into the non-Indigenous population. c. provide a place for homeless orphans to go to school. d. make jobs for unemployed schoolteachers.

46. Residential school had a major negative impact on the health and well-being of many Indigenous people. An example of a loss experienced by children who attended residential school is

a. identity. b. English language. c. physical abuse. d. alcohol misuse.

47. Residential schools

a. were the foremost instrument of state assimilation policy as applied to the Indigenous population. b. reflected official policy of segregation of Indigenous and non-Indigenous populations. c. were only attended by a minority of Indigenous children. d. were only for Indigenous children.

48. The Canadian residential school system left a legacy of

a. successfully preparing graduates for the workforce. b. systematic abuse and neglect of Indigenous children. c. model education widely imitated in other school systems in Canada. d. high-quality education, but primitive facilities and inedible food.

49. In Canada, Indian Reserves are

a. where all Indigenous people live in Canada. b. land reserved for Indigenous people.

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c. the place where Non-Status Indians live. d. inhabited by some First Nations, but not Inuit or Métis.

50. Before 1982, Status Indian men who married a Non-Status woman

a. granted their wife and their children Indian status. b. lost Indian Status themselves. c. kept Indian Status, but could not grant it to either their wife or children. d. passed Indian Status on to their children, but not to their wives.

51. Before 1982, Status Indian women who married a Non-Status man

a. transferred their Status rights to their husband and children. b. kept Indian Status, but could not transfer it to their husband and children. c. kept Indian Status, as did their children, but could not transfer it to their husband. d. were stripped of Indian status, as were their descendants.

52. Which of the following statements best defines ethnocentrism?

a. A form of rejection whereby an individual is denied the opportunity to participate in the dominant culture. b. The belief that one’s culture is superior to any other culture. c. A reality that a variety of injustices have been committed against different groups. d. A form of inclusion whereby an individual is brought in to participate in the dominant culture.

53. The concept of enfranchisement put forwards in 1869 for Indigenous people meant that

a. Indigenous women were now given the vote. b. Indigenous women who married non-Indigenous men lost their status. c. Indigenous women were seen as equal to Indigenous men. d. Indigenous men who gained voting rights lost their status.

54. What has been a major factor in preserving and promoting health among the Indigenous population?

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a. Low smoking rates b. Traditional diet and lifestyle c. Modern medical treatment d. Improved education for health life choices

Type: F 55. The heartland of pre-Contact Indigenous agriculture lay in and

,

. (3 marks)

Type: F 56. Some imported diseases that travelled the Atlantic with explorers and settlers to the Americas include

, and

,

,

. (5 marks)

Type: F 57. Infectious diseases of particular concern in Indigenous communities include ,

and

. (3 marks)

Type: F 58. Generations of Indigenous farmers in southern North America, Central America and the Andean Highlands domesticated a wide range of crops, many still significant today, which include

, ,

, and

, from wild ancestors. (6

marks) (answers may include other crops including: melons, squash, avocados, vanilla and tobacco) 59. Pre-Contact Northern populations were in close contact with mammals. As a result of this contact diseases such as tuberculosis may have infected pre-Contact Indigenous people of the Arctic. a. True b. False

60. Indigenous people were relatively disease free in the pre-Contact period. a. True

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b. False

61. The Indian Act is clear that status Indians do not own property on reserves. a. True b. False

62. Traditionally, Indigenous peoples participated in government and spiritual ceremonies. a. True b. False

63. All Indigenous people are First Nations. a. True b. False

64. Only Status Indians have the right to live on reserves. a. True b. False

65. First Nations without status cannot live on reserves and receive no special government assistance. a. True b. False

66. Without status it is impossible to claim and be Indigenous. a. True b. False

67. Inuit have Indian status. a. True b. False

68. Métis have Indian status. a. True b. False

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69. A treaty Indian is a member of a Prairie First Nation that has signed a land claims treaty with the Canadian government. a. True b. False

70. Most First Nations in British Columbia are treaty Indians. a. True b. False

71. Treaty Indians receive different and better services than other First Nations, even those with Indian status. a. True b. False

72. The term First Nations is now preferred over Indian. a. True b. False

73. Treaties are direct government to government agreements between two sovereign governments. a. True b. False

74. Indian reserves are granted by the Canadian government, not inhabited by right. a. True b. False

75. The Canadian government has been slowly devolving governmental functions to Indigenous governments, without introducing constitutional amendments to do so. a. True b. False

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76. The Charter of Rights and Freedoms places the individual rights of Canadians (including Indigenous Canadians) above the treaty rights of Indigenous peoples. a. True b. False

77. The Canadian constitution entrenches the treaty rights of the Indigenous peoples of Canada and requires Canadian governments to respect them. a. True b. False

78. The Canadian government assigns every Registered Indian a Band Number to identify their eligibility for government services. a. True b. False

Answers to Test Questions 1. a 2. a 3. b 4. c 5. d 6. b 7. d 8. a 9. e 10. a 11. b 12. a 13. a 14. b 15. c 16. a 17. d 18. c 19. d

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20. b 21. d 22. b 23. a 24. d 25. d 26. a 27. d 28. b 29. b 30. a 31. a 32. b 33. e 34. c 35. c 36. a 37. c 38. c 39. c 40. d 41. a 42. d 43. c 44. d 45. b 46. a 47. a 48. b 49. d 50. a 51. d 52. b 53. d 54. b 55. Southern Canada (Ontario/Québec), Central America (including Mexico), South America (Peru, Chile)

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56. small pox, tuberculosis, measles, influenza, rubella 57. upper respiratory infections, tuberculosis, sexually transmitted diseases (HIV [human immunodeficiency virus], HPV [human papillomavirus], chlamydia, etc.)

58. maize/corn, potatoes, tomatoes, chillies, beans, cocoa/chocolate 59. b 60. a 61. a 62. a 63. b 64. a 65. a 66. b 67. b 68. b 69. b 70. b 71. b 72. a 73. a 74. a 75. a 76. b 77. a 78. a

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Part II Indigenous Health and the Canadian Healthcare System Chapter 5 – Understanding the Determinants of Health and Canada’s Native Population Test Questions 1. What are the determinants of health? a. Factors in people’s physical, social, economic and biological environment that affect their health b. Key pharmaceuticals that are used to treat important chronic diseases c. Collective impact of public health agencies on each Canadian’s health. d. Components of a standard medical risk scoring sheet for maternal health

2. Individuals and communities reporting high levels of health have a greater sense of

a. control. b. financial resources. c. spirituality. d. self-preservation.

3. The determinant of health that has the greatest impact on health is

a. education. b. income. c. drugs and alcohol. d. healthcare.

4. Which of the following are considered to impact the health of a population?

i. Access to healthcare services ii. Drinking water

iii. Income

iv. Leisure activities

a. None of the above b. i, ii and iii

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c. All of the above d. i and iii

5. In Canada, higher income and social status usually correlate with

a. better health. b. higher alcohol consumption. c. consumption of fatty foods. d. purchases of Mediterranean food products.

6. Which Indigenous population has the lowest levels of income in Canada?

a. Métis b. On-reserve First Nations c. Off-reserve First Nations d. Inuit

7. Social support networks provide individuals with

a. a network of friends and supporters to help them weather adverse circumstances. b. peer pressure that can lead to unwise personal health decisions. c. a strong sense of control and mastery over life. d. all of the above.

8. How can we measure the strength of social support networks?

a. By measuring physical response to staged family crisis scenarios b. Through participation in family and community events c. By estimating the maximum number of interpersonal relationships possible in the community d. Through use of psychological evaluation

9. Canadians with low levels of education are more likely to

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a. smoke less. b. have excellent health. c. obtain job satisfaction. d. have poorer health.

10. When compared with the non-Indigenous population, Indigenous rates of post-secondary trades certification are

a. much lower. b. about the same. c. much higher. d. not calculated.

11. Canadians with low education are more likely to

a. smoke less. b. have excellent health. c. obtain job satisfaction. d. have poorer health.

12. The Indigenous unemployment rate is

a. lower than the Canadian average. b. roughly the same as the Canadian average. c. a little higher than the Canadian average. d. much higher than the Canadian average.

13. What are the most important years in an individual’s development?

a. Birth to age 6 b. Birth to age 12 c. Ages 12 to 16 d. Ages 18 to 30

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14. An individual’s genetic endowment

a. will determine their health throughout their life. b. can influence their health, but seldom determines it. c. has no effect on individual health. d. refers to modern biomedical gene selection techniques.

15. Public health services include

a. vaccinations. b. mammograms. c. open heart surgery. d. a and b. e. none of the above.

16. Gender roles

a. are biologically invariant. b. are socially assigned and culturally embedded. c. may be changed through surgical and pharmaceutical intervention. d. have important implications for health. e. b and d.

17. Traditional Indigenous health views differ from traditional Western medicine in that

a. Indigenous view is that health is holistic; Western view is that medicine is not holistic. b. Indigenous view is that health is earned; Western belief is that health is bought. c. Indigenous view is that health is a gift; Western belief is that health is holistic. d. both share the same philosophical underpinnings.

18. Culture influences health through

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a. the cultural stereotypes that society imposes upon individuals. b. the cultural roles individuals internalize and incorporate into their lives. c. providing a secure social identity with which to navigate society. d. all of the above.

19. When compared with the general Canadian population, the incidence of cancer mortality among First Nations is

a. less of a problem. b. more of a problem. c. increasing. d. the same.

20. Contaminants in the physical environment can cause

a. cancer. b. respiratory disease. c. birth defects. d. a and c. e. all of the above.

21. The Gaia Theory

a. sees human beings as an integral part of the planetary ecosystem. b. is a mystical belief that the Earth itself is alive and takes the form of an ancient goddess. c. has been discredited by recent scientific research. d. all of the above.

22. Gaia Theory considers the Earth to be

a. a unified interconnected whole. b. easily described by a number of unrelated individual scientific theories.

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c. a living goddess and the spiritual mother of the world. d. a simple piece of inanimate matter.

