Global Indigenous Health and Decolonizing Nursing

Comprehensive vocabulary flashcards covering global Indigenous health, colonial and neocolonial mechanisms, medical history, health disparities, and frameworks for decolonizing nursing practice.

Indigenous People (Martinez Cobo Definition)

Communities having historical continuity with pre-invasion and pre-colonial societies that developed on their territories, considering themselves distinct from other sectors of societies now prevailing in those territories… and determined to preserve and transmit ancestral territories and identity to future generations.

First Wave of Colonialism

The 15th-century Age of Discovery during which Britain, Spain, France, and Portugal colonized lands across North and South America under the primary motives of God, Gold, and Glory.

Second Wave of Colonialism

The 19th-century Scramble for Africa, during which Britain, France, Portugal, Spain, and other European imperial powers claimed large areas of the African continent.

North African Syndrome

A diagnostic concept described by Frantz Fanon (1952) that colonial medical staff created not through experimental evidence, but on the basis of oral tradition to dismiss and medicalize colonized patients.

Medicine as a Colonial Tool

• medicine used to justify colonialism → “you wouldn’t have this medicine if it wasn’t for us”

• medicine acts as spokesperson for occupying power

• medicine can be used to increase surveillance and policing of colonized people

• health care professionals committing war crimes in colonial context - medical experimentation, torture

• white providers have lots to gain from maintaining status quo of colonial relations

Colonial Involvements of Canadian Nursing

Historical health practices and institutions documented by Symenuk et al. (2020) that caused colonial harm to Indigenous peoples, including Indian hospitals, residential schools, child apprehension, forced sterilization, and missing and murdered Indigenous women and girls.

Neocolonialism

The use of economic, political, cultural, or other pressures to control or influence other nations, especially former dependencies.

Multidrug-Resistant Tuberculosis (MDR-TB)

A major public health crisis and health security threat for which only approximately 2 in 5 affected individuals accessed treatment globally in 2024.

UNAIDS 95-95-95 Targets

• Global HIV testing and treatment milestones establishing that 95% of people living with HIV know their status, 95% of those diagnosed receive antiretroviral therapy, and 95% of those treated achieve viral suppression (with actual global metrics at 88-89-95 in 2025).

• some things that complicate the management of HIV include lack of testing equipment, untrained HCW, and stigma surrounding HIV/AIDS

tuberculosis in canada

• introduced to indigenous people through colonization

• global burden in indigenous populations is unknown

• in canada, incidence rates disproportionately higher in indigenous people compared to non-indigenous canadian born people

BCG Trials in Indigenous North Americans

• Unethical clinical trials conducted in the 1930s and 1940s where researchers met with tribal councils to explain skin tests and vaccines, but failed to inform Indigenous community members that they were actively participating in an experimental study to determine the efficacy of the vaccine, even though informed consent was already standard research practice at the time.

• treatment was not voluntary - you could be charged if you refused treatment. indigenous people were not given treaty annuity until they got a chest x ray. they would take kids away to hospitals even if they weren’t sick.

• indigenous people were easy to track because they were confined to reserves

Canada's 95-95-95 Progress (2024)

National performance toward HIV elimination targets demonstrating that 91% of people living with HIV were diagnosed, 86% of diagnosed individuals were on treatment, and 96% of those on treatment achieved a suppressed viral load.

Structural Determinants of HIV in Indigenous Populations

Systemic and societal factors—such as colonialism, globalization, migration, unequal healthcare access, poverty, and limitations on self-determination—that elevate HIV vulnerability and transmission.

Cultural Imperialism

The practice of delivering healthcare or social services in a manner that forces recipients to choose between accepting care that violates traditional norms or foregoing needed assistance entirely.

Three Key Features of Cultural Imperialism

(1) The intention to dominate and reform the cultural beliefs and practices of another group, (2) a presumption of entitlement based on belief in Western cultural superiority, and (3) coercive execution of tasks backed by substantial economic and military resources.

Medical Colonialism

The utilization of medicine as an instrument for resource extraction, land appropriation, and biopolitical dominance over an Indigenous population.

