3IH3 Indigenous Health Midterm

"The land is sacred... The land is our mother, the rivers our blood. Take our land away and we die"

Mary Brave Bird, Lakota

What are considered acceptable terms for indigenous peoples?

-indigenous

-first nations

-inuit

-metis

-aboriginal

What are some unacceptable terms for indigenous peoples?

-indian

-eskimo

-native

-squaw, half-breed, savage, redskin, heathen, Indian giver

-using sacred terms like pow wow

-making up own spirit name, animal, or tribe

What is in the top 10% of the cultural iceberg?

-behaviours

-traditions

-customs

-easily observable things with touch, smell, sound, taste

- these are explicitly learned, conscious, easily changeable, objective knowledge

-these include art, dance, food, clothing, language, greetings, music

What is in the bottom 90% of the cultural iceberg?

-world view

-authority

-religious beliefs

-decision making models

-gender roles

-ideas about leadership

-concepts of time

-power

-concepts of justice

-personal space

-body language

-definition of sin

-communication

-friendship

-ideas about modesty

-designation of status based on positions

-pace of work

-dating and courtship practices

-cooperation/competitiveness

-notions of child-rearing

(these are implicitly learned, unconscious, difficult to change, subjective

-include core values, beliefs, priorities, attitudes, assumptions, perceptions

How many Aboriginal languages are there?

over 70

-more than 600 first nations with distinctive language, culture, music, and art

What is Canada's Indigenous population?

1.7 million (4.9% of total population)

What did Duncan Campbell Scott wish about Indigenous peoples?

he wished they would be rid of and absorbed into society without their culture left so they conform to "white"

Who was Joyce Echanguan?

a woman who died of pulmonary edema in Quebec hospital and was subjected to racism throughout her stay

Who was Brain Sinclair?

an Indigenous man who died after being refused treatment in the ER while suffering from sepsis from a UTI and was ignored by medical staff as they assumed he was drunk

What are the components of Legacy from the TRCC 94 "Calls to Action" (#1-42)

-child welfare

-education

-language

-culture

-health

-justice

What is the status of call to action: "Government to recognize current state of Aboriginal health in Canada is a direct result of previous policies and new rights are needed"?

in progress- projects proposed

What is the status of "Fed government to establish measurable goals to close health outcome gaps between Aboriginal and non- Aboriginal with annual progress reports"?

in progress- projects proposed

What is the status of "Fed government recognize, respect, and address the distinct health needs of Aboriginal people"?

in progress- projects underway

What is the status of "Fed government to provide sustainable funding for healing centres"?

in progress- projects underway

What is the status of "recognizing value Aboriginal healing practices and use them in collaborative care of Aboriginal people"?

in progress- projects underway

What is the status of "government to increase Aboriginals in health professions, ensure retention of current aboriginal HCP's, and provide cultural competency training for HCPs"?

in progress- projects proposed

What is the status of "med/nursing schools in Canada to require students to take an Indigenous health class"?

in progress- projects proposed

What is turtle island?

North America- commonly called this by many Indigenous peoples in Canada for it's shape

What is biomedical model of health?

Focuses on the physical or biological aspects of disease and illness. It is a medical model of care practised by doctors and health professionals and is associated with the diagnosis, cure and treatment of disease.

What are some barriers to healthcare experienced by Indigenous people?

-availability of services and healthcare providers to on reserve First Nations

-availability and retention of hcps

-long waitlists

-limited access to screening and prevention services

-2013 Health Council of Canada's report of healthcare renewal focused solely on wait times as a measure of healthcare access

-financial barriers

What is constructivist epistemology?

meaning is constructed through social interaction

-analyzing power dynamics

What is biomedical perspective?

genetic differences

What is postcolonial perspective?

social construct that impacts how health is viewed and delivered

Intersectionality of racism

structural racism, institutional racism, personal racism

What is structural racism?

envelopes institutionalized and personal racism

consists of:

-hiring policies

-incarceration policies and procedures

-promotion practices

-committee appointments

-mentoring

-work and social culture

-decisions regarding placement of clinics

What is institutionalized racism?

practices and policies in businesses, healthcare settings, schools, organizations, institutions

What is personal racism?

micro-aggressions, disrespectful communications, racist verbal/ physical abuse, hate crimes

What is Jordan's Principle?

legal order across Canada ensuring there is equality and no gaps in government funded health and educational programs for First Nations children

What is a treaty?

A formal agreement between two or more sovereign states

What is the medicine chest clause?

clause in Treaty 6- that a medicine chest shall be kept at the house of each Indian Agent for the use and benefit of the Indians'

How is healthcare funded to Indigenous Peoples?

for non- Indigenous, mostly provided by the provincial government

-on reserve, health care is federally funded, off reserve is provincially funded

-federally funded healthcare services are significantly underfunded than provincially funded healthcare services

What are micro, meso, and macro levels?

micro- actions of individuals

meso- parts of the society e.g. groups, organizations

macro- society as a whole e.g. political, economic, social factors

When was the Indian Act amended?