23. What is population health?

a. The overall health of a population b. The health of each individual in a population c. A statistical measure of average prescription drug consumption in a population d. All of the above

24. What is the relationship between the determinants of health and population health?

a. The determinants of health are the means by which population health can be measured b. There is no relationship c. The determinants of health measure individual health, while population health uses statistical measures d. b and c

25. Health Canada, from http://www/hcsc.gc.ca/hppb/phdd/approach/index.html, adopted population health approach as a tool for population health promotion and public policy specifically to

a. consider gathering information on health inequities among population groups. b. improve the health of the population. c. reflect on the capacity of people to come to terms with life’s challenges. d. discount the range of social, economic and physical factors that contribute to health.

26. How does population health relate to individual health?

a. Good population health means that every individual is healthy. b. Poor population health means that every individual is in poor health. c. Good population health facilitates individual health. d. a and b.

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27. Vaccination rates among the First Nations population are

a. lower than among the non-Indigenous population. b. higher than among the non-Indigenous population. c. non-existent. d. 100%.

28. What has been a major factor in preserving and promoting health among the Aboriginal population?

a. Low smoking rates b. Traditional diet and lifestyle c. Modern medical treatment d. Improved education for health life choices 29. The design and implementation of health policies and programs can promote or violate human rights.

a. True b. False

30. Health status improves with each step up in income and social status.

a. True b. False

31. Canadians with low levels of education are more likely to have poorer health.

a. True b. False

32. Education and literacy increases opportunities for jobs and income security.

a. True

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b. False

33. High levels of trust and group membership are factors of social environment that are associated with reduced mortality rates.

a. True b. False

34. Personal health practices such as immunisation and mammograms are showing positive results in disease prevention.

a. True b. False

35. The mind, body, birthplace and spirit are all integral parts of health according to Indigenous people.

a. True b. False

36. The Gaia Theory is an example of how scientific epistemology can reflect aspects of the traditional Indigenous world view.

a. True b. False

37. Indigenous people experience health problems that are linked with their historical position in the Canadian social system.

a. True b. False Type: MT

Matching (13 Marks)

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Directions: Match the following descriptions of the Determinants of Health in Column A with the appropriate term from Column B. Fill in your answers a, b, c, d, e, etc.

Items from Column B may be used more than once. Each question is worth 1 mark.

Column A

Column B

38. The capacity of people to adapt to,

a. Social environment

respond to, or control life’s challenges and changes 39. Array of roles, traits, attitudes,

b. Income and social status

behaviours, values, relative power and influence that society ascribes to 40. Each step up improves health status

c. Health services

41. Provides a buffer against health

d. Personal health practices

problems 42. Values and norms of a society influence

e. Education and literacy

health 43. Unsafe, lack of or instability can cause

f. Health

adverse effects on mental and physical health 44. Link between hospital admissions for

g. Physical environment

respiratory illness in the summer months and levels of sulphates and ozone in the air 45. Equips people with knowledge and

h. Employment/working conditions

skills for problem-solving 46. Indoor air quality, design of

i. Personal health practices/coping skills

communities and transportation 47. Immunisation and mammograms are

j. Biology/genetic endowment

showing positive results in disease prevention 48. Actions to prevent diseases and promote k. Gender self-care 49. Predisposes certain individuals to particular health problems or diseases

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50. Trust and group membership associated with reduced mortality rates

Type: T 51. Explain how the determinants of health contribute to and have an impact on Indigenous health.

Answers to Test Questions 1. a 2. a 3. b 4. c 5. a 6. b 7. d 8. b 9. d 10. c 11. d 12. d 13. a 14. b 15. d 16. e 17. a 18. b 19. c 20. e 21. a 22. a 23. a 24. a 25. b 26. c 27. b 28. b

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29. a 30. a 31. a 32. a 33. a 34. a 35. a 36. a 37. a 38. f 39. k 40. b 41. b 42. k 43. h 44. g 45. e 46. g 47. c 48. i 49. j 50. a

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Chapter 6 – Diabetes, Diet and Nutrition Test Questions 1. Diabetes rates are rising in the Indigenous population due to a. increased education about environmental contaminants in foods. b. the movement of Status First Nations to the cities and towns from their remote reserves. c. changes in diet from traditional foods to market foods. d. all of the above.

2. Which are common complications of diabetes?

a. Organ dysfunction and failure b. Blindness c. Sexual dysfunction d. Heart disease e. All of the above

3. Traditionally, the Inuit diet was composed of

a. a mixture of wild greens and meat. b. mostly meat and fish, supplemented by some seasonal plants. c. produce from their farms. d. salmon fishing.

4. Village life in pre-Contact British Columbia was supported by

a. an abundant supply of salmon. b. hunting mountain caribou. c. whaling. d. farming.

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5. Pre-Contact Indigenous peoples were

a. well nourished. b. often faced with starvation. c. much less well nourished than their European contemporaries. d. faced with cycles of abundance and starvation.

6. Type 2 diabetes is also known as

a. adult onset diabetes. b. congenital diabetes. c. child onset diabetes. d. inherited diabetes.

7. Currently, the most common type of diabetes among the Indigenous populace is

a. type I. b. type II. c. gestational. d. b and c.

8. Insulin is produced by the pancreas and

a. is required by the body for the metabolism of glucose. b. assists glucose molecules to stay in the blood stream and away from the cells. c. is insufficient when the body is able to use what it makes. d. causes diabetes when too much sugar is eaten.

9. Complications due to the disease process of diabetes generally include all of the following except

a. kidney dysfunction.

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b. heart dysfunction. c. damage to the nerves. d. osteoporosis.

10. Symptoms of diabetes that may become apparent when cells are starved of the glucose needed to perform metabolic activities include everything except

a. excessive thirst. b. frequent urination. c. loss of appetite. d. weight change (gain or loss).

11. Diabetes is already the leading cause of all of the following in all Canadian adults except

a. chronic obstructive pulmonary disease. b. end-stage renal failure. c. blindness. d. non-traumatic amputation.

12. Diabetics are four times more likely than members of the general population to be admitted to hospital because

a. they have third party insurance coverage. b. they have high rates of diagnosed depression. c. the hospital regulations permit their ease of admittance. d. they are sufferers of a chronic disease.

13. Which of the following is not a common health condition associated with organ dysfunction and failure in diabetes?

a. Gradual thickening of the blood vessel walls b. Suppression of the immune system c. Metabolism of body fat and protein d. Suppression of adrenal function

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14. High blood sugar levels lead many diabetics to develop

a. chronic kidney disease. b. gangrene. c. coronary artery disease. d. all of the above.

15. Which of the following is a modifiable risk factor for developing diabetes?

a. Weight b. Genetics c. Family history d. Gestational diabetes

16. Which of the following statements about diabetes and Indigenous people is false?

a. Rates are three to five times higher. b. Rates are highest among Indigenous women. c. The disease is often detected later. d. There are fewer health complications.

17. Which of the following is considered to be an epidemic among Indigenous people in Canada?

a. Diabetes b. Hypertension (high blood pressure) c. Cancer d. Human immunodeficiency virus infection

18. Indigenous people suffer greater rates of renal complications as a result of all of the following except

a. higher rates of diabetes.

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b. higher rates of cardiovascular disease. c. lower referral rates to specialists. d. higher rates of misuse of medications.

19. What percentage of the diabetic population suffers from type 2 diabetes?

a. 10% b. 25% c. 50% d. 90%

20. Which group is more affected by type 2 diabetes?

a. Non-Indigenous men b. Non-Indigenous women c. Indigenous men d. Indigenous women

21. Risk factors contributing towards the development of diabetes among Indigenous populace include all of the following except

a. high-risk sexual behaviour. b. physical activity. c. obesity. d. b and c.

22. Between 2001 and 2015, the age-standardised prevalence of diagnosed diabetes in Canadians increased from 4.48% to a. 5.69% – a 27.0% increase b. 6.78% – a 51.3% increase c. 7.91% – a 76% increase d. 8.69% – a 93.9% increase

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23. The Public Health Agency of Canada (PHAC) recorded a slight decline in the incidence (new cases) of diabetes in the Indigenous population over time, but an increase in the prevalence of the disease in Canada (people living with diabetes) because

a. improved care has allowed patients to live longer. b. this is a statistical estimate. c. the diabetes rates had risen slightly. d. these are measures of the prevalence of diabetes. e. it is useful to generalize about statistics.

24. Market, or store-bought, foods that are rapidly replacing traditional foods in the diet of Indigenous Canadians are

a. preferred because they are inexpensive. b. abundant in fresh vegetables and fruits. c. commonly frozen and pre-packaged. d. processed foods high in nutrient content.

25. The transition from a traditional diet to a market diet is called the

a. nutrition transition. b. tradition transition. c. market transition. d. lifestyle transition.

26. Barriers to developing a healthy market diet among the Indigenous population living in rural and remote areas include

a. limited all-weather road access. b. seasonal water transport. c. reliance on food with long shelf life. d. all of the above.

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27. Individuals suffering diabetes experience financial costs and the significant burden of disability which includes

a. reduced quality of life. b. reduced life span. c. significant loss of income. d. all of the above.

28. Diabetes may impair the functioning of some Indigenous communities where a significant proportion of the population is diabetic because

a. the financial burden of diabetes weighs down the entire community. b. traditional harvesting is affected since sufferers are unable to hunt or gather traditional food. c. it leads to widespread dependence on costly imported market foods. d. all of the above.

29. The “Thrifty Gene” theory claims that a. Canadian Indigenous populations are genetically predisposed towards diabetes. b. Indigenous people possess a deoxyribonucleic acid structure inherently more weighted towards an active lifestyle. c. Indigenous populations are genetically susceptible to starvation. d. The gene for sickle cell anaemia is present in specific Canadian Indigenous populations

30. Measures implemented to reduce diabetes in the Indigenous population would significantly

a. reduce the burden of diabetes to the Canadian healthcare system. b. reduce the community’s financial dependence on the Public Health Agency. c. reduce their opportunities to hunt and gather traditional food.

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d. have no correlation to their consumption of sugar-laden, highly processed market foods.

31. Unlike the non-Indigenous population, household food insecurity is much higher in the Indigenous population because

a. a significant number live in urban communities. b. sociopolitical factors mitigate against a healthy market diet. c. they often live in rural and remote communities. d. they diversify diet through hunting and fishing.

