Health & Place 34 (2015) 181–189
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“Too much moving…there's always a reason”: Understanding urban Aboriginal peoples' experiences of mobility and its impact on holistic health Marcie Snyder n, Kathi Wilson Department of Geography, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario, Canada
art ic l e i nf o
a b s t r a c t
Article history: Received 22 December 2014 Received in revised form 12 May 2015 Accepted 18 May 2015
Urban Indigenous peoples face a disproportionate burden of ill health compared to non-Indigenous populations, and experience more frequent geographic mobility. However, most of what is known about Indigenous health is limited to rural, northern, or in the case of Canada, reserve-based populations. Little is known about the complexities of urban Indigenous health, and the differential impacts of residential mobility and urban migration remain poorly understood. Drawing upon interviews with Aboriginal movers and service providers in Winnipeg, Canada, we apply a critical population health lens, informed by holistic health, to examine these impacts. The results demonstrate mobility is an intergenerational phenomenon, inﬂuenced by colonial practices. While migration can contribute to positive health experiences, residential mobility, which is largely involuntary, and linked to stressors such as neighborhood safety, results in negative health effects. & 2015 Elsevier Ltd. All rights reserved.
Keywords: Canada Urban Aboriginal Mobility Residential mobility Migration Holistic health Urban health
1. Introduction In recent decades, Indigenous peoples1 have become increasingly urbanized, particularly in Western settler nations (King et al., 2009). In New Zealand, 84 percent of Indigenous peoples live in urban areas, in Australia, 70 percent live in urban or regional urban areas, in the United States, 60 percent are urban, and in Canada, approximately 54 percent of the population lives in cities (UN, 2010). Due to a complex history of social, economic, and political inequalities, the growing urbanization of Indigenous peoples has been associated with high rates of geographic mobility between rural and urban areas, as well as within cities (Clatworthy and Norris, 2007; Norris and Clatworthy, 2003; Snipp, 2004; Taylor, 1998), where Indigenous populations tend to change their place of residence at a higher rate than their non-Indigenous counterparts n
Corresponding author. E-mail addresses: [email protected]
(M. Snyder), [email protected]
(K. Wilson). 1 The term ‘Indigenous’ is recognized by the United Nations and by a growing number of scholars to refer to the First Peoples of a region. It usually refers to First Peoples internationally (National Aboriginal Health Organization Terminology Guidelines, 2011). The Indigenous population of Canada are referred to as Aboriginal peoples who, under the Canadian Constitution (1982), are recognized as three distinct groups: First Nations, Métis, and Inuit. http://dx.doi.org/10.1016/j.healthplace.2015.05.009 1353-8292/& 2015 Elsevier Ltd. All rights reserved.
(CMHC, 2002; Distasio etal., 2013). The term mobility has been generally deﬁned by migration, which includes moves between urban and rural or reserve areas, and residential mobility, which refers to a change of residence within a city (Bell and Brown, 2005; Clatworthy and Norris, 2007). Importantly, research suggests that high rates of mobility amongst Indigenous populations can have damaging effects on the wellbeing of individuals, families, and communities, and that population turnover can create challenges for adequate service delivery and access (Norris and Clatworthy, 2003; UN-HABITAT, 2010). The broader health geography literature also suggests that mobility can adversely affect health (Gatrell, 2011). For example, while migration has been shown to offer opportunities for family and social support (Bradley and Van Willigen, 2010), it has also been shown to cause social isolation, difﬁculty maintaining cultural traditions, and stress which, in turn, can lead to mental health concerns (Gatrell, 2011). Furthermore, discrimination of migrant groups has been associated with poor health outcomes and mental health concerns (Gil-González et al., 2014). Speciﬁcally, an increased risk of suicide has been found amongst migrants from the former Soviet Union to Germany (Deckert et al., 2015; Ott et al., 2008) as well as in residential movers living in the US, where those who moved within a 1-year period were twice as likely as non-movers to attempt suicide, citing poor employment opportunities and lack of social support as reasons for
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doing so (Potter et al., 2001). In addition, a large body of research in Canada and the United States has shown that while immigrants are healthier than the non-migrant population upon arrival, their health declines to levels on par with and sometimes below that of the nonmigrant population (Asanin and Wilson, 2010; Frisbie et al., 2001; Newbold, 2005). Given these broader ﬁndings, it is likely that Aboriginal migrants and residential movers may have similar health challenges. The context of Aboriginal migration and residential mobility is however unique, as cities are built on traditional land, and as Peters (2005) reminds us, “unlike other migrants, many Aboriginal people are traveling within their traditional territories” (p. 344). In Canada, the creation of reserves – government owned and controlled parcels of land, spread across the country – breached