Indigenous Peoples' Health in Canada PDF

Chapter 11 Indigenous Peoples’ Health in Canada Introduction to Indigenous Peoples’ Health Indigenous communities experience health disparities and inequities - health disparities: indicators of preventable and unjust differences in health status - health inequities: condition...

Chapter 11 Indigenous Peoples’ Health in Canada Introduction to Indigenous Peoples’ Health Indigenous communities experience health disparities and inequities - health disparities: indicators of preventable and unjust differences in health status - health inequities: conditions that shed light on the underlying causes oh health disparities; they include the distribution of social, economic, and political resources - Infectious diseases & chronic conditions Before European settlers, Indigenous Peoples were in good health overall - They were then exposed to infectious diseases Upon the arrival of the European settlers, Indigenous communities were exposed to myriad infectious diseases - these diseases, introduced by European settlers and their livestock, were devastating to Indigenous communities - the overall disease profile in many Indigenous communities has shifted toward a burden of chronic conditions Overall, the health status of Indigenous People in Canada is often cited as being below the national average. Indigenous Communities More than 600 First Nations, Inuit & Métis communities in Canada - More than 70 Indigenous languages Well-accepted classification (on/off reserve) does not represent reality – 42% lived on- reserve - on-/off-reserve and rural, urban - Many transition between city, rural areas, urban areas and reserves repeatedly to access services and maintain connections - could be due to employment, educational, medical as well as to maintain strong connections to family, culture, and community. Therefore, on-/off-reserve and rural, urban classification is not accurate without recognizing real-world mobility According to the 2016, 1.67 million people self-identify as First Nations, Inuit and Métis people make 4.9% of the total population in Canada. With Alberta having 100% of the population Of the Indigenous population, most people identified as First Nations (58.4%), more than one-third identified as Métis (35.1%) and a small proportion were Inuit (3.9%) In Canada, the Indigenous population is growing at a quicker rate than the general population 43% increase in the total number of self-identifying Indigenous Peoples across Canada Population growth is also due to disproportionately higher birth rates to employment, educational, medical as well as to maintain strong connections to family, culture, and community. Therefore, on-/off-reserve and rural, urban classification not  Urban Indigenous organizations such as Friendship centers, this has been conceptualized as “associational communities” or “communities of interest” – this way Indigenous organizations respond and advocate for community needs and rights Health from an Indigenous Perspective Mainstream approaches within the area of mental health are generally not culturally responsive to Indigenous communities Indigenous cultures have also broadly been understood as “sociocentric” meaning that individuals are part of an interconnected web with family, community, and environment Indigenous cultures tend to be holistic - Holism: involves a balance between emotional, spiritual, mental, and physical aspects of health and wellness Different than biomedicals models, which focus primarily on physical notions of health Biopsychosocial model have adopted similar conceptions of holism Determinants of indigenous Peoples’ Health Health influenced by social determinants at both national and international level - Little research on indigenous-specific social determinants - social determinants broadly defined as the conditions in which people are born, grow, live, work and age - social determinants largely address surface causes of ill health and do not reflect the unique and complex realities of Indigenous Peoples’ lives – more studies for connection between income, education and health status but fewer studies examine colonialism and its impact on Indigenous Peoples’ economic and health status – need to look “beyond the social” according to Indigenous scholars Colonization - the process of geographic invasion, social and economic dispossession, and political control. It often leads to poor conditions for the local people and spreads the idea that colonizers are superior 1. Colonialism – involves oppression and subordination (using methods for controlling populations), it can be exploitative (for economic gain) and it can center on beliefs of the racial superiority of settlers; viewed as one of the most important structural determinants of Indigenous Peoples’ health 2. Self-determination – most important determinant of Indigenous health and wellness; self-determination is understood as the individual and collective right to participate in decision making on issues of community relevance and establishment of state- recognized roles for Indigenous organizations and structures, as well as the right to have control over their health, education and economic systems In short, self-determination is the right to participate in state-recognized decision- making in one’s community both politically and socially - numerous intermediate and proximal determinants of health are rooted within self- determination  - self-determination can lead to increased economic productivity and decreased poverty - self-determination can lead to increased levels of empowerment, coping skills, and self- efficacy which are protective factors with regard to health outcomes - high levels of local control over services in