32. A combination of socioeconomic, cultural and geographic factors contribute to the rise in diabetes rates in the Indigenous population in Canada including

a. traditional diet and sedentary lifestyle. b. resisting diagnosis and mistrust of healthcare system. c. barriers to physical inactivity and leisure-time. d. cost to physical recreation and educational campaigns.

33. Divided jurisdictions of provincial, territorial, or federal healthcare programs and services for the Indigenous population contribute to a lack of clear and consistent

a. policies on controlling and preventing diabetes. b. national diabetes data rates. c. delivery of health services and benefits. d. all of the above.

34. According to the “Thrifty Gene” theory, when there are no longer periods of starvation a. this gene allows the body to store fat and is thus beneficial. b. this gene allows the body to store fat during times when food is scarce. c. this gene allows the body to store fat and is thus harmful. d. this gene allows the body to store fat during times when food is abundant.

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35. Examples of approaches for the prevention and treatment of diabetes that work are ones that work with the community to

a. develop culturally appropriate diabetes awareness curriculum. b. provide physical assessments and feedback on dietary changes. c. promote direct subsidies to retailers for purchase of country foods. d. a and b.

36. Risk factors contributing towards the development of diabetes among Indigenous groups include all of the following except

a. obesity. b. smoking. c. sedentary lifestyle. d. diet.

37. What kind of diabetes is seen only during pregnancy?

a. Type I b. Type II c. Gestational d. Idiopathic

38. Women who develop gestational diabetes suffer a higher risk of developing

a. type 2 diabetes. b. gangrene. c. renal disease. d. all of the above.

39. Currently there is a low prevalence of documented obesity among many Indigenous groups.

a. True

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b. False 40. Prevalence of chronic diseases – diabetes, heart problems, hypertension, arthritis and some cancers – is significantly higher among Indigenous communities and is increasing.

a. True b. False

41. Obesity makes a major contribution to diabetes rates among Canadian Inuit.

a. True b. False

42. There are significant regional variations for different Indigenous populations such as the Inuit and the Cree population in Northern Québec.

a. True b. False

43. On average, diabetes reduces the life span by 5 years and has little effect on the quality of life remaining.

a. True b. False

44. Diabetes carries with it a heavy moral burden that lies on the shoulders of the individual, the community and, ultimately, the nation as a whole.

a. True b. False

45. The effects of the transition to a market diet on the Indigenous population are directly linked to the dietary causes of diabetes.

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a. True b. False

46. Low education is directly linked both to a lack of awareness of health risks that leads to diabetes and its complications and to high income.

a. True b. False

47. Diabetes in the Indigenous population in Canada is considered to be an epidemic disease.

a. True b. False Type: T 48. Diabetes is three to five times higher in the Indigenous population than the general Canadian population. Explain how three changes in the traditional Indigenous lifestyle have contributed to increasing rates of diabetes among the Indigenous populace over time.

Type: T 49. Choose one of the three following determinants of health and explain what factors have affected (or are affecting) the epidemic rates of diabetes in Indigenous communities: Income and social status, culture/identity, or education and literacy.

Answers to Test Questions 1. c 2. e 3. b 4. a 5. a 6. a 7. d 8. a 9. d

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10. c 11. a 12. b 13. d 14. d 15. a 16. d 17. a 18. d 19. d 20. d 21. d 22. c 23. a 24. c 25. a 26. d 27. d 28. d 29. a 30. a 31. c 32. b 33. d 34. b 35. d 36. b 37. c 38. d 39. b 40. a 41. b 42. a 43. b

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44. b 45. a 46. b 47. a 48. i. Traditional diets have changed dramatically, shifting from a diet dependent on eating natural/country foods (e.g., fish, berries, game), to a diet laden with unhealthy saturated/fatty processed and high carbohydrate foods, thereby increasing the risk of developing diabetes.

An increase of the carbohydrate (sugar) content of their foods leads to insulin resistance and eventually type II diabetes mellitus, or to gestational diabetes. ii. Poverty and the loss of social status contribute to increasing rates of diabetes because of the inability/difficulty of families to purchase healthy, but more expensive, store bought food.

There has been a decline in number of youths and adults interested in hunting as the tools, fuel, transportation, time from work, etc., required are often expensive. iii. A loss of culture/identity due to colonization and residential schools and a loss of traditional healing practices have led to an increase in substance misuse (particularly of alcohol) in communities. Substance misuse leads in turn to communities becoming susceptible to increased risks of disease/mortality as alcoholics are not usually following an optimum diet and exercise regime. iv. Access to healthcare services is not readily available on reserves. A lack of healthcare services leads to lack of health promotion practices and education on the benefits of consuming nutritious foods, which in turn contributes to delayed diagnosis/treatment of diabetes. v. Sedentary lifestyle: Where once Aboriginals lived off the land self-sufficiently, they were relegated to living on reserves that were often marginal. With the loss of traditional lands, they were restricted in their ability to actively hunt, fish and forage to provide for themselves. They increasingly developed a much more sedentary lifestyle leading to increased levels of obesity and a correlating increase in diabetes.

Obesity, in turn, places people at increased risk of developing diabetes. vi. Indigenous peoples have lower levels of (formal) education as compared with the general population, and therefore they often lack the knowledge necessary to make informed choices regarding their health. Therefore, an individual’s ability to manage

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the disease may be somewhat limited as there is often a difficulty in understanding the risks associated with the disease as it relates to diet, exercise and insulin therapy.

49. a. Income and social status: i. Poverty and the loss of social status contribute to increasing rates of diabetes because of the inability/difficulty of families to purchase healthy, but more expensive, store bought food. ii.

There has been a decline in number of youths and adults interested in hunting

as the tools, fuel, transportation, time from work, etc., required are often expensive. iii.

Isolated communities’ face difficulties with the costs of flying in shipments,

which then contributes to families and individual being placed in a position where they are unable to purchase expensive but less-nutritious market foods. iv.

A growing dependence on government assistance over time, particularly for

rural and remote communities where there are fewer opportunities for education, an increased prevalence of risk factors persist and go undetected due to a lack of accessible services such as healthcare. b. Culture/identity: i. A loss of culture/identity due to colonization and residential schools and a loss of traditional healing practices have led to an increase in substance misuse (particularly of alcohol) in communities. Substance misuse leads in turn to communities becoming susceptible to increased risks of disease/mortality as alcoholics are not usually following an optimum diet and exercise regime. ii.

Traditional diets have changed dramatically, shifting from a diet dependent on

eating natural/country foods (e.g., fish, berries, game), to a diet laden with unhealthy saturated/fatty processed and high carbohydrate foods, thereby increasing the risk of developing diabetes. iii.

An increase of the carbohydrate (sugar) content of their foods leads to insulin

resistance and eventually type II diabetes mellitus, or to gestational diabetes. c. Personal health practices and coping skills: i. Healthcare services: Access to healthcare services is not readily available on reserves.

A lack of healthcare services leads to a lack of health promotion practices and education on the benefits of consuming nutritious foods, which in turn contributes to a delayed diagnosis and treatment of diabetes. ii.

Smoking rates: Smoking rates among the First Nations populace is double that

of the general population rate. And, as smoking directly influences the pancreatic

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tissue’s ability to function, it causes hypertension. An increase in hypertension thereby increases the risk of diabetes because of an increase in insulin resistance. iii.

Sedentary lifestyle: Where once Indigenous peoples lived off the land self-

sufficiently, they were relegated to living on reserves whose land was often marginal.

With the loss of traditional lands, they were restricted in their ability to actively hunt, fish and forage to provide sufficiently for themselves. They increasingly developed a much more sedentary lifestyle, which is leading to increased levels of obesity rates and a correlating increase in diabetes rates. iv.

Obesity: Obesity, in turn, places people at an increased risk of developing

diabetes. v.

Education and literacy: Indigenous peoples tend to have lower levels of

(formal) education as compared with the general population, and therefore they often lack the knowledge necessary to make informed choices regarding their health.

Therefore, an individual’s ability to manage the disease may be somewhat limited as there is often a difficulty in understanding the risks associated with the diabetes as it relates to diet, exercise and insulin therapy.

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Chapter 7 – Chronic and Infectious Diseases Test Questions 1. Which chronic diseases are markedly higher in the Indigenous population than in the nonIndigenous population?

a. Tuberculosis and diabetes b. Cancer and heart disease c. Chronic kidney disease and chronic obstructive pulmonary disease d. All of the above 2. Prevalence of chronic diseases – diabetes, heart problems, hypertension, arthritis and some cancers – is

a. significantly higher among Indigenous communities and is increasing. b. significantly lower among Indigenous communities and is decreasing. c. significantly higher among Indigenous communities and is decreasing. d. significantly lower among Indigenous communities and is increasing.

3. Which of the following statements about diabetes and Indigenous people is false?

a. Rates are three to five times higher b. Rates are highest amongst Indigenous women c. The disease is often detected later d. There are fewer health complications

4. Risk factors contributing towards the development of diabetes among Indigenous groups include which of the following

a. Obesity b. Smoking c. Consumption of caribou meat

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d. a and b

5. What are the risk factors for type 2 diabetes?

a. Traditional lifestyle b. Physical inactivity c. Obesity d. b and c

6. Diabetes rates are rising in the Indigenous population due to

a. increased education about environmental contaminants in foods. b. the movement of status First Nations to the cities and towns from their remote reserves. c. changes in diet from traditional foods to market foods. d. all of the above.

7. Canadian sources for data on Indigenous health are

a. a realistic look at the health of Indigenous in Canada. b. overestimates of disease and health conditions. c. underestimates of disease and health conditions. d. an unrealistic look at the health of Indigenous in Canada.

8. Infectious diseases

a. led to frequent epidemics among the North American Indigenous peoples before Contact. b. were rare, but serious threats to Indigenous populations. c. were endemic among the Iroquois farmers of Eastern Canada. d. appear to have been unknown before Contact.

9. The predominant pattern of disease among Indigenous people immediately following Contact was

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a. infections. b. injuries. c. chronic diseases. d. suicide.

