An Integrated Analysis of the Health of Indigenous Peoples in Canada

Master of Health Studies 601-Foundations of Health Systems in Canada offered an overview of healthcare in Canada and the many factors that influence the health of Canadians by exploring the Federal and Provincial Health Systems in Canada, an understanding of health and the determinants of health, using a multilevel approach to understanding health, chronic disease prevention and management, vulnerable populations and future directions of healthcare in Canada. This post will summarize these key learnings by applying these outcomes to the population of Indigenous People in Canada.

Federal and Provincial Health Systems in Canada

The Healthcare system in Canada has a twofold relationship with both the Federal and Provincial Government that is administered in accordance with the Canada Health Act. The Canada Health Act was passed in 1984 and sets the criteria for insured services and the standards that provinces and territories must abide by in order to receive federal funding. While the provinces and territories are responsible for delivery of health care services they must meet the below criteria to qualify for full federal funding:

· Public administration

· Comprehensiveness

· Universality

· Portability

· Accessibility (The Council of Canadian, n.d.).

The Healthcare system that serves Indigenous People is often complex, largely due to the 1867 British North America Act that defined health services as a provincial responsibility and Indian Affairs as an area of federal responsibility and then the years of legislative changes that followed added to the complexity. At present, “Aboriginal health policy in Canada is made up of a complicated “patchwork” of policies, legislation and agreements that delegate responsibility between federal, provincial, municipal and Aboriginal governments in different ways in different parts of the country” (National Collaborating Centre for Aboriginal Health, 2013, p. 6).

Understanding Health and Determinants of Health

Defining health can be a daunting task as it often has different meanings to different groups or populations. In 1948 the World Health Organization defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO, 1948). This definition has been argued in the literature as an unattainable ideal where imperfections must be fixed, but what actually matters to patients is how well they feel and if their impairments or imperfections affect their daily living. (Huber, 2018) This is also evident in how Indigenous People view health.

Indigenous peoples in Canada have always considered health as a holistic concept that extends beyond individual behaviors and genetics. (De Leeuw, Lindsay, & Greenwood, 2015). Figure 1 from the First Nations Health Authority depicts their holistic vision of wellness that reflects physical, emotional, spiritual and mental dimensions rather than just the absence of disease.

Figure 1. First Nations Perspective on Health and Wellness (First Nations Health Authority, 2019)

To truly explore the concept of health within a population it is essential to look at the determinants of health. The World Health Organization defines the determinants of health as environmental factors and circumstances that contribute to the health of individuals and communities. Included in these factors are: the social and economic environment, the physical environment and a person’s individual characteristics and behaviors. (WHO, 2019) Health Canada (2018) identified the determinants of health to include the following:

• Income and social status

• Employment and working conditions

• Education and literacy

• Childhood experiences

• Physical environments

• Social supports and coping skills

• Healthy behaviors

• Access to health services

• Biology and genetic endowment

• Gender

• Culture

The disproportionate burden of disparity among the aboriginal population can be noted particularly in employment rates, low income, education, and sub-standard living conditions. Furthermore, the Indigenous Population have unique determinants that have been impacted by colonialism and forced assimilation which affected land rights, culture, language and self-determination which contributed to many disparities. (Indigenous Services Canada, 2018)

Multilevel Approach to Understanding Health

When looking at a population and the determinants of health it is important to gain an understanding from multiple levels of influence. One approach is to use a theory based framework such as the social-ecological model of health which evaluates various health influences and how they interact with and affect each other at many different levels, often simultaneously and by placing those that have the most impact at the center. (White, 2015) By applying the social ecological framework to the Indigenous Population we can look at some of the contributing factors to the health disparities in the population. Willows, Hanley, & Delormier (2012) illustrate below the application of the social ecological model to the concern of childhood obesity among the Aboriginal population.

Figure 2. Socioecological Framework & Obesity among Aboriginal Canadians (Willows, Hanley, & Delormier, 2012)

By applying this framework to Indigenous health concerns it encompasses many unique influences that affect their health outcomes. The multiple levels influencing Aboriginal health are incorporated in this model, beginning at the center with individual factors and extending out to include interpersonal, community, environment, society and historical factors.

Vulnerable Populations and Chronic Disease Prevention and Management

Vulnerable populations can be described as those individuals or groups that carry a larger burden of disease or suffering when compared to other groups. Indigenous People in Canada are considered to be a vulnerable population as they experience a higher number of inequalities when compared with non-Indigenous Canadians. It is recognized that due to these inequalities Indigenous Canadians suffer a larger burden of illness as well as an earlier onset of chronic disease and disability. (Camereon, Plazas, Salas, Bearskin, & Hungler, 2014)

Although there have been some improvements seen in the health of Indigenous People there is a concern for the high burden of chronic illness among this population. Figure 3 displays the increased prevalence of chronic disease among Aboriginal Canadians when compared to non-Aboriginal Canadians. (Statistics Canada, 2015)

Figure 3. Prevalence of diagnosed chronic conditions, by Aboriginal identity group, off-reserve population aged 20 or older, Canada, (Statistics Canada, 2015)

To overcome these determinants of health and tackle the burden of chronic disease, Indigenous Services of Canada (2018), have developed a guidance framework for preventing and managing chronic disease in First Nations communities that serves to “provide broad direction and identifies opportunities to improve the access of individuals, families, and communities to appropriate, culturally-relevant services and supports based on their needs at any point along the health continuum” (p. 10).