treaties between Indigenous peoples and settlers, and started a system of segregation that instigated forced relocation, mobility restrictions, displacement from traditional lands, and removal from cities (University of British Columbia, 2015; Smylie, 2009). Although Aboriginal mobility patterns and ﬂows are well-documented in the Western world (see Frideres et al., 2004; Newbold, 2004; Norris et al., 2004; Snipp, 2004), as well as reasons for this movement (Cooke and Belanger, 2006; Cooke, 2002), little is known about the socio-historical context within which mobility occurs, and its implications on the holistic health of Indigenous movers, particularly within urban settings, remains overlooked. With the exception of Skinner and Masuda (2013) who worked with a small group of urban Aboriginal youth to understand the relationship between place and health inequity and found that the right to a healthy city is contingent on physical and social mobility, and Ristock and Zoccole (2010) who produced a report that explored the impact of mobility on the health of Two-Spirit, LGBTQ (lesbian, gay, bisexual, transgender, and/or queer) youth, little is known about the implications of Aboriginal mobility on health. While the fact of Aboriginal mobility has been well documented, the context in which this mobility occurs remains largely unknown (Taylor and Bell, 2004; Taylor, 1998). A recent literature review that focused on the urbanization and mobility of Indigenous women, and how this impacted mental health, pointed to a gap between understandings of Indigenous mobility and health, and urged the importance of continued site-speciﬁc qualitative research to best capture migration experiences, and the impacts of mobility on individuals (Tait et al., 2007). These gaps are of particular concern given that Indigenous peoples face a disproportionate burden of ill health as compared to non-Indigenous populations (Adelson, 2005; King et al., 2009; Marrone, 2007), and that critical reviews of the literature demonstrate that the health of urban Aboriginal peoples remains underrepresented and under-researched (Wilson and Young, 2008; but see Wilson and Cardwell, 2012). Health disparities manifest in varying aspects across the lifetime, including: higher rates of infant mortality, youth suicide, chronic disease, family violence, incarceration, lower overall life expectancy, lower levels of income and employment, as well as environmental dispossession, and loss of language and cultural traditions (Adelson, 2005; Stidsen, 2006; Richmond and Ross, 2009; Smylie, 2009; Tjepkema, 2002). This burden of health inequality is largely the result of colonial practices that dispossessed and dislocated Aboriginal communities from their families, language, lands, and culture (Smith, 1999; Smylie and Anderson, 2006; Waldram et al., 2006), and is further sustained by an ongoing lack of urban Aboriginal policy as governments continue to focus on reserve and rural populations (Walker et al., 2011). Despite these disparities, the complexities of urban Aboriginal health and the determinants that operate in Aboriginal peoples' everyday lives remain underdeveloped (Richmond and Big-Canoe, 2011; Wilson and Cardwell, 2012), and little research has examined the structures that
underpin and shape Aboriginal health determinants and social inequalities over time (Richmond and Ross, 2009). As a step forward in addressing these gaps, the objective of this paper is to examine the impact of mobility on the holistic health of Aboriginal movers in urban settings. To do so, we draw upon qualitative interviews with 24 urban Aboriginal movers and 15 urban Aboriginal service providers in Winnipeg, Canada. The interviews are analyzed using a critical population health lens, coupled by a holistic understanding of health and its determinants, which privileges Indigenous ways of knowing. The intention of this holistic critical population health approach is to investigate connections between Aboriginal mobility and interrelated aspects of health that may otherwise be overlooked, and to better understand how mobility experiences shape urban health.
2. A holistic, critical population health approach This paper is framed by a critical population health approach so that the underlying context in which Aboriginal mobility occurs, and its implication for overall health, may be considered. Where a population health approach is useful for understanding disparities in health status and health determinants between populations, a critical population health approach extends this lens to consider the socio-economic and political context within which inequities in health determinants and health status occur (Raphael and Bryant, 2002). Typically, a population health approach measures health according to health status indicators, and as inﬂuenced by determinants of health, including income, social support, education and employment, environments, genetics, gender, health service access, and culture (Health Canada, 2014). Population health has, however, been critiqued for its lack of policy relevant research, for neglecting to unpack power relations and historical contexts, and for a lack of meaningful community engagement (Labonte, 2005; Labonte et al., 2005). In response to these criticisms, Labonte et al. (2005), in proposing the need for a critical population health perspective, argue the need for an approach that starts to deconstruct the socio-historic structures that contribute to creating and perpetuating health disparities between populations, and to work toward creating