Social Capital and Wellness Amongst First Nations in Coastal British Columbia

Ralph Matthews, Ph.D.,Professor of Sociology,

The University of British Columbia,And Professor Emeritus of Sociology,

McMaster University

Chris Buse, BAThe University of British Columbia

Presentation to a Symposium on “Aboriginal Experiences of Aging”

Saskatoon, Saskatchewan, September 17-19, 2008

Present Data on Health from Two Studies

1. Coastal Communities Project (CCP)• Working with Six First Nation Communities and Six

Adjacent Civic Communities in Coastal B.C. • Issues of Environment, Resource Management,

Education, Governance, and Health. • Funded through the SSHRC ‘Community-University

Research Alliance (CURA)’ Program.

2. Resilient Communities Project (RCP)• Social Capital and Economic Development 23 Coastal

Communities in British Columbia. • Funded through the SSHRC ‘Initiatives on the New

Economy’ Program.

1.

I : Coastal Communities Project : Investigating Health in Old Massett

• Old Massett Band Council (Haida Gwaii) wished to have a community interview study carried out on a range of issues.– Appointed Councilors who worked with us on designing

it. – All interviews conducted by members of the Band.

• Health and health care was one of the topics covered.

• Focus was on:– Who consulted for health care assistance.– Asked about use of traditional healing versus western

medicine.

The Social and Cultural Basis of Wellness and Healing

• When asked who they had consulted in the past 12 months about a physical or mental health issue and how frequently, many of the ‘consultations’ identified medical advice was obtained from family, friends and non-medical personnel (see Table 1).

• When asked about using traditional healing methods, 40 percent of males and 34 percent of females had done so.– (32 percent of females and 7 percent of males did not

indicate receiving advice regarding any health problems)

Table 1: Old Massett – Persons Contacted and Frequency of Contact Regarding Health

Person contacted

How many times over the past 12 months?

0 1-2 3-5 6+

Family doctor or general practitioner 6 39 27 28

Nurse or Nurse Practitioner 54 21 15 10

Chiropractor, naturopath or alternative medicine 83 3 3 10

Home Care Worker 92 2 2 5

Religious Leader (Non-Traditional) 86 10 2 2

Traditional healer or elder 78 7 7 9

Co-worker 60 18 7 15

Close friend 18 20 13 49

Spouse or partner 33 11 3 52

Other family member 19 20 17 44

Traditional Healing

• Most respondents received traditional healing from family and friends.

• Traditional healing methods were applied to a range of health issues from arthritis, to common colds, to cancer.

• Respondents were least likely to seek traditional healing for broken bones and for eye and tooth problems.

• All but one respondent who sought traditional healing declared it to have been successful.

• Interviewers were sometimes provided with detailed descriptions for the preparation of traditional medicines – knowledge that we regard as the cultural knowledge of the Haida people.

• Throughout coastal B.C. we have been consistently informed about traditional healers from the northwest of the USA (notably Montana, Utah) who complete a circuit of First Nation communities in the Pacific Northwest utilizing/selling a variety of traditional medicines.

Indigenous Healing and Wellness in Social Context

• The point of beginning our discussion with our Old Massett data is to demonstrate that:

– Health care and healing always occurs in a social context.

– This is particularly the case when dealing with indigenous persons’ health care where an awareness of the social and cultural context is critically necessary in order to understand virtually all aspects of health care.

– The social and cultural context retains strong elements of traditional knowledge and healing, operating where more ‘western’ healing and healthcare processes take place.

• Let us turn now to a more quantitative investigation of that social context – using the findings of the Resilient Communities Project (RCP) to examine the relationships involved.

II. The Resilient Communities Project (RCP): II. The Resilient Communities Project (RCP): Examining Examining ‘‘HealthHealth’’ in Social Context in Social Context

• Five year Study –Multi-stage project involving:

1. Background Data.

• Statistical data analysis of pre-existing data.

2. Mailed Questionnaire.

• Sent to 4,386 households in 23 communities.

• N.B.: Five mailings – 60.0 % response rate.

3. Interviews (Semi-Structured).

• 93 local residents from six communities.

