Indigenous Communities and Health (1RR3, Oct 24, 2023) PDF

Indigenous Popula/on Health: Se5ng a Reconcilia/on Path Forward School of Nursing, McMaster University 1RR3 October 24, 2023 By Bernice Downey, PhD Associate Dean, Indigenous Health Assistant Professor, School of Nursing & Dept. of Psychiatry & McMaster University LAND ACKNOWLEDGEMENT We take this...

Indigenous Popula/on Health: Se5ng a Reconcilia/on Path Forward School of Nursing, McMaster University 1RR3 October 24, 2023 By Bernice Downey, PhD Associate Dean, Indigenous Health Assistant Professor, School of Nursing & Dept. of Psychiatry & McMaster University LAND ACKNOWLEDGEMENT We take this time to recognize that we are on the traditional territory shared between the Haudenosaunee confederacy and the Anishinabe nations, which was acknowledged in the Dish with One Spoon wampum belt. That wampum uses the symbolism of a dish to represent the territory, and one spoon to represent that the people are to share the resources of the land and only take what they need. Land acknowledgement https://native-land.ca/resources/territory-acknowledgement/ DOWNEY Learning Objectives 1. Gain an understanding of the socio-historical factors related to Indigenous health and well-being and the contemporary health inequi<es amoung Indigenous peoples in Canada. 3. Increase awareness of Indigenous knowledge and Tradi<onal healing. 4. Discuss the applica<on of Indigenous health Allyship to the provision of care Session 2.Objectives Discuss the implica<ons of power & privilege within the context of providing culturally safe care Who are the Indigenous People of Canada? Indigenous people are the original inhabitants of Canada The Constitution Act, 1982 Section 35(1) • Protects Aboriginal and treaty rights • Recognizes that Aboriginal peoples include “…the Indian, Inuit and Métis people of Canada” • FNIM peoples are not a cultural group to Canada, but rather a distinct Constitutionally recognized peoples with Aboriginal and Treaty Rights 2016 Aboriginal population in Canada: • First Nations: 977,230 Demographics Indigenous Population in Canada • Métis: 587,545 • Inuit: 65,025 These numbers account for 1,673,785 identified Aboriginal peoples, or 4.9% of the total Canadian population. From “Aboriginal peoples in Canada: Key results from the 2016 Census”, Statistics Canada: Population: Age First Na)ons Métis Inuit NonAboriginal Urban Population, 2016 Aboriginal Popula.on in Hamilton Residents Identifying with a Single Aboriginal Identity in the City of Hamilton (2016 Census) n = 11,655 9000 8000 8445 7000 6000 5000 4000 3000 3080 2000 1000 125 0 First Nations Métis Inuk (Inuit) Pre-Contact Context of Indigenous Contact Health Assimilation Historica Canada ResidenOal https://www.youtube.com/ Schools in watch?v=VFgNI1lfe0A Canada Reflections Truth & Reconciliation • Disproportionate burden of disease • Post Truth & Reconciliation = Benevolence • Risk: perpetuating status quo Colonization, Indigenous Racism & health Contemporary Reality 1. Disproportionate apprehension of Indigenous children by childwelfare agencies 2. Disproportionate imprisonment & victimization 3. Denial of positive parenting, community leaders and a positive sense of identity and self-worth • Infant mortality rate for First Nations & Inuit children ranging from 1.7 average to over 4 times the non- Indigenous Contemporary • Nearly twice the rate of diabetes among Indigenous Reality = people aged 45 and older compared to non - Indigenous people; and a picture • An overall suicide rate among First Nations inequity that is about twice that of the communities total Canadian population Social determinants & Inequity 1. Income levels 2. Employment 3. Housing 4. Health overall Structural Inequity • Canadian Institute of Health Research- Institute of Aboriginal Health (CIHR-funded: Governance re-instated) • National Aboriginal Health Organization (funding terminated) • National Collaborating Centre for Aboriginal Health (PHAC - funded) • FNIGC - First Nations Information Governance Committee - OCAP Contemporary Reality: Intergenerational Impact • Impact affected Survivor’s: • partners • children • grand-children • extended families • communities Contemporary Reality: Systemic Racism vSystemic racism is when acceptance of discriminatory and prejudicial practices is normalized across our society, in public services and institutions vThe arrangements and practices that maintain racial hierarchies and racial inequality. Racism & Health • ColonizaPon process = fuelled by racist beliefs & ideas about Indigenous peoples; their ways of knowing & being, customs and pracPces Contemporary Reality: inadequate policy for positive health outcomes The numbers do not serve the purposes or