conditions that improve health equity for all populations. To do so, they advocate theory should be guided by, and responsive to, policy relevant and community-oriented goals. Very little research has applied a critical population health framework, although interestingly that which exists has applied this lens to Indigenous health. Perhaps this is due to the approach's effort to deconstruct how health determinants operate in historic and contemporary contexts, and to challenge how we conceptualize and think about health. Although this approach warrants further attention in both non-Aboriginal and Aboriginalfocused research, as it challenges dominant structures that perpetuate health disparities, and encourages ongoing dialogue and action toward promoting changes to health determining conditions (McIntosh et al., 2010), it has yet to receive broader application. In terms of its approach to Indigenous health, Richmond and Ross (2009) demonstrate that a critical health approach is a useful tool in identifying the determinants of health in First Nations and Inuit communities. Using this approach, they reveal that environmental dispossession, a process through which Aboriginal people lost access to resources in their traditional environments, is an important determinant of health that is not recognized in conventional determinants of health frameworks. Kryzanowski and McIntyre (2011) also use a critical population health approach to examine how industrialization affects key health determinants for on-reserve populations in northern Canada. Using examples from published case studies of reserve communities, they propose
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a holistic model that better integrates Indigenous understandings of health, in order to identify pathways by which industrialization affects health in rural, Indigenous communities. While their ﬁndings are not grounded in empirical research, it does offer an important example of how a critical population health lens may be supported and enhanced by holistic understandings of health that respect Indigenous worldviews. A critical population health approach provides an important lens for Aboriginal health studies, as Aboriginal determinants of health are rooted in unequal power relations and a history of colonization (Adelson, 2005; Richmond and Ross, 2009). Furthermore, critical population health speaks not only to the importance of actively engaging with community, it also provides the space to deconstruct complex and historical relationships. Given that colonization is a core, underlying determinant of Indigenous individual, family, and community health, which is connected to the other social determinants of health, in the Canadian context and globally (Lavallee and Poole, 2009; Loppie Reading and Wien, 2009; Mowbray, 2007), as are environmental dispossession (Richmond and Ross, 2009) and racism (Paradies and Cunningham, 2009; Smylie, 2009), it is crucial that Aboriginal health approaches take into account the persistent and underlying structures that produce health inequalities. In embracing a critical population health approach, it is important to consider Indigenous health from a holistic perspective. A key theme that arose in Tait el al.'s (2007) review of mobility and mental health amongst Indigenous women, is the need for holistic understandings of health and movers' lived experiences as keys to understanding the impacts of migration on health. In this paper, we therefore focus on holistic health and migrant narratives to inform our understanding of residential mobility and migration. While Indigenous teachings around health are vast, holistic health is commonly understood as a balance between physical, mental, emotional, and spiritual health, which are intrinsically interconnected. Mental health is related to the thinking activities of the mind, physical health to the body, emotional health to the feeling self, and spiritual health to inner relationship and self-esteem (for a more in-depth description, see Macdonald, 2008). These elements are deeply interconnected and can have varying impacts over a lifetime (Loppie Reading and Wien, 2009). For instance, it could be said that while physical health refers to the body, a person's state of physical health may depend on emotional stressors. The interactions between physical, mental, emotional, and spiritual health are also understood at the individual, family, and community level, and include relationships, support, and networks over time (King et al., 2009). Furthermore, holistic health can be understood to encompass a balance of life factors, including spiritual understanding, education and training, parenting, kin networks, and physical environments – including the location of quality housing (Saskatoon Aboriginal Women's Health Research Committee, 2004). Holistic approaches to understanding Aboriginal health warrant deeper attention, as they are often undervalued in mainstream governance, health care, and service structures, which tend to view elements of health from a biomedical perspective, where aspects of a person's health are assessed in isolation from the interrelated elements of health, and also in isolation from broader socio-historic contexts (Health Council of Canada, 2012). It therefore remains, that while a critical population health approach provides an important tool for unpacking socio-economic and health disparities, to further reﬁne this approach, and to fully consider mobile Aboriginal peoples’ experiences of health, a holistic health lens is needed.
