Integrated Analysis of Aboriginal Health Issues in Canada
My research of Aboriginal health issues has given me a view of Canadian health care through a different lens. This perspective gives me a broader awareness of those who are marginalized and suffer health inequities due to circumstance and social determinants of health. Women and the homeless are further marginalized within Aboriginal populations and chronic disease management is a health concern for all Aboriginal groups across Canada (NCCAH, 2018). I have broadened my perspective to look outside my home province of Newfoundland and Labrador (NL) and consider health issues on provincial and national levels as I embrace my personal journey of understanding unique barriers and challenges of Aboriginal heath in Canada. Aboriginal populations vary between provinces and the following table displays provincial/territorial distribution of Aboriginal identity across Canada.
I have been challenged to question the status quo of the traditionally accepted definition of health developed by the World Health Organization (WHO). This definition of health as cited in Huber, 2011, is "the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”, however, it cannot be applied universally to Aboriginal populations. Health is rooted in a person’s individual circumstance as impacted by social determinants of health and interrelationships between an individual, peers, family, community and social influences such as government. In my opinion, health can only be defined by each individual based on culture and traditional beliefs.
My professional experiences are as a physiotherapist and my ethical values are in line with my professional code of conduct based on ethical values and professional principles (CPA, 2018). In my current managerial role in the Cancer Care Program I advocate for accessible cancer services for all residents of NL. I have been involved in projects that aim to improve cancer care for Aboriginal groups and have worked collaboratively on proposals seeking grant funding to improve early access to palliative care services. I am interested in future research with key stakeholders and Aboriginal groups to develop a cancer care framework for the province.
A disproportionate burden of health and social suffering upon Aboriginal populations of Canada result from social, economic, cultural and political inequities (Adelson, 2005). Political and economic disadvantage and marginalization are direct effects of colonization and passing of the Indian Act resulting in Aboriginal populations moving onto reserves and children into residential schools (Patrick, 2014). Segregation contributed to the loss of lands, language and culture while children were subject to physical, sexual and psychological traumas. The circumstances in which people are born, grow, live, work and age are responsible for most of the health inequities that have persisted around the world (Halseth, 2013). Biomedical models of health are not effective in achieving better health outcomes for Aboriginal Peoples in Canada as they do not align with Aboriginal culture or traditional ways of life. A personal perspective on residential school impacts is discussed in the video below profiling Janet Longclaws, a residential school survivor (CBC News, 2018).
Aboriginal women suffer “multiple jeopardy” as they face individual and institutional discrimination on the basis of race, gender and class (Sampa, 2014). The Indian Act, residential schools, sterilization laws and forced removal of children attacked the essence of Aboriginal women and perpetuated inequality in healthcare and services (Boyer, 2017). The cycle of health inequity continues as generations of young women grow up without knowing their history as caregivers and healers. The following health statistics are staggering as they compare Aboriginal women to non-Aboriginal counterparts. Aboriginal women are: 4 times more likely to disappear or meet a violent death; have a life expectancy of 5.2 years less; have a suicide rate 3 times the national average; are 3 times more likely to contract AIDS/HIV; have 2 times the rate of diabetes; and 67% are overweight (versus 55%). Aboriginal women have faced considerable barriers to health and wellness yet have demonstrated strength and resiliency to cope with the challenges they face on a daily basis (NCCAH, 2018).
The challenges of disease management began when Europeans settled in Canada and Aboriginal populations continue to be challenged with poor health status and chronic disease management. Chronic diseases affect individuals, families, health-care systems and impact Aboriginal Canadians more than their non-Aboriginal counterparts (Government of NL, 2006) . Heart disease, cancer and HIV are on the rise and diabetes rates are 3 to 5 times the national average and higher in women and those living on reserve (Adelson, 2005) (Patrick, 2014). Tuberculosis, a communicable disease, is typically associated with poverty and has been reported up to 29.6 times higher than the non-Aboriginal population (Adelson, 2005). Mental health, spiritual wellness and addictions are also reported of great concern for the Aboriginal population and can be linked to historical traumas as a result of colonization (Patrick, 2014). A group in particular who struggle with management of chronic disease are homeless Aboriginals across the country.
