scholarly journals Addressing rural and Indigenous health inequities in Canada through socially accountable health partnerships

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e048053
Author(s):  
Ray Markham ◽  
Megan Hunt ◽  
Robert Woollard ◽  
Nelly Oelke ◽  
David Snadden ◽  
...  
Keyword(s):  
British Columbia ◽  
Health System ◽  
First Nations ◽  
Appreciative Inquiry ◽  
Indigenous Communities ◽  
Health Inequities ◽  
Social Accountability ◽  
Indigenous Populations ◽  
Deliberative Dialogue ◽  
Services Delivery

BackgroundThere are few examples of the practical application of the concepts of social accountability, as defined by the World Bank and WHO, to health system change. This paper describes a robust approach led by First Nations Health Authority and the Rural Coordination Centre of British Columbia. This was achieved using partnerships in British Columbia, Canada, where the health system features inequities in service and outcomes for rural and Indigenous populations. Social accountability is achieved when all stakeholders come together simultaneously as partners and agree on a path forward. This approach has enabled socially accountable healthcare, effecting change in the healthcare system by addressing the needs of the population.InnovationOur innovative approach uses social accountability engagement to counteract persistent health inequities. This involves an adaptation of the Boelen Health Partnership model (policymakers, health administrators, health professionals, academics and community members) extended by addition of linked sectors (eg, industry and not-for-profits) to the ‘Partnership Pentagram Plus’. We used appreciative inquiry and deliberative dialogue focused on the rural scale and integrating Indigenous ways of knowing along with western scientific traditions (‘two-eyed seeing’). Using this approach, partners are brought together to identify common interests and direction as a learning community. Equitable engagement and provision of space as ‘peers’ and ‘partners’ were key to this process. Groups with varying perspectives came together to create solutions, building on existing strengths and new collaborative approaches to address specific issues in the community and health services delivery. A resulting provincial table reflecting the Pentagram Plus model has fostered policies and practices over the last 3 years that have resulted in meaningful collaborations for health service change.ConclusionThis paper presents the application of the ‘Partnership Pentagram Plus’ approach and uses appreciative inquiry and deliberative dialogue to bring about practical and positive change to rural and Indigenous communities.

The Northwest Coast

Anthropology ◽  
2020 ◽  
Author(s):  
Leslie H. Tepper
Keyword(s):  
British Columbia ◽  
Material Culture ◽  
18Th Century ◽  
Indigenous Communities ◽  
Geographic Area ◽  
Theory And Practice ◽  
Indigenous Populations ◽  
Northwest Coast ◽  
European Contact ◽  
The North

The distinctive culture of the Indigenous populations on the Northwest Coast (NWC) and their colonial history—from European contact in the 17th century to contemporary issues of land claims and reconciliation—have helped to frame many of the themes and models of ethnographic theory and practice, particularly in American anthropology. The NWC is often defined as the geographic area stretching from Alaska to California. For the purposes of this bibliography, the study area is limited to what is sometimes called the “North Pacific Coast,” which begins at the southern border of Alaska, continues down the coastline of British Columbia (BC), and ends in northern Washington State. Its rocky coastline is broken up by deep fjords and offshore islands, including Vancouver Island in the south and Haida Gwaii (formerly the Queen Charlotte Islands) in the north. Several major river systems provide access to the BC interior through the mountainous Cascade Range. Though local resources vary along the coast, almost all the Indigenous groups followed a similar seasonal cycle of fishing, hunting, and gathering from spring to fall. The winter months were dedicated to the manufacture of material culture, social feasting, and ceremonial gatherings. Large oceangoing canoes and smaller river crafts linked well-established villages into an extensive series of trade routes. Walking trails over the mountains allowed the exchange of seafood and other coastal products for animal skins and goods from interior forests. Warfare brought additional wealth to the victor by means of raiding stored foods and manufactured items. European contact began in the late 18th century with the arrival of Spanish and British explorers. They were followed by English, American, and Russian fur traders. The discovery of gold along the Fraser River in 1858, and later finds in the Cariboo Mountains, brought tens of thousands of American, British, and other immigrants to the area. British sovereignty over the area north of the 49th parallel was quickly reinforced by the Royal Navy and an expanded colonial administration. In 1871 the province of British Columbia joined the Canadian Confederation and NWC Indigenous communities came under the control of the federal Indian Act. This act is still in force.

scholarly journals Qualitative Health Research Involving Indigenous Peoples: Culturally Appropriate Data Collection Methods