3. Methods To examine the impact of mobility on the holistic health of urban Aboriginal peoples, the City of Winnipeg, Canada, was selected as a case study site. Winnipeg is home to the largest urban Aboriginal population in Canada. In 2006, over 68,000 urban dwellers in Winnipeg identiﬁed as Aboriginal, representing over 10% of the city's population. Winnipeg's urban Aboriginal population is made up of the largest urban Métis and First Nations populations in Canada; approximately 40 percent of the Aboriginal identity population in Winnipeg is First Nations and 60 percent are Métis. Less than 1 percent identify as Inuit (Canada, 2012). In terms of mobility, according to the authors' calculations from the 2006 Canadian Census, 26 percent of the Aboriginal population in Winnipeg moved to, or within, the city over a 1-year period and 58 percent over a 5-year period (Canada, 2014a). In contrast, only 13 and 39 percent of the non-Aboriginal population were respectively mobile (Canada, 2014b). Furthermore, twice as many Aboriginal people in Winnipeg were residential movers within the city as compared to the non-Aboriginal population, and Winnipeg's population of Aboriginal residential movers represents the highest percentage of intra-city movers when compared to Canada's ﬁve cities with the largest Aboriginal populations. The research that informs this paper was based upon a collaborative relationship with a Winnipeg-based Aboriginal service organization called Eagle Urban Transition Centre (EUTC). EUTC was established in 2004, and assists in the transition of urban Aboriginal newcomers to Winnipeg, and those who are experiencing frequent residential mobility. As stated earlier, a critical population health approach emphasizes research that considers community needs in meaningful ways. This is consistent with the Indigenous principles of Ownership, Control, Access, and Possession/Stewardship (OCAP) (Schnarch, 2004) which were developed to protect the collective ownership of research information and to exemplify trust, improved research relevance, capacity development and empowerment with Indigenous community members. The authors and EUTC worked collectively according to these principles, and to address our research objectives. In-depth interviews were conducted with 24 urban Aboriginal movers and 15 Aboriginal service providers. Aboriginal movers were recruited through EUTC, snowball sampling, and recruitment ﬂyers posted in community centers, banks, grocery stores, clinics, and educational institutions. For the purposes of this research, urban Aboriginal movers are deﬁned as migrants who moved from reserve or rural areas to the city within the previous ﬁve years, residential movers are individuals who were born in the city and changed their place of residence (in the same city) at least twice in the previous year, and migrants/residential movers are individuals who moved from reserve or rural areas and changed their place of residence in Winnipeg within the last year. These deﬁnitions were used to capture recent and frequent mobility, according to census categories (See Table 1). While we identiﬁed these distinct categories, it is important to note that most individuals maintained some form of connection to reserve or rural communities, often travelling back and forth to visit family. All participants had experienced at least 2 or more moves within the past year, with two respondents reporting as many as 20 moves over a 5-year period, including intra-urban, urban to urban, and rural or reserve to urban. Participants ranged in age from 18 to 54 years, and were of First Nation or Métis descent. Of the First Nations participants, 4 were migrants, 4 were residential movers, and 11 were migrants/residential movers. One Metis participant was a migrant, 1 was a residential mover, and 3 were migrants/residential movers. Nine of the participants were male and 15 were female. Interviews took place in mutually agreed upon locations and ran 20–90 min in length. Aboriginal movers
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Table 1 Aboriginal movers. Aboriginal identity
1. Status First Nations 2. Status First Nations 3. Status First Nations 4. Status First Nations 5. Status First Nations 6. Metis 7. Status First Nations 8. Metis 9. Status First Nations 10. Status First Nations 11. Non-Status First Nations 12. Metis 13. Status First Nations 14. Metis 15. Metis 16. Status First Nations 17. Status First Nations 18. Status First Nation 19. Status First Nations 20. Status First Nations 21. Status First Nations 22. Status First Nations 23. Status First Nations 24. Status First Nations
54 49 49 45 45 44 40 38 38 36 34 34 32 30 28 26 26 26 26 26 23 22 19 18
Female Female Female Male Female Male Female Female Male Female Male Female Male Male Female Female Male Male Female Female Female Female Male Female
Reserve-Urban Migrant and Residential Mover Reserve-Urban Migrant and Residential Mover Reserve-Urban Migrant Urban Residential Mover Reserve-Urban Migrant and Residential Mover Rural-Urban Migrant and Residential Mover Reserve-Urban Migrant and Residential Mover Rural-Urban Migrant Reserve-Urban Migrant and Residential Mover Rural-Urban Migrant and Residential Mover Urban-Urban Migrant and Residential Mover Rural-Urban Migrant and Residential Mover Reserve-Urban Migrant and Residential Mover Urban Residential Mover Reserve-Urban Migrant and Urban Residential Mover Urban Residential Mover Reserve-Urban Migrant and Residential Mover Urban Residential Mover Reserve-Urban Migrant and Residential Mover Reserve-Urban Migrant Reserve-Urban Migrant and Residential Mover Reserve-Urban Migrant Reserve-Urban Migrant Urban Residential Mover
were provided with an honorarium as a gesture of thanks for their time and knowledge. Interviews focused on factors shaping mobility, as well as general experiences of mobility and health. Urban Aboriginal service providers were recruited using purposive sampling. This sampling strategy allowed us, in consultation with EUTC, to select participants based on their ability to provide information-rich understandings of Aboriginal peoples' mobility. Interviewees represented sectors that supported key determinants of health, including housing, education, employment, health, and social support (see Table 2). Participants were referred by EUTC, or were selected from service directories, and were contacted by telephone or email. Service providers were asked about the challenges and successes they experienced working with mobile Aboriginal populations, and how they felt mobility impacted clients' health. All interviews were audio-recorded with participant permission. The transcribed interviews were analyzed using NVivo, a software program that assists with organizing and coding unstructured, qualitative data. Coding was done with the intent to bring out key themes related to experiences of mobility, and its impacts on holistic health. The interviews with Aboriginal movers and organizations indicate that migration and residential mobility are perceived to impact physical, mental, emotional, and spiritual aspects of health at the individual and family level, and across generations. In the following section we address the context in which mobility takes place, and then move on to examine the impacts of mobility on the interrelated aspects of holistic health.