Codifying Race

The biometric categorization and labeling of Indigenous bodies in colonial medicine used to manufacture hierarchies, justify imperial entitlement, and validate the premise that Indigenous populations require colonial intervention. Used to biometrically identify differences

colonial medical experimentation

• colonial medicine is directed toward controlling populations, ensuring workforces

• in lots of colonies, working and living conditions led to outbreaks in indigenous groups

• western powers force their own treatments on indigenous groups even though there were often already indigenous treatments for some of these illnesses. this led to unsanctioned medical experimentation that resulted in deaths and disabilities

• effects still felt today in the mistrust of medical professionals and systems, like vaccine hesitancy

United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP)

An international human rights instrument affirming the individual and collective rights of Indigenous peoples to cultural expression, ceremony, identity, language, employment, health, education, and self-determination.

Indigenous Holistic Framework

A relational paradigm that guides engagement between people, the land, and living beings through concentric circles of individual, family, community, and nation spanning emotional, physical, intellectual, and spiritual realms.

Four R's of the Indigenous Holistic Framework

The core guiding pillars of the framework: Respect (respecting all living beings), Relevance (forming personally meaningful connections to nature), Reciprocity (restoring and replenishing Mother Earth), and Responsibility (stewardship for the Earth and seven generations ahead).

climate change + indigenous people

• indigenous people experience impacts of climate change first because of connection to land

• climate change will exacerbate existing problems in indigenous communities

• indigenous people have fought to protect environmental health for centuries

• traditional land management strategies, which indigenous people are experts in, are more effective at mitigating effects of climate change than other strategies

Indigenous Climate Change Adaptation Systems

Traditional ecological knowledge deployed across three domains: social adaptation (forecasting, communal pooling, water conservation), structural adaptation (cultivation, housing, ecosystem restoration), and institutional adaptation (agricultural and trading strategies).

indigenous social adaptation

• weather forecasting - flora and fauna changes

• farming activities

• water conservation and irrigation

• soil improvement practices

• social cohesion

• communal pooling in times of scarcity

• resource preservation

indigenous structural adaptation

• terracing on hills

• using domestic animals in times of floods

• cultivation

• adapting housing

• ecosystem based strategies

indigenous institutional adaptation

• agricultural strategies

• trading strategies

indigenous health disparities

• lower life expectancy

• higher infant and child mortality

• higher maternal mortality

• higher rates of infectious diseases

• higher rates of malnutrition and stunted growth

• increasing rates of CVD and other chronic diseases

• higher rates of substance abuse and depression

how does canadian health care sustain colonization

• designing + delivering services focused on micro, individualistic, eurocentric perspectives on SDOH

• denying and minimizing indigenous ways of healing

• racism at the point of care

• failing to make cultural safety a national, policy-based priority in health and human services

• failing to develop national standards for embedding cultural safety in educational curriculums

• failure of licensing bodies to systematically integrate cultural safety into codes of ethics so that practice licenses are tied to cultural safety competence

Decolonization (Waziyatawin & Yellow Bird Definition)

The intelligent, calculated, and active resistance to colonial mechanisms that exploit and subjugate Indigenous minds, bodies, and lands, directed toward overturning colonial systems and achieving Indigenous liberation.

Decolonization is Not a Metaphor

A critical premise articulated by Tuck and Yang (2012) stating that decolonization specifically requires the repatriation of Indigenous land and sovereignty, rather than serving as an interchangeable synonym for general social justice, diversity, or anti-racism initiatives to alleviate settler guilt.

colonization in nursing today

• continued belief that colonization is a thing of the past, or that indigenous people need to get over it

• do our outdated theories still work?

• privilege of evidence-based knowledge - whose evidence? how was it gathered?

• impact of racism

• emphasis on western biomedical models of illness and wellness

indigenization vs decolonization

• indigenization is focused on adding indigenous elements whereas decolonization is the removal of colonial elements

• both must be done in conjunction for meaningful change to occur

TRC Calls to Action 23 and 24

Specific mandates from the Truth and Reconciliation Commission of Canada calling upon nursing and health education programs to recruit and retain Indigenous healthcare professionals and incorporate mandatory anti-racism and cultural safety education into curricula.