Indigenous Health Primer

Source: Indigenous Health Writing Group at the Royal College of Physicians

Year: 2019

The following document is designed to provide key approaches, ideas and background knowledge for health care providers, learners and educators in caring for Indigenous Peoples. The primer was written and edited by Indigenous and non-indigenous authors. Many of us are practising Indigenous physicians from a breadth of specialties. Each reference section is linked to detailed sources, the majority of which were created by Indigenous organizations. In addition to the theoretical and medical content, we aimed to include stories to illustrate the experiences of Indigenous Peoples in the health care system.

Creating Cultural Safety: Looking at Ottawa

Source: Wabano Centre for Aboriginal Health

Year: 2014

According to Statistics Canada, there were 19,200 Aboriginal Peoples living in Ottawa in 2011. This number has likely grown a great deal since. Aboriginal Peoples make up 2% of Ontario’s population. Despite the fact that the Canadian health care system is believed to be one of the best in the world, quality health care is not available for many Aboriginal people in Canada. Cultural barriers, fear and mistrust have hindered Aboriginal people from accessing appropriate and quality care which leads to poor health status. According to Anishnawbe Health Toronto, the Aboriginal population in Ontario “has generally noted that they have experienced culturally insensitive healthcare and have noted that at times they [are] also [met] with subtle and overt racism.”

Urban Indigenous Forum: Addressing Systemic Racism in Healthcare

Source: National Association of Friendship Centres

Year: 2020

The Urban Indigenous Forum: Addressing Systemic Racism in Healthcare was a crucial first-step in acknowledging the efforts it will take to ensure Indigenous people can access their right to healthcare with dignity and respect, however, our work does not end here. It remains our view that an Indigenous-led and community-driven process is essential in the path forward and compiling this report to share with Indigenous, Federal, Provincial/Territorial governments, our Partners, and the Canadian public as a whole is our first call to action. In this report you will find comments and suggestions from participants of the forum that range from personal experience, experience of advocates, professionals, and allies.

A Journey We Walk Together: Strengthening Indigenous Cultural Competency in Health Organizations

Source: First Nations Health Managers Association and Canadian Foundation for Healthcare Improvement

Year: 2020

Many health care organizations are familiar with the Donabedian1 model of healthcare quality – incorporating structure, process, and outcomes. This model recognizes that to see better outcomes and improvements in the quality of health services, there needs to be considered and purposeful improvements in structures (facilities, equipment, qualifications, care settings) and processes (care has been appropriate, acceptable, accessible, complete, competent).

Bringing Reconciliation to Healthcare in Canada: Wise Practices for Healthcare Leaders

Source: Dr. Lisa Richardson, Tracy Murphy; HealthCareCAN

Year: 2018

This HealthCareCAN Report discusses critical issues facing Indigenous Peoples in Canada, and the role that Canadian health leaders play in helping to close the health gap. It also presents wise practices for health leaders and organizations to address the health-related Calls to Action of the Truth and Reconciliation Commission of Canada (TRC) based on a literature review, interviews with key stakeholders, and case studies of several health care organizations. The term “wise practices” is widely used in Indigenous contexts to describe locally appropriate Indigenous actions that contribute to sustainable and equitable conditions.

Health Transformation Summit: Getting the Relationships Right: Health Governance in the Era of Reconciliation

Source: Assembly of First Nations

Year: 2018

The First Nations Health Transformation Summit took place February 13-14, 2018, in Toronto, Ontario on the Traditional Territories of the Mississaugas of the New Credit First Nation. The Summit was an opportunity for First Nations, the federal government, and provinces/territories to come together to develop shared priorities and determine next steps towards closing jurisdictional gaps in First Nations health. The First Nations Health Transformation Summit, Getting the Relationships Right: Health Governance in the Era of Reconciliation, is part of the Assembly of First Nations (AFN) efforts to facilitate relationship building, and highlight innovative First Nations built health programs, services and systems from across the country that have found success in overcoming jurisdictional gaps. With 429 in attendance, the Summit included First Nation delegates, AFN’s Chiefs Committee on Health members and health technicians, corporate and government officials, Elders, and other guests. The Summit was opened by Elder Valerie King and the Manitou Mkwa Singers and Drum Group.

Indigenous Health Values and Principles Statement

Source: Indigenous Health Writing Group at the Royal College of Physicians

Year: 2019

Racism is unacceptable in medical education and practice. The Indigenous health values and principles statement was created to complement anti-racism teachings. It was first introduced on July 4, 2013. Its purpose is to articulate clear and concise Indigenous health ideals and beliefs to guide the Royal College in advancing Indigenous health. The work was informed from extensive consultations with the Indigenous Health Committee of the Royal College members, key informant interviews with Indigenous stakeholders, and health care educators and organizations.

