A vulnerable population and hesitation marked by history

The biases I have noticed in my practice coincide with this generalized opinions about the indigenous population at large. It is accepted knowledge that the indigenous population has been widely neglected of services and dignity since the inception of The Indian Act (1876). Individuals living on reserve are essentially attempting to preserve a sense of their cultural identity. However, for the generalized public including myself, my experience in healthcare attributes peoples of this population group to have chronic illnesses and exacerbation of those chronic illnesses due to inability to manage their health choices. The community hospital I work at does not have a highly prevalent Indigenous population, however in areas away from this hospital (I.e.: Belleville, Ontario), patients may be transferred over to this facility in which there are greater number of services and more healthcare staff. Some chronic conditions such as cardiovascular disease, coronary artery disease, cancer, respiratory issues, HIV/AIDS and especially diabetes are seen as conditions where indigenous peoples have the greatest complications to their conditions (Richmond & Cook, 2016). Many of these complications and conditions exist at all because of the poor health choices that perpetuate the conditions. Lack of education, resources and financial security as furthered the social inequities. There is a great disparity apparent between (patients of similar age) and comparing an indigenous person to a non-indigenous population because of the lack of adherence social determinants of health. Indigenous people have greater rates of welfare and have a large income disparity (Richmond & Cook, 2016).

My research on the challenges of healthcare has led me to important resources

The absence of a public policy for addressing gaps in social determinants of health for indigenous peoples leads to great disparity between these peoples and the general population. However, dating back to 1876 the efforts of the government to civilize these groups of people and this continues to debilitate efforts for the groups of people be relived of social inequities and gain access to healthcare and services (Richmond & Cook, 2016). Poor coordination of services, lack of access to quality care and lack of competency of service providers highlight biggest faced issues. In Ontario, a challenge is largely due to insufficient and delayed federal investments in housing which has led to overcrowding in substandard homes, lack of adequate water and sewage systems, increasing the risk of exposure to infectious diseases and mold (Harding, 2006).

In efforts to medicate challenges to social inequity, the Canadian Human Rights Act protect indigenous peoples from discrimination in federally regulated employment, housing, services and facilities under the Canadian Human Rights Act. Examples of organizations covered by the federal law are chartered banks, airlines, federal government departments and agencies as well as First Nations governments and band councils (Ontario Human Rights Commission, 2015). The protection from discrimination is not only protected by the Canadian Human Rights Act and the Ontario Human Rights Commission (OHRC). In Ontario, the OHRC promotes, protects and advances human rights for all Ontarians including status and non status indigenous peoples. The OHRC insists that discrimination be free especially in 5 social areas: employment, housing services and facilities, unions, vocational associations and contracts or agreements. Indigenous peoples in Ontario, including status, non-status, First Nations, Métis and Inuit peoples are included in these protections (OHRC, 2015)

The CBC news had a disturbing article on a woman who had gone to the hospital for abdominal pains and was then discharged with a prescription of which contained a doodle of a “beer bottle, circled with a slash through it”. She complained to the administrators but no word of discipline for the physician (McCue, 2015). The same article suggests that pervasive racism in the healthcare setting illicit preparation from the indigenous people to be aware of what may be said to them. Some examples of negative stereotypes include: the dependence of Indigenous people on governmental funding, alcohol and drug addiction, unemployment, and violence (Harding, 2006).

In Vancouver, the same place from which this article was reported, on mediation effort to assist indigenous peoples become more comfortable in the healthcare setting was the creation of a “sacred space” room. Patients and healthcare staff are also incorporating the works of aboriginal healers to compliment their therapies. This has increased the satisfaction of patients in the hospital.  

Cultural safety is fundamental for providing adequate and safe care for the Indigenous population.  This first begins with respect for the Indigenous people, their culture and practices.  It is also very important to understand the impacts colonization, trauma and grief as they are a key step in understanding and providing culturally safe care (Dodgson, 2005). 

Indigenous people in Ontario have a reported lower life expectancy, higher infant mortality rates and more chronic and infectious disease.  The Ontario government has commissioned a $222 million investment in the First Nations Health Action Plan. This is important to the integration effort to bridge indigenous peoples to health resources and improve their choices (Mckeen, 2018).

One step towards greater involvement was by St. Michael’s Hospital (Toronto, Ontario) having developed an Aboriginal patient navigator role and a few Canadian hospitals have created Indigenous-specific programs for certain health services. Both of these interventions, and others like them, aim to serve as a bridge between Indigenous patients and the health care system (St Michael’s Hospital, 2015).

The self-reflection has led me to research about the challenges and prevalence of chronic conditions present in Canada and particularly in Ontario.

