While the thrust of my argument to support the community of Attawapiskat was received by many understanding and empathetic ears, it also exposed blatant public racism and harmful ignorant commentary, both of which are elaborated upon below. Going up to nurse in northern Manitoba, I felt I knew what I was getting into – abject poverty, abysmal living conditions, and people suffering from health ailments stemming from these conditions. Sitting comfortably at home, surrounded by familiarity and emotional support, I could deal with it. Cerebral ways of knowing, however, are only one way of knowing, and my knowledge in no way prepared me for the emotional shock and conditions far exceeding my expectations. Anything I knew and thought I was prepared for at home became background fodder as I contended emotionally with what presented itself and felt the oppressive crush of poverty and isolation. In the same way that I was academically prepared for nursing in the north, I knew perfectly well of the racist attitudes of many Canadians towards people in some northern communities. My intellectual acknowledgment of racist realities, however, did little to temper the sting of actually encountering it in the flesh – the responses to my post shocked me despite what I thought I knew was out there. And much like in northern Manitoba, I’m still coming to grips with a reality that’s torturing my soul.
Tortured soul aside, when writing the original Attawapiskat piece I thought a lot about my experiences researching and nursing in the north, and reflected on how these experiences refounded my understanding of the social determinants of health and made real just how determinative they can be. In this follow up essay, I am going to talk a bit about the goals I had intended for the original piece, the commentary generated by the piece and my take on it, as well as justice. In addition, I will reiterate on the social determinants of health, coming full circle to Canadian values and the Canadians of Attawapiskat.
The original post, at root, was about increasing the awareness that some Canadians aren’t doing so well. Writing as a nurse with experience working in healthcare in a Northern First Nations community, I further wanted to give an experienced healthcare practitioner’s account of why this is the case. I wanted to emphasize that the situations in which folks in these communities find themselves are largely a function of historical and current events as well as social and environmental determinants over which they have little control. This is something that is important for everyone to understand because, like it or not, all Canadians are implicated in this system, and unless we acknowledge all of this, there’s little hope the situation will improve. Finally, I wanted to generate some discussion about Canadian values and walking the talk, underlining the difference between the cushy lives of many and the starkly harsh lives of others, and perhaps garner some empathy and justice for fellow Canadians in need.
It was Ben (see his posting on B&S) who initially brought my attention to the comments generated by the original Attawapiskat piece and the polarization of the opinions expressed on Reddit. For the uninitiated, Reddit is an online forum that allows users to vote in favour of or against posts and comments, and much like the opinions expressed, the votes on the comments stemming from the Attawapiskat piece were extremely polarized. Such conspicuous polarization on this forum is unusual, especially considering the fact that the article was received fairly favourably by the larger Reddit Canada community (36 votes in favour to 20 votes against the piece as of January 11th 2012). It is difficult to know how representative r/Canada voters are of the general Canadian voting public, but the opinions expressed in the comments are the real opinions of real Canadians, making them valid enough to talk about. Moreover, racist sentiment and attitudes are worth confronting regardless of how many people hold them. So whether or not we have a microcosm of general Canadian public opinions and attitudes with regard to the debate on Aboriginal policy and moral obligation in Canada, I wanted to take some time to take up the shape of the comments. As such, I think it’s important to have a look at the comments first, and then reconsider them in terms of justice and the social determinants of health I highlighted in my previous post.