10. The trade centres of the Northern plains were the hub for disease contact and concomitant spread of many epidemics. Which one of the following diseases fulfils the criteria for depopulating epidemics in the Northern plains?

a. Influenza b. Measles c. Smallpox d. Tuberculosis

11. Introduced epidemic diseases caused Indigenous populations to suffer mortality rates as high as

a. 20% b. 10% c. 40% d. 95%

12. Which of the following diseases were introduced to the Americas by European explorers and traders?

a. Smallpox b. Rubella c. Common cold d. All of the above

13. How far did the 1775 to 1782 smallpox extend across North America?

a. Through the English Thirteen Colonies on the East Coast and Mexico

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b. No further north than Mexico and the French colonies in Louisiana c. Everywhere in North America except the Arctic and the Northwest Coast of British Columbia d. All of the above

14. Of all the impacts of European Contact on the Americas, epidemic diseases were

a. the most insignificant. b. the most devastating. c. as important as new trading opportunities that Contact brought. d. less important than the new weapons, especially firearms, that Europeans brought.

15. The “Thrifty Gene” theory claims that as a population Canadian Indigenous peoples

a. are predisposed towards diabetes. b. possess a deoxyribonucleic acid (DNA) structure inherently more weighted towards an active lifestyle. c. are genetically susceptible to cycles of starvation. d. have the gene for diabetes present in their DNA.

16. Poverty leads to

a. malnutrition/poor diet. b. overcrowding/unhealthy environment. c. lack of education. d. lack of access to medical services. e. all of the above.

17. Which of the following health issues can be linked to lower incomes?

a. Diabetes b. Obesity c. Heart disease d. Cancer

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e. All of the above

18. How can chronic health conditions be caused or exacerbated by lower income?

a. Lower income leads to poor diets and chronic health problems. b. Travel costs to access medical services can deter lower income patients. c. Lower income patients are not entitled to the same level of care as higher income patients. d. a and b.

19. The underlying causes, or risk factors, that inform the prevalence of sexually transmitted diseases (STDs) and their persistence in the Indigenous populations include

a. participation in the sex trade. b. poverty and generational trauma. c. lack of health services. d. all of the above.

20. The Indigenous sub-group at greatest risk for contracting hepatitis C is

a. prostitutes. b. injection drug users. c. homosexuals. d. children.

21. Hepatitis C is spread through an exchange of body fluids. Which source poses the greatest risk?

a. Blood b. Semen c. Saliva d. Urine

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22. Indigenous peoples are at risk for contracting hepatitis C for all the following reasons except

a. low self-esteem. b. sharing needles. c. tattooing. d. poor nutrition.

23. The most serious STD, and the only one for which adequate national statistics is available in Canada, is

a. chlamydia. b. syphilis. c. hepatitis C. d. Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS).

24. When compared with Canadians, the life expectancy of Indigenous people living with AIDS is

a. shorter. b. the same. c. increasing. d. longer.

25. Which population sub-group constitutes the largest proportion of Indigenous AIDS cases?

a. Young men b. Young women c. Pregnant women d. Homosexual men

26. Most varieties of human papillomavirus (HPV) do not cause visible symptoms (warts), but some are known to cause cancer. They may lead to cancers of the

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a. cervix, vulva, vagina and anus in women. b. cancers of the anus and penis in men. c. cancers of the head and neck (tongue, tonsils and throat). d. all of the above.

27. When compared with the general Canadian population, the incidence of cancer among First Nations is

a. less of a problem. b.more of a problem. c. decreasing. d. the same.

28. High rates of lung cancer in the Indigenous population are due to a. environmental contaminants in the traditional food supply. b. high rates of smoking. c. the transition from a traditional to a market diet. d. poor air quality in Indigenous communities.

29. The Indigenous populace suffer greater rates of renal complications as a result of all of the following except

a. higher rates of diabetes. b. higher rates of cardiovascular disease. c. lower referral rates to specialists. d.higher rates of misuse of medications.

30. What are major risk factors for respiratory disease?

a.Smoking and air pollution b. Diet and nutrition c. Genetics and biological inheritance d. Currently suffering from one or more other chronic diseases

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31. Among the Indigenous community, respiratory disease accounts for 85% of hospital admissions of babies and children. The two major risk factors are

a. inadequate sanitation and smoking. b. poor nutrition and environmental conditions (indoor and outdoor). c. poor drinking water and poor nutrition. d. smoking and environmental conditions (indoor and outdoor).

32. First Nations have higher hospitalisation rates due to

a. respiratory diseases. b. HIV/AIDS. c. cancer. d. cardiovascular diseases.

33. The leading cause of death of children aged 28 days to 1 year in the Native American population is

a. pneumonia. b. drowning. c. gastroenteritis. d. diabetes.

34. What is the leading cause of death in HIV/AIDS infected individuals?

a. Cancer b. Diabetes c. Heart disease d. Tuberculosis 35. Tuberculosis was considered a major health risk for the Canadian population until

a. 1900.

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b. 1850. c. 1946. d. 1974.

36. Tuberculosis can survive in a dormant state in the tissues of an infected person for

a. 3 weeks. b. 1 year. c. 5 years. d. the rest of their life.

37. Before the development of antibiotics, the only effective treatment for tuberculosis

a. was seclusion in a special hospital, known as a sanatorium. b. collapsing one lung “to rest” it through surgery. c. a regime of vitamin D supplementation, usually through exposure to sunlight. d. all of the above.

38. The last Canadian tuberculosis sanatorium to close was in

a. 1903. b. 1950. c. 1964. d. 1973.

39. How prevalent was tuberculosis infection in Canada before World War II?

a. It was very common; most Canadians carried the disease. b. It was most prevalent in the Indigenous population, but some non-Indigenous people were also infected. c. It was very rare in Canada before 1939. d. None of the above.

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40. What factors helped tuberculosis to flourish among Indigenous people during the 20th century?

a. Lack of racial immunity b. Relocation to reserves c. Genetic susceptibility d. Poor water quality

41. Very high latent infection rates of tuberculosis in the Indigenous population are directly due to

a. anti-tuberculosis campaigns of the past focusing on the rural and northern populations. b. emergence of drug-resistant strains of tuberculosis, namely, MDR-TB and XDR-TB. c. non-compliance of potent cocktails of steroid drugs. d. sovereignty concerns driving the Inuit anti-tuberculosis campaigns and evacuations.

42. The spirochete bacterium that causes syphilis was

a. present in Indigenous populations and caused frequent outbreaks of syphilis before Contact. b. introduced to the Americas as a venereal disease by Europeans. c. brought to Europe as a venereal disease and then reintroduced to the Americas in this new form. d. brought to the Americas by sailors trading in the Far East.

43. Historically, the most feared STD, and the one which if left untreated kills the infected person over a period ranging from months to years, is

a. chlamydia. b. syphilis. c. hepatitis C. d. HIV/AIDS.

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44. Chronic otitis media can cause

a. damage to vision. b. chronic respiratory syndrome. c. tissue necrosis. d. hearing damage.

45. High blood pressure is a risk factor for

a. injury. b. heart disease. c. cancer. d. diabetes.

46. Prevalence of chronic diseases – diabetes, heart problems, hypertension, arthritis and some cancers – is significantly higher among Indigenous communities and is increasing.

a. True b. False

47. Indigenous people were relatively disease free in the pre-Contact period.

a. True b. False

48. Syphilis follows three stages over time if left unchecked: stage 1 leads to wart-like skin lesion formation, stage 2 sets in with fevers and weight and hair loss and stage 3 leads to degeneration of the cardiovascular or neural system and death.

a. True b. False

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49. Otitis media is a health issue in the Indigenous population because it is associated with substandard housing.

a. True b. False

50. The rate of tuberculosis is higher among Indigenous people compared with the general population because Indigenous people have lower rates of poverty.

a. True b. False

51. Everyone who contracts tuberculosis will display signs and symptoms of the disease within 2 years.

a. True b. False

52. One out of three Indigenous persons newly diagnosed with HIV is under 30 years of age.

a. True b. False

53. HIV/AIDS has a significant impact on Indigenous men, making up 47% of all new HIV diagnoses among Indigenous people.

a. True b. False

54. Chronic obstructive pulmonary disease (COPD) is often seen in people addicted to smoking tobacco.

a. True b. False

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55. Infection of herpes simplex is lifelong as the virus remains latent in the body, emerging regularly as sores on the genital region.

a. True b. False

56. Currently, there is a low prevalence of documented respiratory diseases among many Indigenous groups.

a. True b. False 57. Prevalence rates of documented infectious diseases – such as HPV, HIV, chlamydia – are currently lower among many Indigenous groups.

a. True b. False

58. Lack of racial immunity is the greatest factor in allowing tuberculosis to flourish among First Nations people during the 20th century.

a. True b. False

59. The transmission of hepatitis C is only through blood transfusion, sometimes sexual intercourse but more often through shared IV needles.

a. True b. False

60. High obesity rates are closely correlated with the transition from a traditional diet to a market diet among rural and remote Indigenous populations.

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a. True b. False

61. Incidence of chlamydia in the Indigenous population is compounded by late diagnosis, inadequate medical treatment and failure to follow medication schedules.

a. True b. False

62. Gonorrhoea, caused by the Neisseria gonorrhoeae bacteria, is spread through any variety of sexual intercourse and is often contracted in isolation of other STDs.

a. True b. False

Type: T 63. Choose either one infectious disease (such as tuberculosis, human immunodeficiency virus, sexually transmitted infections), or one chronic disease (other than diabetes) that is especially problematic among Indigenous people today, and answer the following questions: a. Which age group and gender are most affected? b. List and explain three contributing factors for the increased rates of the disease in this population. c. List and explain how two determinants of health can be modified to improve the health of people with this disease, either in terms of prevention or in terms of treatment.

Type: T 64. What was the predominant pattern of disease among Indigenous people following Contact? What is it today? Why?

Type: T

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65. The trade routes of the northern plains and boreal forest were the hub for disease contact and concomitant spread of many epidemics. Which diseases fulfil the criteria for depopulating epidemics? Why?

Type: T 66. What are the trajectories by which an infectious disease spreads through a population?

Explain and give examples.

