Health and Society Lecture Notes PDF

Lecture 1: Decolonization and Indigenization Who are Indigenous Peoples? - Generally live within, or maintain attachments to, geographically distinct territories - Tend to maintain their own institutions within these territories - Typically aspire to remain culturally, geographically...

Lecture 1: Decolonization and Indigenization Who are Indigenous Peoples? - Generally live within, or maintain attachments to, geographically distinct territories - Tend to maintain their own institutions within these territories - Typically aspire to remain culturally, geographically, and institutionally, distinct rather than assimilate fully into the settler society - Often will self-identify as indigenous or tribal - Defining who specifically is indigenous is often best done by members of these communities themselves Colonization: Control or governing-influence over a dependent country, territory, or people; and system or policy by which a settler nation maintains or advocates such control or influence Manipulated the historic, political, social, and economic contexts shaping Indigenous/State/Non-Indigenous relations and account for the public erasure of political and economic marginalization and racism today Types of Colonization and Key Features/Examples: - Settler (Canada) - Large scale immigration - Motivated by religious, political, or economic reasons - Replaces the original population (often forcibly) - Exploitation (India) - Fewer colonists - Focused on the exploitation of natural resources or population as labor - Surrogate (United States) - A foreign power provides support for a settlement project of a non-native group over land occupied by its indigenous peoples - Internal (India) - Structural, political, and economic inequalities between regions within a state Cultural Genocide: - Systematic destruction of political and social institutions/practices of the targeted group with the intention of destroying the culture past repair - Families are disrupted to prevent the transmission of oral knowledge of cultural values and identity from one generation to the next - Major Events Defining Colonization in Canada 1876: Indian Act - Pre-confederation - 1869: Gradual Enfranchisement - 1884: forced attendance of Indian youth in school - 1895: outlaw all dances, ceremonies, and festivals that involved the wounding of animals and humans, or the giving away of money or goods - 1911: Amended to allow municipalities and companies to expropriate portions of reserves, without surrender, for roads, railways, and other public works, Further amended to allow a judge to move an entire reserve away from a municipality if it was deemed “expedient” - 1914: needed to seek official permission before appearing in “aboriginal costume” in any dance, show, exhibition, stampede, or pageant - 1918: lease out uncultivated reserve lands to non-aboriginals if the new lease-holder used it for farming or pasture - 1920: mandatory for aboriginal parents to send their children to Indian residential school & involuntary enfranchisement and loss of treaty rights of any status Indian - 1927: prevented any First Nation from pursuing aboriginal land claims - 1951: enfranchisement of indigenous women who married non-indigenous men - 1985: Bill C-31 allowed indigenous women the right to keep or regain their status and grant status to the children, but not grandchildren, or the marriage (“two-generation cut-off clause”) - 2011: grandchildren of such marriages became entitled to registration for indian status 1870’s - 1996: Residential Schools 1950’s - 1990’s: Sixties Scoop (national apprehension of approximately 20,000 children relocated to non-Indigenous homes in the US, Canada and overseas) Steps to Decolonization: 1. Recognize cultural diversity and different worldviews 2. Weaken entrenched and exploitative points of view of non-indigenous minds 3. Develop and historical perspective and explore how colonialisms persists 4. See how human lives are controlled and understand the basis for their identities and understanding of their events 5. Examine the desires and identity individuals have inherited and internalized: decolonize the self  6. Change the language used to describe another’s experience Decolonization Efforts: - Identifying colonial systems, structures, and relationships and working to challenge them - Often goes with indigenization and is a response to the inherent colonialisms in canada - Paradigm shift from a culture of denial to the making of space of indigenous political philosophies and knowledge systems as they resurge Indigenization: - Transformations in essential elements of education, legal, health, and more Canadian systems by including indigenous knowledges, voices, critiques, scholars, students, and materials as well as the establishment of systems that synergize the information of many indigenous knowledges Decolonization Indigenization Restores indigenous world views, cultures, and Recognizes the validity of indigenous traditional ways worldviews, knowledge, and perspectives Replaces mutated interpretations of history Identifies opportunities for indigeneity to be with indigenous perspectives of history expressed Incorporates indigenous ways of knowing and doing Gendering Colonialism - Women were active participants within indigenous communities - The indian act devalues women while male privilege was normalized and legitimized - Gender inequality was introduced from the forced perpetuation of an entire foreign society fuels by capitalism, christianity, heteronormativity, and racism and is now imbedded in indigenous communities Opposition to Bill C-31 and other Bills regarding matrimonial property rights by Indigenous Leaders - Disconnect between gender equity and Indigenous rights Decolonizing Gender requires ‘postcolonial’ thinkers grounded in… - Indigenous thought, traditions, and language - Indigenous understandings of gender - In conjunction with discourses of sovereignty and nationalism - Avoid being constructed from outdated ideas that dominate and oppress women Lecture 2: Governance, Resurgence, and Self-Determination Creating Equity for Indigenous People in Canada; Specified Focus on Indigenous Women - 1997 Royal Commission on Aboriginal Peoples (RCAP) - Truth and Reconciliation of Canada (TRCC) - Missing and Murdered Indigenous Women (MMIW) 1997 Royal Commission on Aboriginal Peoples (RCAP) - Established after the OKA crisis; mohawk protesters tried to defend the land from development of a golf course over an Indigenous burial site - Document draws inspiration from TRCC documents from other countries (RCAP written before TRCC) - Addressed Indigenous women’s rights Truth and Reconciliation of Canada (TRCC) - Efforts began in 2008, final report released in 2015 - Earmarked funding for reconciliation - Acknowledged the impact of colonial agenda on Indigenous people - 94 calls to action; protect and promote education, language and culture, justice, youth programming, and professional training and development Indigenous Governance - Patterns and practices of rule by which Indigenous people govern themselves in formal and informal settings - Existing forms of governance may exist pre-colonization such as traditional institutions, diplomatic practices in relation to other Indigenous groups, ceremonial activities, etc. - Integration into the political structures imposed by colonial power such as band councils, formal legal challenges, treaty negotiations, etc. - Practices opposing colonial power, resisting colonialism, and counteracting the negative effects of exploitation and domination like decolonization organizations Indigenous governance refers to how Indigenous peoples govern themselves through traditional and colonial frameworks: (1) Pre-Colonial Governance: Political communities such as clans, tribes, and ceremonial activities, as well as diplomatic practices between Indigenous nations. (2) Colonial Influence: Integration into colonial systems through band councils and treaty negotiations, and participation in colonial governing institutions. (3) Resistance and Resurgence: Decolonization movements, anti-racism initiatives, and grassroots activism such as forming warrior societies Data Governance Framework - Set and enforce standards including definitions and classification systems, development and technical standards, and organizational data models - Develop and enforce policies and processes around creation, development, access and delivery, monitoring and measurement, management and auditing of data - Set out a data governance structure, including the roles, responsibilities and accountabilities of actors from planning by executive committees to day-to-day use by data analysts - Put in place suitable technological infrastructure that provides built-in capabilities to access, cleanse, transform, deliver, and monitor data Data Commons —-- Data Partnership —-- Data Hierarchy 1. Data commons: Shared platforms for discussion and exchange but costly with challenges in controlling data use (to facilitate data sharing, might need approval, strong data security but don't discriminate on who can access it (no criminals), might be open to specific institutions) 2. Data partnership: Mutual data exchange between equal partners with a focus on secure, credible, and high-quality data (need expertise, don't need to pay but need government approval, sharing data back and forth between groups, usually have the same goal and capacity, usually try to highlight that there is no hierarchy but there typically is, mutually beneficial) 3. Data hierarchy/Outsourcing: External parties handle data when internal resources are lacking or for cost-efficiency, the organization retains data ownership (someone at the top distributing data, might have different representatives within their organization) Indigenous Data Sovereignty and OCAP Principles Data sovereignty involves managing data in line with Indigenous laws, customs, and practices. Key principles include Ownership, Control, Access, and Possession (OCAP® Principles). Ownership connects communities to their cultural knowledge and data. Control involves the right to manage research and data processes. Access ensures communities can access data about themselves. Possession acts as a mechanism for asserting ownership. OCAP® Principles The OCAP® principles guide Indigenous data governance and ensure that data concerning Indigenous peoples is managed in a way that reflects their inherent rights and cultural practices: Ownership: Data and information are collectively owned by the community. It establishes a connection between First Nations communities and their cultural knowledge, distinct from stewardship (managed by external entities). Control: First Nations retain control over their data and information management processes. This extends to research design, conceptual frameworks, and data review processes, ensuring autonomy. Access: Indigenous communities have the right to access their collective information, regardless of its current location. Decisions about access and use rest with the community. Possession: While distinct from ownership, possession of data ensures that data is protected from breaches and misuse, reinforcing the community's ownership rights. CARE Principles The CARE principles build on OCAP® by emphasizing collective benefit, authority, responsibility, and ethics in data governance:  Collective Benefit: Data should support inclusive development, innovation, and equitable outcomes for Indigenous communities. Authority to Control: Indigenous communities must have the authority to manage their data, respecting their worldviews and self-determination. Responsibility: Ensures data governance minimizes harm, upholds justice, and strengthens capacity-building for Indigenous peoples. Ethics: Promotes positive relationships, Indigenous languages, and cultural preservation while fostering trust and equity. Framework for Working with Indigenous Principles at ICES ICES collaborates with Indigenous communities to ensure ethical data governance and mutual benefit: 1. Indigenous Research Ethics: Engages Indigenous communities in the research process, promoting capacity-building and mutual respect. 