Truth and Reconciliation Commission Calls to Action

Source: Truth and Reconciliation Commission of Canada

Year: 2015

In 2015, the Truth and Reconciliation Commission of Canada (TRC) published its final report detailing the experiences and impacts of the residential school system, creating a historical record of its legacy and consequences. The TRC recorded testimony of more than 6,000 survivors affected by residential schools. Over more than a century, it is estimated approximately 150,000 Indigenous children were separated from their families and communities and forced to attend one of 139 residential schools across Canada.

One outcome of the report was a document detailing 94 calls to action across a wide range of areas including child welfare, education, health, justice, language and culture.

It’s important to recognize the historical and ongoing wrongs perpetrated against Indigenous peoples and the legacy of colonialism still in place today. The legacy of that separation and suppression of culture has had a profoundly negative impact on Indigenous communities, families and cultural connections through the generations.

The TRC calls to action address the ongoing impact of residential schools on survivors and their families.

Honouring the truth, reconciling for the future: Summary of the final report of the Truth and Reconciliation Commission of Canada

Source: Truth and Reconciliation Commission of Canada

Year: 2015

Canada’s residential school system for Aboriginal children was an education system in name only for much of its existence. These residential schools were created for the purpose of separating Aboriginal children from their families, in order to minimize and weaken family ties and cultural linkages, and to indoctrinate children into a new culture—the culture of the legally dominant Euro-Christian Canadian society, led by Canada’s first prime minister, Sir John A. Macdonald. The schools were in existence for well over 100 years, and many successive generations of children from the same communities and families endured the experience of them. That experience was hidden for most of Canada’s history, until survivors of the system were finally able to find the strength, courage, and support to bring their experiences to light in several thousand court cases that ultimately led to the largest class-action lawsuit in Canada’s history.

The Right to Food and Indigenous Peoples

Source: Food and Agriculture Organization of the United Nations

Year: 2008

Indigenous peoples, like everyone else, have a right to adequate food and a fundamental right to be free from hunger. This is stipulated in Article 11 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) of 1966 and constitutes binding international law. This means states parties to the ICESCR are obliged to implement the right to food domestically, ensuring that it becomes part of their national legal system. The right to food entitles every person to an economic, political, and social environment that will allow them to achieve food security in dignity through their own means. Individuals or groups who do not have the capacity to meet their food needs for reasons beyond their control, such as illness, discrimination, age, unemployment, economic downturn, or natural disaster, are entitled to be provided with food directly. The obligation to ensure a minimum level necessary to be free from hunger is one of immediate effect.

Social Determinants of Health Inequities in Indigenous Canadians Through a Life Course Approach to Colonialism and the Residential School System

Source: Paul Kim

Year: 2019

Indigenous populations in Canada have experienced social, economic, and political disadvantages through colonialism. The policies implemented to assimilate Aboriginal peoples have dissolved cultural continuity and unfavourably shaped their health outcomes. As a result, Indigenous Canadians face health inequities such as chronic illness, food insecurity, and mental health crises.

Culture and language as a social determinants of First Nation, Métis, and Inuit health

Source: National Collaborating Center for Indigenous Health

Year: 2016

Culture is a dynamic and adaptive system of meaning that is learned, shared, and transmitted from one generation to the next and is reflected in the values, norms, practices, symbols, ways of life, and other social interactions of a given culture (Krueter & McClure, 2004). It is the foundation of both individual and collective identity, and its erosion can adversely affect mental health and well-being, leading to depression, anxiety, substance abuse, and even suicide (Kirmayer, Brass, & Tait, 2000). Language is “a conveyor of culture” (Ibid., p. 613) and the means by which knowledge, skills, and cultural values are expressed and maintained.

Cultural continuity, traditional Indigenous language, and diabetes in Alberta First Nations: a mixed methods study

Source: Richard Oster, Angela Grier, Rick Lightning, Maria Mayan, Ellen Toth

Year: 2014

Cultural continuity, or “being who we are”, is foundational to health in successful First Nations. Self-determination, or “being a self-sufficient Nation”, stems from cultural continuity and is seriously compromised in today’s Alberta Cree and Blackfoot Nations. Unfortunately, First Nations are in a continuous struggle with government policy. The intergenerational effects of colonization continue to impact the culture, which undermines the sense of self-determination, and contributes to diabetes and ill health.