Answers to Test Questions 1. d 2. a 3. d 4. d 5. d 6. c 7. c 8. d 9. a 10. c 11. d 12. d 13. c 14. b 15. a 16. e 17. e 18. d 19. d 20. b 21. a 22. d 23. d 24. a 25. b

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26. d 27. b 28. b 29. d 30. a 31. d 32. a 33. a 34. d 35. d 36. d 37. d 38. d 39. a 40. b 41. b 42. c 43. b 44. d 45. b 46. a 47. a 48. b 49. b 50. b 51. b 52. a 53. b 54. a 55. a 56. b 57. b 58. b 59. a

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60. a 61. a 62. b

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Chapter 8 – Women’s and Children’s Health Test Questions 1. Current Indigenous women’s well-being and health issues are informed by

a. legal discrimination. b. childhood experiences. c. their place in Indigenous culture and society. d. all of the above.

2. Overcrowding affects which segments of the Indigenous population?

a. Inuit b. On reserve/ Off reserve First Nations c. Métis d. All of the above

3. When compared with the general Canadian population, the proportion of Indigenous women living with acquired immunodeficiency syndrome (AIDS) is

a. smaller both as a population and as a gender. b. the same both as a population and as a gender. c. increasing both as a population and as a gender. d. higher both as a population and as a gender.

4. What has changed in both Indigenous and Canadian society that has had implications for Indigenous women’s roles historically?

a. Their public role as leaders has become more prominent b. The collapse of fur trade c. Displacing men from their position as material providers d. All of the above

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5. Why should nurses care about Indigenous women’s health?

a. This is an important and rapidly increasing component of the population. b. Most nurses will be responsible for female Indigenous patients at some point in their careers. c. Nurses and the nursing profession bear a responsibility for health promotion in the population. d. All of the above

6. Indigenous women are at higher risk for becoming victims of violence at the hands of their partners for all the following reasons except

a. low self-esteem. b. lack of support from judicial system and community leaders. c. availability of community safe houses. d. diluted sentences given to perpetrators.

7. What were the implications of professionalisation of healthcare in Canada by the 19th century?

a. There were no implications. b. Everyone was treated for illness when they become ill. c. Tertiary care services became very important. d. Midwifery was legally discouraged and delivery of babies became a male specialty.

8. An example of assimilation as it applies to Indigenous people is

a. forced attendance of children at residential schools. b. evolution of the Métis culture. c. participation of Indigenous people in the fur trade. d. use of traditional medicine in the biomedical system.

9. When compared with the non-Indigenous population Indigenous children participation in post-secondary trades education is

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a. much lower. b. about the same. c. much higher. d. not calculated.

10. The Indigenous unemployment rate is

a. lower than the Canadian average. b. roughly the same as the Canadian average. c. a little higher than the Canadian average. d. much higher than the Canadian average.

11. Which of the following statements about diabetes and Indigenous women is false?

a. The rates are three to five times higher. b. The rates are highest among Indigenous women. c. The disease is often detected later. d. There are fewer health complications.

12. Women in traditional Indigenous society

a. held spiritual and religious roles. b. were healers and family caregivers. c. were midwives. d. all of the above.

13. Depression and low self-esteem

a. are a product of racism, marginal socioeconomic status and a lack of healthcare. b. lead to higher suicide rates, abusive relationships and substance abuse. c. are found to have a strong correlation to sexual activity. d. a and b.

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14. Children in Indigenous society

a. were traditionally educated through example and experience. b. were disciplined regularly. c. were educated by recognized tutors. d. all of the above.

15. Which of the following are causal factors for poor mental health?

a. Dependence on government b. Racism c. Residential schools d. All of the above

16. Violence has a generational impact. Children who are exposed to violence in an abusive family a. absorb the message that this is “normal” behaviour. b. are susceptible to entering into abusive relationships in turn. c. are susceptible to becoming perpetrators in turn. d. all of the above.

17. The major issues specific to Indigenous children have all their origins in the determinants of health and their effects are played out on Indigenous society. They include all of the following except

a. poverty. b. violence. c. otitis media. d. traditional diet.

18. Complete the following statement. In the 2016 Census, the First Nations birth rate was

a. less than the Canadian rate for non-Indigenous people.

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b. more than the Canadian rate for non-Indigenous people, but dropping. c. in steep decline. d. less than half of what it was 10 years ago.

19. When compared with Canadians, the life expectancy of Indigenous women living with AIDS is

a. shorter. b. the same. c. increasing. d. Longer.

20. First Nations women have higher hospitalisation rates due to

a. respiratory diseases. b. Human immunodeficiency virus (HIV)/AIDS. c. cardiovascular diseases. d. all of the above.

21. What risk factor is associated with sexually transmitted diseases (STDs) among Indigenous women?

a. Endometriosis b. Low parity c. Poor self-esteem d. Obesity

22. According to Statistics Canada, chronic conditions are much more prevalent among

a. non-Indigenous women. b. First Nations off-reserve women. c. Métis women. d. b and c.

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23. Individuals and communities reporting high levels of health have a greater sense of

a. control. b. financial resources. c. spirituality. d. self-preservation.

24. Risk factors contributing towards the development of diabetes among Indigenous women include all of the following except

a. obesity. b. smoking. c. sedentary lifestyle. d. environmental contaminants.

25. Which statement is not true about issues relating to the health of women and children in Indigenous communities?

a. Health of women and children are insubstantially linked b. Poor health indicators for women lead directly to poor health indicators for children c. Approximately 50% of Indigenous children are girls d. Childhood experiences predict their role as mothers and partners

26. When compared with the general Canadian population, the incidence of cancer mortality among First Nations women is

a. less of a problem. b. more of a problem. c. decreasing. d. the same.

27. Indigenous women are at risk for contracting hepatitis C for all the following reasons except

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a. low self-esteem. b. sharing needles. c. tattooing. d. poor nutrition.

28. All of the following are factors that affect the mental health of Indigenous women except

a. racism. b. poverty. c. past experiences. d. genetics.

29. The determinant of health that has the greatest impact on the health of Indigenous women and children is

a. education. b. income. c. drugs and alcohol. d. healthcare.

30. Poverty generally leaves children to suffer from conditions harmful to their health, and it may lead to

a. nutritional deficiency. b. poorer health. c. domestic violence. d.

all of the above.

31. Traditional educational methods focused on learning through

a. experience and example. b. memorization. c. repetitions of the same activity. d. all of the above.

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32. Residential school had a major negative impact on the health and well-being of many Indigenous children. An example of a health issue specific to children is all of the following except

a. poverty. b. violence. c. diabetes. d. alcohol misuse.

33. Violence has a generational impact. Children exposed to violence in an abusive family a. absorb the message that this is “normal” behaviour. b. are susceptible to entering into abusive relationships in turn. c. are susceptible to becoming perpetrators in turn. d. all of the above.

34. Traditionally, given personal experience with pregnancy and childbirth, the vast majority of childbirths were attended by

a. shamans. b. one or more midwives. c. relatives of the father. d. older children of the mother.

35. By the 19th century, the medical profession was growing largely as a result of

a. discouraging competitors everywhere. b. attacking traditional medicine practitioners (mostly women) in Europe and North America. c. large budgets being invested in healthcare. d. all of the above.

36. Shamans

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a. had no gender identity. b. were always men. c. were always women. d. were usually male, but sometimes female.

37. In Indigenous society, children are expected to be borne and raised by the

a. mother. b. father. c. grandmother. d. clan leader.

38. What was the title given to children who were descendants of marriages between Indigenous women and European men?

a. Métis b. Indian c. Status Indian d. First Nations

39. Indigenous children suffered poor health from both disease and misguided attempts at forced assimilation through

a. the residential schools. b. the 60’s scoop. c. social disruption as family and community safeguards have been eroded. d. all of the above.

40. Indigenous women suffer greater rates of renal complications as a result of all of the following except

a. higher rates of diabetes. b. higher rates of cardiovascular disease.

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c. lower referral rates to specialists. d. higher rates of misuse of medications.

41. Diabetes is still an increasing problem among Indigenous women, and susceptibility to it is passed on to children as it is driven by

a. respiratory conditions and dietary changes. b. increasing obesity and labour-intensive harvesting. c. lifestyle changes and continued traditional diets. d. lifestyle changes and dietary changes.

42. Which of the following is one of the fastest growing populations in Canada?

a. Non-Indigenous people under 30 years b. First Nations under 30 years c. First Nations elders d. Non-Indigenous people over 30 years

43. The leading cause of death of children ages 1 month to 1 year is

a. Sudden infant death syndrome (SIDS). b. drowning. c. gastroenteritis. d. diabetes.

44. Residential schools were created to

a. preserve Indigenous traditions and language. b. force Indigenous children to learn to assimilate into the non-Indigenous population. c. provide a place for homeless orphans to go to school. d. make jobs for unemployed school teachers.

45. The effects of residential schools on generations of Indigenous children were

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a. decimation of Indigenous culture. b. the colonisation of Indigenous peoples. c. removal of Indigenous children from their families during the 1960s to 1980s by provincial child welfare system. d. a and b.

46. The Canadian residential school system left a legacy of

a. successfully preparing graduates for the workforce. b. systematic abuse and neglect of Indigenous children. c. excellent conditions widely imitated in other school systems in Canada. d. high quality education, but primitive facilities and inedible food.

47. It is important to remember that the learning path for children in a pre-modern society was much the same as that of modern educational systems.

a. True b. False

48. A higher proportion of Indigenous children live in conditions of poverty.

a. True b. False

49. Midwifery usually included physical assistance with the birth, but also included advice and assistance with pregnancy and postnatal care, especially for young mothers.

a. True b. False

50. Outwardly, women in Indigenous society appeared to play an insignificant role as they were consigned to bearing and transmitting cultural values.

a. True

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b. False

51. Indigenous peoples experience health problems that are linked with their historical position in the Canadian social system.

a. True b. False

52. Traditionally, First Nations women participated in government and spiritual ceremonies.

a. True b. False

53. Indigenous traditional midwifery was outlawed in the late 19th century on the recommendations made primarily by European settlers.

a. True b. False

54. More than legal changes, disease, economic change and settlement brought immense social disruption to Indigenous women.

a. True b. False

55. The rate of smoking is lower among Indigenous women compared with that of the general Canadian population.

a. True b. False

56. Very high levels of under education and unemployment among the on-reserve First Nations youth are over five times than the non-Indigenous population.