Urban Aboriginals experience homelessness at disproportionate rates and constitute a significant percentage of homeless populations in cities with suggested rates of homelessness approximately 8 times higher than non-Aboriginals (Patrick, 2014) (The Homelessness Hub, 2017). The table below depicts urban Aboriginal homelessness in Canada. The definition of homelessness includes circumstances such as: unsheltered or absolutely homeless; emergency sheltered; temporary accommodation; and those at risk of homelessness (Patrick, 2014). First Nations homes on reserve continue to lack plumbing, electricity, contain mould, require major repairs and are overcrowded which severely impact the quality of life of residents (Patrick, 2014). Health risks related to homelessness include exposure to the elements, chronic disease management and poor nutrition. Homeless people have higher than average levels of morbidity and mortality and often experience barriers in accessing safe and effective health-care services (Reading, 2009).
Addressing issues such as poverty, employment, diet, societal stressors on multiple levels are key to improving Aboriginal health. As such, approaches in areas beyond direct health services are important to address broader social determinants of health including housing, family, community relationships and self-determination. An Aboriginal model of wellness must be embedded in the Canadian health-care system to improve the health of Aboriginal populations. Support of emerging trends in health care such as telehealth technology is critical to improve health of Aboriginal populations as they often live in rural and remote communities. Lack of funding continues to be the most profound barrier to the ongoing sustainability of telehealth in Aboriginal communities, where operational costs, particularly those related to infrastructure, are significantly higher (Muttitt, Vigneault, Loewen, 2004). Government must prioritize acquiring and updating technology so health-care can be accessed as close to home as possible.
The future of Aboriginal health in Canada depends on implementing culturally safe approaches to government policy and involving Aboriginal communities, partners and leaders in decision making (Christensen, 2016). Canadian leaders must commit to fulfill all 94 Calls to Action recommended by the Truth and Reconciliation Commission of Canada. A video at the end of this blog post chronicles the true story of Chanie Wenjack's residential school experience and subsequent death (Downie, 2016). Videos and storytelling are essential components in cultural safety education for health professional curriculum and post graduate clinical practice. It is through learning the long-term impact of colonialism that we can begin to recognize the lived realities of many Aboriginals throughout the country. Acknowledgment of the contributions of Aboriginal women to their families, communities and culture must occur in tandem with the work of the National Inquiry into Missing and Murdered Indigenous Women and Girls. Additionally, Aboriginal Health navigation services should be standard practice throughout the Canadian health system to assist populations who are marginalized. Collection, analysis and interpretation of Aboriginal health data across the country must meet provincial and federal privacy laws. Governments and health providers must work collaboratively with Aboriginal groups to ensure data is collected, managed and reported in culturally safe ways in accordance with OCAP® (FNIGC, 2018). The following video describes Aboriginal perspectives on information gathering and the importance of being stewards of their own health information.
Governments on all levels must co-design strategies that address revitalization and recovery of Aboriginal culture and traditional ways of knowing including concepts of spirituality, connectedness and reciprocity to the land, self-reliance, and self- determination to advance health equality and outcomes (NCCAH, 2018). All Canadians, in collaboration with governments and Aboriginal stakeholders are called to work together to end this “endless circle of disadvantage” in which Aboriginal groups are caught in a never ending cycle of poverty, violence, educational failure and ill health (Adelson, 2005). We can no longer tolerate complacency and must address issues such as Aboriginal homelessness and violence against Aboriginal women. My personal journey over the last several months has enlightened me regarding social determinants of health, the massive inequities Aboriginal people suffer and resultant poor health outcomes. As emerging health leaders, we must use an ethical lens to guide us, treat people in the way we would wish to be treated and develop trusting relationships with health care consumers of all races and socioeconomic status Giltiane (2013).