2016 ◽  
Author(s):  
Amy Wright ◽  
Olive Wahoush ◽  
Marilyn Ballantyne ◽  
Chelsea Gabel ◽  
Susan Jack
Keyword(s):  
Data Collection ◽  
First Nations ◽  
Indigenous Peoples ◽  
Health Research ◽  
Indigenous Communities ◽  
Indigenous Populations ◽  
Policy Statement ◽  
Culturally Appropriate ◽  
Data Collection Methods ◽  
Collection Methods

Historically, health research involving Indigenous peoples has been fraught with problems, including researchers not addressing Indigenous research priorities and then subsequently often failing to utilize culturally appropriate methods. Given this historical precedence, some Indigenous populations may be reluctant to participate in research projects. In response to these concerns, the Government of Canada has developed the Tri-Council Policy Statement (TCPS2): Research Involving the First Nations, Inuit and Métis Peoples of Canada, which stipulates the requirements for research collaborations with Indigenous communities. Utilizing this policy as an ethical standard for research practices, this paper describes, critiques and synthesizes the literature on culturally appropriate oral-data collection methods, excluding interviews and focus groups, for use with Indigenous people in Canada. Results suggest that photovoice, symbol-based reflection, circles and story-telling can be methodologically rigorous and culturally appropriate methods of collecting data with this population. Suggestions are made for researchers wishing to use these methods to promote respectful and collaborative research partnerships with Indigenous peoples in Canada.

Transforming First Nations’ health governance in British Columbia

2016 ◽  
Vol 21 (4) ◽  
pp. 229-244 ◽  
Author(s):  
John O’Neil ◽  
Joe Gallagher ◽  
Lloy Wylie ◽  
Brittany Bingham ◽  
Josee Lavoie ◽  
...  
Keyword(s):  
British Columbia ◽  
Health System ◽  
First Nations ◽  
Indigenous Health ◽  
Service Planning ◽  
Cultural Safety ◽  
Health Governance ◽  
Content Type ◽  
Governance Process ◽  
First Nations People

Purpose The purpose of this paper is to present a study of the transformation of First Nations’ health governance, describing the development of partnerships between First Nations and provincial and federal governments for co-creating solutions to address First Nations’ health inequities in British Columbia (BC). The paper frames this transformation in the context of a Canada-wide reconciliation initiative stimulated by the Truth and Reconciliation Commission. Design/methodology/approach This qualitative case study was a joint initiative between Simon Fraser University and the BC First Nations Health Authority (FNHA), involving interviews with senior leaders within the BC health system, FNHA and First Nations communities. In addition, a policy roundtable was held in February 2015 which gathered 60 participants for further dialogue on the process. Findings Key themes included: partnership and relationships, governance and reciprocal accountability, First Nations perspectives on health and wellness, and quality and cultural safety. Findings indicate that significant transformational changes have happened in the relationship between First Nations and the mainstream health system. The creation of the FNHA has led to more representation for First Nations people at all levels of governance and health service planning, which will ultimately lead to more culturally safe health services that incorporate a First Nations perspective of wellness. Social implications The transformation of First Nations health governance in BC can serve as an example in other indigenous health settings both within Canada and internationally. Originality/value This paper describes a transformative health governance process in First Nations communities that is an historical first in Canada.

scholarly journals Qualitative evaluation of a mandatory health insurance ‘wait period’ in a publicly funded health system: understanding health inequities for newcomer im/migrant women

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047597
Author(s):  
Maggie Hamel-Smith Grassby ◽  
Mei-ling Wiedmeyer ◽  
M Ruth Lavergne ◽  
Shira M Goldenberg
Keyword(s):  
British Columbia ◽  
Health Insurance ◽  
Health System ◽  
Service Providers ◽  
Unmet Need ◽  
Qualitative Evaluation ◽  
Health Inequities ◽  
Migrant Women ◽  
Family Plan ◽  
Community Based

