Indigenous Health: Working With First Nations People, Inuit, and Métis

Chapter 14: Indigenous Health: Working With First Nations People, Inuit, and Métis

I. Indigenous Peoples in Canada: Definitions

The term Indigenous refers to the First Nations, Inuit, and Métis Peoples in Canada, and it has largely replaced the term Aboriginal. This shift acknowledges contemporary identities while recognizing that the term Aboriginal is still used within the context of the Constitution Act, which defines the legal identification of individuals not classified as Inuit or Métis using the term Indian.

Additionally, the term First Peoples serves as a collective identifier for the original inhabitants of Canada. It is emphasized that when discussing Indigenous peoples, it is vital to use their specific and preferred identifiers to respect their individual identities and cultures.

The Innu represent a First Nation located within eastern Quebec and southern Labrador. Conversely, Inuit are identified as a distinct cultural group not classified under First Nations, primarily originating from the Northwest Territories and Nunavut.

II. Population Snapshot of Indigenous Peoples

Indigenous Population Statistics

As per the 2016 Census, Indigenous peoples constitute approximately 4.9% of the Canadian population, categorized as follows:

  • First Nations: 58.4% (largest group)

  • Métis: 35.1% (second-largest group)

  • Inuit: 3.9% (smallest group)
    This demographic is notable for being the fastest-growing segment in Canada and characterized as a young population, with over 29.2% of Indigenous individuals under the age of 14.

As of July 2016, there are over 100 comprehensive land claim and self-government negotiations occurring in eastern Canada, Quebec, British Columbia, the Northwest Territories, and the Yukon, regions where historical treaties were never signed, and Aboriginal title persists. Various treaties including the James Bay Northern Québec Agreement (JBNQA), Northeastern Québec Agreement (NEQA), and Nunavut Land Claim Agreement (NLCA) have been established, among others. The list of treaties with their corresponding dates indicates the historical context of negotiations regarding Indigenous lands.

III. The Health Status of Indigenous People

The health status of Indigenous peoples in Canada is markedly lower than that of the general Canadian population. Indigenous individuals face higher rates of chronic and infectious diseases, such as type 2 diabetes and tuberculosis.

Factors Contributing to Vulnerability

Several factors may explain the increased health vulnerabilities within the Indigenous population, including:

  • Biological Susceptibility: Genetic predispositions that may heighten health risks.

  • Rural and Remote Lifestyles: Limited access to healthcare services and resources due to geographical challenges.

  • Health Practices: Traditional practices may not always align with mainstream health recommendations.

  • Socioeconomic Status: A prevailing low socioeconomic status limits access to critical social determinants of health.

  • Lack of Culturally Appropriate Health Education Programs: Programs that do not consider cultural contexts are less effective.

The historical forced loss of natural resources and land significantly disrupted traditional food systems, leading to poor dietary practices and consequent health issues among Indigenous peoples.

Chronic and degenerative diseases, particularly diabetes and cardiovascular diseases, have increased across all Indigenous groups in Canada. In 1945, health services for First Nations and Inuit peoples were transferred to Health Canada, which assumed responsibility for providing health services on reserves and in Northern Canada. Notably, Métis people have been excluded from similar health service access.

Health services for Indigenous communities vary widely, ranging from primary care to public health initiatives. Primary health care predominately serves isolated communities, while the Non-Insured Health Benefits (NIHB) program covers essential health services, including vision and dental care, prescription medications, medical supplies, and short-term mental health interventions.

IV. The Historical and Legislative Context of Indigenous Health Issues

Prior to European contact, Indigenous peoples typically lived in harmony with their environment. Post-contact, the Indigenous population plummeted from an estimated 500,000 to 102,000 due to infectious diseases introduced by Europeans, to which Indigenous peoples had no immunity. Furthermore, systemic displacement and the appropriation of lands further exacerbated the decline of Indigenous populations.

The Indian Act is a critical piece of legislation that emerged to consolidate various laws affecting First Nations, providing a legal framework that governs many aspects of Indigenous life, including reserve lands and coded definitions of Indigenous status. This Act continues to exert extensive power and control over Indigenous affairs today.