References
Adelson, N. (2005). The embodiment of inequity. Canadian Journal of Public Health. 96(2)45-60. Retrieved from http://pubs.cpha.ca/pdf/p24/22247.pdf
Boyer, Y. (2017). First Nations, Metis and Inuit women’s health: a rights-based approach. Alberta Law Review. 54: 3. 611-635. Retrieved from https://www.albertalawreview.com/index.php/ALR/article/view/764
Canadian Physiotherapy Association (CPA). (2018a). CPA code of ethics. Retrieved January 25, 2018 from https://physiotherapy.ca/cpa-code-ethics
CBC News. [Janet Longclaws] (2018, March 21). Residential school survivor to Canadians: Have some empathy. [Video file]. Retrieved from https://www.youtube.com/watch?v=ZdnEPvNGUYY
Downie, Gord. (2016, October 13). "The Stranger" video from the Secret Path. [Video file]. Retrieved from https://www.youtube.com/watch?v=za2VzjkwtFc
Christensen, J. (2016). Indigenous housing and health in the Canadian North: revisiting cultural safety. Health and Place. 40: 83-90. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27206162
First Nations Information Governance Center (FNIGC). (2018). The First Nations Principles of OCAP® . Retrieved March 30, 2018 from http://fnigc.ca/ocap.html
Giltinane, C. (2013). Leadership styles and theories. Nursing Standard , 27 (41), 35-39.
Government of Newfoundland & Labrador (NL). (2006). Improving health together: a policy framework for chronic disease prevention and management in Newfoundland & Labrador. Retrieved from http://www.health.gov.nl.ca/health/chronicdisease/Improving_Health_Together.pdf
Halseth, R. (2013). Aboriginal women in Canada: gender, socio-economic determinants of health,and initiatives to close the wellness gap. Prince George, BC: National Collaborating Centre for Aboriginal Health. Retrieved from https://www.ccnsa-nccah.ca/495/Aboriginal_Women_in_Canada__Gender,_socio-economic_determinants_of_health,_and_initiatives_to_close_the_wellness-gap.nccah?id=77
Huber, M. (2011). Health: How should we define it? British Medical Journal, 343(7817), 235-237. Retrieved from https://doi.org/10.1136/bmj.d4163
Muttitt, S., Vigneault, R., Loewen, L. (2004). Integrating telehealth into aboriginal healthcare: the Canadian experience. Int J Circumpolar Health, 401-413. Retrieved from https://doi.org/10.3402/ijch.v63i4.17757
National Collaborating Centre for Aboriginal Health (NCCAH) (2018). Social determinants. Retrieved from https://www.ccnsa-nccah.ca/28/Determinants.nccah
Patrick, Caryl. (2014). Aboriginal Homelessness in Canada: A Literature review. Toronto: Canadian Homelessness Research Network Press. Retrieved March 16, 2018 from http://www.homelesshub.ca/sites/default/files/AboriginalLiteratureReview.pdf
Reading, J. (2009). The crisis of chronic disease among Aboriginal Peoples: A challenge for public health, population health and social policy. Retrieved March 16, 2018 from http://cahr.uvic.ca/nearbc/documents/2009/CAHR-B2-Chronic-Disease.pdf
Sampa, J. (2014). Evidence for equity: public health examples from Aboriginal women in Canada. Health Law Review. 22(2), 28-39. Retrieved from http://0-eds.a.ebscohost.com.aupac.lib.athabascau.ca/eds/pdfviewer/pdfviewer?vid=2&sid=76f5e9f4-754d-4a8d-858b-8f30368795b3%40sessionmgr4008
Statistics Canada. (2006). Provincial/Territorial Distribution of Aboriginal Identity Population, 2006. Retrieved March 21, 2018 from https://www.statcan.gc.ca/pub/89-645-x/2010001/c-g/c-g004-eng.htm
The Homelessness Hub. (2017). Indigenous Peoples. Retrieved March 17, 2018 from http://homelesshub.ca/solutions/population-specific/indigenous-peoples