Indigenous Health

According to the 2016 census, approximately 260,000 Albertans identify as Indigenous, which is 6.5% of the population. Indigenous peoples is a broad term that includes First Nations, Metis, and Inuit. In Alberta in 2016, approximately 53% of Indigenous peoples were First Nations people, 44% were Métis, and 1% were Inuit.

Within Treaty 6, 7 & 8, which overlap the geographical boundaries of Alberta, 45 First Nations are represented. There are 140 reserves that cover approximately 812, 771 hectares of land. The most commonly spoken First Nation languages are Blackfoot, Cree, Chipewyan, Dene, Sarcee, and Stoney. 

Indigenous Albertans live in all areas of the Province. According to the 2016 census, the majority of Indigenous peoples live in smaller population centres and rural settings (52.6%) and nearly 56.1% of First Nations peoples live off reserves.  

Indigenous youth are the fastest growing population in Alberta. In 2016, the proportion of Indigenous peoples aged 15–24 was 23.7%, compared with 15.2% of Albertans in general in this age range. The proportion of Indigenous peoples aged 25–54 was 58.1%, while the proportion of Albertans for the same age group was 55.6%. This population is a major social force and resource for the Alberta economy. 

History has shown that the process of colonization in Canada created inequities for Indigenous peoples, which have resulted in great harms.

 Colonization is the act of one country settling another place, in order to live in and become the new rulers of the new country.

The result of our colonial past is widespread systemic racism towards Indigenous peoples and intergenerational trauma.

 Systemic racism is a form of racism that is embedded as normal practice within society or an organization. It can lead to such issues as discrimination in criminal justice, employment, housing, health care, political power, and education, among other issues.

 Intergenerational trauma is a cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma. – Maria Y.H. Brave Heart

This has resulted in reduced access for Indigenous peoples to basic human and citizenship rights including education, health care, housing, and safe drinking water, as well as over-representation in the criminal justice and child welfare systems and under-employment.

The Truth & Reconciliation Commission of Canada was the beginning of a process for Canadians to grapple with the realities of and harms caused by residential schools. Survivors from across Canada shared with the Commission the lasting damage that the forced removal from their families and lands, the loss of culture and connection, and in many cases, the abuse endured while attending residential schools, caused in their lives and for generations of Indigenous peoples in Canada.

While the Commission completed its work in 2015, the process of truth and reconciliation is ongoing. In their final report, the Commission provided 94 calls to action for further reconciliation between settler Canadians and Indigenous peoples related to all aspects of life.

The 7 calls to action related to health were:

1. Acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies and recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties.
2. Create a collaborative process to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess long-term trends.
3. Recognize, respect, and address the distinct health needs of the Métis, Inuit, and off-reserve Aboriginal peoples.
4. Provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools.
5. 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.
6. Require all health professional 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.
7. For all levels of government to:
   – Increase the number of Aboriginal professionals
   working in the health-care field.
   – Ensure the retention of Aboriginal health-care
   providers in Aboriginal communities.
   – Provide cultural competency training for all
   health-care professionals.

To learn more about Indigenous peoples of Canada, the Faculty of Native Studies at the University of Alberta has created a free, massive open online course (MOOC) to explore historical and contemporary issues from an Indigenous perspective.

The First Nations Mental Wellness Continuum (FNMWC) is a national framework for mental wellness among First Nations in Canada. The goal of the framework is to enhance service coordination and support culturally safe delivery of services. Many partners worked together to develop the Framework, including the Assembly of First Nations, Health Canada’s First Nations and Inuit Health Branch, the National Native Addictions Partnership Foundation, the Native Mental Health Association, and other community mental health leaders.

 Mental wellness is supported by culture, language, Elders, families, and creation and is necessary for healthy individual, community, and family life. – First Nations Mental Wellness Continuum Framework

The First Nations Mental Wellness Continuum Framework is a complex model, rooted in culture and comprised of several layers. Embedded within the model are the key themes that emerged through dialogue with partners as well as the social determinants of health. The centre of the model refers to the interconnection between mental, physical, spiritual, and emotional behaviour – purpose, hope, meaning, and belonging. A balance between all of these elements leads to optimal mental wellness. 

The Continuum must be supported by communities, Nations, local, provincial, and federal governments, non-government organizations, and private industry. The Continuum supports individuals across the lifespan, including those with multiple and complex needs. 

Indigenous peoples continue to experience barriers to health care, which results in significant health disparities compared to non-Indigenous Canadians. The accessibility, availability and acceptability of health services have indirect and direct impacts on Indigenous peoples’ health and health outcomes. Current health structures, policies, and systems must be transformed so that Indigenous peoples receive equitable access to healthcare.

With the lack of accessibility to health services in the far north, lengthy travel to southern health care hubs like Edmonton may be required. Indigenous peoples can experience financial hardships, loneliness, emotional stress, and elevated anxiety and fear associated with medical relocations, which may delay their recovery. Living in an urban centre can provide better access to healthcare services, but studies suggest that Indigenous peoples may experience additional challenges accessing urban health care services, including racism and discrimination, long wait lists, and culturally unsafe care.  

One solution is to create partnerships between Indigenous peoples and health service providers. The Indigenous Wellness Core is a great example of such a partnership. This group is the point of contact at Alberta Health Services for all Indigenous health needs and topics. Their work focuses on five important areas: 

• Caring for our patients with respect and dignity 
• Improving access to health services 
• Treating people as unique individuals 
• Managing addictions and mental health 
• Staying up to date on the health of Indigenous Albertans 

The Wisdom Council provides culturally specific support for the Indigenous Wellness Core by identifying Indigenous health priorities and ensuring that AHS  develops and implements culturally appropriate health services and resources.  

AHS has specific resources for continuing care in Indigenous communities and Indigenous cancer health among other topics.   

The video below describes how AHS has taken steps so Indigenous patients and family can access and feel comfortable in our provincial health system. 

A number of excellent videos on a variety of topics can be found on the AHS Indigenous Health Program YouTube Channel.

Offering cultural competence training to all health professionals is one of the calls to action from the final Truth and Reconciliation Commission report. The Health Council of Canada (2012) defines cultural competency as being

 …about creating a health care environment that is free of racism and stereotypes, where Aboriginal people are treated with empathy, dignity, and respect. Culturally competent health-care providers are more likely to recognize the effects of history on Aboriginal people and to adapt the way care is provided to more effectively meet their patients’ distinct needs.” (p.5)

Cultural competence training can include:

• understanding the central role of culture in all lives and how it shapes behaviour;
• respecting and accepting cultural differences; learning to effectively use culturally appropriate practices; and,
• continuously develop of one’s awareness of personal cultural influences and prejudices or biases.

Cultural competence training has mostly focused on developing knowledge, attitudes, awareness and sensitivity of those working in healthcare.

The Canadian Council on Social Determinants of Health created a guide for Indigenous cultural competency training programs. These training options have met the following criteria:

• developed or endorsed by Indigenous groups or organizations
• fosters better understanding of Indigenous cultures and history in Canada
• addresses a diversity of perspectives within Indigenous traditions, customs, and events
• avoids stereotyping and bias and uses culturally appropriate language
• content is appropriate for a broad cross-section of Canadians
• accessible and user-friendly
• incorporates a social determinants or health equity perspective

Cultural competence in health care is important; however, there are calls to move beyond knowledge and awareness towards an understanding of power dynamics that are inherent in a health professional/patient interaction. This is called cultural safety.

The Health Council of Canada (2012) defines cultural safety as:

…an outcome, defined and experienced by those who receive the service – they feel safe; … based on respectful engagement that can help patients find paths to well-being; …based on understanding the power differentials inherent in health service delivery, the institutional discrimination, and the need to fix these inequities through education and system change; and requires acknowledgement that we are all bearers of culture – there is self-reflection about one’s own attitudes, beliefs, assumptions, and values. (p.5)

The Society of Rural Physicians of Canada (SRPC) is developing a series of virtual education events on Indigenous health education. The recordings are available to everyone. There first two topics covered were:

• Jordan, Joyce, and Justice: Decolonializing Healthcare for Indigenous Children and Youth
• Moving towards Cutltural Safety, Reconciliation and Anti-Racism

They also have an extensive list of resources for further reading.

The San’yas Indigenous Cultural Safety Training Program is a leading approach in Indigenous-specific cultural safety training in Canada. Developed by Indigenous women leaders via the Provincial Health Services Authority of British Columbia, San’yas has worked in collaboration with Indigenous stakeholders in other provinces to design training for the unique contexts and histories of Indigenous peoples. 40,000 people across Canada have now been trained using the San’yas platform.

Completing Indigenous cultural safety training does not mean reconciliation is achieved. Reconciliation is an ongoing  process that can be supported by this training, but only if people commit to put what they have learned about cultural safety into practice.

Read up on the new Alberta Indigenous Virtual Care Clinic (AIVCC) that was launched last year. The AIVCC serves individuals self-identifying as First Nations, Inuit and Métis and their families. Patients and their caregivers can receive consultations, usually within 24 hours, by phone or through their computer with Alberta-based physicians experienced in delivering culturally-safe health care and wellness support. 

In an episode of the Ahkameyimok Podcast, National Chief Perry Bellegarde talks with Grand Chief Alvin Fiddler of Nishnawbe Aski Nation in Treaty 9 territory about ways to improve health care in First Nations communities.

In an APTN video a Cree doctor shares hopes for positive changes post pandemic.

Sherri di Lallo is a registered nurse with the Awasisak Program. In the video below, she describes her role as an Indigenous Child Nurse Coordinator is to help Indigenous families feel welcomed into the hospital and provide emotional and spiritual support to help them manage a challenging time.

O’tsisina – Joe’s Family Story is an AHS Patient & Family Storytelling Project video about one rural Indigenous family and end of life care.