First Nations communities in BC was related to lower levels of youth suicide 3. Racism - prejudice: a negative bias characterized by negative attitudes, behaviors, and judgements toward entire categories or groups of people. Prejudice can impact anyone Racism: discrimination ascribed to differences in skin colour, hair colour, and facial features. It is linked with power based on social differences - Racism toward Indigenous Peoples has been expressed in multiple ways, including stereotyping, stigmatization, othering, and violence - Racism in Canada also known as systemic racism in child welfare, policing so on. - systemic racism: when the group in power discriminates on the basis of race, affecting all spheres of a person’s life. It occurs when discrimination and prejudice become normalized in society or within an organizational context - “In Plain Sight” – evidence of anti-Indigenous racism in the BC healthcare system. People report that they had been labelled by health care professionals as “drunk”, “dishonest” and “bad parents” - significant reported that they did not feel safe interacting with health care workers and did not trust health care system - overt racism – means it is easier to see observe - subtler forms of racism exist like eye-rolling or beliefs that everyone is same i.e. colour blindness 4. Land, culture, and language Land: linked with community, cultural practices - Barriers to accessing land impact health Culture: linked with belonging, self-esteem Language: linked with sense of welcoming, sense of belonging Land-based practices have also contributed to the development and maintenance of intimate relationships between communities and their environments through traditional harvesting practices and environmental stewardship Cultural identity is important for holistic wellness and can contribute to healing of trauma and associated with pride and self-esteem Cultural identity is also known as a protective factor for mental health Health and wellness are inclusive of multiple levels of determinants, where an individual’s health cannot be separated from family and community health and wellness Language is also connected to resilience and healing Indigenous languages may act as protective factors for mental health concerns that disproportionately affect indigenous Peoples, including suicide  Indigenous languages also create welcoming environments for Indigenous patients – people will return to more follow-up care, therefore Indigenous language revitalization is seen as a health promotion strategy Mainstream health programming is not always effective for Indigenous Peoples Greatest improvement of Indigenous communities and nations lies in the repositioning, revaluing and reinvigoration of traditional indigenous healing practices and concepts Culture is an important aspect of holistic wellness for Indigenous Peoples. Culture is healing 5. Genetics and Race - “Race” often used as biological construct, but is rather social construct - Genetics of ‘races’ used to explain health disparities - ‘Ethnicity’ (including culture, language, history etc.) is more effective in explaining health disparities and inequities - the current prevalence of diabetes for First Nations adults on-reserve is three times greater compared to non-Indigenous adults and two times greater for First Nations adults living off-reserve - First Nations considered to be one of the highest-risk populations in terms of developing diabetes and they are also susceptible to hypertension, kidney issues, and retinopathy - because of these disparities, researchers often looked to genetic differences that may explain increased risk of diabetes in Indigenous populations - Race is a construct designed by white people as a tool for suppressing other people - “First Peoples, Second Class Treatment” – foundational document for understanding misconceptions about race - race which has no biological basis it has been used for hundreds of years to argue to argue for and promote hierarchies of supposed superiority and civility among ‘races’ of people - genetic predisposition used to justify health disparities is rooted in prejudicial Western theory - Allan and Smylie note that reducing health inequities to disparities in genetic attribution is dangerous as it may result in presuming that the extremely poor health status and socioeconomic challenges faced by many Indigenous Peoples is a matter only of physiological or biomedical failure  Indigenous Peoples inhabited Turtle Island (now known as North America) at the time of European contact. Indigenous Peoples far outnumbered the European settlers when their settlement first began – relationships characterized as political equals o Relationship shifted with the introduction of infectious diseases, along with wars in the mid-1700s leading to a critical decline in the Indigenous populations o Small pox and other infectious disease introduced by European settlers destroyed Indigenous communities during the 1800s and Nations diminished in size up to 90% o So, decline coupled with an increase in European immigration and a shift in the economic system as the availability of furs declined and European settlers expanded further into the west o Europeans came up with the European law “Doctrine of Discovery” which uses the term Terra Nullius “empty land” argues that Indigenous lands were unoccupied prior to the assertion of European concepts of ownership and were thus free for exploitation Colonialism: oppression and subordination - ongoing because of maintenance of colonial structures, policies, and practices a. Indian Act o Department of Indian Affairs was formed to administer policies related to First Nations people (using the legal term “Indian”) o Government