Calls to Action Accountability: A 2020 Status Update on Reconciliation

Source: Eva Jewell and Ian Mosby; Yellowhead Institute

Year: 2020

December 15, 2020, marks a full five years since the release of the Final Report of the Truth and Reconciliation Commission of Canada. It was a momentous day that saw residential school Survivors, their families, and representatives of the institutions responsible for overseeing the horrors of Canada’s Indian residential school system gather in Ottawa to chart a new path for the future guided by the Commission’s 94 Calls to Action. Governments committed to work with provincial, territorial, and municipal counterparts to, “fully implement the Calls to Action of the Truth and Reconciliation Commission.” But five years later, that commitment has not materialized. In 2020, a tumultuous year for many reasons, our analysis reveals that just 8 Calls to Action have been implemented, this is down from 9 in 2019.

Inuit Qaujimajatuqangit: The role of Indigenous knowledge in supporting wellness in Inuit communities in Nunavut

Source: Shirley Tagalik; National Collaborating Center for Indigenous Health

Year: 2010

Indigenous worldviews are generally holistic in perspective and encompass interconnections amongst all aspects of life and place (Barnhardt & Kawagley, 2005). From this interconnected view of the universe, a sense of cultural identity, collective purpose and belonging is derived. Cultural wellbeing relies on the individual becoming situated within a cultural worldview. For Inuit, being grounded in Inuit Qaujimajatuqangit supports personal wellness, but also contributes to a collective cultural sense of health and wellness which has sustained Inuit over generations. Inuit Elders in Nunavut are documenting Inuit worldview so that the strengths which have always sustained them will still be available to future generations.

Social Determinants of Health: Understanding Racism

Source: Charlotte Reading; National Collaborating Center for Indigenous Health

Year: 2013

This fact sheet is the first of three that will focus on anti-Indigenous racism in Canada, beginning with an exploration of the concept of race, its history and contexts, and continuing with a discussion of the various forms of racism within societies. In order to address racism in Canadian society, we must first understand what racism is, how it became a way to identify people, and the forms it takes.

Understanding the value and promise of Indigenous food sovereignty in western Canada

Source: Tabitha Martens

Year: 2015

Food sovereignty has recently emerged as a means of addressing food-related problems that confront many Indigenous and rural communities around the world. It moves beyond access to food, and is grounded in the idea that people should self-determine their food systems and cultural traditions. This is particularly important for Indigenous people who still face threats to their food systems linked to colonialism.

Responsibilities and reflections: Indigenous food, culture, and relationships

Source: Tabitha Martens

Year: 2018

Understanding Indigenous food systems requires positioning ourselves in our own understanding of Indigenous food, culture, and place. The resurgence of Indigenous culture occurring around food, and the protection and revitalization of Indigenous food systems must be documented with a commitment to Indigenous values, worldviews and perspectives. This commentary offers insight into how we can do so.

Administering Colonial Science: Nutrition Research and Human Biomedical Experimentation in Aboriginal Communities and Residential Schools, 1942-1952

Source: Ian Mosby

Year: 2013

Between 1942 and 1952, some of Canada’s leading nutrition experts, in cooperation with various federal departments, conducted an unprecedented series of nutritional studies of Aboriginal communities and residential schools. The most ambitious and perhaps best known of these was the 1947-1948 James Bay Survey of the Attawapiskat and Rupert’s House Cree First Nations. Less well known were two separate long-term studies that went so far as to include controlled experiments conducted, apparently without the subjects’ informed consent or knowledge, on malnourished Aboriginal populations in Northern Manitoba and, later, in six Indian residential schools. This article explores these studies and experiments, in part to provide a narrative record of a largely unexamined episode of exploitation and neglect by the Canadian government.

Make Food a Part of Reconciliation, 5 Big Ideas for a Better Food System

Author: Food Secure Canada

Year: 2017

A national food policy for Canada must acknowledge the history and ongoing legacy of colonialism and prioritize reconciliation and decolonization as key guiding principles of our food system. Food was often used as a tool of oppression and marginalization, including through the use of starvation and malnutrition in residential schools and the assumption, upon the arrival of European settlers, that Canada was largely an empty, uninhabited land (“terra nullius”). For many years, it was the Canadian government’s practice to provide only enough food to Indigenous communities on-reserve for basic survival. In addition, policies were implemented with the intention of limiting Indigenous people’s ability to engage in hunting and fishing activities, thereby eroding the food sovereignty and food security of many communities.