2020 Kristin Burnett - Indigenous Peoples settler colonialism and access

Indigenous Peoples and Health Care in Rural Northern Ontario

  • Authors and Affiliations:

    • Kristin Burnett, Chris Sanders, Donna Halperin, Scott Halperin

    • Various departments from Lakehead University and St. Francis Xavier University.

  • Keywords:

    • Indigenous Peoples, Canada, Settler colonialism, Healthcare, Northern Ontario, Rural, Vaccines.

  • Abstract:

    • Indigenous communities in rural and northern Ontario face significant barriers to accessing health care compared to urban populations. This study analyzes beliefs about vaccination and the impact of settler colonialism on health care access.

Context of Health Care Access

  • Disparities in Access:

    • Indigenous peoples encounter challenges in accessing health care services, significantly affected by geographical and social factors.

    • These disparities are compounded by identities tied to Indigeneity, race, gender, and colonial history.

  • Geographical Considerations:

    • Northwestern Ontario includes multiple rural areas with over 49 First Nations, many of which are only accessible via plane or seasonal roads.

  • Significance of Space:

    • The geographic and historical context of settler colonialism shapes health access and outcomes for Indigenous peoples.

    • Trust and rapport are crucial elements influencing vaccination attitudes in these communities.

Defining Rurality and Indigenous Context

  • Definitions of Rural:

    • There is no singular definition of 'rural,' as it varies greatly based on travel distance, access to services, and population size.

    • Canada’s definition includes all areas outside urban population centers, typically set at a minimum population of 1,000.

  • Northern Ontario’s Specifics:

    • Rural communities in Northern Ontario are defined by their distance from urban centers (over 30,000 population).

    • Indigenous relationships to land and community are often neglected in conventional definitions of rurality, impacting health service organization.

Structural Barriers and Health Systems

  • Jurisdictional Conflicts:

    • Access to health services for Indigenous peoples falls under federal governance due to the British North America Act, creating a fragmented system with inconsistent service provision.

    • Health care services on reserves are primarily provided through a combination of federally funded nursing stations and provincial health care systems, resulting in a patchwork of care.

  • Challenges for Remote Communities:

    • Residents of remoteFirst Nations face unique challenges such as frequent health service evacuations and lack of consistent access to transportation.

Research Methodology

  • Data Collection:

    • Data collected through interviews with healthcare providers (N=14) and community members (N=72) from various locations (Thunder Bay, Sioux Lookout) and contexts (on-reserve, off-reserve).

    • The research approach emphasized respectful engagement, focusing on local knowledge and the validity of Indigenous perspectives.

Findings

  • The Importance of Relationship and Trust:

    • Relationships between community members and health care providers heavily influence access to care and vaccination decisions.

    • Historical racism and colonialism have created deep distrust in health institutions among Indigenous communities, affecting willingness to seek care.

Themes of Rural Space

  1. Urban-rural spaces:

    • Urban centers, like Thunder Bay, provide limited long-term care options and foster negative experiences due to racism, resulting in temporary or casual health care engagements.

  2. Fly-in/remote spaces:

    • Health care delivery is challenged by transient health care providers, inadequate community consultation and a recurring inability to establish trust.

  3. Mid-range spaces:

    • Communities closer to urban centers experience better health outcomes due to established trust with long-term care providers, allowing strategic decisions regarding health services.

Implications for Health Equity

  • Addressing Racism and Colonialism:

    • Recognizing the impact of settler colonialism on health access is crucial for developing equitable health care strategies.

    • There is a need for systemic change alongside cultural safety in health service provision to better serve Indigenous communities.

Conclusions and Recommendations

  • The complexity of rural space and Indigenous identities necessitates a nuanced understanding of health service access in northern Ontario.

  • To improve health outcomes, efforts must focus on addressing structural barriers and fostering trusting relationships between Indigenous peoples and health care providers.