Unit 2: The Canadian Healthcare System and Indigenous People

What does Indigenous-governed mean?

Indigenous people lead their own decisions instead of outside governments making them

What is health care financing in the context of Indigenous healthcare?

How the federal government collects and uses money to provide healthcare to Indigenous people

What are jurisdictions?

Who has the authority to make decisions about services in a particular area

Which level of government is responsible for Indigenous healthcare?

The federal government

Which level of government is responsible for healthcare in general?

The provincial government

Why can jurisdictions delay care for Indigenous people?

Governments may not know who pays for what so care gets delayed

What does the biomedical model focus on?

Identifying and treating illness and anatomy and physiology

Are the social origins of disease usually considered in the biomedical model?

No (the social determinants of health are often not considered)

How does the biomedical model view disease processes?

In an isolated manner

How dominant is the biomedical model in Canada?

It dominates the healthcare system in Canada

What is a deficiency of the biomedical model regarding the patient?

The patient is decontextualized

How does the biomedical model see the body?

As a machine

Is the biomedical model sufficient on its own?

No (it is insufficient on its own)

What non-medical factor most impacts health in Canada?

Socioeconomic factors (about 40%)

What are examples of socioeconomic factors that impact health?

Education and job status and income and community support

What does the postcolonial model examine?

The impact of colonial rule (which is ongoing despite law changes)

What does the postcolonial model challenge?

Existing assumptions and power structures

Whose viewpoints does the postcolonial model amplify?

Marginalized viewpoints (it values Indigenous healing practices)

What are the 5 focus areas of the postcolonial model?

1. Historical injustice and lasting effects 2. Power dynamics between Indigenous person and healthcare provider 3. Cultural impacts 4. Healthcare system and unequal access 5. Decolonization and encouraging Indigenous perspectives

What power dynamic does the postcolonial model focus on?

The power dynamic between the Indigenous person and the healthcare provider

What does the postcolonial model focus on regarding history?

Historical injustice and its lasting effects

What does the postcolonial model aim to encourage?

Decolonization and Indigenous perspectives

What are the 4 social determinants of health (SDOH) highlighted in the postcolonial model?

1. Cultural safety 2. Importance of land on identity 3. Empowerment for Indigenous people in politics 4. Policy and advocacy and how Indigenous health is impacted

What is race?

A social construct used to categorize people based on physical characteristics

What is ethnicity?

Ancestors of people born in the same region with shared language and culture

What is culture in the context of race vs ethnicity vs culture?

A system of shared beliefs and behaviours and norms

What are treaties?

Legal agreements between Indigenous people and the Crown

What caused disputes over Indigenous healthcare in treaties?

Differences between oral promises and the written text

What clause makes healthcare a treaty right?

The medicine chest clause in Treaty 6

Is healthcare a treaty right for Indigenous people?

Yes (under the medicine chest clause in Treaty 6)

What is Jordan's Principle?

A principle named after Jordan who was cleared to leave the hospital at 2 years old but was never sent home

What happened to Jordan in the case behind Jordan's Principle?

He died at age 5 without ever going home

Why was Jordan never sent home?

Jurisdictional arguments over who would pay for home services

What problem does Jordan's Principle highlight?

Jurisdictional disputes between governments over payment can harm Indigenous children

When did Indian Hospitals operate in Canada?

Between the 1930s and the 1980s

What was the primary driver of Indian Hospitals?

Rampant TB epidemics

How were Indian Hospitals part of the colonial system?

They isolated people with TB and did not trust their self-care

What were the staffing and capacity conditions in Indian Hospitals?

Overcrowded and understaffed

Why were Indian Hospitals overcrowded and understaffed?

Inadequate funding

What choice did patients have in Indian Hospitals?

Limited choice for where people received their care

What kind of abuse happened in Indian Hospitals?

Sexual abuse and assault by hospital staff

What physical mistreatment did patients experience in Indian Hospitals?

They were beaten and deprived of food and forced to eat their own vomit

What was the environment of Indian Hospitals like?

An institutional environment under authoritarian regimes

What experimental practices occurred in Indian Hospitals?

Experimental practices were used without consent

What TB vaccine experiment was done in Indian Hospitals?

A TB vaccine was tested on newborns

What happened to most newborns in the TB vaccine experiment?

Most died before age 5 due to pneumonia

What was the quality of care and staff in Indian Hospitals?

Substandard practices and doctors who would not have been allowed to practice elsewhere

When did Indian Hospitals start to close?

Through the 1970s and 1980s

What lasting effect did Indian Hospitals have?

A deep mistrust in the Canadian healthcare system

What 2 things are important for Indigenous care going forward?

1. Indigenous healers for holistic care 2. Smudging

What did the Indian Health Regulations criminalize?

Ill health

What did the Indian Health Regulations authorize?

Medical exams and arrests and detention

Who executed apprehension warrants under the Indian Health Regulations?

The RCMP

When were apprehension warrants executed by the RCMP?

If a patient left AMA (against medical advice)

What does AMA stand for?

Against medical advice

What was frequently used under the Indian Health Regulations?

Immobilization

What is postcolonial feminist theory?

A theory that explores how power operates through intersecting social locations

What is structural violence?

How political and economic and institutional arrangements put individuals and populations in harm's way

What is social suffering?

How large scale forces manifest as body pain and chronic illness and mental distress

How does the biomedical model conceptualize access?

As an individual responsibility and a-contextual

How does the postcolonial model conceptualize access?

As a social responsibility and a form of social relationship

How does the postcolonial model view healthcare spaces?

As social spaces

Which contexts are important in the postcolonial model of access?

Social and historical and political contexts

What does a-contextual mean in the biomedical model of access?

Access is viewed without considering social or historical or political context

What are the 4 barriers to access in the biomedical model?

1. Geographical location 2. Availability of services 3. Availability and retention of healthcare providers 4. Financial (ability to pay for non-insured care)

Which services are included under availability of services in the biomedical model?

Primary care and screening and preventative care

What are the 3 categories of barriers to access in the postcolonial model?

1. Social 2. Historical 3. Policy

What are the 3 social barriers to access in the postcolonial model?

1. Previous negative experiences in healthcare 2. Language barriers 3. Ongoing colonial relations within the healthcare system

What are examples of previous negative experiences in healthcare that act as social barriers?

Racism and discrimination and fear of judgment

What do previous negative experiences in healthcare cause?

Delays in seeking care and discouraged trust in healthcare providers

How do ongoing colonial relations show up in the healthcare system?

Reflected in "othering" mentalities

What are the 2 historical barriers to access in the postcolonial model?

1. Legacy of colonization leading to distrust in government-provided healthcare 2. Historical trauma leading to delays and difficulties accessing care

What are the 2 policy barriers to access in the postcolonial model?

1. Variation in healthcare benefits depending on location of residency (patchwork policy) 2. Federal and provincial jurisdictional ambiguities

What is patchwork policy?

Variation in healthcare benefits depending on where a person lives

What are the 4 solutions to access in the biomedical model?

1. Increase services provided 2. Increase healthcare providers 3. Increase awareness of available healthcare services 4. Increase funding for medical transportation

What are the 3 solutions to access in the postcolonial model?

1. Create socially accepting and safe and inviting spaces to reduce social distance 2. Invest in decolonizing education and research and healthcare practices 3. Coordinate policy between levels of government

What is one decolonizing strategy in the postcolonial model?

Cultural safety

What is the goal of creating socially accepting and safe and inviting spaces?

To reduce social distance

What does the biomedical approach to Levesque's first A pair emphasize?

Approachability and availability

What does the postcolonial approach to approachability and availability emphasize?

Cultural safety and trust

What does the biomedical approach to Levesque's second A pair emphasize?

Acceptability and appropriateness

What does the postcolonial approach to acceptability and appropriateness emphasize?

Decolonization

What does the biomedical approach to Levesque's third A pair emphasize?

Affordability and ability to pay

What does the postcolonial approach to affordability and ability to pay emphasize?

Socioeconomic and structural determinants

What does the biomedical approach to Levesque's fourth pair emphasize?

Ability to engage

What does the postcolonial approach to ability to engage emphasize?

Rational resistance and defensive coping

Which postcolonial concept matches approachability and availability?

Cultural safety and trust

Which postcolonial concept matches acceptability and appropriateness?

Decolonization

Which postcolonial concept matches affordability and ability to pay?

Socioeconomic and structural determinants

Which postcolonial concept matches ability to engage?

Rational resistance and defensive coping

What is cultural competency?

An approach that requires becoming an expert in another culture's customs

What is cultural safety?

An approach that focuses on the nurse's self-awareness and NOT mastery of a culture

What is the key difference between cultural competency and cultural safety?

Competency aims at mastering another culture while safety focuses on the nurse's own self-awareness

What is the first key theme of the Aboriginal Healthcare Study?

Expectation of racism

What defensive coping strategies did participants use in healthcare?

Over-explaining symptoms and suppressing emotional distress

What happened to the therapeutic relationship when providers had biases?

Trust broke down (breakdown of trust)

What were the roots of chronic pain in the Aboriginal Healthcare Study?

Structural trauma and living conditions and long-term illness

What label was given to people with chronic pain in the study?

"Drug-seeking"

Why were people labelled "drug-seeking"?

Because of their chronic pain

What is systemic abandonment in the Aboriginal Healthcare Study?

Primary care lacked trauma-informed care for pain