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a. True b. False

Type: T 57. The role of Indigenous women in contemporary Western society has changed since Contact. a. How has the role of women changed in Indigenous society? List two factors that have contributed to the overall change of roles from the pre-Contact to post-Contact period. b. How has this change been positive or negative for Indigenous women?

Answers to Test Questions 1. d 2. d 3. d 4. d 5. d 6. c 7. d 8. a 9. c 10. d 11. d 12. d 13. d 14. a 15. d 16. d 17. d 18. b 19. a 20. d 21. c 22. d 23. a

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24. d 25. a 26. b 27. d 28. d 29. b 30. d 31. a 32. d 33. d 34. b 35. d 36. d 37. a 38. a 39. d 40. b 41. d 42. b 43. a 44. b 45. d 46. b 47. b 48. a 49. a 50. a 51. a 52. a 53. b 54. a 55. b 56. a

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Chapter 9 – Mental Health Test Questions 1. Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSMIV- TR) and International Classification of Diseases, tenth edition (ICD-10) are

a. classification systems for disorders. b. pharmaceutical mental reference manuals. c. mental health treatment systems. d. anti-anxiolytic treatment modalities.

2. Complete the following statement. According to the American Psychiatric Association (2013), the Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) defines a mental disorder as a. a syndrome characterised by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour. b. a collection of psychological, biological, or developmental processes underlying mental functioning. c. a socially deviant set of behaviours (political, religious, or sexual) that results in conflicts between the individual and society. d. reflecting an expectable or culturally approved responses to a common stressor or loss, such as the death of a loved one.

3. Currently, which Indigenous group is the best documented in terms of mental health history?

a. Registered Indian people b. Urban Status Indian people c. Rural Métis people d. Inuit people

4. Which of the following are causal factors for poor mental health?

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a. Community dependence on government b. Racism c. Residential schools d. All of the above

5. Causes for poor mental health among Indigenous peoples include all of the following except

a. community interdependence on government. b. loss of traditional ceremonies. c. geographic isolation. d. racism.

6. Manifestations of poor mental health include

a. post-traumatic stress disorders (PTSD). b. low suicide rate. c. substance abuse. d. a and c.

7. Canadian sources for data on addictions and Indigenous youth are

a. an up-to-date realistic look at the mental health of Indigenous youth in Canada. b. overestimates of addictions and mental health conditions of Indigenous youth in Canada. c. underestimates of addictions and mental health conditions of Indigenous youth in Canada. d. an unrealistic look at the mental health of Indigenous youth in Canada.

8. In November 2000, the internationally known mental health crisis affecting the Labrador Innu community of Davis Inlet deteriorated to the point where

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a. as many as 50 children, some as young as five, could be found in the woods sniffing gas on any given night of the week. b. the Innu leaders called on the Canadian government to take away their children and place them into addiction treatment programs. c. Health Canada, working with the Innu and the Newfoundland government, initiated treatment programs developed for long-term solutions since many of the children who were sent away for treatment resumed sniffing gas on their return d. all of the above 9. “Holism” in health must be a central goal of Indigenous treatment centres, and not only of healthcare professionals, citizens and their governments, because

a. they are omitted as part of the public infrastructure system. b. they should deal with the other issues faced by Indigenous peoples, such as the impacts of the residential schools and sexual abuse, and not just alcohol abuse. c. they should implement government developed mental health programs. d. health outcomes following alcohol treatment help them in dealing with their other issues.

10. Causes of accidents and injury include

a. cultural and material losses. b. reckless and potentially self-destructive behaviour. c. drug and alcohol use. d. all of the above.

11. One reason many suicides have a direct link to depression might be due to

a. linkages to legal fears. b. individuals being over-extended. c. individuals being underdiagnosed. d. individuals lacking information.

12. Studies have determined that depression has direct links to

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a. reduced levels of suicide, alcoholism, violence. b. culturally insecure communities which have lower suicide rates. c. acculturation and residential school syndrome. d. all of the above.

13. All of the following are factors that affect the mental health of Indigenous people except

a. racism. b. poverty. c. past experiences. d. genetics.

14. Which of the following statements best defines acculturation?

a. The process of passing on a culture from one generation to the next b. A form of inclusion whereby an individual is brought in to participate in the dominant culture through the process of change in one’s beliefs or traditional practices c. A form of rejection whereby an individual is denied the opportunity to participate in the dominant culture d. A reality that a variety of injustices have been committed against different groups

15. Since Confederation, the Canadian government sought to

a. displace the Indigenous population of Canada. b. suppress Indigenous cultural resistance by any means, particularly through military force. c. use various approaches to change the beliefs and traditional practices of Indigenous peoples and integrate them into the Canadian population. d. keep the Indigenous population politically separate and distinct from the nonIndigenous population.

16. Many First Nations and Inuit children were sent to church administered Indian residential schools across Canada to

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a. educate them well enough to sign treaties with the government in colonial times. b. make Indigenous people into “normal” Canadians. c. make them recognise the authority of the Canadian, territorial, or provincial governments. d. force them to surrender their lands in treaties.

17. An example of indoctrination as it applies to Indigenous peoples is

a. residential schools b. evolution of the Métis culture. c. participation of Indigenous people in the fur trade. d. use of traditional medicine in the biomedical system.

18. Which of the following statements best defines indoctrination? a. The process of defining one’s culture from one generation to the next b. A form of acceptance in which individuals are given the opportunity to participate. c. Forcing people to accept new beliefs uncritically d. The reality that a variety of opportunities to adapt are available to different groups

19. The belief that some cultures, because of their supposed belief in their own superiority and power, have the right to incorporate other cultures is called

a. cultural imperialism. b. assimilation. c. segregation. d. annihilation.

20. The process of two or more cultures adapting to one another so that people from both respective cultures can interact with each other is called

a. acculturation. b. assimilation.

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c. segregation. d. annihilation.

21. Treatment centres for addictions for Indigenous communities are more successful if

a. they utilise harm reduction philosophy. b. they utilise abstinence philosophy. c. are based on traditional healing practices. d. are based on Western healing practices.

22. The Canadian residential school system left a legacy of

a. successfully preparing graduates for the workforce. b. systematic abuse and neglect of Indigenous children. c. excellent conditions widely imitated in other school systems in Canada. d. high quality education, but primitive facilities and inedible food.

23. Residential schools were created to

a. preserve Indigenous traditions and language. b. force Indigenous children to assimilate into the non-Indigenous population. c. provide a place for homeless orphans to go to school. d. make jobs for unemployed teachers.

24. Residential school syndrome is

a. a pattern of repressed memories tied to negative experiences in residential schools. b. a mental disorder closely related to PTSD. c. not very common. d. a physical disability caused by exposure to tuberculosis in residential schools.

25. Primary behaviours associated with fetal alcohol syndrome disorder (FASD) are a result of

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a. the learning environment. b. structural/chemical changes in the brain. c. social skill development. d. lack of structure in the environment.

26. Secondary characteristics associated with FASD are a result of

a. environment. b. physical disabilities. c. structural changes to the brain during fetal development. d. chemical changes to the brain after birth.

27. Fetal alcohol syndrome disorder (FASD) is an umbrella term encompassing fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). FASD

a. is 100% preventable. b. is the leading cause of developmental delays in infants/children. c. has links to binge drinking during pregnancy. d. all of the above.

28. Which statement is true about patterns of drinking (alcohol) in Indigenous communities?

a. A tendency towards daily overuse of alcohol b. A tendency towards little alcohol use c. A tendency towards binge drinking rather than daily drinking d. A tendency towards daily binge drinking

29. The traumatic event in 1992 that lead the Mushuau Innu and the Innu Nation of Davis Inlet to hold an internal enquiry that resulted in a seven-point long-term plan was when

a. two community members drowned on a fishing trip. b. three teenagers died drinking antifreeze. c. five children died in a motor vehicle crash. d. six children died in house fire.

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30. Overcrowding and substandard housing affects which segments of the Indigenous population?

a. Inuit b. On-reserve First Nations c. Off-reserve First Nations d. Métis e. All of the Above

31. In terms of violence, and not unintentional accidents, what is one of the leading causes of death/injury among Indigenous peoples?

a. Poisonings b. Gunshot wounds c. Diabetes d. Beating (without a weapon)

32. Some studies suggest that though less than 1 in 10 of non-Indigenous women are abused, in contrast the ratio of Indigenous women being abused is

a. 1:1. b. 1:2. c. 1:3. d. 1:4.

33. Most Indigenous women do not come forwards to report the acts of violence committed against them because a. they don’t view the abuse as violence unless they are abused at least 10 times. b. they are offered a chance to begin their lives again in a different community. c. they feel support either from the Canadian justice system or from Indigenous leaders. d. the convicted offenders are returned to their communities.

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34. Child abuse is usually perpetrated by

a. teachers in residential schools. b. older children. c. family members. d. none of the above.

35. Child abuse comes in many forms and may be classified as physical, sexual, emotional and spiritual abuse. Tackling the issue of violence directed towards children has proven to be problematic in that

a. it often involves multiple abuses by multiple perpetrators. b. it is often related to alcohol and drug abuse. c. it often is complicated by custody and access issues. d. all of the above.

36. Inuit children are more likely to abuse what substance?

a. Alcohol b. Prescription drugs c. Non-prescription drugs d. Solvents

37. The most commonly abused substance among Indigenous youth is

a. tobacco. b. morphine. c. codeine. d. crystal meth.

38. Half of Inuit who smoke started at what age?

a. As adults b. Younger than age 14 years

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c. The teen years d. Younger than 7 years of age

39. Addiction in Indigenous communities is a major cause of

a. suicide. b. child abuse. c. domestic violence. d. all of the above.

40. Which of the following are considered to impact the treatment of mental illness in a population?

i. Access to considerable resources

iii. Depression

ii. Cycle of sexual abuse or physical abuse

iv. History of alcohol/substance abuse

a. None of the above b. i, ii and iii c. All of the above d. i and iii

41. In December 2000, Health Canada, in partnership with the Innu and the Newfoundland government, promised

a. to initiate programs for entire families in Davis Inlet. b. to build a permanent treatment centre in Labrador. c. to create long-term solutions for children who resumed sniffing gas on their return. d. all of the above.