Table 2 Aboriginal service organization representatives. Service sector
1. Non-Aboriginal Program Coordinator 2. Aboriginal Policy Analyst 3. Aboriginal Organization Development Manager
4. Aboriginal Executive Director, Education & Employment Services 5. Non-Aboriginal Director 6. Non-Aboriginal Chair of Employment & Training
7. Aboriginal Director of Education 8. Aboriginal Intake Coordinator 9. Aboriginal Manager of Community Relations
10. Aboriginal Executive Director 11. Non-Aboriginal Long-term Support Coordinator 12. Non-Aboriginal Client Advocate
13. 14. 15. 16. 17. 18. 19. 20.
21. Aboriginal Tribal Council Representative – Urban Service Advocate Worker 22. Non-Aboriginal Municipal Representative – Community Services
Aboriginal Community Transition Counselor from EUTC Aboriginal Employment Counselor from EUTC Aboriginal Family Counselor from EUTC Aboriginal Youth Project Coordinator Aboriginal Managing Director Aboriginal Executive Director Aboriginal Treatment Worker Non-Aboriginal Director
4. Causes for mobility: setting the context As described earlier, Aboriginal mobility may be understood according to two streams of movement: migration between rural or reserve and urban areas, and residential mobility within urban spaces. The factors that shape these types of movement are quite distinct in nature. According to the literature, the most common reasons for migration to urban settings are family-related reasons, education and employment opportunities, and housing (CMHC, 1996, 2002). The interview ﬁndings reveal much the same, with
service providers echoing these views. A housing provider explained that “housing…education, employment…when they [migrants] come to the city, those are probably the three things they’re most concerned about.” An urban tribal council member described much the same, stating, “We have people that move from the [reserve] for employment, for education, for training, and y'know, just a better life for their families. And what we see is also families with children, who come to the city for better education and for better housing”. Nearly all the migrants indicated that they
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moved to the city for education and training purposes. Two had moved to the city for personal reasons, with one stating that it was time for a “new life for [her]self.” While not without its challenges, migration is often motivated by the potential for positive opportunities in the city. Residential mobility, on the other hand, is often involuntary, and driven by negative factors. The most common reasons cited by interview participants include substandard housing conditions (e.g., pests, mold, disrepair), strained tenant–landlord relations, and issues with neighborhood safety. More than half the residential movers identiﬁed neighborhood and housing conditions as reasons for moving numerous times. For example, a residential mover who had migrated to the city 30 years prior, and had been in a cycle of residential instability most of her adult life, explained, “The challenge right now is ﬁnding a place that's affordable, but yet, y'know, clean…a decent place with no bugs or gang activity or addict[s].” Although the reasons for these streams of movement are quite distinct in nature, the ﬁndings also importantly reveal aspects of the socio-historic context within which mobility occurs. In particular, the interviews reveal that Aboriginal mobility experiences are intergenerational in nature. Mobility over the lifetime, and intergenerationally, appears to be rooted in the effects of assimilationist policies, including the residential school system, which forcibly removed Aboriginal children from their homes. Residential schools, the last of which closed its doors in 1996, destroyed family ties and long-held social and political systems within communities and many young people faced brutal abuses in these institutions (Lavallee and Poole, 2009). The “Sixties Scoop” also had a devastating impact on children and families, where from the 1960s until the 1980s, Aboriginal children in Canada were removed from their families and communities, without prior knowledge or consent, and were placed in non-Aboriginal homes throughout North America, and beyond. In the province of Manitoba alone, during the 1970s, there was a 60 percent increase in Aboriginal children taken into care. This legacy of forced mobility and disrupted family ties can be seen today, where three times the number of children are in state care as compared to those who attended residential school (Blackstock, 2007). One residential mover, who moved to the city 20 years prior and had since moved back and forth between urban, reserve, and rural areas, described her lifetime of mobility – including being in and out of state care: When I was younger…I used to live in foster homes… Well my parents, they were either going back and forth [between remote Northern reserve and the city]. I'm so used to moving all my life… I'm just used to moving all the time…I'm immune to it. Y'know, that's it. Nearly half of the migrants and residential movers interviewed spoke about being involuntarily mobile as children, how they had continued to move frequently in their adult years, and were now relocating their own families in some cases. Nearly all respondents had been impacted by experiences with residential schools and state-run child protection agencies.
5. Aboriginal peoples' mobility and holistic health As discussed above, the factors shaping residential mobility and migration are quite distinct. Not surprisingly, the research reveals that these two types of mobility have differential health effects on movers. In the next section, we examine these impacts from a holistic health perspective that includes the interrelated physical, mental, emotional, and spiritual dimensions of health.