2. Ethical Relationships: Formalized agreements ensure trust and privacy in data sharing. 3. Indigenous Data Governance Principles: Collaborative projects adhere to OCAP® principles, empowering communities to guide data collection and analysis. 4. Evidence to Build Policies: Uses culturally relevant data to inform health programs and policies. 5. Methodology and Approaches: Incorporates Indigenous perspectives on well-being, addressing data gaps and ensuring culturally appropriate analysis. Barriers in Data Sharing Several systemic barriers hinder equitable data governance for First Nations communities: Recognition Limitations: Most First Nations are not recognized as “governments” under Canada’s Access to Information Act (ATIP), restricting their ability to engage in confidential data exchanges. Legislative Constraints: ATIP allows the government to withhold data under broad categories, such as ongoing investigations or economic interests. Data Control: Indigenous Affairs and Northern Development Canada controls over 200 categories of data related to Indigenous peoples, limiting direct community access. First Nations Data Sovereignty First Nations data sovereignty asserts that Indigenous peoples have the inherent and constitutionally protected right to control their data. Definition: Managing data in accordance with Indigenous laws, practices, and customs.  Accountability: Communities are responsible for the ethical use and management of their data. Connection to Cultural Rights: Data sovereignty supports the protection and development of cultural heritage, traditional knowledge, and intellectual property rights. Self-Determination Self-determination is a foundational right outlined in Article 3 of the UN Declaration on the Rights of Indigenous Peoples (UNDRIP): “Indigenous peoples have the right of self-determination to freely determine their political status and pursue their economic, social, and cultural development.” Scope: Includes governance over education, health, law, and cultural heritage. International Recognition: Self-determination is a globally acknowledged principle but requires local implementation to address colonial legacies. Empowerment: Enables Indigenous peoples to design and control systems that reflect their values and priorities. Indigenous Women in Diplomatic Spaces Indigenous women face unique challenges in advocating for their rights within international and domestic frameworks: Dual Advocacy: Women’s rights are recognized in international forums, but Indigenous rights are less established. Indigenous women often face a dichotomy of advocating as women or as Indigenous peoples, with limited intersectional spaces. Trade-offs: Advocacy in women’s rights movements often overlooks Indigenous-specific issues, while Indigenous rights movements may marginalize gender concerns. Creating Spaces: Indigenous women establish platforms at local, state, regional, and global levels to address their dual identities and pursue both individual and collective rights. Barriers in Treaty Processes: Traditional treaty-making and legal standard-setting have often excluded Indigenous women, necessitating new frameworks that incorporate their voices and experiences. Lecture 2 Continued: Research Questions Evaluating Your Research Question A good research question should: Be of interest to the researcher and others, addressing either a new issue/problem or shedding light on a previously researched topic. Be researchable within the available time frame and resources, with a feasible methodology. Be measurable, producing data that can be supported or contradicted.  Avoid being too broad or too narrow. Follow FINERMAPS criteria: Feasible, Interesting, Novel, Ethical, Relevant, Manageable, Appropriate, Potential value & Publishability, Systematic. PICO(T) Framework P – Population I – Intervention or Exposures C – Comparison O – Outcome T – Timeline Examples: 1. Can music therapy help autistic students improve their communication skills? ○ Population: Autistic students ○ Intervention: Music therapy 2. How effective are antidepressant medications on anxiety and depression in pregnant women? ○ Population: Pregnant women with anxiety and depression ○ Intervention: Antidepressants 3. How does race impact help-seeking for students with mental health diagnoses? ○ Population: Students with mental health diagnoses, students of minority races ○ Comparison: Students of different races ○ Outcome: Seeking help for mental health issues PEO Framework P – Population E – Exposures O – Outcome Focuses on associations between exposures/risk factors and outcomes. Example: How do preparation programs (E) influence the development of culturally safe teaching (O) among nurse educators (P)? SPIDER Framework S – Sample PI – Phenomenon of Interest D – Design E – Evaluation R – Research Type Focuses on experiences or perspectives, often used in qualitative or mixed methods research. Example: What are the experiences and perspectives (E) of undergraduate nursing students (S) in clinical placements within prison healthcare settings (PI)? Design: Interview and surveys Evaluation: Attitudes, experiences, and reflections on learning Research Type: Qualitative, quantitative, or mixed methods SPICE Framework S – Setting P – Perspective I – Intervention/Interest/Exposure C – Comparison E – Evaluation Used to evaluate outcomes of a service, project, or intervention. Example: What are the impacts and best practices for workplace (S) transition support programs (I) for the retention (E) of newly hired, new graduate nurses (P)? Comparison: No or limited transition support/orientation Evaluation: Retention of newly hired nurses PCC Framework P – Population C – Concept C – Context Designed for broader scoping questions. Example: How do nursing schools (Context) teach, measure, and maintain nursing students' (P) technological literacy (Concept) throughout their educational programs? These frameworks provide structured approaches to formulating clear and actionable research questions tailored to specific study designs and objectives. Intergenerational and Ongoing Impacts of Colonization on Public Health Public Health: Definitions University of Toronto Definition: Ensuring safety and improving population health via education, policies, and research.  Johns Hopkins University Definition: Focus on preventing diseases and implementing solutions on a large scale with communities. Acheson & WHO (1988): Preventing disease, prolonging life, and promoting health through organized societal efforts. WHO Expanded Definition: ○ Aims for health and well-being across the population spectrum. ○ Goes beyond eradicating diseases to promoting broader health strategies. Ten Essential Public Health Functions 1. Health Surveillance: surveillance of population health and wellbeing 2. Emergencies: monitoring and response to health hazards and emergencies 3. Health Promotion: Reducing inequities and promoting broader health determinants. 4. Evaluation: Measuring health programs' effectiveness, accessibility, quality of personal and population-based health service 5. Governance: Establishing laws and structures for public health. 6. Sustainability: Financing and sustainable health systems. 7. Prevention: Disease and health condition prevention, including early detection of illness 8. Protection: health protections including environmental, occupational, food security, and others, and assuring governance for health and wellbeing. 9. Research: Advancing public health research to inform policy practice 10. Workforce Development: Training competent health professionals and ensuring sustainable organizational structures and financing The Ottawa Charter for Health Promotion (1986) Endorsed at WHO International Conference in 1986 in Ottawa and Core Focus: Universal approach to "Health for All." associated with establishing health promotion Key Critiques: ○ Lack of representation from developing nations. Top-down approach focused on industrialized countries ○ Attendance at conference was by invitation only; 38 largely wealthy nations with only 2 indigenous representative referencing having indigeneity ○ Reading material dictated by WHO established the premise for the charter ○ The reading material included language claiming a collective view of humanity and health depicting a homogenous population; individualist worldview in contrast to other models of health and wellbeing ○ Representation of otherness in the reading material; what ‘we’ do for the ‘other’ ○ Dominance of Eurocentric, individualistic frameworks.  ○ Failure to account for cultural diversity, particularly Indigenous perspectives and the voices of developing nations Health Promotion Defined as enabling individuals and groups to control and improve their health. A positive concept emphasizing social and personal resources as well as physical capacities. Reaching complete physical, mental, and social wellbeing necessitates being able to identity and realize aspirations, to satisfy needs, and to change or cope with the environment Responsibility of the health sector but goes beyond healthy lifestyles to wellbeing Health promotion policy Requires an inclusive approach addressing inequities via legislation, fiscal measures, taxation, and organizational change that lead to health, income, and social policies that foster greater equity Joint action contributes to ensuring safer and healthier goods and services, healthier public services, and cleaner environments Requires the identification of obstacles to adopting healthy public policies in non-health sectors, and ways of removing them in order to make the healthier choice the easier choice for policy makers as well Indigenous health policy patchwork Overview: ○ A fragmented system of policies and programs serves First Nations, Inuit, and Métis communities. ○ The system includes both formal policies/legislation and informal arrangements. Policies and Legislation: ○ Formal Documents: Shape institutional arrangements and denote a long-term commitment. Can include laws, regulations, or structured programs. These documents may be amended or repealed, reflecting adaptability to changing needs. ○ Informal Arrangements: Serve as tools to bridge jurisdictional gaps. Limitations: Lack of documentation, leading to uncertainty and variability. Subject to changes in government policies, funding cuts, or shifts in staff, which can cause instability in service delivery. Health Services for Indigenous People Non-Insured Health Benefits (NIHB): ○ A program covering essential health services for all status First Nations and Inuit. ○ Examples of covered services: Prescription medications, dental care, medical supplies, and transportation for medical reasons. Provincial and Territorial Health Services: ○ Delivered as per the Canada Health Act (1984). ○ Services are designed to meet both national and local priorities: Some services are complemented by provincial/territorial initiatives based on specific regional needs. ○ Applies to: Métis. Off-reserve registered and non-registered First Nations individuals. Inuit living outside their traditional territories. Who Is Responsible for Supporting Indigenous Health? Section 73 of the Indian Act: ○ Grants the federal government authority to create regulations related to medical treatment and public health for First Nations. ○ Limitations: Does not establish a clear obligation for service provision. Insufficient for a comprehensive regulatory framework on health and public health services for reserves. Key National Health Policies: ○ 1979 Indian Health Policy: Focuses on shared responsibility for health services between governments and communities. ○ 1989 Health Transfer Policy: Emphasizes community-based health services and allows Indigenous communities to manage some health programs regionally. Public Health Agency of Canada (PHAC): ○ Established in 2004. ○ Offers off-reserve health programs, but jurisdictional clarity regarding provinces and territories is absent. Decentralized Models of Health Care Delivery: Decentralized Models of Health Care Delivery:  ○ Implemented by most provinces and the Northwest Territories (NWT). ○ Involves transferring authority from centralized Departments of Health to Regional Health Authorities (RHAs). Purpose: ○ RHAs are responsible for: Priority setting: Determining health service priorities for the region. Resource allocation and management: Ensuring efficient use of healthcare funds and resources. ○ Intended to increase citizen engagement by addressing local needs more effectively. Challenges: ○ Limited to no mechanisms for Indigenous representation within RHAs. ○ Lack of entrenched structures often excludes Indigenous perspectives from decision-making processes. Indigenous Determinants of Health The concept of Indigenous determinants of health (DoH) refers to the broad range of social, economic, environmental, and political factors that impact the health and well-being of Indigenous populations. These determinants are organized into three categories: proximal, intermediate, and distal, each influencing health at different levels. Proximal Determinants Definition: Proximal determinants are the factors that directly impact an individual's physical, emotional, mental, or spiritual health. ○ These are the immediate conditions that affect an individual’s day-to-day well-being and health outcomes. Key Features: ○ Direct Impact: They have an immediate effect on health, such as influencing health behaviors and mental well-being. ○ Health Stressors: Contribute to stressors that exacerbate health problems or limit an individual’s ability to make decisions about their life. ○ Examples: Health behaviors Physical environment Social environment Income and Employment Education Food Security Intermediate Determinants Definition: Intermediate determinants are the underlying factors that shape the proximal determinants of health. ○ They address the systemic causes of health disparities, such as inequities in resources, infrastructure, and access to services. Key Features: ○ These determinants are less directly visible than proximal ones, but they have significant long-term effects on health outcomes. ○ They often involve community-level and societal factors that affect the quality and availability of services and resources. ○ Root Causes: Poverty and negative physical environments are often rooted in a lack of adequate community infrastructure and resources. Examples: ○ Health and Educational Systems: Inequitable healthcare systems and educational systems act as barriers to accessing essential health services and the development of health-promoting behaviors. ○ Community Infrastructure and Resources: A lack of infrastructure (e.g., roads, healthcare facilities, housing) and limited community resources reduce the ability of Indigenous communities to address health challenges. ○ Environmental Stewardship: The ability of communities to manage their natural environment and resources, which is essential for maintaining cultural practices and health. ○ Cultural Continuity: The preservation and revitalization of Indigenous languages, traditions, and cultural practices, which promote mental and spiritual health. Loss of cultural continuity can undermine resilience and health. Distal Determinants Definition: Distal determinants represent the larger political, economic, and social contexts that influence the intermediate and proximal determinants of health. ○ These determinants are the root causes of health inequities and contribute to the creation and perpetuation of social and health disparities across generations. Key Features: ○ Broad Impact: These determinants operate at the societal and systemic level, influencing entire populations and shaping conditions at more immediate levels. ○ Long-Term Influence: Their effects are often felt over generations, influencing the overall framework within which health is experienced and understood. Examples:  ○ Colonialism: Historical and ongoing colonization practices have led to the dispossession of land, resources, and sovereignty of Indigenous peoples. This has long-lasting effects on health, social structure, and cultural identity. ○ Racism and Social Exclusion: Racism, both systemic and individual, creates barriers to accessing healthcare, education, and employment, leading to disparities in health outcomes. Social exclusion further marginalizes Indigenous populations, contributing to poor health. ○ Repression of Self-Determination: The denial of self-determination for Indigenous peoples, including the control over their own governance, healthcare systems, and cultural practices, hinders their ability to address health challenges effectively. Historical Trauma and Its Impacts Definition: Historical trauma is the collective phenomenon of trauma experienced by a group over generations, especially related to historical oppression, colonization, and violence. It encompasses: ○ Psychological: Emotional and cognitive impacts. ○ Social: Effects on relationships and community well-being. ○ Physiological: Impacts on physical health. ○ Biological: Changes in genetic expression and brain development. Cumulative and Intergenerational: ○ Cumulative: The effects accumulate over time and worsen with each generation. ○ Intergenerational: The trauma is passed down from one generation to the next, making future generations more vulnerable to its harmful effects. Current Issues Linked to Historical Trauma Residential Schools (1870s – mid-1990s): Systematic removal of Indigenous children from their families to attend church-run schools that often subjected them to abuse and neglect. Sixties Scoop (1950s – 1990s): The forced removal of Indigenous children from their families and communities by child welfare agencies. Boarding Schools (1620-1880): Early institutions established to assimilate Indigenous children, often through harsh and abusive methods. Church-Run Schools (1820s): The role of religious institutions in the forced assimilation and abuse of Indigenous children. Intergenerational Transmission of Historical Trauma The trauma inflicted upon Indigenous peoples through practices like residential schools, the Sixties Scoop, and colonial policies has far-reaching effects on subsequent generations. This trauma is transmitted through: Psychological Processes Hormones released during periods of chronic stress negatively impact the development of a healthy maternal child relationship ○ Hormones impact a child's ability to develop self-regulation skills ○ Attachment reduces stress levels and the harmful effects of hormones to early brain development ○ Children lacking parental attunement in their early years develop poor self-regulation and a higher likelihood of developing negative coping mechanisms Stressful environmental and relational factors in childhood can undermine brain development at conception and predispose individuals to adversities in life ○ Healthy development of the brain depends on healthy development of the brain stem and emotional brain ○ The brainstem and midbrain take shape period to the cortical brain during fetal development–chronic maternal stress compromises the healthy development of them Physiological Processes Stress Biomarkers: The body's response to stress involves the activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). ○ HPA Axis: Regulates cognitive, metabolic, and immune functions, influencing emotions and physical health. ○ Impact of Cortisol: Abnormal cortisol levels can lead to chronic conditions such as heart disease, stroke, cancer, diabetes, and mental health disorders. ○ SNS and Disease: Chronic stress can affect SNS function (unconscious bodily actions such as heart rate and blood pressure) contributing to physical health problems ○ Dysregulation of Stress Response: Dysregulated responses (e.g., α-amylase production) can be predictive of conditions like chronic pain, depression, and stress-related diseases. Social Processes Adverse Childhood Experiences (ACE): The trauma experienced by one generation influences the next, perpetuating cycles of dysfunction. ○ Poor Parenting and Abuse: Children of trauma survivors often experience abuse or neglect themselves, which contributes to poor mental health outcomes. ○ Cognitive and Emotional Impacts: Exposure to trauma in childhood can lead to negative coping strategies, poor self-appraisal, and emotional instability. ○ Cumulative Stress: The ongoing effects of stressors in one generation lead to poorer health and mental well-being, which are transmitted to the next generation.  ○ Parenting Deficits: Trauma survivors often struggle with healthy parenting due to the impact of their own childhood experiences, further perpetuating cycles of trauma. Specific Health Outcomes from Colonization (residential schools, sixties scoops, and the Indian Act) Mind, heart, body, and spirit imbalances Addictions and substance use-maladaptive coping skills Abuse among victims and their families, self-abuse and violence, suicide Crime Poverty Trauma Absence of culturally-specific parenting models Difficulty forming healthy relationships Societal response- discrimination and stigma and socioeconomic disasters Gaps in Determinants of Health for Indigenous Persons Widening Census Data Analysis (1981-2006): Studies using census data from 1981 to 2006 show that Indigenous Peoples in Australia, Canada, and New Zealand continue to experience poorer health outcomes compared to non-Indigenous persons. Over this period, the gaps in various determinants of health have either remained the same or widened in the following areas: ○ Education: In 1981, the education gap between Indigenous and non-Indigenous people was 6.6% in Australia and 10.9% in Canada. By 2006, these gaps had increased to 19.5% in Australia and 25.2% in Canada. This indicates a growing disparity in educational attainment, which can have long-term effects on employment, income, and health. ○ Unemployment: In 1981, the unemployment gap between Indigenous and non-Indigenous people ranged from 5.4% to 16.9%. By 2006, the unemployment gap ranged from 6.6% to 11.0%, indicating a persistent and widening difference in employment opportunities. This gap affects economic stability and access to health resources. ○ Income:  In 1981, the income gap between Indigenous and non-Indigenous persons ranged from 77.2% to 45.2%. By 2006, this gap had increased to 80.9% to 54.4%, demonstrating that Indigenous people are still significantly disadvantaged in terms of economic resources. Income is a key determinant of health as it influences access to healthcare, housing, and nutrition. ○ Overall Disadvantage: Despite improvements in some areas, Indigenous persons continue to face the same disadvantages in 2006 as they did in 1981, especially in terms of income, education, and employment. Source: Mitrou et al., BMC Public Health, 2014;14:201. Creating Conditions for Indigenous Health Equity Achieving health equity for Indigenous peoples requires addressing a wide range of economic, social, environmental, and political factors. The following elements are essential to fostering conditions for equity: Investment and Coordination: To close the health gap, there must be significant investment in social, economic, environmental, and political factors. Coordination across sectors is necessary to improve the health outcomes of Indigenous populations. Cultural Contexts and Histories: Efforts to create health equity must take into account the unique cultural, historical, and social contexts of Indigenous peoples. This includes respecting Indigenous knowledge systems, traditions, and ways of life when designing health programs and services. Understanding the Indian Act: ○ The Indian Act is a Canadian law that governs the rights and privileges of Indigenous peoples in Canada, and it has a deeply problematic foundation. ○ The Act is based on the assumption that Indigenous people are inferior, unequal, and uncivilized. This discriminatory perspective continues to shape the implementation of health policies, leading to barriers in accessing services and perpetuating inequities. Perpetuation of Racism, Sexism, and Discrimination: ○ The Indian Act continues to perpetuate systemic racism, sexism, and discrimination against Indigenous peoples. This institutionalized  discrimination is reflected in policies that limit access to services, benefits, and healthcare. ○ The Indian Act reinforces stereotypes about Indigenous peoples and perpetuates their marginalization in Canadian society. Indian Act – Racism and Sexism Discriminatory Legislation: ○ The Indian Act is a key piece of Canadian legislation that continues to limit the access of Aboriginal peoples to various services and benefits based on a descent criterion. ○ This criterion establishes eligibility for certain rights and benefits solely based on whether an individual has Indigenous ancestry, which has led to unequal treatment of Indigenous peoples. Gender Bias in the Indian Act: ○ The Indian Act has historically been gender-biased and has imposed discriminatory practices based on gender, particularly in how it treats Indigenous women. ○ For example, the Act has historically disenfranchised Indigenous women, particularly when they married non-Indigenous men. Their status and the status of their children were often stripped, leading to a loss of rights and benefits. ○ This gender bias in the Indian Act has contributed to the further marginalization of Indigenous women and their communities, reinforcing historical and ongoing inequities in health, economic, and social outcomes. Self-Determination in Healthcare Examples: ○ Tajikeimik (Mi'kmaw Health and Wellness): Focus on culturally safe health systems. ○ First Nations Health Authority (British Columbia): Indigenous-led health governance. Pathways to Indigenous Health Equity 1. Address social and economic inequities. 2. Challenge systemic barriers perpetuated by laws like the Indian Act. 3. Promote Indigenous knowledge and cultural frameworks. Indigenous Women's Sexual and Reproductive Health and Motherhood Indigenous Women in Canada in 2006: This data from Statistics Canada offers a detailed demographic breakdown of Indigenous women across Canada: Total Indigenous Population: 600,695 females (51.2% of Indigenous population). First Nations Women: 359,975 females (59.9% of Indigenous population). Métis Women: 196,280 females (32.7% of Indigenous population). Inuit Women: 25,455 females (4.2% of Indigenous population). Multiple Indigenous Identities: 4,055 females (0.7% of Indigenous population). Other: 14,930 females (2.5% of Indigenous population). Regional Distribution of Indigenous Females in 2006: Indigenous females made up significant proportions of the female populations in specific regions: ○ Manitoba: 16% of all females. ○ Saskatchewan: 15% of all females. ○ Alberta: 6% of all females. ○ British Columbia & Newfoundland and Labrador: 5% of all females. ○ Other Provinces: 3% or less. Territorial Breakdown: ○ Northwest Territories: 52% of females were Indigenous. ○ Yukon: 26% of females were Indigenous. ○ Nunavut: 86% were Inuit. Provincial Distribution: ○ The largest number of Indigenous females (124,900) resided in Ontario, making up 21% of Indigenous females in Canada. ○ Other significant populations were in British Columbia (17%), Alberta (16%), Manitoba (15%), and Saskatchewan (12%). ○ The Métis population was most prevalent in Alberta (22%), while Inuit females predominantly lived in Nunavut (48%). Age Distribution of Indigenous Females in 2006: Median Age: ○ Indigenous females had a median age of 27.7 years, compared to 40.5 years for non-Indigenous females (a gap of almost 13 years). ○ Inuit females had a median age of 22.3 years, First Nations females had a median age of 26.4 years, and Métis females had a median age of 29.9 years. Age Breakdown: ○ 46% of Indigenous females were children and youth:  28% were under 15 years of age. 18% were aged 15-24 years. ○ Among Inuit females, about 34% were under the age of 15, 31% of First Nations females, and 24% of Métis females were in this age group. Life Expectancy at Birth, by Indigenous Identity (Canada, 2001): Residential Schools and Their Impact on Indigenous Women: First Nations Women: Off-Reserve First Nations Women: ○ 12% of First Nations women ≥ 25 years living off reserve attended residential schools. ○ About 1 in 5 First Nations women ≥ 55 years had attended residential schools. On-Reserve First Nations Women: ○ 20% of First Nations women ≥ 18 years living on reserve attended residential schools (as per the 2002/2003 RHS). Inuit Women: Inuit Women: ○ 19% of Inuit women ≥ 25 years attended residential schools.  ○ The highest rates of attendance were among Inuit women aged 45-54 years (40%) and 55-64 years (31%). Métis Women: Métis Women: ○ Only 3% of Métis women ≥ 25 years reported attending residential schools. Intergenerational Impact: Among Indigenous women ≥ 15 years: ○ 34% of First Nations women living off reserve had a parent or grandparent who attended residential school. ○ 15% of Métis women had a parent or grandparent who attended residential school. ○ 21% of Inuit women had a parent or grandparent who attended residential school. Lone Parents (2006): Prevalence of Lone Parenthood: ○ 18% of Indigenous women ≥ 15 years were heading families on their own, compared with 8% of non-Indigenous women. ○ 20% of First Nations women ≥ 15 years were lone parents, while 17% of Inuit women and 14% of Métis women fell into this category. Family Size in Lone-Parent Households: ○ Lone-parent families headed by Indigenous women tend to be larger compared to non-Indigenous women: 22% of Indigenous female lone parents had 3 or more children, more than double the rate of 10% for non-Indigenous lone parents. Among First Nations and Inuit women: 25% of First Nations female lone parents had 3 or more children. 23% of Inuit female lone parents had 3 or more children. 16% of Métis female lone parents had 3 or more children. Fertility Rates: Comparison of Fertility Rates: ○ Fertility rates for Indigenous women were higher than for non-Indigenous women: From 1996-2001, the fertility rate for Indigenous women was 2.6 children, compared to 1.5 children for all Canadian women. Inuit women had a fertility rate of 3.4 children, First Nations women had 2.9 children, and Métis women had 2.2 children. Teen Parents (2006):  Teenage Motherhood: ○ 8% of Indigenous teenage girls (ages 15-19) were parents, compared to 1.3% of their non-Indigenous counterparts. ○ Among Indigenous groups: 9% of First Nations and Inuit teenage girls were parents. 12% of First Nations teenage girls living on reserve were parents. 4% of Métis teenage girls were parents. Fertility Rates for Status First Nations Teens: ○ Between 1986-2004, the fertility rate for Status First Nations teenage girls aged 15-19 was 6 times higher than that of other Canadian teens. ○ In Manitoba, the fertility rate for Status First Nations teenage girls from 2000-2004 was 125 births per 1,000 women, the highest of all provinces. Impact of Early Motherhood: ○ Early motherhood increases the vulnerability of young First Nations women, especially given socio-economic disadvantages due to their cultural background and gender. Forced Sterilization of Indigenous Women Historical Context: Forced Sterilization in British Columbia (1961): ○ Dr. Tecson, a psychiatrist, recommended sterilization for a 22-year-old Indigenous woman, citing her "mental defect" and promiscuous behavior. The rationale was to prevent her from having "illegitimate children" that the community would have to care for. Sterilization in Ontario and Northern Canada: Eugenics Movement: ○ Sterilization was a public measure supported by the eugenics movement in the early 20th century. ○ The industrialization and capitalist policies contributed to poverty, illness, and social problems among marginalized groups. ○ Rather than addressing these issues through improved public health measures, society targeted the poor and marginalized groups, particularly Indigenous women, as the source of these problems. Targeting Indigenous Women: ○ Sterilization practices were carried out largely by eugenically minded doctors in Ontario and Northern Canada.  ○ These procedures were often implemented without formal legislation and aimed to control Indigenous women’s reproduction, aligning with state interests. ○ While upper and middle-class women were encouraged to reproduce, Indigenous women living in poverty were seen as a threat to social order. Forced Sterilization in British Columbia (1935–1943): Between 1935-1943, 57 out of 64 individuals sterilized in British Columbia were women. ○ In 35 cases, sterilization was recommended due to "promiscuous behavior." ○ 46 of the 57 women were single, 22 had illegitimate pregnancies, and 5 had their pregnancies terminated prior to or during the sterilization procedure. ○ While ethnicity was not always documented, some of the sterilized women were Indigenous, as indicated by Indian Health Service records. Lack of Documentation: The extent of sterilization among Indigenous women remains unclear. Indian Health Services were aware of sterilizations occurring outside of legal channels but failed to condemn such actions. Sterilization was often performed under the guise of other medical procedures (e.g., caesarean sections), with unnecessary removal of fallopian tubes or procedures lacking proper justification. Allegations of non-consensual sterilization continued into the 1970s in Northern Canada and Alberta Birth Alerts as Barriers to Motherhood What is a Birth Alert? Definition: A birth alert is a notification sent by children's aid societies to hospitals when they believe a newborn may be in need of protection. The alert is meant to inform the hospital and child welfare authorities of potential concerns regarding the child's safety or well-being. Impact of Birth Alerts on Indigenous Women: Disproportionate Impact on Indigenous Women: ○ Birth alerts disproportionately affect Indigenous women, often leading to infant apprehensions soon after delivery. This practice is particularly damaging for Indigenous communities, where the history of child apprehension has caused intergenerational trauma.  ○ The unwritten practice of birth alerts frequently results in the removal of infants from their mothers, often without sufficient cause, leading to trauma for both mother and child. Deterrent to Prenatal Care: ○ The practice of birth alerts can deter at-risk women—particularly Indigenous women—from accessing prenatal care. Fear of having their child apprehended upon birth may lead these women to avoid seeking necessary healthcare during pregnancy, which further exacerbates health risks for both the mother and the child. Provincial and Territorial Policies on Birth Alerts: End Dates for Birth Alerts: ○ Alberta: 2019 ○ British Columbia: September 2019 ○ Manitoba: July 2020 ○ Ontario: October 2020 ○ Newfoundland and Labrador: June 2021 ○ Nova Scotia: November 2021 ○ Prince Edward Island: February 2021 ○ Saskatchewan: February 2021 ○ Yukon: 2019 Ongoing Practices: ○ Québec: Birth alerts are still in practice, with no known end date. ○ Despite the gradual elimination of birth alerts across various provinces and territories, newborn apprehensions continue in hospitals, signaling the persistence of child welfare interventions and their disproportionate impact on Indigenous mothers. Policy Change and Efforts Toward Reform: Ontario's 2020 Decision: ○ Ontario officially announced the elimination of the birth alert practice on July 14, 2020, recognizing the harm it causes, especially to Indigenous women. This decision marks a significant step towards a child welfare system that focuses on prevention and early intervention, rather than punitive measures that disproportionately target Indigenous communities. Missing and Murdered Indigenous Women and Girls Systemic Violence:  Definition: Systemic violence refers to violence that is not just about individual acts, but embedded in institutions and systems. It occurs through the unjust or unwarranted exertion of power within structures like government, healthcare, and law. ○ This violence is difficult to see in isolated acts, but can be understood as the result of deep-rooted societal beliefs, carried out through policies, laws, and practices within institutions. Systemic Violence in Canada: Government Policies: Decades of policies have disrupted Indigenous families and communities, including practices like the residential school system, which aimed to assimilate Indigenous children by devaluing their culture. Educational Policies: These policies attempted to eradicate Indigenous culture, resulting in cultural disintegration and loss of knowledge across generations. Inequality and Poverty: Many Indigenous women and girls face social and economic marginalization, making them more vulnerable to violence. Healthcare System: Embedded racism in the healthcare system has contributed to poorer health outcomes for Indigenous women and perpetuates a lack of physical, emotional, and mental well-being. Legal System Discrimination: Indigenous women face discrimination in the legal system, which denies them access to culturally appropriate support when escaping violent situations. 17 Themes in the Legal Strategy Coalition on Violence Against Indigenous Women (2015): 1. National Inquiry: Call for a national inquiry into violence against Indigenous women and girls. 2. National Action Plan: Need for a cross-jurisdictional, federally coordinated action plan to address violence. 3. Acknowledgment: Public condemnation by federal, provincial, and territorial governments of violence against Indigenous women and girls. 4. Public Education: Need for greater awareness and public education about violence against Indigenous women. 5. Access to Transportation: More accessible transportation services for Indigenous women, especially in remote areas. 6. International Human Rights: Full ratification of international human rights declarations, like the UN Declaration on the Rights of Indigenous Peoples. 7. Compensation and Healing: A call for compensation for families and a healing fund for survivors. 8. Root Causes of Violence: Properly resourced initiatives to address the root causes of violence against Indigenous women. 9. Indigenous-Led Programs: Programs addressing violence should be led by Indigenous people, particularly Elders, Two-Spirit people, and Indigenous women’s organizations.  10. Survival Sex Work and Trafficking: Need for measures to protect Indigenous women involved in survival sex work or sex trafficking. 11. Police-Community Relations: Better relationships between police and Indigenous communities, especially with vulnerable women. 12. Policing Accountability: Calls for more responsive, transparent, and accountable policing, particularly in investigations and prosecutions. 13. Community Justice: Adequately resourced community-based justice and restorative measures. 14. Legal Reform: Reform of discriminatory legislation, including gender discrimination under the Indian Act and matrimonial property laws on reserve. 15. Information Sharing: Better sharing of information regarding violence against Indigenous women. 16. Access to Supports: Access to more culturally appropriate supports for Indigenous women to leave violent situations. 17. Gender-Based Violence: Recognition of and actions to address the specific needs of Indigenous women experiencing gender-based violence. Vulnerability Factors – Murdered Indigenous Women (2015): Statistics (comparison between Aboriginal and Non-Aboriginal females): ○ Employment Rate: 16% for Indigenous women vs. 40% for non-Indigenous women. ○ Alcohol and Drug Use: 63% of Indigenous women were more likely to have consumed intoxicants prior to the incident, compared to 20% for non-Indigenous women. ○ Involvement in Illegal Activities: 18% of Indigenous women were involved in illegal activities for income, compared to 8% of non-Indigenous women. ○ Sex Trade: 12% of Indigenous women were involved in the sex trade, compared to 5% of non-Indigenous women. ○ Criminal Record: 44% of Indigenous women had a criminal record, compared to 13% of non-Indigenous women. ○ Age: Indigenous women are younger on average (29 years) compared to non-Indigenous women (36 years). Missing and Murdered Indigenous Women in Canada: Statistics: ○ In 2013, there were 671,554 Indigenous females in Canada, making up 4.3% of the female population. ○ 1,181 Indigenous females have been recorded as missing or murdered (as of 1980-2012).  225 cases are missing, which represents 11.3% of all missing females on record. 1,017 cases were murdered, representing 16% of all murdered females on record, and 5% of all murders in Canada. Unsolved Homicides: ○ 88% of Indigenous homicides (897 of 1,017) have been solved, compared to 65% of non-Indigenous homicides. Overrepresentation of Indigenous Women: Indigenous women are overrepresented in homicide and missing persons statistics. This indicates a systemic pattern of violence and neglect, disproportionately affecting Indigenous women compared to non-Indigenous women in Canada. National Inquiry into Missing and Murdered Indigenous Women and Girls Overview of the Inquiry: The National Inquiry into Missing and Murdered Indigenous Women and Girls was conducted from September 2016 to December 2018. The inquiry gathered evidence from a variety of sources: ○ Community and institutional hearings. ○ Past and current research. ○ Collaboration with Elders and Knowledge Keepers. ○ Forensic analysis of police records. ○ Testimonies from over 1,400 witnesses, including survivors, families of victims, and subject-matter experts. The final report, titled "Reclaiming Power and Place", was released in June 2019. It consisted of two volumes and a supplementary report on genocide, alongside 231 "Calls for Justice" aimed at governments, institutions, and individuals. Key Findings from the Inquiry (2019): High Rates of Violence: ○ Indigenous women and girls experience high rates of domestic and family violence, as well as stranger violence. ○ They are more likely to be killed by acquaintances than non-Indigenous women and are 7 times more likely to be targeted by serial killers. ○ Indigenous women face more severe forms of physical assault and robbery than other groups in Canada. ○ They are 3 times more likely to be sexually assaulted compared to non-Indigenous women.  ○ The majority of women and children trafficked in Canada are Indigenous. Overarching Findings: Systemic Violations: The inquiry determined that systemic racial and gendered human rights violations against Indigenous women, girls, and 2SLGBTQQIA people are a major cause of the disappearances, murders, and violence they face. This violence was categorized as genocide. International Treaties: Canada has signed or ratified numerous international declarations and treaties related to the rights, protection, and safety of Indigenous women, girls, and 2SLGBTQQIA people, but fails to implement them effectively or hold violators accountable. Displacement from Leadership Roles: The inquiry found that Indigenous women and 2SLGBTQQIA people have been displaced from their traditional roles in governance and leadership by the Canadian state, continuing to experience violations of their political rights. Self-Determination and Self-Governance: There was a strong recognition that self-determination and self-governance are fundamental Indigenous and human rights and should be central to the inquiry's recommendations. ○ In service delivery for Indigenous women and 2SLGBTQQIA people, barriers exist due to underfunded and temporary services that are often deficit-based, failing to support long-term self-determination and capacity-building for these communities. Calls for Justice: The inquiry included 231 "Calls for Justice" aimed at various levels of government, institutions, and individuals to address these issues, emphasizing the need for fundamental changes in how Indigenous women and 2SLGBTQQIA people are treated by both the state and society. Hitchhiking and Missing and Murdered Indigenous Women: A Critical Discourse Analysis of Billboards on the Highway of Tears - Morton, 2016 Hitchhiking, framed as contentious mobility, supports the construction of missing and murdered Indigenous women as willing, available and blame-worthy victims What is the Highway of Tears? The Highway of Tears refers to a stretch of highway (Highway 16) in northern British Columbia, Canada, known for the disappearance and murder of numerous Indigenous women since the 1970s. This remote and underserviced highway is a critical case of violence against Indigenous women, with the relationship between mobility, space, gender and race being embodied in the acts of violence perpetrated against Indigenous women. Billboards Along the Highway of Tears The Royal Canadian Mounted Police (RCMP) in conjunction with the municipal, provincial and federal levels of government have implemented a campaign against hitchhiking on this highway. One of the major apparatuses used in this effort is the publication of large roadside billboards that indicate the dangers of hitchhiking. The response by the province is one of targeting the behaviour of Indigenous women who hitchhike. Indigenous Girls and the Violence of Settler Colonial Policing Source: Dhillon, 2015 Policing in settler colonial contexts has historically been used as a tool of control and marginalization. For Indigenous girls, this often translates into criminalization and systemic violence that contributes to their victimization. Recent Missing Mi’kmaw Women-Date: February 18, 2022 Recent cases of missing Mi'kmaw women highlight ongoing issues of violence and disappearances within Indigenous communities. February 14: Day to Honour the Lives of Missing and Murdered Indigenous Women and Girls, and 2SLGBTQQIA People February 14 is a day of commemoration in Canada dedicated to honouring the lives of missing and murdered Indigenous women, girls, and 2SLGBTQQIA people. This day serves as a moment to reflect on the ongoing violence, the systemic causes of these tragedies, and to acknowledge grassroots initiatives that continue to raise awareness and drive reconciliation efforts across Canada. Portrait of Patience Commanda, Miikinwash (from Rama First Nation) Artist: Chief Lady Bird The portrait of Patience Commanda, also known as Miikinwash, symbolizes the strength and resilience of Indigenous women, while also highlighting the ongoing injustices faced by Indigenous peoples. Patience Commanda is an important figure representing Indigenous identity, culture, and community strength within the broader fight for justice for missing and murdered Indigenous women. Indigenous Women’s Health Services and Healing What Does Mainstream Health Services Look Like in Canada? Five Canada Health Act Principles: 1. Public Administration: Health services must be publicly managed and accountable. 2. Comprehensiveness: Health services should cover all medically necessary healthcare services. 3. Universality: All residents of Canada are entitled to the same level of health services. 4. Accessibility: Health services must be accessible to all, without financial or other barriers. 5. Portability: Health services are portable across provinces and territories. What Does Mainstream Health Services Experience Look Like for Indigenous Women in Canada? Cancer – Healing with Indigenous and Mainstream Medicines: The healing of cancer involves integrating both Indigenous and mainstream medical practices, offering a holistic approach to care. Episodes on Thunder Blanket (CBC Gem) provide insight into this practice. ○ Episode 1: 15 minutes ○ Episode 4: 14 minutes, 19 seconds Maternal Healthcare and Medical Evacuation Lack of Local Birthing Services Inuit Women, Canadian Arctic: ○ Emotional, physical, and economic stress arise from having to travel away from their communities to give birth, which disrupts cultural ties and increases stress. ○ Limited choice and support regarding the place of birth and method of delivery. ○ Community birthing centers offer psychosocial benefits, including reduced family disruption, greater parent satisfaction, and increased father involvement. First Nations Women, British Columbia: ○ The loss of antenatal services in a community can result in decreased access to prenatal and postpartum care. ○ Local birth services help reinforce cultural identity, emphasizing the importance of community and kinship ties and connections to traditional territories. ○ Maternal care helps establish trusting relationships with healthcare providers, improving overall healthcare experiences. Being Indigenous While Pregnant: Judgement and Stereotypes  Indigenous Women, British Columbia: ○ Pregnancy is a time for personal growth, where women reconsider their past and make healthier choices for the sake of their children. ○ A non-judgmental, supportive healthcare environment is crucial for fostering positive relationships between healthcare providers and patients. ○ Holistic care is emphasized, integrating cultural knowledge and personal experiences of the patient. First Nations and Inuit Women, Canadian City: ○ Racism and lack of local healthcare availability contribute to negative healthcare experiences. ○ Economic issues further exacerbate access to proper care. ○ Historical context must be considered when addressing Indigenous healthcare issues to understand the systemic challenges women face. Culture and Connection with Family in the Healthcare Setting First Nations Women, Sioux Lookout, Ontario: ○ Indigenous women were receptive to culturally appropriate healthcare programs, such as doula programs and visits from First Nations Elders. ○ The sense of safety in the hospital setting was crucial for positive experiences. ○ Much of the prenatal information came from family members rather than healthcare providers. ○ Women felt isolated during travel for intrapartum maternity care, missing their families. Health Service Providers Must Consider Historical Trauma Mothers, Remote Coastal BC Communities: ○ Pregnancy and birthing experiences are impacted by the loss of local maternity care, racism, and challenging economic circumstances. ○ The intersections of rural life, historical trauma, and colonization contribute to difficult healthcare experiences. ○ Positive outcomes occur when healthcare providers understand cultural context and establish strong connections with communities. Pregnant Indigenous Women, Wetaskiwin, Alberta: ○ The provision of culturally safe care and the removal of transportation barriers led to increased participation in prenatal care programs.  ○ Community-based care proved to be more efficient and supportive than mainstream healthcare services, emphasizing self-determination in healthcare delivery. Indigenous Birthing Practices Midwives Traditional Midwife Roles: ○ The role of the traditional midwife is multi-faceted, encompassing various duties such as teacher, healer, caregiver, nurturer, dietician, deliverer, and a spiritual partner in some communities. For example, the Nishnawbe Aski Nation describes the midwife as a “do-dis-seem” who becomes spiritually connected to the child through the cutting of the umbilical cord. ○ The word midwife varies across Indigenous languages: Mohawk: "She is pulling the baby out of the earth." Nuu-chah-nulth (BC): "She who can do everything." Ojibwe: "The one who cuts the cord." Cree: "The ones who deliver." Childbirth Mi’kmaq (Nova Scotia) and Inuit (Northern Communities): ○ In these communities, it’s believed that a mother should remain quiet during labor to avoid discouraging the baby or indicating a lack of courage or concentration. The belief emphasizes spiritual connection during childbirth. Native American and Inuit Populations: ○ Knots are avoided during pregnancy, especially during childbirth, as they are thought to increase the risk of nuchal cords (cord around the neck). Indigenous Practices Around Health and Healing Breastfeeding Common among North American Indigenous Populations: ○ Breastfeeding is typically practiced for at least two years. ○ First foods for infants often include meat or fish broth introduced between two months and one year of age, as seen among the Alberta Woodland Cree. Connection to the Land  Sacred Practices: ○ The umbilical cord is often kept as a sacred object in many communities. Among the Chippewa, the cord was stored in a small bag attached to the cradleboard, later dropped during a hunting trip to assist the child in becoming a good hunter. Caring for Mother and Baby Post-birth Care: ○ After childbirth, mothers are often isolated to recover and to receive natural remedies. This care is important not only for the mother's wellbeing but also for the child’s health and the family’s stability. Maternal Health Issues Gestational Diabetes Mellitus (GDM) Indigenous Women, Manitoba: ○ Diet and activity patterns are recognized as significant factors in managing GDM. ○ Grandmothers talk about the impact of stress and activity reduction on GDM development, while mothers recognize the physical changes in maternal size. Indigenous Women, Winnipeg: ○ Fear, anxiety, and frustration are common emotions associated with a GDM diagnosis. ○ There is a sense of social isolation, poor self-image, and feelings of failure from ineffective management. First Nations and Métis Women, Winnipeg: ○ Access to prenatal care and diabetes education is often limited due to assumptions of blame regarding GDM diagnosis. ○ Trust with caregivers is essential to improving communication and supporting GDM management. ○ Negative experiences are linked to health professionals using their position of power to enforce compliance, causing distress. Maternal Weight Changes and Breastfeeding First Nations Mothers, James Bay, Quebec Weight and Health: ○ Mothers viewed weight gain during pregnancy as necessary for milk production. ○ Cultural beliefs emphasized that breastfeeding women should eat frequently to support lactation, which inhibited postpartum weight loss.  