V. The Consequences of Colonization and Historical Trauma

Historical Trauma

The legacy of residential schools has left profound effects on Indigenous communities:

  • Residential schools aimed to assimilate Indigenous children forcibly. Compulsory attendance began in 1920, resulting in many children being removed from their families and communities, contributing to a cycle of trauma that persists across generations.

  • The effects included the severing of familial bonds and traditional roles, leading to a loss of cultural learning and identity.

  • Historical traumas manifest in intergenerational grief impacting the well-being of Indigenous individuals, families, and communities today.

Jonathan Labillois’s artwork, Still Dancing, poignantly illustrates the stories of missing and murdered First Nations, Inuit, and Métis women and girls, serving as a cultural reminder of the ongoing impacts of these traumas.

VI. Indigenous Determinants of Health

Framework of Determinants

Indigenous determinants of health are categorized into three layers:

  • Proximal Determinants: Include health behaviors, physical environments, employment status, income levels, social status, education quality, and food security.

  • Intermediate Determinants: Focus on health care systems, educational frameworks, community resources, environmental stewardship, and the continuity of cultural practices.

  • Distal Determinants: Address broader systemic issues such as colonialism, racism, social exclusion, and the repression of self-determination.

VII. CHN in Practice: A Comprehensive Case Study

Town of Northern Creek

Initiatives aimed at enhancing physical activity among low-wage earners include:

  • Advocacy for social assistance programs

  • Healthy Babies/Healthy Children program

  • Organized walking programs in malls and seniors' centers

  • Promoting healthy workplaces

Priority populations for these health initiatives encompass:

  • Indigenous communities

  • Youth living independently

  • Parents of young children

  • Homeless and underhoused individuals

  • Older persons in isolated conditions

Goals and Approaches to Population Health

The overarching goal is to improve community health by addressing inequities and enhancing access to vital social determinants of health. Capacity-building is essential on both community and individual levels. Community-level capacity building entails connecting local organizations and sharing resources, while individual-level processes involve engaging service users in planning and evaluating health services.

Primary Prevention Strategies

Health promotion efforts focus on understanding risk factors associated with chronic diseases. Identifying at-risk populations enables tailored interventions to disseminate information about these risks and preventive measures.

Planning and Implementing Health Interventions

A community health nurse (CHN) communicated observations at a planning network group leading to the development of a six-week wellness program for Indigenous women.
Implementation of walking programs includes:

  • Encouraging participation and securing commitment

  • Selecting program formats (time, place, frequency)

  • Evaluating volunteer involvement

  • Reviewing best practices to promote activity

Evaluation of Health Programs

An evaluation of the physical activity program after its six-week duration provided feedback on its effectiveness as well as baseline measurements of physical activity for future sessions. This evaluation is crucial for deriving lessons learned and recommendations for subsequent health initiatives.

Chapter Summaries

  1. The term indigenous refers to native populations deeply connected to their lands. The term Indian holds legal implications in Canada but may be considered offensive beyond legal contexts.

  2. In 2016, the Indigenous population of First Nations, Inuit, and Métis in Canada totaled 1,673,785 individuals, representing 4.9% of the national population and constituting the fastest-growing demographic.

  3. The health status of Indigenous populations is disproportionately poor, influenced by numerous social, political, and historical factors.

  4. The colonial history of Indigenous peoples frames a narrative of trauma and oppression affecting modern Indigenous health.

  5. Many Indigenous peoples harbor distrust towards authorities and healthcare providers, necessitating trauma-informed care measures that account for past traumas in addressing current conditions.

  6. Health determinants for Indigenous populations include proximal (individual behaviors and environments), intermediate (community resources and systems), and distal (broader societal issues).

  7. A trauma-informed, relational, and capacity-building approach is imperative for analyzing health concerns and interventions among Indigenous communities. Factors such as community-based practices, health promotion, chronic disease prevention, and programming sustainability are crucial for improving Indigenous health outcomes. Community Health Nurses employ rights-based, strengths-based, and collaborative strategies to foster wellness within Indigenous populations.