ObjectivesTo evaluate impacts of a residency-based waiting period for health insurance coverage on lived experiences of health and settlement for im/migrant women in British Columbia, Canada.DesignThe IRIS study is a mixed-methods, community-based, qualitative evaluation of recently arrived im/migrant women’s access to sexual and reproductive care. In-depth, semistructured interviews were conducted by trained multilingual and multicultural interviewers with lived migration experience in the participant’s preferred language.SettingMetro Vancouver, British Columbia, Canada from July 2018 to January 2020.ParticipantsData collected from community focus groups (four groups, n=29) of both service providers and im/migrant women was used. Following this, qualitative interviews with service providers (n=10) and im/migrant women (n=47) were conducted. Eligible participants self-identified as women; were aged 18–49 and had arrived in Canada from another country. Eligible providers were employed in the health, social or legal sectors working with im/migrant women.ResultsThe wait period resulted in mistrust and internalised stigma for racialised im/migrant women, for whom the policy resulted in feeling ‘undeserving’ of care. Resulting administrative burden produced delays and unmet need for care, particularly related to sexual and reproductive healthcare and children’s health. Unexpected costs meant difficult choices between survival and care. Negative health outcomes included the inability to family plan, difficulties during pregnancy, as well as hardships related not being able to seek help for sick children. Community-based organisations provided support in many areas but could not fill all gaps produced by this policy.ConclusionsFindings highlight severe, yet commonly overlooked, health inequities produced by a mandatory health coverage wait period within a purportedly ‘universal’ healthcare system. Health system policies such as mandatory ‘waiting periods’ produce discriminatory and inequitable outcomes for im/migrant women. Policy reforms towards full ‘healthcare for all’ are urgently needed to affirm the health and human rights of all im/migrants.

scholarly journals High Rates of COVID-19 Infection Among Indigenous Maya at a US Safety-Net Health System in California

2021 ◽  
pp. 003335492199037
Author(s):  
Patricia K. Foo ◽  
Berenice Perez ◽  
Neha Gupta ◽  
Gerardo Jeronimo Lorenzo ◽  
Nana-Yaa Misa ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Indigenous Communities ◽  
Health Department ◽  
Safety Net ◽  
The United States ◽  
Indigenous Populations ◽  
Alameda County ◽  
System A ◽  
Record Review

Coronavirus disease 2019 (COVID-19) has disproportionately and negatively affected communities of color in the United States, especially Black, Latinx, and Indigenous populations. We report a cluster of COVID-19 cases among the Maya in Alameda County, California, most of whom were misclassified in public health data as nonindigenous Spanish-speaking people. We conducted a retrospective cohort study of all COVID-19 tests performed from April 1 through May 31, 2020, at Alameda Health System. A total of 1561 tests from 1533 patients were performed, with an overall test positivity rate of 17.0% (N = 265). We used the language field from the electronic health record to identify 29 patients as speaking an indigenous Mayan language; by medical record review, we identified 52 additional Maya patients. Maya patients had a test positivity rate of 72.8% as compared with 27.1% ( P < .001) for nonindigenous Latinx patients and 8.2% ( P < .001) for all other patients. In our sample, 39.6% of patients who had a positive test result for COVID-19 were hospitalized, 11.3% required admission to the intensive care unit (ICU), and 4.9% died of COVID-19. Maya patients had lower rates of hospitalization, ICU admission, and 30-day in-hospital mortality than non-Maya patients. We shared our data with the county health department to inform responses for education, testing, and isolation for Maya patients in Alameda County. Ongoing COVID-19 public health efforts should assess the community prevalence of COVID-19 in the Maya community and other indigenous communities and implement interventions that are linguistically and culturally appropriate.

scholarly journals Responding to health inequities: Indigenous health system innovations

2016 ◽  
Vol 1 ◽  
Author(s):  
J. G. Lavoie ◽  
D. Kornelsen ◽  
L. Wylie ◽  
J. Mignone ◽  
J. Dwyer ◽  
...  
Keyword(s):  
Health System ◽  
Indigenous Health ◽  
Indigenous Communities ◽  
Health Inequities ◽  
Healthcare Services ◽  
International Perspective ◽  
Full Potential ◽  
Community Members ◽  
Culturally Informed ◽  
The Usa

Over the past decades, Indigenous communities around the world have become more vocal and mobilized to address the health inequities they experience. Many Indigenous communities we work with in Canada, Australia, Latin America, the USA, New Zealand and to a lesser extent Scandinavia have developed their own culturally-informed services, focusing on the needs of their own community members. This paper discusses Indigenous healthcare innovations from an international perspective, and showcases Indigenous health system innovations that emerged in Canada (the First Nation Health Authority) and Colombia (Anas Wayúu). These case studies serve as examples of Indigenous-led innovations that might serve as models to other communities. The analysis we present suggests that when opportunities arise, Indigenous communities can and will mobilize to develop Indigenous-led primary healthcare services that are well managed and effective at addressing health inequities. Sustainable funding and supportive policy frameworks that are harmonized across international, national and local levels are required for these organizations to achieve their full potential. In conclusion, this paper demonstrates the value of supporting Indigenous health system innovations.

