My search for resources and education on indigenous people in Canada was both informative, and eye opening. There are many articles that emphasize the disparities and gaps in the healthcare that the government and we as health care professionals provide. It appears Aboriginal populations in Canada do not have the same experiences as non-Aboriginal Canadians, when it comes to health and well-being. (Sampa, 2014).
After the Medical Care act was passed in 1966, health services in Canada were to “be informed by 5 principles: universality, comprehensiveness, public administration, portability and accessibility” (Chambers & Burnett, 2017). Despite the 5 principles, it remained difficult for many services to be obtained. A major interference with the quality (and equality) of care is the lack of resources for those living on-reserve. Distance plays a big part in limiting the healthcare and health promotion resources that are accessible without cost. This cost is not limited to just financial burden, but the stresses and time commitment that comes with the necessary travel. An example of this that I came across was the evacuation of Inuit mothers when they are preparing to deliver a new baby. In the 1970’s it was decided that in many northern Canadian communities, “the evacuation of all pregnant women to hospitals to give birth, often in distant southern Canada” (Sampa, 2014) was part of the official ‘standard’ of maternity care. Many of these Inuit women have reported “a lack of sensitive, culturally appropriate care” and their experience resulting in “emotional, physical and economic stressors” (Sampa, 2014). After a month, one young child didn’t even recognize her mother.
There are many other influential factors besides living environment and location. The social determinants of health (SDOH) are a major part of maintaining and improving health, and in the Aboriginal population (living on-reserve) these determinants may differ from other Canadian populations. These could include housing/living conditions, genetics/biology, sanitation and nutrition, and income and job/educational opportunities. The outcomes of pregnancy can change with the variability of SDOH, and in Aboriginal women Shah, Zao, Al-Wassia, & Shah identify:
1) Unique innate genetic characteristics
2) Reduced access to standardized prenatal care
3) Inaccurate estimation of gestational age, and subsequent complications of post-date pregnancies
4) Higher rates of preexisting medical illnesses or coexisting pregnancy related conditions (example: gestational diabetes)
5) Urinary tract infections
6) Cultural and social distinctiveness of this population resulting in variation in behaviors
7) Higher incidences of younger maternal age, multiparity and low educational attainment
(Shah, Zao, Al-Wassia, & Shah, 2011)
With these health impacts in mind, one article identified that the infant mortality rate in the Inuit population is “higher than the first nations rate and is about three times the Canadian national rate” (Waldram, Young & Herring, 2006).
The SDOH are important to consider as we grow and reduce inequalities, but our attention is also needed in reducing discrimination. While working in the Emergency Department (ED) and Neonatal Intensive Care Unit (NICU) I often witnessed the discrimination of aboriginal/indigenous populations. The ED at Rockyview General Hospital in Calgary is located very close to the Tsuu T’ina nation, and as a student there I noticed many health care providers were often quick to judge the patients, showed less empathy or compassion, and lowered the quality of care the provided as a professional. In the NICU, it was often assumed that Aboriginal babes would be screened for withdrawals (from any substance), before the doctor had put in the order. I have unfortunately witnessed the inequality of care of indigenous populations in my day-to-day practice.
So what is Alberta doing to cease the inequality of care and resources? The province has identified that indigenous health promotion, disease prevention and primary care services are needed, and received $200 million to the Aboriginal Health Transition Fund (AHTF) in 2004-2010 (Henderson, Montesanti, Crowshoe & Leduc, 2018). First Nations, Inuit and Metis peoples make up 4.3% of Canada’s population, and hopefully the country can work together to address and diminish these health disparities.
Resources:
Chambers, L., & Burnett, K. (2017). Jordan’s Principle: The Struggle to Access On-Reserve Health Care for High-Needs Indigenous Children in Canada. American Indian Quarterly, 41(2), 101–124. Retrieved from http://0-search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=rfh&AN=ATLAiB8W170911002167&site=eds-live
Henderson, R., Montesanti, S., Crowshoe, L., & Leduc, C. (2018). Advancing Indigenous primary health care policy in Alberta, Canada. Health Policy, 122(6), 638–644. https://0-doi-org.aupac.lib.athabascau.ca/10.1016/j.healthpol.2018.04.014
Sampa, J. A. K. (2014). Evidence for Equity: Public Health Examples from Aboriginal Women in Canada. Health Law Review, 22(2), 28–39. Retrieved from http://0-search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=rch&AN=108526925&site=eds-live
Shah, P. S., Zao, J., Al-Wassia, H., & Shah, V. (2011). Original article: Pregnancy and Neonatal Outcomes of Aboriginal Women: A Systematic Review and Meta-Analysis. Women’s Health Issues, 21, 28–39. https://0-doi-org.aupac.lib.athabascau.ca/10.1016/j.whi.2010.08.005
Waldram, J. B., Young, T. K., & Herring, A. (2006). Aboriginal Health in Canada : Historical, Cultural, and Epidemiological Perspectives (Vol. 2nd ed). Toronto [Ont.]: University of Toronto Press, Scholarly Publishing Division. Retrieved from http://0-search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=nlebk&AN=468769&site=eds-live
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