42. Studies have determined that the causes of accidents and injury are the result of all of the following except

a. adverse psycho-social and economic factors. b. cultural and material losses.

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c. reckless and potentially self-destructive behaviour. d. transportation and use of firearms.

43. Some of the consequences of accidents and injuries include hospitalisation, increased healthcare costs, long-term disability and death by injury occurring

a. two times as likely. b. four times as likely. c. six times as likely. d. eight times as likely.

44. Indigenous suicide victims tend to be

a. male youths and young men. b. female youths and young women. c. elders. d. alcoholic parents.

45. Suicides account for up to a quarter of all injury deaths in the Indigenous population. The following are characteristics exhibited by females versus males when the act of suicide is committed

a. Hanging and firearms are most commonly used by males b. Hanging and drug overdose are most commonly used by males c. Hanging and firearms are most commonly used by females d. Hanging and cluster suicides are most commonly used by females 46. According to the study conducted by Tjepkema and Kumar (2019), Canada’s highest rate of suicide is

a. among terminally ill non-Indigenous people. b. among Indigenous male youth and young men. c. among Indigenous female youth and women. d. among chronically ill First Nations women.

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47. The act of suicide is not evenly distributed and indeed most communities have none, or very few suicides occurring. This means that suicide rates are

a. much, much higher in the few Indigenous communities where they are concentrated. b. much, much less evenly distributed in the general Canadian population. c. negatively correlated with retention of languages and practices. d. a and c.

48. What are the different characteristics exhibited by males versus females when the act of suicide is committed?

a. Males tend to be less successful than females. b. Males tend to be less violent than females. c. Males tend to overdose whereas females tend to hang themselves. d. Males tend to be more violent than females.

49. What are the key stressors identified that make Indigenous individuals more susceptible to committing suicide over non-Indigenous individuals?

a. The key stressors are relationship problems and depression. b. The key stressors are mental illness and relationship problems c. The key stressors are depression and financial problems. d. The key stressors are mental illness and criminal behaviour.

50. Suicide rates vary widely from one Indigenous community to another and the impact of suicide outbreaks can be devastating. Responses of crisis intervention to suicides in communities

a. is often driven by the news cycle. b. are not based on valid measures of need. c. are not applied equitably. d. all of the above.

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51. The roots of the problem with regard to the lack of support to Indigenous communities with mental health needs are due to

a. federal/provincial jurisdiction issues. b. the lack of strategies in identifying mental health issues at an early stage. c. the lack of support and remuneration available for appropriate mental health services. d. all of the above.

52. Indigenous women and girls are victims of suicide at much higher rates than nonIndigenous women and girls, but the ratio is much lower than for that of Indigenous males.

a. True b. False

53. Poor mental health may be demonstrated in some Indigenous communities through high rates of injury and accidents, violence and suicide.

a. True b. False

54. One reason why there have been mixed results in addressing some Indigenous communities’ poor mental health outcomes is that there have been many attempts in forcing a biomedical mental disease classification and treatment system.

a. True b. False

55. It is uncommon for suicides to occur in clusters at times.

a. True b. False

56. Alcohol use in the Indigenous population is high, but not remarkably higher than in the non-Indigenous population.

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a. True b. False

57. The money allotted to Davis Inlet in Labrador for relocation by the government has had a significantly positive impact on the health of the population.

a. True b. False

58. Secondary characteristics of FASD are a result of brain damage caused by prenatal consumption of alcohol

a. True b. False

59. Residential schools were responsible for a significant amount of the mental health issues in the Indigenous population.

a. True b. False

60. Assaults are greater within Indigenous populations than among those involving nonIndigenous people and are characterized by use of firearms as the weapon of choice.

a. True b. False

61. Suicide rates are much higher among Indigenous women and girls than among nonIndigenous women and girls.

a. True b. False

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Type: T 62. Although suicide rates for Indigenous people are higher than non-Indigenous people, discuss the factors that contribute to the LOWER rate of suicide in some Indigenous communities.

Type: T 63. How and why did the goal of the Canadian government, which was to make the Indigenous population a part of the Canadian polity, lead to the poor mental health outcomes experienced by some of the Indigenous communities today?

Type: T 64. Mental health issues affect all Canadians. However, Indigenous children and youths have higher rates of addictions that are linked to higher rates of suicide, substance misuse, depression, etc.

Explain three causal factors that have led Indigenous children and youth to experience higher rates of mental health issues.

Answers to Test Questions 1. a 2. a 3. d 4. d 5. a 6. d 7. d 8. d 9. b 10. d 11. c 12. c 13. d 14. b 15. c

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16. b 17. a 18. c 19. a 20. b 21. c 22. b 23. b 24. b 25. b 26. a 27. d 28. c 29. d 30. e 31. b 32. c 33. d 34. c 35. d 36. d 37. a 38. b 39. d 40. c 41. d 42. d 43. b 44. a 45. a 46. b 47. d 48. d 49. a

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50. d 51. d 52. b 53. a 54. a 55. b 56. a 57. b 58. b 59. a 60. a 61. a 64. Possible causal factors:



Community dependence on government



Loss of traditional knowledge/culture and identity



Geographic isolation



Racism/bigotry



Residential schools

a) Community dependence on Government - Indigenous peoples had unique societies and status of importance prior to colonization, and with the suppression of their culture they lost much of their identity and their ability to live off the land. As people living in remote and isolated communities, dependence on government assistance grew because of lack of opportunities for employment or other means of providing for their families.

- The Canadian government implemented policies, laws and the Indian Act to outlaw many traditional Indigenous practices (such as the sundance and the potlatch). It was done with the intention of integrating the population into the Canadian polity. These acts have led to higher rates of mental health disparities as Indigenous peoples have lost a sense of control over their lives while also battling legal cases over their treaty rights.

- Income and socioeconomic status also play a significant role in the health disparities of Indigenous people as a large majority live in poverty, often in cramped housing conditions and often do not have the financial means to improve their physical environment. This causes serious health issues in and of itself (e.g., dealing with poor air quality in housing, lack of potable water, etc.), and it also contributes to potentially

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adding to a sense of inferiority people feel in relation to others (more affluent) with whom they interact with. b) Loss of traditional knowledge/culture and identity - The suppression of traditional practices has left many Indigenous people with feelings of loss of belonging and despair, and with feelings of an increased sense of isolation.

This leads many to engage in high-risk activities (such as substance abuse) that can have negative mental, emotional, spiritual and physical health effects.

- Substance abuse leads many to becoming susceptible to engaging in high-risk behaviour, which contributes to the increases in the rates of health disparities. These health disparities are reflected in the higher rates of infectious diseases (such as human immunodeficiency virus [HIV]/acquired immunodeficiency syndrome [AIDS], hepatitis C and sexually transmitted disease [STDs]), for example.

- People living in Indigenous communities often lack the necessary knowledge needed to make informed decisions regarding their own health promotion and disease prevention. c) Geographic isolation - People living in remote and isolated communities often experience lower standards of living because of a lack of opportunities for employment and because there is little or few other means of providing for their families.

- The remoteness and isolation of some reserves contributes to an increased number of health issues because the resources needed to help manage the illnesses are not readily available. This, in addition to the high costs of leaving town to seek medical attention for family members, proves to be very costly.

- The recruitment of health professions to work and reside in remote and isolated communities is often difficult, and as such residents don’t have the same access to the same quality or diversity of healthcare services that should be made available to them. d) Racism/bigotry - Social stigma and marginalisation of Indigenous people occurred because of Western perceptions of Indigenous culture, which is recognizably different and does not correlate to European paradigms. Marginalisation increases their risk for experiencing health disparities as a result of being forced into lower paying jobs, of having less opportunities for education and of receiving decreased access to healthcare services over time.

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- Cultural insensitivity on the part of the healthcare practitioners working with Indigenous peoples and communities contributes to health disparities because Indigenous people may feel inadequate when do not fully understand the healthcare worker. When people feel inadequate or inferior coming out of this kind of negative experience, they may then be less likely to seek out health advice or medical care in the future – this reluctance adds to higher levels of health disparities.

- The present lack of knowledge of the health profiles of Indigenous peoples and their traditions is reflective of government disinterest in fulfilling their obligations to them through the treaties signed. This irregularity of knowledge has led to a lack of culturally appropriate healthcare being developed for Indigenous people, which adds to current health disparities. e) Residential Schools - Residential schools removed children from their social support system with the aim of stripping them of their identity. This break from community disrupts their sense of belonging and sharing in a continuity of culture from one generation to the next.

- Many Indigenous people find it difficult to form relationships and to feel a sense of belonging because of their experiences of isolation and separation from their communities.

- Without social relationships and a sense of belonging individuals can experience negative mental and physical health effects. Social stigma and acculturation practices aimed at Indigenous people over time have added to their loss of social relationships, and instead environments may be fostered where individuals engage in high risk activities, thus affecting health.

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Chapter 10 – Hybridisation of Healthcare and the Way Forwards for Indigenous Health Test Questions 1. The Indian Residential Schools Truth and Reconciliation Commission was created to

a. pay for loss of income caused by Indian Residential Schools in Canada. b. to uncover the truth about Residential Schools. c. to find a pathway for reconciliation between Indigenous peoples and Canada. d. b and c.

2. The Truth and Reconciliation Commission shocked many in Canada and internationally when it referred to the Residential Schools as part of a program of

a. social re-education. b. cultural genocide. c. moral realignment. d. economic development.

3. The legacy of the residential schools includes

a. cultural and economic integration of Indigenous peoples into the Canadian population. b. poor Indigenous health outcomes. c. economic development. d. political apathy in the Indigenous population.

4. Idle No More was started by

a. four women, three Indigenous and one non-Indigenous supporter. b. a group representing unemployed Indigenous men. c. the Canadian government.

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d. the Canadian Public Health Association.

5. Idle No More is a

a. branch of the federal government. b. a provincial non-profit organisation located in Saskatchewan c. a decentralised grass-roots feminist organisation. d. a traditional First Nations secret society.