There’s a lot to pick apart in the comments, but for the purposes of this essay I’m going to focus on providing a very brief overview only. Some participants offered well-considered and thoughtful remarks reflecting an understanding of history, causation, and moral obligation. Just as many used the forum to sling disdain and promote ignorant and harmful opinions. Rampant throughout were vindictiveness and resentment, as well as hateful characterizations of Aboriginal people as lazy, irresponsible, and entitled. Many racist remarks were made and slurs slung, and participants denied moral responsibility. The idea that “people should pull themselves up by the bootstraps” underscored a lack of understanding of how social and environmental determinants can severely limit people’s opportunities to improve their situation, and confirmed that many determinants are taken for granted and assumed to be options available to everyone. None of this is pretty. Nothing new to those who spend any amount of time on the ‘net, but in this instance, the level was exceptionally remarkable. Some of the more horrible comments were also the most popular and polarized ones in terms of votes, for example, this one received 14 upvotes and 11 downvotes, and this one received 9 upvotes and 10 downvotes. I would encourage readers to have a look at the other comments – their popularity and number of upvotes vs. downvotes are revelatory. Arguably the most tragic occurrence, a few people also displayed internalized racism and oppression, failing to recognize the existence of such phenomena and their insidious effects on identity and well-being. What Ben and I found especially horrible was the degree to which internalized racism seemed to be interpreted by non-Aboriginal people as substantiation for racist sentiment and discrimination. And what struck me as interesting is that, supposedly responding to a piece about how social and environmental determinants affect the trajectory of one’s health and well-being, the significance of these determinants was largely ignored.
So where do we go from here?
Racism 101: Even though race is a social construct, it is still wrong to discriminate racially against someone, and discrimination, both individual and systemic, is learned and can be unlearned. Unfortunately, many people who propagate racism and discriminate against others think of themselves as non-racist and of their actions as non-discriminatory. No one is exempt from this. So if you think you are one hundred percent free of racist or discriminatory thought, it’s time to re-examine because you are wrong.
Justice 101: Since the idea of giving people what they deserve had a strong presence in the comments, and since logic can help us think categorically about social issues, I thought it might be good to broach the topic of justice. Broadly defined, justice is acting in a just and/or fair manner. It can be rather nebulous when trying to apply this concept to practical situations. Fortunately for us, Michael Sandel gives a brilliant and relevant interview on justice and the various ways of understanding it, highlighting the contributions of various philosophical traditions. He not only explains the more abstract stuff eloquently, but also touches on practical ethics and the application of these philosophical traditions to certain questions that are very relevant to the whole Attawapiskat piece and its resulting discourse. One of the theoretical aspects of his lecture that is highly pertinent to our discussion here is the fact that while commonly applied philosophical traditions play a huge part in our debates about what is right, they lack the depth required to provide us with soundly considered answers that are reflective of our complex social existence.
On a more practical note, he talks about collective responsibility, the notion of community and individual identity, and the idea of special responsibility based on particular community membership, and how these fit into justice. For example, he argues that in as much as it is possible and appropriate for one to take pride in a country’s historical achievements (e.g., many Canadians are proud of the Canada Health Act despite having had nothing to do with its establishment or current implementation), it is also possible and appropriate for one to bear a moral responsibility for wrongs previously committed (e.g., contemporary Canadian society is making financial reparations to survivors of the residential school system). Stated explicitly, if it is possible for Canadians to feel pride in something in which they were not directly contributing, it is must be possible to bear a moral burden for wrongs that were not committed by them.
In another example, Sandel elaborates that there are certain cases in which you can be responsible for actions that were not your doing, a stance that is in sharp contrast with the Kantian position that you are only responsible for your own actions. In one case, Sandel discusses the fact that contemporary Germans who were not alive during the holocaust feel it is their moral burden to right the wrongs of their grandparents’ generation, and make reparations to Jewish families because they understand how those events devastated Jewish communities and that lingering trauma from those events are still being felt today. Similarly, some Canadian people make the argument that they are not responsible for what other people did in this country hundreds of years ago, especially given the fact that they didn’t even have ancestors on the continent at that time. This clearly a Kantian approach to ethics, the idea that one is only responsible for one’s own actions that arise from the exercise of one’s will, is difficult to reconcile with the idea of a collective responsibility that extends across communities and across time. Unfortunately, reasoning via this philosophical perspective fails to take into account the fact that the only reason we, as contemporary Canadians, are able to live here and prosper is because of the genocide and colonization of Aboriginal people that occurred. So while we are not responsible for the genocide or colonization, it is incontrovertible that we benefit from the spoils of these events. And it follows that we should take moral responsibility for those historical events.
So go listen to the Sandel podcast. It is well worth its 20 or so minutes in length and will augment our consideration of justice in the current context.
