Preventing the Tragedy of Suicide Among Indigenous People in Canada: Physician Advocacy Through the Training Pipeline and Beyond

ABSTRACTFor decades, Canada’s Indigenous populations have experienced high rates of suicide relative to the general population. This commentary suggests that suicide among Indigenous people cannot be explained solely through the causal effects of downstream determinants of health; upstream health determinants such as Canada’s colonial past and cultural continuity are equally, if not more, instructive in understanding the tragedy that is taking place in many Indigenous communities across Canada. Medical trainees and physicians can contribute to improvements in Indigenous health by advocating for culturally safe healthcare access and research, as well as Indigenous-oriented medical training. RÉSUMÉPendant des décennies, les populations autochtones au Canada ont connu des taux élevés de suicide comparativement à la population générale. Ce commentaire suggère que le suicide chez les personnes autochtones ne peut être expliqué uniquement par les effets causaux des déterminants de la santé « en aval » ; les déterminants de la santé « en amont », tels le passé colonial du Canada et la continuité culturelle, sont tout aussi, sinon plus importants pour comprendre la tragédie se déroulant dans plusieurs communautés autochtones à travers le Canada. Les médecins et étudiants en médecine peuvent contribuer à l’amélioration de la santé autochtone en plaidant pour de la recherche et un accès aux soins de santé qui sont culturellement sécuritaires, et pour des formations médicales axées sur la santé autochtone.

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Indigeneity

Anthropology ◽

10.1093/obo/9780199766567-0199 ◽

2018 ◽

Author(s):

Paulette F. Steeves

Keyword(s):

Human Rights ◽

Indigenous People ◽

Cultural Practices ◽

Political Identity ◽

Indigenous Communities ◽

Indigenous Populations ◽

Historical Continuity ◽

Regional Area ◽

The World ◽

The Impact

There are minimally 370 million Indigenous people in the world. The term Indigenous was not used to identify human groups until recently. Indigenous people are often identified as the First People of a specific regional area. Indigeneity as applied to First People came into use in the 1990s, as many colonized communities fought against erasure, genocide, and forced acculturation under colonial regimes. An often-cited definition of Indigenous peoples is one by Jose Martinez Cobo, special rapporteur for the UN Sub-Commission. Cobo’s 1986 report was completed for the United Nations Economic and Social Council, Commission on Human Rights, Sub-Commission on Prevention and Discrimination and Protection of Minorities, thirty-fifth session, item 12 of the provisional agenda, titled, “Study of the Problem of Discrimination against Indigenous Populations.” Cobo described Indigenous people, communities, and nations as groups that have a “historical continuity with pre-colonial societies” within territories they developed, and as communities that “consider themselves distinct from other sectors of societies” now in their territories. Cobo further stressed that Indigenous people and communities are minorities within contemporary populations that work to preserve their ethnic identities and ancestral territories for future generations. It is important to include displaced people whom prior to colonization identified with specific land areas or regional areas as homelands, as well as Indigenous communities that have for decades been in hiding in areas away from their initial homeland areas. Many descendants of Indigenous people were forced to hide their identities for their own safety due to colonization and genocidal policies focused on physical and cultural erasure. That does not make them non-Indigenous. It makes them survivors of genocide, erasure, and forced acculturation. Many Indigenous people are just coming to terms with the impact of ethnic cleansing and the work to reclaim and revive their identities and cultures. Indigenous is both a legal term, and a personal, group, and pan-group identity. Scholars have argued there are at least four thousand Indigenous groups, but that number is likely very low. Indigeneity is not as simple as an opposition to identity erasure or a push back against colonization. Indigeneity is woven through diverse experiences and histories and is often described as a pan-political identity in a postcolonial time. However, that can be misleading, as the world does not yet exist in a postcolonial state, despite ongoing concerted efforts by Indigenous people and their allies in political and academic spheres to decolonize institutions and communities. Diverse Indigenous communities weave Indigeneity through a multifaceted array of space and time to revive identities and cultural practices and to regain or retain land, human rights, heritage, and political standing.

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‘Best Intentions’ Lives on: Untoward Health Outcomes of Some Contemporary Initiatives in Indigenous Affairs

Australian & New Zealand Journal of Psychiatry ◽

10.1046/j.1440-1614.2001.01040.x ◽

2002 ◽

Vol 36 (5) ◽

pp. 575-584 ◽

Cited By ~ 31

Author(s):

Ernest Hunter

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Health Outcomes ◽

Social Issues ◽

Indigenous Health ◽

Indigenous Communities ◽

Indigenous Populations ◽

Royal Commission ◽

Indigenous Mental Health

Objective: A shortened version of a presentation to the Australian Institute of Aboriginal and Torres Strait Islander Studies, this paper raises questions regarding policy and program directions in Indigenous affairs with consequences for Indigenous health. Method: The author notes the inadequate Indigenous mental health database, and describes contemporary conflicts in the arena of Indigenous mental health, drawing on personal experience in clinical service delivery, policy and programme development. Results: Medicalized responses to the Stolen Generations report and constructions of suicide that accompanied the Royal Commission into Aboriginal Deaths in Custody are presented to demonstrate unforeseen health outcomes. Examples are also given of wellintentioned social interventions that, in the context of contemporary Indigenous society appear to be contributing to, rather than alleviating, harm. Problems of setting priorities that confront mental health service planners are considered in the light of past and continuing social disadvantage that informs the burden of mental disorder in Indigenous communities. Conclusions: The importance of acknowledging untoward outcomes of initiatives, even when motivated by concerns for social justice, is emphasized. The tension within mental health services of responding to the underpinning social issues versus providing equity in access to proven mental health services for Indigenous populations is considered.