Future Directions of Health Care in Canada

As we look to the future of the healthcare system in Canada it is important to recognize some of the major areas for improvement. The healthcare system in Canada is currently overburdened, especially with the aging baby boomer population. Some areas to focus on for future improvements would be a comprehensive information management system, seniors care due the large aging population, and chronic illness prevention and management rather than a system designed for urgent medical situations. To achieve this it will be necessary to have greater coordination among healthcare centers and to have a truly integrated system that takes a cohesive system approach to include all aspects of care such as primary care, acute care and community programs. (Riddell, 2019; Forest, & Martin, 2018; Weeks, 2014)

A major component of the future of healthcare for Indigenous people in Canada will rely on the Truth and Reconciliation Commission of Canada’s Calls to Action. The twenty-four health related Calls to Action provide a framework for moving forward within the health sector. (Truth and Reconciliation Commission of Canada, 2015; Richardason, & Murphy, 2018) There has been some scrutiny of the Canadian Government on their response to these calls to action. Beyond 94 is a website that was established by CBC to provide an up-to-date status report on each call to action. The below video gives an overview of the history of Indigenous Peoples, the Calls to Action and some of the progress made to date.

(Canadian Broadcasting Corporation, 2018)

As we look towards the future it is important to note the progress made in the province of British Columbia in terms of Aboriginal self-determination in healthcare with the establishment of the First Nation Health Authority. As Canada strives to improve the health inequities it will be important to incorporate the knowledge and preference of the aboriginal communities as was done in British Columbia. (Richmond, & Cook, 2016).

To summarize, Master of Health Studies 601 has been an incredible experience in discovering my professional identity, identifying my knowledge gaps, learning needs, and exploring the health care system in Canada. What I found most beneficial was the in-depth examination of the health of Indigenous people in Canada. Prior to MHST601, the understanding I had of Indigenous People in Canada was only the tip of the ice berg, I am happy to say that this increased knowledge can be transferred to my everyday practice especially considering my community serves the largest population of Indigenous people in Nova Scotia.

References

Cameron, B.L., Carmargo, Plazas, M., Salas, A.S., Bearskin, L.B., & Hungler, K. (2014). Understanding Inequalities in access to health care services for Aboriginal people: a call for nursing action. Advances in Nursing Science, 37(3), Retrieved from https://cloudfront.ualberta.ca/-/media/nursing/about/docs/understandinginequalities.pdf

Canadian Broadcasting Corporation. (2018). Beyond 94: truth and reconciliation Canada [video file]. Retrieved from https://newsinteractives.cbc.ca/longform-single/beyond-94?&cta=84

First Nations Health Authority. (2019). First Nations Perspective on Health and Wellness. Retrieved from http://www.fnha.ca/wellness/wellness-and-the-first-nations-health-authority/first-nations-perspective-on-wellness

Forest, P.G., & Martin, D. (2018, April 6). A plan to overhaul Canadian healthcare systems. The Star. Retrieved from https://www.thestar.com/opinion/contributors/2018/04/06/a-plan-to-overhaul-canadian-health-care-systems.html

Greenwood, M., de Leeuw, S., Lindsay, N.M and Reading C. (Eds.). (2015) Determinants of Indigenous Peoples’ Health in Canada: Beyond the Social. Toronto: Canadian Scholars’ Press Inc.

Health Canada. (2018). Social determinants of health and health inequalities. Retrieved from

https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-

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Huber, M. (2011). Health: How should we define it? British Medical Journal, 343,(7817), 235-237. https://doi.org/10.1136/bmj.d4163.

Indigenous Services Canada. (2018). Preventing and managing chronic disease in First Nations Communities: a guidance framework [PDF file]. Retrieved from

http://publications.gc.ca/collections/collection_2018/aanc-inac/H34-313-1-2017-eng.pdf

National Collaborating Centre for Aboriginal Health. (2013). An overview of Aboriginal health in Canada.Retrieved from https://www.ccnsa-nccah.ca/docs/context/FS-OverviewAbororiginalHealth- EN.pdf

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July, 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April, 1948.

Riddell, C. (2019). The future of Canada’s healthcare system. Media Planet: Personal Health News. Retrieved from http://www.personalhealthnews.ca/news/the-future-of-canadas-healthcare-System

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Richmond, C.A.M., & Cook, C. (2016). Creating conditions for Canadian aboriginal health equity: the promise of healthy public policy. Public Health Reviews, 37(2). doi: 10.1186/s40985-016-0016-5

Statistics Canada. (2015). Prevalence of diagnosed chronic conditions, by Aboriginal identity group, off-reserve population aged 20 or older, Canada, 2006/2007. Retrieved from

https://www150.statcan.gc.ca/n1/pub/82-622-x/2010004/fig/Figure02-eng.htm

Truth and Reconciliation Commission of Canada. (2015). Truth and reconciliation commission of Canada: calls to action [PDF file]. Retrieved from http://www.trc.ca/assets/pdf/Calls_to_

Action_English2.pdf

The Council of Canadians. (n.d.). Factsheet: Understanding the Canada health act. Retrieved from https://canadians.org/healthcare/documents/Canada_Health_Act.pdf

Weeks, C. (2014, February 21). Why the future of health care may depend on tearing down the hospital. The Globe and Mail. Retrieved from https://www.theglobeandmail.com/life/health-and-fitness/health/the-hospital/the-future-of-health-care-may-depend-on-tearing-down-the-hospital/article17030106/

Willows, N.D., Hanley, A.J., & Delormier, T. (2012). A socioecological framework to understand weight-Related issues in Aboriginal children in Canada. Applied Physiology, Nutrition, and Metabolism, 37(1), 1-13. DOI: 10.1139/h11-128.

White, F. (2015). Primary health care and public health: foundations of universal health systems. Medical Principles and Practice, 24(2). DOI: 10.1159/000370197.