interests of Indigenous Peoples. limited scope, aggregate format, deficit focus and decontextualized framework the policy narrative perpetuates inaccurate portraits of the embodied realities of Indigenous lives Need for race-based data Covid – 19 Reality SDOH intersection Data Governance The reconciliation path forward Truth & Reconciliation 1. First task – to understand the ‘truths’ • Historically • Locally 2. Develop partnerships that are based on values of reciprocity and equality 3. Personal/professional journey Calls to Action: Health 1. - link between current state of FNIM health and government policies 4. - sustainable funding for healing centres including residential school 5. - recognize value of Indigenous healing practices 2. - measurable goals to close gap 3. - address jurisdicAonal issues 6. – to increase number of Indigenous health professionals & cultural competency for all healthcare professionals Indigenous people have been engaged in global self-determining efforts to have control over their institutions, resources, knowledge and information systems. UNSelf Permanent Forum on the Rights of Indigenous Peoples Determination United Nations Declaration on the Rights of Indigenous People (UNDRIP) UNDRIP • Canada ~ 25 years of participation • Canadian Government pledged to respect – adopt as reconciliation framework • ‘Nothing about us – without us’ Without discrimination……. Indigenous RIGHTS • Improvement of health • to be actively involved in developing and determining health • the right to their traditional medicines and to maintain their health practices • the right to access to all social and health services United Nations Declaration on the Rights of Indigenous Peoples: Article #24 Indigenous Right to Health 1. Indigenous peoples have the right to their traditional medicines and to maintain their health practices, including the conservation of their vital medicinal plants, animals and minerals. Indigenous individuals also have the right to access, without any discrimination, to all social and health services. 2. Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively the full realization of this right.202 The right to our own knowledge systems UNDRIP - recognizes that respect for indigenous knowledge, cultures and traditional practices contributes to sustainable and equitable development. Indigenous Knowledge • Indigenous Knowledge is central to culturally relevant exchange of health information • Indigenous scholars have articulated the complex nature and importance of IK towards the culturally safe services for Indigenous populations ONE TRUTH? Two - eyed Seeing ‘Close the gap’ • • • • ‘Level the gradient’ Concnuum of approaches Universal, targeted, blended Assessment of values, assumpcons & evidence ‘Complete the Circle’ • • promote Indigenous -centered ways Indigenous epistemology & ontology • Cultural safety training • Trauma-informed care • Initiatives to increase the number of Indigenous healthcare providers • Ensuring organizational capacity & readiness to address racial and ethnic disparities in health care • Training aimed at addressing implicit, pro-white bias in health care which has been linked to differential treatment in health care service provision Interventions & Training https://ihll.mcmaster.ca/app/uploads/2022/02/the-coinmodel-of-privilege-and-critical-allyship-implications-forhealth.pdf https://ihll.mcmaster.ca/app/uploads/2022/02/indigenous-ledhealth-care-partnerships.pdf personal commitment educate oneself challenge discomfort & prejudice learn and practice ally skills Reflexive Allyship take action for change Local partners Institutional Community Engagement allyship • Identify key stakeholders for community engagement and build relationships with them. • Make reconciliation and Indigenous health equity part of the organization’s strategic plan. Recruitment and Retention of Indigenous Faculty, Staff and Students An:-Racism and Cultural Safety Educa:on Indigenous Relational Frameworks 1. Dish With One Spoon: maintaining peaceful relations; recognition of land, nations 2. Medicine Wheel: recognition of interdependency among four races of the world; seven grandfather teachings/principles: honesty, humility, courage, wisdom, respect, generosity & love • Indigenous Health Learning Lodge https://healthsci.mcmaster.ca/ihi/resources • Ontario Indigenous Cultural Safety Program (ICS) Education https://soahac.on.ca/wpcontent/uploads/2018/11/Core-Training-CourseDescriptions-Leresha.pdf • Cancer Care Ontario: Aboriginal Relationship Cultural Competency https://www.cancercareontario.ca/en/guidelinesadvice/education-events/e-learning The path forward: seven generations. • Kichi-Miigwetch! - (Thank-you Very Much!) • [email protected]