Issues of justice and philosophy aside, my personal and professional stance is that as decent human beings, we should recognize current and historical facts, and work towards helping to strengthen communities who are suffering as a result of historical and contemporary oppression. Furthermore, as decent Canadians, we should do what we can to take care of each other and help any struggling Canadian community regardless of its history. So even if you don’t agree that we have, as contemporary Canadians, some moral responsibility to help repair genocidal and colonial damage done to Aboriginal Canadians, we still have a collective responsibility to help struggling Aboriginal Canadian communities on the basis that they are just that – Canadian communities.
Social determinants of health 101: Justice is important to discuss here, both theoretically and practically, because it is strongly related to social determinants of health, especially with regard to social and distributive justice. Following from the Reddit comments it is clear that a significant proportion of people might not actually understand what social determinants of health are, and how they affect health and well-being. Either that, or they don’t care. To reiterate from the original Attawapiskat piece, the World Health Organization has defined social determinants of health as:
(…)the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.”
Much like justice, the idea of social determinants affecting the trajectory of one’s health can be rather nebulous. So instead of rattling off the fourteen Canadian social determinants of health, let us firstly appreciate that Aboriginal Status is the one and only grouping of people in Canada for whom specific ethnicity is a social determinant of health. That Aboriginal status is its own social determinant of health is weightily significant, and something demanding serious consideration in addition to “why” questions. So, why is this important? Well, namely because the health of Aboriginal Canadians is inextricably linked to their unique history of colonization and genocide. Adverse social determinants of health stem from discrimination in the form of legislation (e.g, the Indian Act of 1876), community relocations, residential schools, and the sixties scoop, to name a few. Financially, Aboriginal Canadians fare significantly more poorly than non-Aboriginal Canadians, and educationally, achieve a lower level of education. Moreover, crowded living conditions, food insecurity, and infectious and chronic diseases are much more prevalent in Aboriginal Canadians. In short, merely being born an Aboriginal Canadian predisposes one to poor social determinants of health.
While the issues and implications elucidated therein are vastly different than the situation in Attawapiskat, I would strongly recommend listening to the following two podcasts from the program “Ideas” by CBC radio. The podcasts are called “Boot Camp Moms” parts one
. In it, the producer talks about a program set up in Toronto called “Women Moving Forward
” designed to assist a group of young mothers on social assistance, most of whom have histories of abuse and neglect, rebuild their lives with their children and transition to a position of self-sufficiency and independence. She stresses that money, while one important contributor to poverty, is merely one of the many factors entrapping Canadians in the poverty cycle. She also has numerous interviews with the women where issues stemming from social determinants of health are exposed, enabling listeners to make the link between inadequate housing, mental health issues, as well as minority status, and impaired health and well-being. I won’t go into details of these podcasts, but they are an excellent and free resource for those who want to gain a better understanding of the mechanisms behind generational poverty and the social determinants of health.
As a closing note, I would be happy to meet Canadians in the middle ground. It would be a huge step forward if Canadians took some time to try to unpack the issues surrounding marginalization and oppression in general, and surrounding Aboriginal Canadians in particular. It would also be a huge step forward if we would regularly practice self-reflection, challenging ourselves to ask hard questions, like: “Am I reasoning justly? Am I acting in a discriminatory fashion? Am I being empathetic and understanding of the effects of social determinants of health?” Idealistically, I would be ecstatic if as an end result of self-reflection, empathy and understanding, we saw eliminated, through collective responsibility and equity, the barriers that impede optimal health and well-being for all Canadians.
“a civilization is to be judged by its treatment of minorities.” [m. gandhi]
Brief update on the situation in Attawapiskat: Despite some emergency aid going to the community, the Canadians living in Attawapiskat are still far from being in the black. It’s going to be minus thirty-nine degrees Celcius with the wind there tonight, and many people still have no choice but to continue to live in shacks and dump raw sewage in their yards… more than two months following the declaration of a state of emergency. So let’s not forget about them, ok? Just sayin.’