1953

Included the Indian Health Regulations that made it a crime for Indigenous people to refuse to see a doctor, to refuse to go to hospital, and to leave hospital before discharge. The RCMP arrested patients and returned them to hospital or sent them to jail. They would die and be buried in the nearest cemetery in unmarked graves

What happened on January 25th, 2018?

Former patients of Indian hospitals filed a $1.1 billion class- action lawsuit against the federal government. They are seeking financial compensation and a formal acknowledgement of the government's negligence in the operation of Indian hospitals

What were Indian Hospitals?

racially segregated hospitals for First Nations and Inuit peoples in Canada

-more than 25 by the 1960s

-Indian Health Regulations

-there were many inhumane practices taking place including a lobectomy with local anesthetic vs general, infestation with pests, casting of children

What are the first steps in decolonization?

-learn who you are and where you came from

-address the oppressive systems and histories that enable you to occupy the territory you now do

-learn whose land you live on and what has been done to them

-find out how you benefit from that history and activate one strategy wherein you can use your privilege from which to dismantle that

-share the knowledge that the work of decolonization is for everyone

What are the social determinants of health?

-education access and quality

-healthcare and quality

-neighbourhood and built environment

-social and community context

-economic stability

What's the difference between proximal and intermediate and distal social determinants of health?

proximal: income, education, substance use, employment, smoking

intermediate: social network/ supports, health care access, cultural continuity

distal: racism/ discrimination, colonialism-> the Indian act, residential schools

Proximal determinants of health

direct impacts on health and root of ill health and well-being

Intermediate determinants

can be thought of as the origin of those proximal determinants

What are some examples of proximal social determinants of health?

-smoking status

-misuse of substances

-prenatal care

-exercise

-food security

-housing -> overcrowding (increased risk of transmitting infectious diseases)

-education

-income and employment

-socioeconomic status

-gender

What is cultural continuity?

Degree of social and cultural cohesion within a community - self- governance (control of education, security and cultural facilities as well as control of the policies and practice of health and social programs

What is environmental stewardship?

traditional ties to the land is acknowledged as a major resources for the superior health enjoyed by Indigenous Peoples prior to first contact, colonization has impacted and disrupted the healthy relationship with the land. Contamination of wildlife, fish, vegetation and water has forced Indigenous Peoples further from the natural environments that once sustained community health

What are the root causes of food insecurity?

-remoteness and isolation of northern communities

-high costs to ship and store perishable and nutritious food

-poverty, financial hardship, low educational attainment and unemployment/ underemployment also contribute

-long-lasting and ongoing effects of colonial policies- including forced relocations, sixties scoop and residential schools disrupted Indigenous peoples access to land/ resources and traditional food systems

-colonial policies also negatively impacted Indigenous peoples intergenerational knowledge transfer of hunting, moving (being mobile as food sources moved), and traditional knowledge of healthy eating habits

-climate change and the presence of contaminants in the environment (including water) is a major concern in many northern first nation reserves

What is health inequity?

health inequalities that are unfair or unjust and modifiable. Canadians who live in remote or northern regions do not have the same access to nutritious foods such as fruits and vegetables as other Canadians

What is upstream nursing?

-addressing health determinants

-recognizing social determinants of health and how they contribute to health of Indigenous people

-consider social, economic, environmental, political contexts

-root cause analysis

-holistic strategies/ worldviews

-overcoming marginalization

-mental health support

-improve housing situation

-improve social support

-respectful relationships

-implementing the truth and reconciliation Calls to Action

-develop community-based programs

-develop intersectoral partnerships

What is a medicine wheel?

-used by some Indigenous Peoples to give teachings about life

-a circular symbol, usually broken down into 4 sections

-each section of the medicine wheel consists of layers of teachings

What is smudging?

Smudging is a traditional Native American method of burning sacred herbs to produce a smoke cloud which is used in various cleansing or prayer ceremonies and purification or healing rituals.

Each area that we smudge carries a different purpose:

1. mind: to have good thoughts

2. eyes: to see the good in others

3. ears: to listen and hear good sounds

4. mouth: to speak well of others

5. heart: to purify our hearts

6. back: to have others watch our back

7. hair: to take care of our lifeline

8. whole being: to portray only the good part of ourselves through our actions

9. feet: to walk a good life

What is deficit discourse?

disempowering patterns of thought, language and practice that represent people in terms of deficiencies and failures

What are strengths-based approaches?

seek to move away from the traditional problem-based paradigm and offer a different language for thinking about and discussing issues

What is a strength-based lens?

a form of reconciliation to change the narrative of Indigenous Peoples

-it shifts the discussion from deficits to the strengths (resilience, cultural continuity, community strengths, etc.)