First Nations Mothers, BC, Manitoba, Ontario: ○ Environmental factors can support or discourage breastfeeding. ○ Obstacles include a history of residential school attendance, psychological trauma, teen pregnancy, and evacuations for childbirth. ○ Fathers play a pivotal role in the decision to breastfeed. Impacts of Policies on Maternal Healthcare Pregnant or Postpartum Current or Former Smokers, Ontario Barriers to Smoking Cessation: ○ There is a need for capacity building within tobacco control services and maternal health services. ○ Barriers include geographical challenges, the absence of a provincial cessation strategy, and lack of tailored resources for Indigenous women. Recommendations: ○ Incentives, transportation support, childcare, and meals/snacks should be provided. ○ Implement woman-centered, harm-reduction approaches to reduce stigma and promote program accessibility through local venues. Impact of Policies on Maternal Healthcare for Indigenous Women First Nations Women, Saskatoon, SK: ○ Government services and short-term addiction programs with limited aftercare negatively impacted women's pregnancy, birth, and parenting experiences. ○ These women’s lives were shaped by residential school histories, negative experiences with child protection services, domestic violence, and poverty. Indigenous Women, Urban Health Centres: ○ Indigenous women with children involved in the child protection system face socio-political and economic challenges. ○ Racism, prejudice, and fear of child apprehension deter women from seeking healthcare for themselves. First Nations Women's Encounters with Mainstream Health Care Services & Systems Invalidating Encounters  Being Dismissed: Indigenous women often report being dismissed or not taken seriously by healthcare providers. Transforming One’s Self: Indigenous women may feel compelled to change or adapt their identity in order to navigate healthcare systems. Negative Stereotypes: Indigenous women face harmful stereotypes, such as being seen as uneducated or uncooperative, which affect their treatment. Marginalization: Indigenous women often find themselves marginalized within mainstream healthcare systems, where their cultural needs and concerns are overlooked. Vulnerability: These encounters can create situations where Indigenous women feel vulnerable or powerless. Disregard for Personal Circumstances: Healthcare providers may fail to consider personal, social, or cultural contexts, leading to inadequate or insensitive care. Affirming Encounters Active Participation: In affirming encounters, Indigenous women are encouraged to actively participate in their healthcare decisions, leading to greater empowerment. Genuine Care: Positive healthcare experiences are marked by feelings of being genuinely cared for and respected by providers. Cultural Affirmation: Affirming encounters allow for the affirmation of personal and cultural identity, with providers acknowledging and supporting the woman’s cultural needs. Long-term Relationships: Positive interactions with healthcare providers foster long-term, trusting relationships and a sense of security in the healthcare process. Indigenous Women Leading the Way Winona Stevenson (1999) – Nehiyaw Scholar: Stevenson describes how Indigenous women had considerable power and autonomy before and during colonization, contrasting them with European women. ○ European women were seen as fragile and weak, confined to domestic roles and dependent on men. ○ Indigenous women, on the other hand, were economically independent, actively engaged in the public sphere, and had autonomy over their sexuality, marriage, and divorce. ○ They also owned the products of their labor, marking a stark difference in gender roles and power dynamics. Notable Indigenous Leaders: Cindy Blackstock: A relentless advocate for Indigenous children's rights in Canada.  Dr. Margo Greenwood: Recognized with the Order of Canada for her contributions to health equity and Indigenous health. Madeline Dion Stout: Member of the Order of Canada for her pioneering work in Aboriginal healthcare as a nurse, researcher, and advocate. Candice Lys: Recipient of the Indspire Award, recognized for her leadership in Indigenous health services in the Northwest Territories. Culture as Healthcare - Indigenous Women’s Experiences in Thunder Bay Defining Culture Culture is defined as the customs, arts, social institutions, and achievements of a particular nation, people, or other social group. (Oxford English Dictionary) Expanding the Definition: ○ Consider incorporating Indigenous ways of knowing and understanding cultural identity as central to healthcare. Two-Eyed Seeing (Etuaptmumk) Definition: ○ From Mi'kmaw Elder Albert Marshall’s teachings, etuaptmumk means "learning to see from one eye with the strengths of Indigenous ways of knowing and from the other eye with the strengths of Western ways of knowing and using both eyes together" (Bartlett et al., 2012). Significance: ○ This approach promotes a holistic worldview where both Indigenous knowledge and Western science can be integrated in healthcare and community practices. Circle of Care Research Study Goal: To build an Indigenous Healing Program consisting of Bundles of Ceremony based on feedback from Indigenous service providers and women in Thunder Bay, Ontario. Key Components: ○ Focus on cultural and emergency services. ○ Women's input on the cultural services they use or wish to access, as well as ancestral teachings, helped shape the program. Circle of Care Materials Focus Group Elements: Ceremony  Feast Craft Relationships Focus Group Feedback: Connection with the materials: ○ Many participants expressed a desire to reconnect with their cultural practices, such as ceremonies, even after having been disconnected due to circumstances like abusive relationships or substance use. ○ Acknowledgment of the importance of ceremonies for emotional and spiritual healing. Target Audience for the Information: ○ Women who are struggling with personal issues, particularly addiction, and anyone wanting to reconnect with their culture. ○ Non-Indigenous people should learn about Indigenous culture to foster understanding and support. Self-Advocacy through Cultural Health Needs: ○ Many women felt empowered by being asked for their input, affirming that their community and cultural needs matter. ○ They noted that when Indigenous women’s needs are heard and respected, they feel important and valued. Desire for More Cultural Information: ○ One participant suggested including specific protocols around moon time and cedar during ceremonies, indicating that cultural details are essential for proper spiritual practices. ○ Moon time (a woman’s menstrual cycle) is regarded as a powerful time for ceremonies, with participants emphasizing the importance of cultural acknowledgment during this period. Family and Community Engagement: ○ There was a strong desire to make ceremonies and cultural services more inclusive of children. Participants emphasized that the next generation needs to be involved to carry on traditions and build a healthy community. Making Ceremonies More Accessible: ○ Participants suggested that cultural ceremonies, such as smudging, could be integrated into everyday life, especially in challenging situations such as addiction recovery. ○ Increasing access to cultural ceremonies was seen as a way to promote healing and sober living. How Does the Circle Project Demonstrate Culture as Healthcare?  Cultural Practices as Healing Tools: ○ Ceremony is central to the Circle of Care model, providing emotional, spiritual, and communal healing. ○ Participants recognized the value of ceremonies like smudging and sweat lodge as healing practices. Empowerment through Cultural Reconnection: ○ Engaging in cultural practices allows Indigenous women to feel connected and empowered. It provides a sense of belonging to their community and cultural identity. Holistic Approach to Health: ○ By integrating traditional knowledge and practices into healthcare, the Circle of Care project addresses the whole person: physical, mental, emotional, and spiritual health. This approach is rooted in the recognition that Indigenous culture plays a key role in health maintenance and recovery. Healing and Sobriety: ○ Ceremonial practices help promote sobriety and provide individuals with the support they need to overcome challenges, such as addiction or trauma, by fostering a sense of purpose and cultural identity. Community-Centered Healthcare: ○ The involvement of children and family in cultural practices, like learning how to make dreamcatchers, fosters intergenerational knowledge and ensures that the healing process extends beyond the individual to the broader community. Indigenous Women and the Environment Economy vs. Environment Resource Exploitation in the North Phases of Development: ○ Construction, operation, and closure phases of extractive developments are linked to negative outcomes. Impacts of Resource Exploitation: ○ Environmental Degradation: Surface disturbances caused by extractive activities, including infrastructure development, mining, and hydrocarbon production. ○ Pollution: Significant polluting wastes generated, such as tailings and wastewaters. Radiological and chemical contaminants harm the local environment around mineral processing, oil, and gas facilities.  ○ Types of Pollution: Air pollution, fuel spills, and improperly managed community wastes contribute to environmental harm. Remediation Challenges Lack of Community Inclusion: Indigenous community participation in remediation policies and practices remains poorly understood. Contamination and remediation are often viewed solely as technical or scientific issues, marginalizing contributions from Indigenous knowledge systems. Limited Role of Indigenous Knowledge: Indigenous knowledge is typically relegated to "traditional" areas such as: ○ Pre-contact cultural history. ○ Knowledge of biotic and land-based resources. The broader potential of Indigenous knowledge in environmental remediation is not fully integrated. Framing of Environmental Remediation: Remediation is often treated as an engineering and technical problem, excluding community-centered approaches. Absence of Indigenous People and Women in the Mining Industry Barriers to Participation: Indigenous women face unique barriers: ○ They often have children at a younger age and may care for more dependents than non-Indigenous women. ○ Cultural perceptions of mining work make it inappropriate for women in some communities. Workplace Realities: ○ Mining or drilling jobs may not be suitable or accessible for all individuals. Employment and Business Opportunities Opportunities Created by Resource Extraction Projects: Employment Opportunities:  ○ Indigenous women gain financial independence and self-confidence through employment. ○ Some women become primary breadwinners. Challenges in Employment: Limited Roles for Women: ○ Jobs available to women are often lower-paying and less skilled, including roles in cafeterias, housekeeping, and office work. ○ Fewer opportunities for skilled or high-paying jobs compared to men. Temporary Contracts: ○ Indigenous women are more likely to hold temporary/casual job contracts, resulting in less job security. Associated Challenges: Family Separation: ○ Shift work and fly-in/fly-out arrangements require women to be away from families and children for extended periods. ○ This separation can lead to family conflict and violence. Single Mothers: ○ Single mothers face significant challenges securing childcare while working shifts. Harassment: ○ Indigenous women are more likely to experience racialized and sexual violence and harassment in these roles. ○ Many perceive themselves as token hires in the industry. Education and Training Opportunities and Challenges Training Programs: Women are encouraged to adopt Western standards of workplace behavior, such as: ○ Changing speech patterns to fit workplace norms. ○ Demonstrating confidence, which may be perceived as "boasting." Barriers to Success: Family Dynamics: ○ Financial reliance on extended family is portrayed as a barrier to success, which conflicts with the importance of close family relationships in many Indigenous cultures. Objectification:  ○ Training programs reinforce the sexualization of women by instructing them to cover their "three Bs" (backs, breasts, and buttocks). Access Challenges: ○ Limited finances and lack of childcare prevent many women from participating in training opportunities. Negative Socioeconomic Impacts Economic Inequities: Indigenous women often face lower levels of employment, income, and well-being compared to Indigenous men. Land Claim Agreements: While these agreements are portrayed as positive steps for economic development, marginalized members of the community, particularly women, often face worsened conditions. Cost of Living: Resource extraction projects cause income-related inflation in food and housing prices. Marginalized members are less likely to benefit from increased wages and opportunities. Impact of Resource Extraction on Health Health Risks: Women face elevated risks of cancer downstream from tar sands projects. Women are more susceptible to radiation harms from uranium mining and nuclear waste. Methylmercury Contamination: Hydroelectric dams increase methylmercury (MeHg) levels in water, fish, and wildlife. Vulnerable Populations: ○ Fetuses accumulate MeHg at higher rates than pregnant women, increasing risks of intellectual disabilities, ADHD, and vision problems. ○ Women of childbearing age and children under 12 are especially sensitive. Sexual and Reproductive Health: The influx of male workers contributes to higher rates of STIs and teen pregnancies in communities. Mental Health and Substance Use Mental Health Challenges: High rates of suicide among Indigenous populations, compounded by the intergenerational impacts of colonization. Depression and anxiety tied to the boom-and-bust cycles of resource extraction industries. Substance Use: Zero-tolerance workplace policies lead to overindulgence in alcohol and drugs upon returning to the community. Substance use increases gendered and sexualized violence, particularly against women and girls. Country Food and Water Security Impact on Country Food: Resource extraction projects compromise food security for low-income Indigenous families. Many depend on country food, such as hunted game, fish, and berries, for sustenance and income. Some women generate additional income by trading inedible animal parts. Impact on Water Security: Indigenous communities rely on untreated freshwater during hunting and fishing trips for drinking, food preparation, and butchering. Fears of contamination have led many to carry bottled water instead. Culture, Rights, and Sovereignty Exclusion of Women’s Contributions: Activities traditionally performed by women, such as harvesting plants, picking berries, and gathering medicinal herbs, are often excluded from regulatory processes. Places of cultural importance to women, including those used for birthing or other traditional practices, are overlooked in environmental assessments. Loss of Cultural Knowledge:  Resource extraction keeps Indigenous people, particularly women, away from their lands, hindering the transfer of cultural teachings. Environmental accidents further limit access to land, exacerbating cultural loss. Water Safety in First Nations Communities Drinking Water Advisories (DWA) Baseline (November 2015): ○ 105 drinking water advisories on public systems in reserves. Progress (September 30, 2020): ○ Reduced to 58 DWAs, representing a 55% net decrease. ○ Greatest reduction in February 2018, with 11 advisories lifted. Long-term Drinking Water Advisories (LTDWA) LTDWA Lifted Since November 2015: ○ 147 advisories removed. Remaining LTDWAs (as of November 7, 2024): ○ 31 advisories are still active in 29 communities. Breakdown of Advisory Progress (2024): 83%: Lifted. 9%: Projects complete, awaiting lift. 6%: Projects under construction. 1%: Projects in the design phase. 1%: Feasibility studies underway. Reported Water Contaminants Types of Contaminants 1. Physical and Chemical: ○ Free chlorine residuals, mercury, lead, arsenic, phenols, dioxins, and polycyclic aromatic hydrocarbons. 2. Microbial Pathogens: ○ Bacteria: Escherichia coli, Campylobacter jejuni, Shigella spp., Helicobacter pylori, Giardia lamblia. ○ Viruses: Hepatitis A. ○ Protozoa: Cryptosporidium. 3. Improper Filtration/Chlorination:  ○ Over-chlorination and improper filtration contribute to contaminants. Health Outcomes from Contaminated Water in Indigenous Communities Reported Health Impacts (% of studies reporting): Gastrointestinal infections: 75%. Birth defects/developmental issues: 31%. Skin problems: 31%. Obesity, diabetes, and cancers: 19% each. Infant mortality, mental stress, neurological issues: 13% each. Hypertension, heart, liver, kidney diseases: 6% each. Immunopathy/autoimmune diseases, thyroid disease: 6% each. Challenges to Safe Drinking Water Remote Location: Reserves often isolated from reliable infrastructure. Raw Water Consumption: Reliance on untreated water sources. Trucked Water: Uncertainty regarding quality and delivery consistency. Operator Challenges: Difficulty in training and retaining certified water operators. Cultural Differences: Conflicts in water management approaches due to differing cultural beliefs. Women's Roles in Confronting Environmental Contamination Responsibilities of Women in Traditional Territories Childcare and Family Care: ○ Monitoring and preparing food, ensuring safety, assisted by aunties and grandmothers. Land-based Economy: ○ Economy consisted of harvesting foods and ceremonial practices of redistributing food resources to promote community well-being. ○ Facilitating intergenerational trading and fostering political relationships between Indigenous nations. ○ Governance tied to ancestral foodways and seasonal ceremonies. Women's Relationship to Water Sacred Role: ○ Water is viewed as a purifier and lifeblood for ecosystems and unborn children. Responsibilities:  ○ Ensure water cleanliness and safety. ○ Connect ceremonies and governance systems to water. Impacts of Contaminated Ecosystems Observations in Grassy Narrows and Wabauskang First Nations: ○ Declining health, especially among children. ○ Increases in neurological disorders, miscarriages, birth defects, and childhood illnesses. Causes: ○ Environmental contamination impacts ancestral food sources, leading to illnesses. Case Study: Confronting Contamination in Grassy Narrows and Wabauskang Initiatives Led by Women A’ndawenjigwe Survival Project: ○ Cultural immersion project teaching youth survival and traditional skills. Blockade on Logging Roads: ○ Physical blockade to halt logging activities and raise awareness about deforestation impacts. Collaborative Scientific Research (2001–2005): ○ Investigations into environmental contamination by Judy DaSilva, Roberta Keesic, and Betty Riffel in partnership with Indigenous and non-Indigenous scientists. Gender, Mental Health, and Resilience in Armed Conflict: Life Stories of Internally Displaced Women in Colombia The Danger of a Single Story Colombia's history is often summarized by a single narrative of a violent, tragic, and unstoppable armed conflict. This narrow portrayal distances people from the complex realities of the conflict. The study aims to amplify the voices of women who have been historically silenced and ignored, contributing to a future shaped by their true needs. The Colombian Conflict: Context and Consequences Conflict Overview: Colombia has experienced intermittent internal conflict since the 19th century, stemming from political divisions and socioeconomic disparities (Shultz et al., 2014; Suárez, 1998).  Consequences include: ○ 262,619 recorded deaths. ○ 7 million forcibly displaced people (National Center for Historical Memory, 2018). Displacement is often unidirectional, meaning many individuals are displaced permanently, sometimes across generations (Shultz et al., 2014). Conflict and Gender: War disproportionately affects women, who bear the heaviest burden of armed conflict (McKay, 2006; Tuft, 2001). In Colombia: ○ 90% of murder/disappearance victims are men. ○ Women face heightened risks of displacement, often fulfilling traditional roles (housewives, mothers, caregivers) while becoming household financial providers (Fraser, 2014; Cadavid Rico, 2014). Violence and Gender Inequality: Women are more likely to experience: ○ Poverty, due to limited access to employment and unequal distribution of unpaid care work (Goldstein, 2001; Salcedo, 2013; Salazar et al., 2018). ○ Gender-based violence, which exacerbates pre-existing inequalities and discrimination during conflicts (Gardam & Jarvis, 2006; Salcedo, 2013). Gender and Internal Displacement: Internally displaced persons (IDPs) face significant challenges at every stage: departure, transit, and arrival (Shultz et al., 2014). Women are at a greater risk of violence along displacement routes (Willers, 2016). Displacement leads to: ○ Psychological distress. ○ Risks of victimization, physical illnesses, and mental health disorders (Shultz et al., 2014). Relevance of Resilience Understanding Resilience: Despite being at increased risk, many victims of conflict and displacement do not develop mental health issues (Siriwardhana et al., 2014).  This phenomenon has driven efforts to understand mechanisms of resilience that help i