• 78 ‘leaders’ from six communities.

• All households on two First Nation reserves.

Measuring Social Capital in the RCP:

• Social Capital seen as an attribute of the access that people have to ‘resources’ through their contact with other persons within their social network. – Refers to embedded social relations entrenched in social ties

(Granovetter 1985).

• We define social capital as resulting in the ‘social ties’ that people have with one another.– Embodied through strength of ties between individuals or

groups that foster norms of trust, reciprocity, social participation and civic engagement (Putnum 2000; Burt 2001; Coleman 1990)

• The RCP measures social capital in terms of the extent to which people have strong ties (i.e. friends and relatives) and weak ties (acquaintances) with people who reside inside or outside their communities, and who have potential access to important social and economic resources (measured with a Position Generator).

Role of Trust in Relation to Social Capital

• Trust can be seen as both a precondition for the cooperation that allows social capital relations to form.

• Trust is also the result or outcome of these social relations.

• In the context of healthcare and wellness trust provides or

produces:– access to resources– allows for greater efficiency in healthcare services

delivery and traditional healing– Networks of social support

• Higher trust = higher levels of wellness (Rose 2000).

Measuring Trust in the RCP:

• Respondents were asked to indicate support or disagreement with 12 statements concerning trust.

• Statements ranged from ‘global’ measures (e.g. Most people can be trusted), to ‘community specific’ measures (e.g. Business leaders in this community can be trusted).

• Factor Analysis of our ‘Trust’ variables identified two distinct factors comprising seven of the 12 statements.

• We have labeled these Generalized Trust and Institutional Trust.

Trust Factors - Component Loadings

Loading

Most people in this community can be trusted. 0.818Most people can be trusted. 0.797Most people in this community are [not] likely to take advantage of you if they get the chance.1 0.694Young people in this community can be trusted 0.652

Component 1: Generalized Trust (16 point scale)

TABLE 2 . Factor Analysis Component Loadings

The politicians who represent this community can be trusted to do a good job. 0.853I trust the leaders of this community to respond to the community needs. 0.853Business leaders in this community can be trusted. 0.699

Component 2: Institutional Trust (16 point scale)

Measuring Health and Wellness in the RCP:

• General Well-Being / Wellness:– “All things considered, how satisfied are you with your

life as a whole these days?”• (Dissatisfied to Satisfied on a 10 point scale)

• Physical Well-Being:– “How would you describe the state of your health

compared to other persons your age?” • Poor; Fair; Good; Very Good; Excellent

• Psychological Well-Being:– “How much of the time, over the past two weeks, have

you: Been a nervous person; Felt calm and happy; Felt down-hearted and blue; Been a happy person; Felt so down in the dumps that nothing could cheer you up?’

• All; Most; Some; Little; or None of the time.• Calculated a 16 point scale constructed from the questions

above

Other Variables in Our Analysis:

• Age– In years as of 2004

• Income– Measured in five categories

• Education– Measured in four categories

• Ethnic Status– First Nation versus Non-First Nation

Age Distribution of RCP First Nation Population

Traditional Indicators of Health

Health and

Wellness

Summary of Findings Comparison: First Nation and Non-First

Nations Respondents:

• F.N. persons have significantly lower household incomes, significantly lower educational levels.

• F.N. persons have significantly higher formal and informal social participation (i.e. the basis of social capital)– Formal (17 point index) = scheduled formal meetings for sports

teams, arts and crafts, FN ceremonies, etc.– Informal (15 point index) = going out for drinks, movies, etc.

• F.N. have significantly lower levels of trust:– Note contradiction with most social capital literature that sees

trust as being directly associated with social participation.

• F. N. persons have significantly lower of levels of all three measures of wellness and health – i.e. General wellness; Physical Health; Mental Wellness.

IncomeChi-Square Crosstab Comparison of First Nation vs. Non-First Nation Income

Household Income

TotalLess than $10 000

$10 000 - $29 999

$30 000 - $49 999

$50 000 - $69 999

$70 000 or more

Member of a First Nation?

No Count 101 551 599 522 664 2437

% within Member of a First Nation? 4.14% 22.61% 24.58% 21.42% 27.25% 100%

Yes Count 33 51 35 15 13 147

% within Member of a First Nation? 22.45% 34.69% 23.81% 10.20% 8.84% 100%

Total

 

Count 134 602 634 537 677 2584

% within Member of a First Nation? 5.19% 23.30% 24.54% 20.78% 26.20% 100%

Chi-Square 124.611***

Education

Chi-Square Crosstab Comparison of First Nation vs. Non-First Nation Education

Respondent Education TotalLess than

High School

High School

Diploma

Some College

University

GraduateMember of a First Nation?

No Count 97 343 938 875 2253% within

Member of a First

Nation?

4.31% 15.22% 41.63% 38.84% 100%

Yes Count 18 46 40 35 139% within

Member of a First

Nation?

12.95% 33.09% 28.78% 25.18% 100%

Total

 

Count 115 389 978 910 2392% within

Member of a First

Nation?

4.81% 16.26% 40.89% 38.04% 100%

Chi-Square 57.767***

Physical Health DifferencesChi-Square Crosstab Comparison of First Nation vs. Non-First Nation Health

State of health Total

Poor Fair GoodVery good

Excellent

Member of a First Nation?

NoCount 82 323 874 908 406 2593

% within Member of a First Nation?

3.16% 12.46% 33.71% 35.02% 15.66% 100%

YesCount 19 41 49 30 17 156

% within Member of a First Nation?

12.18% 26.28% 31.41% 19.23% 10.90% 100%

Total

 

Count 101 364 923 938 423 2749

% within Member of a First Nation?

3.67% 13.24% 33.58% 34.12% 15.39% 100%

Chi-Square 66.951***

Means Comparison – F. N. versus Non-F. N. :

All Social Capital and Trust Variableswith All Wellness and Health

VariablesAnalysis of Variance - Measuring Statistical Differences Between First

Nations and Non-First Nations Respondents

Member of a First Nation?

Generalized Trust

Institutional Trust

Formal Social

Activity

Informal Social

Activity

Mental Health Scale

Life Satisfactio

n Scale

No Mean 14.84 12.97 22.43 20.07 20.49 7.64  N 2537 2489 1996 2462 2465 2577

Yes Mean 12.90 12.47 23.80 22.15 19.52 6.68  N. 151 153 116 149 151 153

Total Mean 14.73 12.94 22.51 20.18 20.43 7.59  N. 2688 2642 2112 2611 2616 2730

F-Statistic 96.58*** 5.41* 33.27***109.09**

*15.40*** 34.07***

Review of our Findings regarding the Context of Trust

• Many studies of the social determinants of health emphasize the role of social capital (i.e. networks and involvement in social relations) in ‘health’. – We have used measures of involvement in formal and informal groups as

our proxy measure of this. – We see significant differences between F.N. and non-F.N. persons in terms

of their involvement in formal and informal groups (i.e. F.N. persons are more likely to be involved in both formal and informal groups).

• Many studies of social capital demonstrate that the more people are involved in community formal and informal activities within their community, the more likely they are to trust community members.– We see that there are significant differences between First Nation and Non-

First Nation persons in terms of trust. – First Nation persons are likely to have less trust than non-First Nation

persons. – The more First Nation persons are involved in formal and informal

groups/activities in their community the LESS likely they are to trust members of their community.

• Now let us look at the relationship between trust, wellness and other social variables.

Building a Model of Wellness and Its Relationship to Trust

• Statistical models set up to explain the relationship between Trust and Wellness– Bi-variate statistics illustrate trust disparities and relationship

directionality.– In other studies, trust is rarely modelled as the primary explanatory

variable of health; it is generally something to be controlled. – Hypothesis not formally tested amongst F.N. populations in Canada.

• Three measures – general wellness; physical health; mental health– Wellness is argued as a more stable measure of health and well-

being; going beyond physical health and attempting to encompass a greater social depiction of an individual’s life. Therefore, it is most important in our considerations.

• Literature suggests that trust may have implications for health. (Veenstra 2000; Hardin 2002; Rose 2000; Kawachi 1999).