scholarly journals Promoting Resilience Within Public Health Approaches for Indigenous Communities

2021 ◽  
pp. 78-99
Author(s):  
Christopher Mushquash ◽  
Elaine Toombs ◽  
Kristy Kowatch ◽  
Jessie Lund ◽  
Lauren Dalicandro ◽  
...  
Keyword(s):  
Public Health ◽  
Best Practices ◽  
First Nations ◽  
Indigenous Health ◽  
Indigenous Communities ◽  
Careful Consideration ◽  
Health Interventions ◽  
Indigenous Populations ◽  
Process And Outcome ◽  
Mental Wellness

Resilience within public health is conceptualized to be fostered through individual, community, and systemic initiatives that promote capacity through interconnected primary, secondary, and tertiary health interventions. Within community public health settings, particularly for Canadian Indigenous communities, an emphasis on interconnected, multisystemic interventions that promote resilience can be particularly useful. Fostering resilience within Indigenous health seeks to prioritize unique needs of individuals and communities, through both process- and outcome-based measurement. Given that Indigenous individuals’ needs may differ from non-Indigenous populations in Canada, careful consideration of how to best conceptualize, measure, and promote resilience is required. Tools such as the Native Wellness Assessment and the First Nations Mental Wellness Continuum Framework can be helpful to both measure and conceptualize resilience, as they can provide insight on what is considered to be best practices to increasing wellness within Indigenous communities. Such tools continue to prioritize the multisystemic promotion of resilience.

scholarly journals Cancer among Indigenous Communities: Disparities & Challenges

2021 ◽  
Author(s):  
Anamika Mishra ◽  
Nancy Shi
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
First Nations ◽  
Chronic Conditions ◽  
Indigenous Communities ◽  
Health Inequities ◽  
Mortality Rates ◽  
Indigenous Groups ◽  
Incidence Risk ◽  
History Of

Given the history of racism and systemic oppression of Indigenous communities, examining and addressing health inequities in in Indigenous continues to be relevant and important. An increasing number of healthcare problems are emerging from Indigenous communities.1,2 Canadian First Nations women and men have lower life expectancies and increasing rates of chronic conditions, such as diabetes, cardiovascular diseases, heart disease, and obesity.1 Some evidence suggests that the burden of cancer is lower among Indigenous communities than the overall population.3 However, there is much data indicating that this rate in increasing and that members of Indigenous communities have increased mortality rates when compared to non-Indigenous groups for cancers of the cervix, breast, gallbladder, lip and oropharynx, liver, lung, prostate and stomach.4,5  This paper discusses cancer incidence, risk factors, screening, and detection of cancers among Indigenous communities. This is followed by a discussion of potential interventions that may reduce the burden-related morbidity and mortality of cancer on these communities. Indigenous communities continue to experience unique barriers to accessing appropriate cancer care and preventive services and steps to minimize health inequalities should be taken.

scholarly journals Cultural Resiliency and the Rise of Indigenous Media

2016 ◽  
Vol 4 (2) ◽  
pp. 38-41
Author(s):  
Derek Moscato
Keyword(s):  
New York ◽  
New Media ◽  
First Nations ◽  
Indigenous Communities ◽  
Indigenous Populations ◽  
Past Century ◽  
World Government ◽  
Media Technologies ◽  
Indigenous Media ◽  
The World

Valerie Alia’s book, <em>The New Media Nation: Indigenous Peoples and Global Communication </em>(New York: Berghahn Books, 2012, 270 pp.), points the way to major communication breakthroughs for traditional communities around the world, in turn fostering a more democratic media discourse. From Canada to Japan, and Australia to Mexico, this ambitious and wide-reaching work examines a broad international movement that at once protects ancient languages and customs but also communicates to audiences across countries, oceans, and political boundaries. The publication is divided roughly into five sections: The emergence of a global vision for Indigenous communities scattered around the world; government policy obstacles and opportunities; lessons from Canada, where Indigenous media efforts have been particularly dynamic; the global surge in television, radio and other technological media advances; and finally the long-term prospects and aspirations for Indigenous media. By laying out such a comprehensive groundwork for the rise of global Indigenous media over a variety of formats, particularly over the past century, Alia shows how recent social media breakthroughs such as the highly successful #IdleNoMore movement—a sustained online protest by Canada’s First Nations peoples—have been in fact inevitable. The world’s Indigenous communities have leveraged media technologies to overcome geographic isolation, to foster new linkages with Indigenous populations globally, and ultimately to mitigate structural power imbalances exacerbated by non-Indigenous media and other institutions.

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