controlled use of reserve lands and in exchange, offered limited legal protection of land o First created in 1876, the act gave legal power for the federal government to control the lives of First Nations across Canada, created 150 years ago still in force today  o Department of Indian Affairs currently called Indigenous Services Canada o Indian Act gone through several amendments but remains untouched since initially passed o Indian Act dictates who falls under federal jurisdiction and who can access federally funded programs and services, does not replace ways of determining who belongs to a community, nor does it dictate cultural identity o Highly invasive law – controls who is and is not considered Indian under the law as well as matters related to bands and reserve system o Reserves fall under federal; like health care, social services, running water and housing o Reserves lacked clean drinking water, had overcrowded housing so on. o Indigenous people were required to get permission slips to leave their reserve o Indian act involved legislated band council system and only men could vote in these elections until 1951 o Indian Act also prohibited the sale of alcohol, ammunition and other things to First Nations people and First Nations from voting in federal and provincial elections until 1960; ceremonies, spirituality, cultural practices were all declared illegal, many cultural items were stolen from Indigenous communities wither sold or destroyed which now is found in museums and given back to communities o Indian Act also forbade First Nations people from speaking their traditional language until 1951 o 1951 major amendment to the Indian Act reversal of its oppressive policies, no longer illegal for Indigenous Peoples to participate in their cultural practices o Bill C-31 passed in 9185 – addresses sex-based inequities regarding women’s status under the Indian Act o Bill S-3 – credited to hard-fought battles led by First Nations women b. Residential school system o Most well-known strategies for forcing Indigenous Peoples to assimilate into colonial society o Founded on the belief that Indigenous People were inferior to people of European descent o With the creation of residential schools, the Canadian government aimed to eradicate the language, cultural traditions, and spiritual beliefs of Indigenous children to assimilate them into Canadian society o The churches supported the government’s beliefs and objectives and ran the school on their behalf o The churches involved in the residential school system were primarily the Catholic, Anglican, United (Methodist Presbyterian) churches o Residential schools were chronically underfunded and mismanaged – provided inferior educational services and atrocious living conditions, and many of the students were mistreated, neglected, and abused. o The poor conditions in residential schools contributed to high rates of illness and death for the children who attended the schools  o Around 30% of students died in Residential schools the government stopped recording probably because the death rates were so high o High rates of death due to infectious disease (particularly tuberculosis) o The Department of Indian Affairs made residential school attendance mandatory for Indigenous children with a formal amendment to the Indian Act in 1920 o Dr. Bryce continued to criticize Indian Affairs and bring public awareness to residential schools even when he was fired o Established 1870s closure of last school 1996 more than 150000 Indigenous children attended residential schools across Canada o Increased risk of HIV, diabetes, tuberculosis, hepatitis C, and arthritis in residential schools o Mental health concerns including depression and distress, post-traumatic stress disorder, addiction, and suicidality c. Indian hospitals o Racially segregated health care that existed in Canada from the 1920s to the 1980s o in these hospitals, Inuit, and First Nations people were isolated for long periods of time, often receiving substandard and even unethical treatment for tuberculosis o in 1867, tuberculosis was the leading cause of death in Canada o in 1946. Streptomycin was discovered as the first antibiotic that could kill the TB-causing bacterium - significant decrease occurring in the 1970s o Indian hospitals were created by the Canadian government to protect non-Indigenous Canadians from exposure to “Indian tuberculosis” – racist way of classifying o Indian hospitals received funding based on the number of patients that were kept in the hospitals; this led to severe overcrowding o Indian hospitals functioned on the promise that they would operate at half the cost of care as community hospitals o Care received was far below the standards accepted in other hospitals o Indian hospitals were usually located in basements, annexes, or old military hospitals. They were poorly staffed due to a lack of interest among doctors, who did not necessarily want to work in remote, isolated communities and poorly funded facilities o Children would be immobilized in bed through the use of plaster casts on each leg – strict bedrest o Children offered only minimum education opportunities in hospitals and separated for minimum interaction o Indian hospitals were also a site for experimentation where patients subjected to experimental treatment without consent o the emotional, mental, physical, and spiritual affects from Indian Hospitals have resulted in intergenerational trauma as well as mistrust of the health care system among survivors, their families, and their communities - intergenerational trauma: the transfer of trauma-induced harm from one generation to the next. This means that harm done in the past can be readily perceived in the present