-aware of language, bias, views and how they affect Indigenous peoples

What is resiliency?

remaining positive and overcoming challenges in face of adversity

Which type of determinant of health is most profound?

distal determinants

-represent political, economic, and social contexts that construct both intermediate and proximal determinants of health

-includes colonization (Indian Act & Residential School Legacy), racism, social exclusion and self-determination

What is colonization?

the action or process of settling among and establishing control over the indigenous people of an area.

-recognized international as key determinant of health

-includes Indian Act, Residential Schools

What did the Indian Act (1876) do?

it provided the fed government of Canada with the right to determine who can and cannot be an "Indian"

-controlled movement of first nations peoples onto "reserve lands"

-governed the movement of "indians" on and off reserve through a pass system

What were Indian Day Schools?

in the 1860s to 1890s

-aimed to assimilate Indigenous children prior to the implementation of residential schools

-in 1920s there were 247 Indian Day Schools in Canada with 7500 students

-First nations, metis and inuit and non-status children were sent there during the day but lived with their parents and remained in their communities

-students experienced many types of abuse

What was the sixties scoop?

-Large-scale removal of Indigenous babies and children from their families without proper investigation

-Based on assumptions about "race" and character by provincial agencies

-Estimated 20,000 children scooped

-Vast majority placed in non-Indigenous families

What is race?

a socially constructed category of people who share biologically transmitted traits that members of a society consider important

What is racism?

the belief that one race is superior to others

-"othering"

What is the trajectory of racism?

ideology of race, hierarchy of racism, negative beliefs & stereotypes, discrimination, inequities

What is epistemic racism?

knowledge is power

What is relational racism?

sticks and stones

What is structural racism?

exclusion and marginalization

What is symbolic racism?

maintain the status quo

What is colourblind racism?

ignoring the reality

What is embodied racism?

living the reality

What has structural racism done to our society?

roots of our society- hidden from us but influences everything we think and do

-discrimination is not always overt like slavery or genocide

What was the Indigenous lifestyle pre-contact?

-diet, daily nourishment and medicines were provided by resources of local ecosystem

What did the Indian act give the federal government responsibility for?

Indian affairs -under section 91.24 of the constitution act

-this mandated the federal government with the sole responsibility for all matters relating to "Indian and Indian lands"

-1871 to 1921, several treaties signed between Indigenous Peoples and

Truth and Reconciliation: Health #18 (1st one listed)

Recognize and implement the health-care rights of Aboriginal people

- the federal government hasn't implemented the healthcare rights of Indigenous people, but it is developing new legislation designed to improve Indigenous access to culturally relevant health services

-in progress- projects proposed

Truth and Reconciliation: Health #19 (2nd listed)

Identify and close the gaps in health outcomes between Aboriginal and non- Aboriginal communities

- the federal government hasn't established measurable goals to identify and close gaps in most health outcomes, though it has committed to do so in some

- in progress- projects proposed

Truth and Reconciliation: Health #20 (3rd listed)

Recognize, respect, and address the distinct health needs of the Metis, Inuit, and off-reserve Aboriginal peoples

- the federal government has committed to recognize and address the distinct health needs of the Metis and Inuit, but financial commitments are in the beginning stages

- in progress- projects underway

Truth and Reconciliation: Health #21 (4th)

Provide sustainable funding for existing and new Aboriginal healing centres

-the 2019 fed budget committed to support the construction and ongoing operation of a mental health and substance abuse treatment facility in Nunavut

- in progress- projects underway

Truth and Reconciliation: Health #22 (5th)

Recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients

-the Canadian Medical Association, the Royal College of Physicians and Surgeons of Canada and the Canadian Nurses Association are working on ways to incorporate Indigenous knowledge and practices in health care

- in progress- projects underway

Truth and Reconciliation: Health #23 (6th)

Increase the number of Aboriginal professionals working in the health care field

-there are efforts in place to retain and increase the number of Indigenous health care providers, but most are still in the development stage. Furthermore, not all health care professionals are required to take cultural competency training

- in progress- projects proposed

Truth and Reconciliation: Health #24 (7th)

Require all medical and nursing students to take a course dealing with Aboriginal health issues

-several medical and nursing schools across Canada offer courses on Indigenous health issues, but not all are mandatory

Call to action #18

We call upon the federal, provincial, territorial, and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties.

Call to Action #19

We call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes Calls to Action| 3 between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess longterm trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services

Call to Action #20

In order to address the jurisdictional disputes concerning Aboriginal people who do not reside on reserves, we call upon the federal government to recognize, respect, and address the distinct health needs of the Métis, Inuit, and off-reserve Aboriginal peoples.

Call to Action #21

. We call upon the federal government to provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools, and to ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority.

Call to Action #22

We call upon those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.

Call to Action #23

23. We call upon all levels of government to: i. Increase the number of Aboriginal professionals working in the health-care field. ii. Ensure the retention of Aboriginal health-care providers in Aboriginal communities. iii. Provide cultural competency training for all healthcare professionals

Call to Action #24

We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism