Indigenous Peoples and Colonization

• Indigenous Peoples are those who inhabited a country or region before later settlers and immigrants arrived.
• There are approximately 5000-6000 different Indigenous groups in 70 countries, representing 300-350 million people, or 5% of the world's population.
• In Canada, First Nations represent 58.4% of the Indigenous population, Métis 35.1%, Inuit 3.9%, and multiple or other Indigenous identities make up the rest.

Colonization Defined

• Colonization involves establishing a colony in a new land, with settlers accountable to their country of origin.
• It also means acquiring political control over another country, occupying it with settlers, and exploiting it economically.

Medicine's Role in Colonization

• Western medicine was used by colonizers to spread perceived benefits.
• It was believed that western medicine was needed everywhere.
• It helped maintain the health of colonial settlements.
• It helped maintain the health of the local workforce.

Residential School System

• The Residential School System in Canada operated from 1880 to 1996, with compulsory attendance from 1884 to 1948.
• It aimed to remove children from their homes, families, traditions, and cultures.
• It aimed to assimilate children into the dominant culture.

Impacts of Colonization

• Colonization led to violence, land appropriation, and oppression.
• It resulted in the loss of livelihoods, ways of life, culture, and language.
• It caused negative health impacts, including structural anti-Indigenous racism.

Health Concerns Due to Colonization

• Changes to traditional lifestyle and diet have led to cardiovascular disease, obesity, and diabetes.
• Poverty and poor living conditions have caused TB, exposure to toxins, injuries, and diseases from contaminated water.
• Trauma, social exclusion, and injustice have contributed to substance abuse, family violence, mental health concerns, and suicide.

Food Insecurity

• Food insecurity rates are 11.1% among non-Indigenous/non-racialized people.
• Food insecurity rates are 28.2% among Indigenous people off-reserve.
• Food insecurity rates are 50.8% among First Nations people on-reserve.

Cycle of Negative Outcomes

• Colonialism involves systems of oppression and beliefs about Indigenous inferiority.
• The Canadian healthcare system is built on colonialism, with a history of segregation, racism, and discrimination.
• Stereotypes portray Indigenous patients as less worthy of care, alcoholics, irresponsible, or unfairly advantaged.
• Discrimination leads to harm, poorer care, and even death, including abusive interactions, denial of service, and lack of respect for cultural protocols.
• Racism limits access to medical treatment through unwelcoming environments, geographic barriers, and mistrust of providers.
• Indigenous Peoples have higher rates of self-reported distress, suicidal ideation, and substance use.

Determinants of Indigenous Health

• Key factors include financial security/insecurity.
• Key factors include housing conditions.
• Key factors include water safety.
• Key factors include food security/insecurity.
• Key factors include experiences of discrimination and injustice.
• Key factors include loss/strength of language, culture, and heritage.
• Key factors include connection to the land.
• Key factors include self-determination.
• Key factors include level of access to services.

Web of Being: Social Determinants

• Distal determinants include self-determination, language, culture and heritage, and land resources.
• Distal determinants include racism, poverty, dislocation, residential schools, and social exclusion.
• Intermediate determinants include health systems, location, education systems, and early childhood.
• Intermediate determinants include environmental stewardship, justice, social services, racism and social exclusion, community infrastructure, and cultural ways.
• Proximal determinants include employment, income, social support networks, and personal access to the land.
• Proximal determinants include food security, education, and gender.

Health Determinants by Community

• Remote communities rely on hunting, fishing, and foraging.
• Remote communities face food insecurity and high imported food costs.
• Remote communities have limited higher education opportunities.
• Remote communities often have limited housing quality and quantity.
• Reserve communities sometimes have lower quality or limited public services.
• Reserve communities often have limited space for housing and community development.
• Reserve communities often have formal governance to advocate for community needs.
• Urban communities may have less access to traditional food or land.
• Urban communities may have more diverse educational or occupational experiences.

Reconciliation

• Reconciliation is an ongoing process between Indigenous and non-Indigenous Peoples for mutually respectful co-existence and strong Indigenous nations within Canada.

Recent Events on the Road to Reconciliation

• In 2008, the federal government issued a formal apology for the residential school system.
• In 2015, the TRC report was released.
• In 2016, the Indigenous population was increasing, with a younger demographic than the overall Canadian population.
• In 2019, the government launched an investigation into the deaths and disappearances of over 2,298 murdered or missing Indigenous women and girls.
• In 2021, documentation of thousands of unmarked graves of Indigenous children at former residential school sites across Canada was released.

Indigenous and Community Protocol

• Specific protocols, such as the exchange of tobacco, are required when asking an Elder to share traditional knowledge or engage in a ceremony.
• Specific ways are required to ask a community to participate in an event or project.
• This often requires an advisory group to review a request and/or have the project led by members of the community.