F.N. Findings: It’s all about Generalized Trust

• Generalized Trust is a significant predictor of all three health measures (Higher Trust = Better Health).

• Institutional trust suppresses original trust relationship; controlling for it makes Generalized Trust/Health association stronger (Has no effect on health and wellness on its own).

• Social participation has little to no effect on the trust/health association, and little to no influence on wellness more generally.– This seems contradictory to evidence presented in the social

capital literature.– We would expect higher social participation to produce better

health.

• Variance – the proportion of health and wellness explained by trust is high

• Age is not a significant predictor of health and wellness

• Education– Importance of H.S. Diploma, but results are not statistically

significant– Achieving more than a H.S. Diploma does not seem to produce

greater levels of wellness as indicated in the literature

• Income– Income is not as important to this relationship as trust is, and for

the most part, income is not significantly associated with health; contradicts traditional literature on health

– a threshold effect is present; that is, individuals occupying the lowest income category are worse off, but occupying successively higher income categories is not necessarily better for health or wellness

• Variance– Age and Education do not explain health and wellness outcomes– Income accounts for a little less than half of health and wellness

(still not as much as generalized trust)

F.N. Findings: Traditional Predictors of Health

Physical HealthBinary Regression: Odds Ratios of Reporting Good/Very Good/Excellent Health for First Nations RCP Respondents (n = 140)

Model 1 Model 2 Model 3

Variable ExpB P-value ExpB P-Value ExpB P-value

Generalized Trust 1.131 0.041 1.156 0.020 1.131 0.079

Age - - 0.976 0.059 0.979 0.116

Income - - - - - 0.221

$10K - $29K - - - - 2.644 0.048

$30K - $49K - - - - 2.696 0.063

$50K - $69K - - - - 2.102 0.290

$70 000+ - - - - 4.028 0.071

Model Chi-Square (p) 4.313 (0.038) 7.982 (0.018) 13.655 (0.034)

R-Square 0.039 0.071 0.083Note that the ‘Less than $10 000’ variable is a reference group for income categories

Mental WellnessLinear Regression for Mental Wellness of First Nations RCP Respondents (n = 88)   Model 1 Model 2 Model 3 Model 4 Model 5 Model 6Variable B B B B B BGeneralized Trust 0.414** 0.473** 0.474** 0.473** 0.418** 0.320*Institutional Trust - -0.103 -0.102 -0.102 -0.062 -0.054Formal Social Activity - - -0.013 -0.014 -0.018 0.010Informal Social Activity - - 0.031 0.032 -0.006 -0.015Age - - - 0.001 0.002 0.000Dummy HS Diploma - - - - 0.655 1.280Dummy Some College - - - - 1.229 1.992Dummy Uni Grad - - - - 1.584 1.884Dummy $10K - $29K - - - - - -0.244Dummy $30K - $49K - - - - - 1.577Dummy $50K - $69K - - - - - 0.802Dummy $70K+ - - - - - 2.909*

 F Statistic (p) 12.650** 6.713** 3.298* 2.606* 1.787 1.926*R-Square 0.128 0.136 0.137 0.137 0.153 0.236Note that the Dummy Less than High School Diploma and Dummy Less than $10 000 variable is left out of the analysis and is the reference group for education and income, respectively* p <0.05; **p < 0.01; ***p < 0.001

WellnessLinear Regression for Wellness of First Nations RCP Respondents (n = 89)  Model 1 Model 2 Model 3 Model 4 Model 5 Model 6Variable B B B B B BGeneralized Trust 0.324*** 0.344*** 0.344*** 0.353*** 0.298** 0.249*Institutional Trust - -0.035 -0.036 -0.029 0.002 0.020Formal Social Activity - - 0.013 0.03 0.046 0.075Informal Social Activity - - 0.093 0.076 0.022 0.021Age - - - -0.014 -0.008 -0.006Dummy HS Diploma - - - - 1.559 1.416Dummy Some College - - - - 1.822 1.766Dummy Uni Grad - - - - 1.798 1.548Dummy $10K - $29K - - - - - 1.195aDummy $30K - $49K - - - - - 1.391bDummy $50K - $69K - - - - - 1.315Dummy $70K+ - - - - - 0.984

