Education

Indigenous Awareness and Effective Strategies for Health Care: A Challenge for Community Health Nurses

By Wendy Timmermans

On January 24, 2017, I was fortunate to be able to attend a University of Alberta Alumni Panel discussion in Edmonton entitled “Indigenous Awareness and Effective Interaction Strategies for Health Care Professionals". As a Public Health care professional myself, this topic is of great interest to me given that calls for attention continue to be aimed towards the significant health and wellbeing  disparities of Indigenous peoples across Canada, along with numerous calls to action that the Truth and Reconciliation Commission of Canada put forth in its 2015 report. Admittedly I was surprised to realize how limited my knowledge has been regarding Indigenous peoples’ experiences in Canada, which is ironic when I consider who our clients are within community health, and for whom we strive to be culturally sensitive. As I continue to learn more about the history and contemporary challenges that First Nations, Métis and Inuit communities contend with, I have realized that there is a greater role for public health professionals who work for, and with, Indigenous peoples in the health care domain. Here I’d like to share with you a few considerations that were identified during the panel discussion I recently attended in Edmonton.

The “Indigenous Awareness and Effective Interaction Strategies for Health Care Professionals” keynote presentation was provided by Dr. Jaris Swidrovich, addressing common strategies and gaps in knowledge experienced by healthcare professionals treating Indigenous patients. Dr. Swidrovich is a member of Yellow Quill First Nation and was born, raised, and continues to reside in Saskatoon. He completed a Doctor of Pharmacy (PharmD) from the University of Toronto in 2013.

Throughout his presentation, Dr. Swidrovich outlined the health inequities and challenges faced by Indigenous peoples and communities. He spoke about the Human Development Index rating, in which Canada ranks #68 out of 177 countries when applied to First Nations Communities in Canada (ranking is based on criteria including life expectancy at birth, educational rankings and income rankings). He cited that “while non-Aboriginal Canadians enjoy one of the highest standards of living in the world, Aboriginal people are at the bottom of almost every available index of social economic well-being” (RCAP1996). Dr. Swidrovich outlined how colonization, loss of culture and the legacy of residential school experience is a significant social determinant of health which must recognized and addressed in conjunction with education, housing, access to health, income and other social determinants. What I found to be most relevant for myself and for Public Health is how Dr. Swidrovich described the common challenges and gaps in knowledge experienced by healthcare professionals treating Indigenous patients. Thankfully, Dr. Swidrovich followed this information with suggestions on how to increase knowledge and incorporate understanding of Indigenous culture and healing practices into health care. This included a review and discussion of six of the Calls to Action that have been published by the Truth and Reconciliation Commission of Canada in 2015. The Calls to Action identified as most relevant to health are numbered 18 to 24 of the TRC final report. The full TRC Final Report can be accessed online here.

The following Calls to Action that Dr. Swidrovich discussed in his presentation are listed under Health, beginning on page 322 of the TRC report. Indigenous health challenges and disparities in Canada are clearly complex, historically rooted and diversely experienced. As you will see, these Calls to Action must involve several levels of support, from all governments in Canada to local health practitioners and the Aboriginal peoples they serve.

Calls to Action:

18) We call upon the federal, provincial, territorial, and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties.

19) We call upon the Federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess long-term trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services.

20) In order to address the jurisdictional disputes concerning Aboriginal people who do not reside on reserves, we call upon the federal government to recognize, respect, and address the distinct health needs of the Métis, Inuit, and off-reserve Aboriginal peoples.

21) We call upon the federal government to provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools, and to ensure that the funding of healing centres in Nunavut and the Northwest Territories is a priority.

22) We call upon those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.   

23) We call upon all levels of government to:

I.Increase the number of Aboriginal professionals working in the health-care field.

II.Ensure the retention of Aboriginal health-care providers in Aboriginal communities.

III.Provide cultural competency training for all health-care professionals.

24) We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism (TRC Canada 2015: 322-323).

These calls for action may seem intimidating: they are broad, multi-layered, and even perhaps beyond the scope of one’s position as a health care professional. However, maybe the best way to move forward in improving health outcomes is for us all to become informed, to increase awareness and understanding of the context through which these Calls to Action were created. This may be done through community meetings, workplace conversations, and/or through dialogue with Aboriginal communities and clients. Or if you are similar to me, perhaps as a health-care professional your role in this transition might begin by attending local conferences and presentations, or by reading through the full Truth and Reconciliation Commission report. There are many ways that health care professionals can increase their awareness and develop effective ways to serve their Indigenous clients. During the presentation I attended, I was pleased to discover that there are numerous health care professionals – including Dr. Swidrovich – who have already begun working to improve the health and wellbeing of Indigenous peoples in Canada. With an open mind and willingness to listen to all voices in our society, I believe that health care professionals have a significant role to play in these changes – so long as we all choose to do so.

In 1986, Health and Welfare Canada presented “Achieving Health for All: A Framework for Health Promotion” which serves as the foundation for much of our community health practice today. I have found that this framework is as relevant now as it was in 1986, especially if one inserts ‘Aboriginal Communities’ into its mandate. The gaps in health outcomes and indicators between Aboriginal and non-Aboriginal peoples must be diminished, and perhaps the “Health for All” framework is a means to accomplish this.

While the panel discussion and key-note presentation delivered by Dr. Swidrovich proved to be very enlightening for me, it also caused within me a deep feeling of distress in becoming aware of my own ignorance and naiveté regarding  the historical and contemporary challenges facing Indigenous peoples in Canada today. I have always believed in and promoted health care that is equal and accessible to all people in our communities and our country, and to learn that this has not been true has provided a sharp wake-up call for me as a health care professional. However, what I do know for certain is that Community Health Nurses have tremendous strength and capacity to effect change in our communities, and this gives me a warm hope for the future of community health care and Indigenous peoples in Canada. There is a great deal of work to be done in “Achieving Health for All”, and one first step, the very least that Community Health Nurses can do, is to choose to learn more.

Submitted 2017 MAY 02.

Further resources and recommended readings:

Adelson, Naomi. (2005). The Embodiment of Inequity: Health Disparities in Aboriginal Canada. Canadian Journal of Public Health, S45-S61.

Epp, Jake. (1986). Achieving Health for All: a Framework for Health Promotion.  Ottawa: Health and Welfare Canada, p.13

Truth and Reconciliation Commission of Canada. (2015). Honouring the Truth, Reconciling for the Future. Retrieved from www.nctr.ca