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I ENVIRONMENTAL HEALTH MANAGEMENT PRACTICES IN ENVIRONMENTAL HEALTH MANAGEMENT PRACTICES IN INDIGENOUS COMMUNITIES: A CASE STUDY WITH MISSISSAUGA FIRST NATION A Thesis Submitted to the Committee on Graduate Studies in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in the Faculty of Arts and Science Trent University Peterborough (Nogojiwanong), Ontario, Canada © Copyright by Daneen Dénommé 2015 Indigenous Studies PhD Graduate Program May 2015 i ABSTRACT Environmental Health Management Practices in Indigenous Communities: A Case Study with Mississauga First Nation Daneen Dénommé Environmental factors play a critical role in the health and well-being of people worldwide and the distribution of the burden of disease associated with environmental causes is disproportionately high in marginalized populations, including First Nations. In this way, environmental health problems are as much social and political problems as environmental and must be addressed as such. In Canada, the division of responsibilities for environmental health, in combination with the jurisdictional complexities of health and environment regulation and service provision on-reserve creates a First Nations environmental health management system with significant gaps. This research set out to explore the question: What are the current strengths and challenges in First Nations environmental health policy and management? A qualitative exploratory design organized in two stages and employing key informant interviews, document review and a community case study was used to examine this topic. In the first stage a review of existing programs and policies applicable to Ontario First Nations and a series of interviews with key experts on the topic in the province were conducted. A conceptual framework of the core elements affecting environmental health management in First Nations communities was developed and then applied to a case study with Mississauga First Nation in Northern Ontario. The framework included five core elements: Environmental Health Jurisdiction and Responsibility; Participation in Environmental Health Decision-Making; Access to Environmental Health Resources, Communication of Environmental Health Information; and, Role and Influence of Leadership. The findings indicate that “internal” ii issues, like community-based decision-making and support for environmental health initiatives seem to be least affected by the “external” issues such as access to federal funding. The “internal” issues were also shown to be critically important factors having impacts on environmental health management practices and policies in Mississauga First Nation. While there are countless barriers associated with the “external” factors that have significant impacts on environmental health management practices and policies, this research suggest that the “internal” factors can potentially be the most important factors in creating positive change in this area and as a result warrant further study in order to improve the state of environmental health issues in First Nations. Keywords: First Nations, Environmental Health, Policy, Community, Framework iii ACKNOWLEDGEMENTS I would like to thank all of the people who participated in this research by sharing their knowledge and experiences with me. I know they are all very busy doing important work and I am truly grateful for the time they spent explaining their ideas and helping me answer my research questions. A special thank you to Mississauga First Nation for participating in this case study and to all of the people there who welcomed me, answered my many questions, and took the time to make sure my understandings and interpretations of their experiences were accurate. I want to especially thank Sue Chiblow, who was absolutely instrumental in ensuring the case study was a success. My job would have been so much more difficult without Sue’s continuous guidance and expertise. Chris Furgal has been an extraordinary supervisor throughout this process and has provided an abundance of support of every kind. With his help and direction I (almost) never lost sight of what I was trying to accomplish and why it was important – thank you for ensuring each step of this process was manageable! I would like to thank my committee members Dan Roronhiake:wen Longboat and Bob Paehlke for their support and guidance. I have very much appreciated their feedback throughout this project. I must thank the Indigenous Studies Department for a life-changing (and gruelling!) first two years of this program – I believe I became a better student and more importantly, a better person. Thank you also to all my peers who have encouraged, supported, and made me laugh these past few years! I was very fortunate to have had financial support to do this work and for this I would like to thank the Canadian Institutes of Health Research, the Indigenous Health Research Development Program, the Network Environments for Aboriginal Health Research, and the Nasivvik Center for Inuit Health and Changing Environments. iv A million thank yous to my husband and my parents for their never-ending encouragement and belief that someday I would finish this thing! Ta-dah! We did it! v TABLE OF CONTENTS Contents ABSTRACT ..............................................................................................................................................................ii ACKNOWLEDGEMENTS ..................................................................................................................................... iv TABLE OF CONTENTS ......................................................................................................................................... vi LIST OF FIGURES .............................................................................................................................................. viii LIST OF TABLES ................................................................................................................................................ viii LIST OF ACRONYMS ............................................................................................................................................ x Chapter 1: Introduction ............................................................................................................................................. 1 Chapter Two: Methods ........................................................................................................................................... 20 Introduction ......................................................................................................................................................... 20 Ethical Considerations ........................................................................................................................................ 20 Research Design.................................................................................................................................................. 24 Stage 1 Methods: Literature Review and Conceptual Framework Development............................................... 26 Stage 2 Methods: Case Study Process and Protocol ........................................................................................... 34 Validity, Generalizability, and Reliability .......................................................................................................... 43 Chapter Three: Conceptual Framework Development ........................................................................................... 49 Introduction ......................................................................................................................................................... 49 Results: Conceptual Framework Development .................................................................................................. 50 Document Review Analysis ................................................................................................................................ 55 Semi-directed Interview Analysis ....................................................................................................................... 75 Core Conceptual Framework Elements .............................................................................................................. 96 Chapter Four: Case Study ..................................................................................................................................... 102 Introduction ....................................................................................................................................................... 102 vi Results: Case Study Description ....................................................................................................................... 104 Results: Framework Analysis ........................................................................................................................... 122 New Framework Elements ................................................................................................................................ 146 Conclusion ............................................................................................................................................................ 165 Chapter 5: Discussion, Conclusions and Recommendations ................................................................................ 167 Discussion ........................................................................................................................................................
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