5.1. Residential mobility and Its impacts on holistic health In terms of physical health, most participants perceived residential mobility to have a notable impact. For example, an urbanborn residential mover and student, who had been a ward of a child protection agency, attributed her mobility history to the onset of a physical illness, in the form of a brain tumor: My mom was moving around lots until she abandoned me at 13 and then moved in with my stepfather and my baby brother, and then he decided to move up North to raise my brother. And I was on my own since I was 15. So, high school was very, very difﬁcult for me. I hated [moving] when I was younger. I didn't like it at all. Having to make new friends and make those changes and stuff. It was very difﬁcult…And then it became harder over the years when I was on my own trying to ﬁnish school…And that's part of the reason why my tumor came about because of my stress. It was because of the stress the doctor said. Another residential mover spoke to physical, as well as emotional and mental health concerns that she believed arose from frequent mobility. She was a lone parent who moved within the city four times that year, and had recently been diagnosed with an ulcer. She felt that this physical ailment had surfaced due to the stress of chronic moving and worrying about her daughter's education: It's really stressful. Like, since I've been here…it's just like on the move all the time…It's impacted me a lot. Actually the doctor had to put me on medication because I've been under a lot of stress. I guess with my daughter growing up, like it was her ﬁrst year starting school. And then having to move, she couldn't start school…It's put me under a lot of stress so the doctor had to put me on medication… I'd just say moving is really a big job and it does take a lot of stress out of you and anger. And it is frustrating to move. Another respondent, who had moved from a reserve to the city two years prior, explained that he had yet to secure stable housing. Although he was seeking out residential stability, he was living in and out of shelters and temporary accommodation. He believed that the resulting cycle of residential mobility to which he was exposed was taking a toll on his physical body at the age of 39: I love to work but I need a place too, a stable place to go home after work. It just gets tiring when you've done a day's work and you're wandering around on the street. I've been there before, I got sick doing that, before, hey? I don't want to do that again. You get overtired, hey. The body can only take so much. Residential mobility is often spurred by a lack of access to safe, adequate housing, which is perceived to negatively impact movers' emotional and mental health. A female residential mover, and mother of three teenagers described the unhealthy and stressful living conditions that she endured while moving house to house over a period of several years: Too much moving…There's always a reason. That place was always ﬂooding. Yeah, that house the sewer was always backing up and it was unhealthy…So we left and then we moved… and there it was too small. Then [another address] there was too much gang activity there…people were getting killed there…Yeah, lots of room there but it was too dangerous…. It is stressful. Service providers also acknowledge the stress that residential mobility places upon movers. A counselor who worked with those in transition explained that, “moving around in the city too, is, you
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know, mentally exhausting, like it's, trying to get another place, you know, it's hard with housing, it's draining.” Furthermore, frequent urban relocation is often a result of racism in the rental market. A housing provider explained, “the more entrenched you are in poverty and marginalization, and racism, [the vacancy rate] just goes down, down, down.” Another service provider pointed to mobility's impact on physical health: Because you know what, every time you move, you've spent whatever you have to spend just to move…You're switching all your supports again, and I do feel like people really fall through the cracks…And y'know even like if they're diabetic, then their system gets kinda out of wack ‘cause they're not eating as regularly as before. One respondent, having been in and out of foster care, and moving between reserve, rural and urban areas, explained that when he became an adult, he did not have the skillset or conﬁdence to ﬁnd secure, stable housing. As a result, for nearly a decade he had been frequently mobile within the city. Moving more times than he could count, had impacted his emotional and spiritual health especially with respect to his self-esteem. He explained: I don't think I believed in myself too much to ﬁnd a place…it's kind of a sad story…I never chose this life. Kinda just happened. Residential mobility is rarely voluntary, whether it stems from childhood relocation, or neighborhood safety issues, and is perceived to have harmful impacts on Aboriginal movers’ holistic health, including stress, and in some cases, physical ailments. 5.2. Migration and its impacts on holistic health In contrast to residential mobility, migration is thought to offer some positive beneﬁts (as well as some challenges to holistic health). Most migrants had relocated to the city to pursue education and employment training opportunities, and a better life for their families. As a result, they felt migration had overall positive health effects. In some cases participants indicated that programs offered in the city provided connection to culture and spiritual healing. Spiritual health is open to many interpretations, and can include elements related to spirit and self-esteem, as well as ceremony, connection to the land, and kinship (MacDonald, 2008). A 50-year old woman who had recently moved from a remote northern community with her family to pursue second career training explained that migration had a positive impact on her health, in that it offered a sense of community, support, and kinship. The Aboriginal-led training program she was attending “supported her in any way they could” and she found spiritual and emotional healing through the program that was “like a mother… a long overdue support that I needed”. She also indicated that for her family as a whole, the transition was positive, in that it was strengthening family connection: We have more family time here because we didn't have that at home [reserve]. Because we were both working and after we'd get home from work we're tired and the kids go out…While here, because my kids don't really know the area, or the place here, so they tend to stay home, relax. We watch movies and we talk more. A young migrant who had moved from the reserve to the city for education, also experienced positive spiritual health effects: Well, coming to school has given me…they do offer y'know cultural awareness here, there's an Elder…y'know if one of the students or myself need to y'know speak to them or use traditional holistic healing.