Community and Funding programs for indigenous population in Ontario are a useful resource to assist integrate and bridge gaps in their social determinants of health. The following list of community and funding programs are from the Ministry of children, community and social services (2012):

The Business and Community Fund Program

This program provides:

• grants for economic capacity-building projects in Indigenous communities and organizations

• business financing for promising community projects as well as Aboriginal-owned businesses

• funding for business support services delivered by Aboriginal Financial Institutions

Who is eligible

The following kinds of organizations are eligible to apply:

• start-up, early stage and expanding Aboriginal businesses

• First Nation, Métis and Inuit communities

• Indigenous organizations recognized by the province

Economic Diversification Grant Program

The Economic Diversification Grant program helps Indigenous communities broaden their economic base.

These grants provide project funding for initiatives that contribute to economic diversification as well as employment, training and business opportunities.

Healthy Babies Healthy Children Program

• screening and assessments to see if there are any risks that could affect a child's healthy development and referrals to community programs and services

• supports for new parents

• help in finding community programs and resources on all kinds of subjects such as: breastfeeding, nutrition and health services, parenting programs and family literacy programs

Regional Partnership Grant Program

The Regional Partnership Grant Program supports Indigenous economic development through investments in regional projects that span multiple communities and province-wide projects. These projects improve skills training opportunities and provide financing for promising projects.

These grants support projects that provide jobs, training and/or business opportunities to Indigenous people.

The Regional Partnership Grant Program can also help smaller projects with potential expand to multiple communities or go province wide.

Sample projects

Projects funded by Regional Partnership Grants may include:

• skills training initiatives (e.g., sector-specific or on-reserve business mentorship, internships, or apprenticeship initiatives that result in provincially recognized qualifications)

• regional or sector-specific business incubators or accelerator programs.

• financing in the natural resource sector for high-potential development projects, like the Ring of Fire

Funding amounts

Grants support up to 50% of eligible project operating costs for training initiatives and 100% of eligible costs for financing initiatives. You can receive a maximum of $250,000 per year, per project.

Aboriginal Healing and Wellness Strategy

These community-based programs and services are available to Aboriginal people living on-reserve and in urban and rural communities. They include:

• community wellness programs

• Aboriginal Healthy Babies, Healthy Children Program

• Counselling to address mental and emotional issues

• crisis intervention services

• healing lodges

• health care, health promotion and education

• shelters and safe houses for women escaping domestic violence and their children

• pre and post-natal care

• substance-abuse treatment centres.

The Aboriginal Healing and Wellness Strategy is a joint program between the Ontario government and First Nations and Aboriginal organizations. Five Ontario government ministries fund the strategy:

• Children and Youth Services

• Community and Social Services

• Health and Long-Term Care

• Aboriginal Affairs

• Ontario Women's Directorate

The success of the Strategy

Since it was launched in 1994, the strategy has had many successes both on and off reserve. It has:

• improved access to health care

• enhanced services to address family violence, and

• built the capacity of First Nations, Métis and Inuit communities within a holistic and culture-based framework.

Since its creation the strategy has:

• established a network of programs, including:

  • six healing lodges

  • seven family shelters

  • two family violence healing programs

  • two outpatient hostels, and

  • crisis intervention teams in 47 northern communities

• created more than 650 jobs and 460 community-based health and healing programs, and

• trained more than 1,000 staff in health and social services

(Ministry of children, community and social services, 2012)

Resources:

Dodgson J.  (2005). Indigenous women's voices. Journal of Transcultural Nursing, 16(4). https://doi.org/10.1177/1043659605278942

Harding R.  (2006). Historical representations of Aboriginal people in the Canadian news media. Discourse & Society, 17(2). https://doi: 10.1177/0957926506058059

McCue, D. (2015). Racism against aboriginal people in health-care system ‘pervasive’: study. CIBC. Retrieved from http://www.cbc.ca/news/indigenous/racism-against-aboriginal-people-in-health-care-system-pervasive-study-1.2942644

Mckeen, A. (2018). Province aims to ‘hand back’ health-care decisions to First Nations within years. The Star. Toronto. Retrieved from https://www.thestar.com/news/queenspark/2018/02/14/province-aims-to-hand-back-health-care-decisions-to-first-nations-within-years.html

Ministry of children, community and social services. (2012). Programs and support for indigineous organizations. Toronto, Ontario. Author. Retrieved from https://www.mcss.gov.on.ca/en/mcss/programs/community/programsforaboriginalpeople.aspx

Ontario Human Rights Commission. (2015). Indigineous peoples in Ontario and the Ontario human rights code (brochure). Toronto, Ontario. Retrieved from http://www.ohrc.on.ca/sites/default/files/Indigenous%20Peoples%20in%20Ontario%20and%20the%20Ontario%20Human%20Rights%20Code_brochure....pdf

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

St. Michael’s Hospital. (2015). Racism linked to illness in indigineous peoples in Canada. Toronto, Ontario. Retrieved from: http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2015/20150203_h