6. A common tactic used to raise public awareness of Indigenous issues used by Idle No More is

a. press conferences. b. road blockades. c. flash mobs. d. radio and television ads.

7. Idle No More was started in response to

a. Bill C-45’s changes to environmental protections to Canadian waterways. b. Chief Theresa Spence’s hunger strike in Ottawa. c. resource development on Indigenous lands. d. all of the above.

8. Indigenous women have odds of being murdered that are roughly

a. 16 times higher than non-Indigenous women. b. double that of non-Indigenous women. c. half that of non-Indigenous women. d. a quarter of what they were 30 years ago.

9. The Missing and Murdered Indigenous Women and Girls Inquiry found that Indigenous women were more vulnerable to

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a. intimate partner violence. b. family violence. c. stranger violence. d. all of the above.

10. The highway between Prince George, BC and Prince Rupert, BC is known as

a. the Highway of Tears. b. the North Pacific Highway. c. the Spirit Bear Highway. d. all of the above.

11. The report of the Missing and Murdered Indigenous Women and Girls inquiry described violence facing Indigenous Women and Girls as a product of

a. cultural genocide. b. systematic neglect. c. racism. d. all of the above.

12. What are the implications of universal healthcare for the Canadian heath care system?

a. There are no implications. b. Everyone is treated for illness when they get sick. c. Tertiary care services are very important. d. If the health of a part of the population is allowed to suffer, the burden falls on everyone.

13. What has changed in the healthcare environment in the last 25 years?

a. Increased non-Western immigration to industrialized countries b. Increased population diversity c. More assertive populations, including ethnic minorities d. All of the above

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14. What concept is cultural safety based on?

a. Sharps safety b. Patient-centred care c. Public health d. Homeopathy e. None of the above

15. How does epistemological accommodation apply to the Canadian nursing context? a. It doesn’t apply at all. b. It allows both practitioners and patients to retain their own values while accommodating each other in the clinical setting. c. It explicitly gives practitioners permission to compromise professional standards in order to provide patient-oriented care. d. None of the above

16. What are the disadvantages of cultural sensitivity?

a. It is very hard to put into practice. b. It is not useful in the clinical setting. c. It is not very well defined. d. It is very hard to teach to students.

17. The Kahnawake Schools Diabetes Prevention Project is an example of

a. cultural imperialism. b. cultural assimilation through education. c. culturally safe health promotion. d. application of cultural competency to diabetes education.

18. Non-modern epistemology is defined as

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a. combining a pre-modern world view with the use of the tools and techniques of modern science, technology and biomedicine. b. a religion that rejects all aspects of modern science and medicine in favour of returning to pre-modern life. c. the philosophy that underlay the 1970’s Back to the Land movement. d. refusal to receive blood transfusions on religious grounds.

19. A culturally sensitive nurse would recognise that First Nations

a. cry and mourn loudly with the death of a community member. b. wear copper bracelets as a preventative measure for arthritis. c. value assertiveness as a communication style. d. none of the above.

20. Biomedical ethics assumes that patients’ bodies are

a. machines to be repaired. b. situated in their social and cultural matrix. c. vulnerable to psychological disturbances. d. none of the above.

Type: T 21. Discuss how epistemological accommodation can create a space for communities and healthcare professionals to address the underlying causes that have contributed to poor health in Indigenous communities as discussed in class to date in at least three of the following areas:

Loss of identity/culture Remote locations/isolation Personal life skills Stress Culture Social relationships Education

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Sense of control

Answers to Test Questions 1. d 2. b 3. b 4. a 5. c 6. c 7. d 8. a 9. d 10. a 11. d 12. d 13. d 14. a 15. b 16. b 17. c 18. a 19. d 20. a 21. Answers may include points including the following:

a) Loss of identity/culture - Culture is a way for individuals to identify with self and others, and it provides them with a framework through which they can understand the world. It is important for building a solid sense of identity and for building a feeling of community with others of a similar background. Conversely, individuals lacking a sense of strong identity, or lacking pride in their culture makes them susceptible to harmful influences concerning their life and health choices.

- First Nations have lost much of their culture as a result of colonization and the residential school system, and many had negative mental and emotional effects

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resulting from the loss of their identity. This leads often to the development of impaired abilities to cope with challenges or in carrying out activities of daily living, which then often leads to poor health practices and coping skills, and thus poor health outcomes.

- The “60’s Scoop” was a time when up to 1 out of 3 Indigenous children were removed from their families and placed into foster homes, or they were adopted by nonIndigenous families. This practice also added to the loss of Indigenous culture (as did the experience of residential schools), and so traditional knowledge and cultural practices were not passed down effectively. b) Remote locations/isolation - People living in remote and isolated communities often lack opportunities for employment, and there is little or few other means of providing for their families.

- The remoteness and isolation of some reserves contribute to an increased number of health issues because the resources needed to help manage the illnesses are not readily available. This, in addition to the costs incurred when leaving town to seek medical attention for family members, proves to be very costly for families. c) Personal life skills - Personal life skills are obtained through life experience as well as education, and they give people the ability to make informed choices about their health as well as to provide them with effective problem-solving skills and the knowledge needed to cope with life’s difficulties as they arise.

- Personal life skills enable individuals to learn about ways to cope with the environment and learn ways to change and handle stress; this in turn equips them in developing decision making abilities in preventing diseases and improving health.

- Due to the impact of residential schools, Indigenous peoples may not have developed the personal life skills they would have traditionally learned from the family. Having poor personal life skills, in addition to having decreased levels of education, income and social support, may also lead individuals to make poor decision-making choices, such as using alcohol, drugs and other substances to cope with stress and life’s challenges.

- Negative peer influences lead to difficulties in learning about healthy coping skills/mechanisms. d) Stress - Stress increases the demands on the body, which over time reduces an individual’s resistance to outside factors such as disease.

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- Emotionally, when people are under a great deal of stress, they tend to make poorer decisions regarding their health, or they fall back into using their old habits such as alcohol or drug misuse to cope with stress, which may be self-destructive.

- Stressors such as unemployment, low income and residential school syndrome are often commonly experienced by Indigenous peoples.

- A combination of stressors such as low income and lower socioeconomic status, when coupled with poor personal life skills, may lead individuals to engage in adopting poor or negative decisions, or to engage in behaviours that have poor outcomes regarding their health. e) Culture - When Indigenous peoples had their culture suppressed due to colonization, the residential school system and various other acculturation practices in Canada, they lost a good deal of their identity and their strength. This contributed to their dependence on government assistance as people living in remote and isolated communities often lack opportunities for employment or other means of providing for their families.

- Lack of a strong sense of culture, or lack of pride in one’s culture, makes people susceptible to poor influences. Not being able to practice one’s culture has negative mental and emotional effects and often leads to an inability to cope with challenges and to solve problems appropriately.

- This leads to difficulties in coping with life’s challenges or in completing activities of daily living as a poor sense of self predisposes individuals to using poor health practices and coping skills, which in turn leads to poor health choices and poor health outcomes. f) Social relationships - Residential schools removed children from their social support system with the aim of stripping them of their identity and acculturating them into another dominant culture.

This break from their communities cut their sense of belonging and continuity. Thus, many Indigenous people find it difficult to form relationships and feel a sense of belonging because of isolation and separation from their communities - The better the social network and the greater the sense of belonging the more likely a person is to feel better about themselves and to draw upon those networks for help in order to make it through difficult times. This helps influence people’s health choices and increases their chances of health promotion and coping strategies.

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- Changes to social relationships also result from changes in the socioeconomic status of members living in communities faced with deteriorating physical environments.

Overcrowding of homes occurs in many remote communities due to a lack of the resources needed to build new homes in keeping up with the growth of the population.

A shortage of homes results in members of families having to live together in overcrowded conditions, which leads to tensions developing both among members within the home and among families in the community who require new housing solutions to deal with the housing shortage. g) Education - Due to the impact of residential schools, many Indigenous communities often lack the knowledge needed to make informed decisions regarding their health. Many individuals may have not developed the personal life skills they would have done traditionally, such as learning through example, due to the fact they were sent away from their families before they could learn them from the older generations - Education enables individuals to learn about ways of coping with change, the environment and unexpected challenges and it helps with their decision-making regarding disease prevention, both infectious and chronic.

- Decreased levels of education and income, as well as decreased social support, may also lead to individuals having learned less life skills and in engaging in higher risk behaviour.

- Being subjected to negative peer influences regarding efforts to receive an education also leads individuals to experience difficulties in learning healthy coping skills.

- Lacking an education predisposes people to having poor personal life skills and in developing poor decision-making abilities. This leaves them prone to engaging in selfdestructive coping behaviours when faced with stress or illness, such as the misuse of alcohol and drugs. Substance abuse, in turn, can lead individuals to engaging in risktaking behaviour and thus contracting infectious diseases such as human immunodeficiency virus (HIV), for example.

- Cultural insensitivity – lack of education on the part of the healthcare practitioner – contributes to health disparities among Indigenous people. This may occur because Indigenous people often feel inferior when they do not fully understand what the healthcare worker wishes to convey. This contributes to feelings of inadequacy, and

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negative experiences such as these often makes Indigenous people feel less likely to seek healthcare services in the future. h) Sense of control - Indigenous traditions and cultural practices were repressed through acculturation.

Reserves were created and land treaties were breached in the dominant culture’s efforts to take away Indigenous peoples’ lands, and with it their sense of control over their lives. Without this sense of mastery over their lives, hopelessness can result, which can contribute to other negative emotional and physical health effects.

- When a person feels they are in control, that is when they feel they are making decisions regarding their life choices, this belief leads them to an increase in their selfesteem. Conversely, when a person does not feel they have control over their lives then they may make poor personal choices in an effort to regain some control. That is, it may lead individuals to act out and become violent or to fight in an effort to regain some control over their circumstances (e.g., a man who beats his family in order to feel he has control over them even if momentarily).

- Enabling people to make their own choices and to have control over their lives gives individuals a sense of purpose, and this can reduce stress. Among people with lower socioeconomic status, however, there may be sense of a lack of control in their lives and over their environment.

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