Despite its positive health beneﬁts, coping with migration to the city can also create health challenges. One service provider related the story of an individual who migrated with his family from a remote northern community to pursue postsecondary education. Upon moving to the city, they experienced disconnect from traditional activities, such as hunting and ﬁshing: He had four kids I think and his wife, and they moved from up North, and he said that affected him a lot because he couldn't go out hunting, he couldn't go out ﬁshing and stuff like that, where he could just do it every day back home. Here, you know, he was totally – everything's totally different right? …You don't have the time just to go out, to do your things that they did. And then his kids, he started having problems with his kids because they started getting into the wrong crowd, you know, meeting the wrong people…[moving] does affect because it's totally different life from the reserve life to the city life. It's totally different, and you have to, you have to cope with that. Another service provider suggested that migrating to the city could create varied health challenges: Mentally you know like the challenge of all the adjusting, you know, it's mentally exhausting, and spiritually, it's the culture, you know. Not being a part of it, or losing it, or like coming here and not having anyone to talk to in your language. These urban health challenges are echoed by Indigenous scholars, who have described how Western values and culture shock can cause spiritual loneliness for Aboriginal people, as language, ceremony, and traditional activities are important aspects of health and wellness (Lavallee and Poole, 2009; Little Bear, 2000). Some migrants also pointed to this spiritual loneliness. A 19 year-old who moved to the city several months prior, suggested that the support of family and traditional ceremony (i.e., sweat lodge), assisted with his spiritual wellbeing and relieving loneliness, as he adapted to city life: I had some rough patches here and there but I got through them…I have people to talk to too. I have family out here. My auntie takes me to sweats once in awhile. Yeah, that's pretty good. The ﬁndings demonstrate that although migration can create some health-related challenges (e.g., loneliness, lack of access to traditional activities), it can also potentially create a positive impact on holistic aspects of health (e.g., cultural and spiritual support). Residential mobility, on the other hand, is perceived to have a detrimental impact on overall health.
6. Discussion and conclusions The purpose of this paper was to examine the impact of mobility on urban Aboriginal peoples' holistic health, and to contribute to the nascent body of urban Aboriginal health literature (Richmond and Big-Canoe, 2011; Wilson and Young, 2008). Using a critical population health framework (Labonte, 2005; Labonte et al., 2005), informed by holistic health, this paper examined the socio-historic structures that shape Aboriginal migration and residential mobility, and to how these two types of mobility impact health for urban Aboriginal peoples. Before discussing the contributions of the research to deepening understandings of the relationship between Aboriginal mobility and holistic health, certain limitations deserve mention. While this research offers important insight into Aboriginal mobility experiences in a city known for its high population of Aboriginal peoples, the experiences of Aboriginal peoples moving to and
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within cities where they represent a smaller minority is potentially an important area for comparative work, to further unpack the impacts of mobility on urban health. Furthermore, the majority of migrants and residential movers interviewed were connected in some way to a service organization. This may overlook the service needs and experiences of more isolated or disconnected movers. Notwithstanding, the research ﬁndings importantly bring attention to the relationship between urban Aboriginal mobility and health, and to the holistic health impacts of two distinct streams of mobility – migration and residential mobility. This is one of the ﬁrst studies in the ﬁeld of migration/mobility and health to examine both streams of movement. Importantly, the results indicate that these two types of movement have differential health inﬂuences. While all respondents who experienced residential mobility spoke of its negative effects, migration had the potential to both heal and to create health challenges. As compared to residential mobility, which was propelled and sustained by negative circumstances, such as neighborhood violence, the most common reason for moving to the city was to pursue education and training opportunities. Residential mobility is inﬂuenced by unfavorable factors – including exposure to crime and housing issues that push vulnerable, socio-economically marginalized Aboriginal movers into cycles of frequent mobility. In particular, the stress of frequent movement impacts not only the emotional and mental wellbeing of movers, but some movers also stated that it resulted in physical health conditions. Where moves for the general population usually result from a desire to better align housing consumption with needs and resources, Aboriginal peoples are all too often marginalized by systemic racism and unequal access to socio-economic resources. This is consistent with the literature, which has attributed frequent mobility to: housing, racism, poverty, eviction, family violence, or crime and safety (Clatworthy and Norris, 2007; CMHC, 2002, 1996; Habibis, 2013; McCaskill et al., 2011), which can result in mental health concerns such as stress, and in some cases even suicide (Deckert et al., 2015; Potter et al., 2001). Arguably, health and mobility are also interrelated, where unhealthy housing circumstances and stress, for example, may affect mobility decisions. Migration, on the other hand, had positive impacts on health (e.g., accessing supports and training programs) as well as potentially negative health impacts (e.g., loneliness, lack of access to traditional activities). These ﬁndings are signiﬁcant, as they point not only to the relationship between Aboriginal mobility and health, but also to important distinctions in types of mobility. These ﬁndings are of particular importance as residential mobility has received far less attention in the Aboriginal mobility literature, with research tending to focus on reserve and rural migration (Clatworthy and Norris, 2007). The results also contribute to the migration and health literature, demonstrating that unique forms of mobility, such as those set within the socio-historic context of Aboriginal mobility, can likewise adversely affect health through social isolation, discrimination, and stress, while comparably offering opportunities for social supports (Bradley and Van Willigen, 2010; Gatrell, 2011; Gil-González et al., 2014). Furthermore, the results demonstrate that Aboriginal mobility experiences are intergenerational in nature, and deeply inﬂuenced by colonial practices – such as the residential school legacy, and resulting child welfare injustices – that impact holistic health at the individual, family, and community level. This begins to deconstruct the socio-historic context that has led to the health and mobility disparities that a disproportionate number of urban Aboriginal people experience. By applying a critical population health lens to mobility, this research examines how unequal power relations, particularly the ongoing legacy of assimilationist policies that removed children from their families and communities, has directly manifested in frequent and ongoing mobility.