 F Statistic (p) 15.697*** 7.870** 4.327** 3.525** 2.502* 2.019*R-Square 0.153 0.155 0.171 0.175 0.2 0.242Note that the Dummy Less than High School Diploma and Dummy Less than $10 000 variable is left out of the analysis and is the reference group for education and income, respectively

a - Statistical Significance was not achieved, but B has an accompanying p-value of 0.099

b - Statistical Significance was not achieved, but B has an accompanying p-value of 0.065

Limitations

• Small sample size• Social Participation – What gives?

– RCP data may not be asking the right questions:

• Does not adequately address social activity around family ties or family relations

• To look at health, wellness, and healing, we need to analyze social relationships, not just social participation

• Data need to reflect the way in which First Nation respondents engage in activities; family may play a more important role than First Nation community activities

Policy Directions: Towards a CHED Model• CHED Model – Community Health and Economic

Development– Developed by Glen Timbers, Director of United Church Health Services,

Bella Coola, BC.

– A service delivery model that focuses on the community basis of health and the development of trust – particularly with F. N. communities.

– Building Community requires meaningful participation from members

– Sees ‘health’ and ‘wellness’ as a community based phenomenon related to the economic and social well-being of a community.

– The CHED Model is centred around the development of community based generalized trust. Our findings show that this is a dominant factor in self-reported physical and mental health and general well-being, particularly for First Nation communities.

Central Coast Health and Well-Being Charter

• Central Coast Health and Well-being Charter– Agreement to work on local strategies to improve

service delivery, to strengthen community bonds and to promote relationships, spirit and service networks of communities.

– CHED depends on: leadership, learning and

development systems; social and recreational activities; unique history, location and social attributes; work and economic activity; infrastructure and environment; health services; governance and coping systems

– Signed by Five First Nation Band Communities and all non-First Nation Communities.

Policy Directions: Towards a CHED Model• Healing and wellness are social processes requiring social

considerations– Wellness is a resource for daily life– Health services need incorporate and respect traditional

medicines/values as an integral part of the economic, social, and spiritual community

• Addressing trust may be more beneficial to health than palliative care

• Community Involvement– Needed to influence regional authorities, independent community

service providers, and provincial/federal governments– Band Unity via Trust Building; Community Gardens

• Cross-cultural issues are important when dealing with healing and wellness

Towards a CHED Model: Trust and Community

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Theory and Research, Eds. Nan Lin, Karen Cook, & Ronald Burt. New York: Aldine De Gruyter. Pp. 31-56.

Central Coast Regional District. (2005). Central Coast Health and Well-being Charter. Charter Implemented on July 24, 2006 by Wuikinuxv Nation, Nuxalk Nation, Heiltsuk Nation, Kitasoo Nation, Bellac Coola General hospital Board, RW Large Memorial Hospital Board, Central Coast Regional District, and United Church Health Services.

Coleman, J. (1990). Relations of Trust. Foundations of Social Theory. Cambridge, MA: The Belknap Press of Harvard University Press. Pp. 91-116.

Granovetter, M.S. (1985). Economic Action and Social Structure: The Problem of Embededness. The American Journal of Sociology, 91(3): 481-510.

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Healthy Communities. Presentation made to VCH Accreditation Team.Veenstra, G. (2000). Social Capital, SES and Health: An Individual-Level Analysis. Social

Science and Medicine, 50: 619-629.Veenstra, G. (2007). Social Capital and Health in Canada: Compositional Effects of Trust,

Participation in Networks, and Civic Activity on Self-Rated Health. Social Capital, Diversity, and the Welfare State, Eds. F.M. Kay and R. Johnson. Vancouver, BC: UBC Press.

THANK YOU!

• For more information:

• Websites:– Resilient Communities Project

• www.resilientcommunitiesproject.ca

– Coastal Communities Project• www.coastalcommunitiesproject.ca

• E-MAIL: ralph.matthews@ubc.ca