This impacts the holistic health of Aboriginal peoples at all ages, and across generations. To take steps toward improving the material circumstances and health of mobile Aboriginal peoples, urban policy needs to consider these distinct aspects of mobility. A Winnipeg-based, selfgoverned Aboriginal child and family service provider may offer an example of step toward considering the holistic health needs of mobile urban Aboriginal children and families. This program offers residential stability and reunites mobile parents with their children who have been taken into state care. Rather than have the child move alone, the parent and child are essentially “adopted” into a foster home together. An interview participant from this organization, having worked with families that “moved around too many times,” describes the positive health impacts of this type of program: Mentally, that they're stable. And I'm talking about both child and parent…that they're ﬁnally with their child. Physically would have to be that they're not moving around…because like I said, the parent, they're not stable. They're always moving house to house…before we actually give them this opportunity. One of the things that I honor about our agency is that we give them the voices…It's giving the power back to them [parents] …Because you know what, this program wouldn't be a success if they weren't heard. Although colonial practices have disrupted family ties, and contributed to frequent mobility, this program acknowledges Aboriginal movers' voices and gives mobile parents opportunities to actively improve their family health, across generations. This example could perhaps serve as a template for urban Aboriginal policy and programming initiatives that address the holistic health impacts of intergenerational mobility. There remains a need for policy and programming that recognizes the intergenerational effects of mobility on health, particularly given that “the origin of good health arises long before conception, with the historical, political, economic and social contexts into which we are born” (Loppie Reading and Wien, 2009, p. 25). Although government and policy have tended to focus on reserve populations, there remains a need to consider the urban Aboriginal population and its diverse peoples. Service organizations that support transitional issues, like our community partner EUTC are key to supporting urban Aboriginal migrants and facilitating the healthy transition of residential movers. Given that the research showed that inadequate and unsafe housing conditions led to cycles of frequent mobility, another step forward in addressing transitional issues is to consider the need for adequate and culturally sensitive housing that supports mobile Aboriginal populations. For example, Belanger et al. (2013), in their work on urban Aboriginal housing and homelessness, point to the need for a national urban housing strategy, in cooperation with Aboriginal community members that provides just this. Current federal housing programs do not proactively facilitate urban transition. Addressing and evaluating this gap in policy could contribute to improving health outcomes. For instance, proactive measures could include on-reserve support for those considering migrating to an urban area, or newcomer housing supports. To achieve residential stability and to support movers' health, governments need to prioritize urban Aboriginal health, and critically assess the structures that create a climate for frequent mobility in the ﬁrst place. Rather than treat Aboriginal mobility as an occurrence that creates challenges for service providers, we must consider mobility according to its impacts on holistic health, as well as its colonial context, in order to better respond to the health and healing needs of mobile urban Aboriginal communities. Given the context in which Aboriginal mobility occurs, it is crucial
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that we consider health determinants from a holistic perspective, taking factors such as colonization, racism, and environmental dispossession into account, and the role that they play in shaping Aboriginal movers' health. By applying a critical population health approach, guided by a holistic understanding, Aboriginal peoples' mobility may be viewed not as a deﬁcit, nor as a symptom that needs mending, but rather as an intricate and interrelated element that plays out holistically across a lifetime and intergenerationally. It remains that continued research is needed to address the complexities of urban Indigenous health and its determinants.
Acknowledgments We acknowledge the Social Sciences and Humanities Research Council (SSHRC) (Grant No. 767-2008-1038) and the Manitoba Networks for Aboriginal Health Research (MB-NEAHR) for supporting and funding this research. We would also like to acknowledge all the interview participants, who shared their stories and experiences.
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