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Traditional Medicine for Children among Kaluppini Indigenous People in South Sulawesi

ETNOSIA Jurnal Etnografi Indonesia ◽

10.31947/etnosia.v5i2.9905 ◽

2020 ◽

pp. 319-331

Author(s):

Nurbaya Nurbaya ◽

Wahyu Chandra ◽

Pramesthi Widya Hapsari

Keyword(s):

Traditional Knowledge ◽

Indigenous People ◽

Indigenous Health ◽

Indigenous Communities ◽

Indigenous Community ◽

Traditional Birth Attendants ◽

Birth Attendants ◽

South Sulawesi ◽

Traditional Remedies ◽

Sick Children

The traditional knowledge about the use of ancestral medicines to cure children was highly valued by the indigenous community and an essential part of their indigenous health system. This study aimed to provide insight into the traditional medication using plant-based medication to children in an indigenous community in South Sulawesi Province. This study was conducted in Kaluppini Village, Enrekang Regency, South Sulawesi. In-depth interviews and focus group discussions were conducted both in Bahasa Indonesia and the local language. Informants were traditional birth attendants and mothers of under-five. This study was carried out from January to June 2018. Data were analyzed using thematic coding. It is found that Kaluppini mothers have traditional knowledge of treatment. They used kinds of plants as traditional remedies to cure their children. This traditional medication named as pembollo’ and pejappi. Pembollo’ are traditional plants intended to cure sick children. Kaluppini people believe that pejappi is a collection of traditional plant that can treat kinds of illnesses among children, including to prevent them from supernatural things. Kaluppini indigenous people practice and believe in their traditional plants to cure their children. Traditional birth attendants play a crucial role in providing these traditional plants. Information provided in this study could be a rational basis for health-related stakeholders to develop programs of health education and promotion for indigenous communities.

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Indigenous Trauma Intervention Research in Canada: A Narrative Literature Review

International Indigenous Policy Journal ◽

10.18584/iipj.2021.12.2.10936 ◽

2021 ◽

Vol 12 (2) ◽

pp. 1-24

Author(s):

Sarah Panofsky ◽

Marla J. Buchanan ◽

Roger John ◽

Alanaise Goodwill

Keyword(s):

Mental Health ◽

Indigenous Health ◽

Historical Trauma ◽

Indigenous Communities ◽

Psychological Trauma ◽

Mental Health Research ◽

Indigenous Populations ◽

History Of ◽

Narrative Literature Review ◽

Indigenous Mental Health

Contemporary Indigenous mental health research is beginning to address colonization, contextualizing Indigenous health within a history of colonial relationships and inadequate mental health responses. In practice, however, dominant counselling models for mental health in Canada have neglected Indigenous perspectives and there is a paucity of research regarding interventions that address psychological trauma with Indigenous populations. We identified 11 Canadian studies that employed culturally appropriate trauma interventions within Indigenous communities. We discuss the findings in relation to the study participants, outcomes reported, and research design. Recommendations are provided to address the need for evidence-based trauma interventions that have efficacy for Indigenous people in Canada to address Indigenous historical trauma.

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Principles guiding ethical research in a collaboration to strengthen Indigenous primary healthcare in Australia: learning from experience

BMJ Global Health ◽

10.1136/bmjgh-2020-003852 ◽

2021 ◽

Vol 6 (1) ◽

pp. e003852

Author(s):

Jodie Bailie ◽

Alison Frances Laycock ◽

Kathleen Parker Conte ◽

Veronica Matthews ◽

David Peiris ◽

...

Keyword(s):

Indigenous People ◽

Large Scale ◽

Critical Reflection ◽

Research Collaboration ◽

Indigenous Health ◽

Indigenous Communities ◽

Indigenous Leadership ◽

Evaluation Approach ◽

Guiding Principles ◽

Over Time

IntroductionIndigenous communities worldwide are leading calls for all research involving Indigenous people to be underpinned by values and principles articulated by them. Many researchers are explicitly adopting these principles to guide what, where, how and when research is undertaken with Indigenous people. With critical reflection to support the implementation of such principles largely absent from published literature, this paper explores both the implementation of, and the outcomes from a set of guiding principles used in a large-scale Australian research collaboration to improve Indigenous health.MethodsIn this inductive qualitative study, we adopted a principles-focused evaluation approach. Based on interviews with 35 actors in the collaboration and a review of project documents, we generated themes that were then iteratively discussed, refined and categorised into (1) ‘strategies’—activities by which implementation of our guiding principles were recognised; (2) ‘outcomes’—results seen from implementing the principles and (3) ‘conditions’—aspects of the context that facilitated and constrained implementation of the principles.ResultsRespondents found it difficult to articulate how the guiding principles were actually implemented, and frequently referred to them as part of the fabric of the collaboration. They viewed the set of principles as mutually reinforcing, and as providing a rudder for navigating complexity and conflict. Implementation of the principles occurred through five strategies—honouring the principles; being dynamic and adaptable; sharing and dispersing leadership; collaborating purposefully and adopting a culture of mutual learning. Outcomes included increased Indigenous leadership and participation; the ability to attract principled and values-driven researchers and stakeholders, and the development of trusting and respectful relationships. The conditions that facilitated the implementation of the principles were collaborating over time; an increasing number of Indigenous researchers and taking an ‘innovation platform’ approach.ConclusionOur findings show that principles guiding collaborations are valuable in providing a focus, direction and a way of working together when they are collaboratively developed, hold genuine meaning for all members and are implemented within a culture of continuous critical reflection, learning and adaptation, with ongoing reinterpretation of the principles over time.

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Towards attainment of Indigenous health through empowerment: resetting health systems, services and provider approaches

BMJ Global Health ◽

10.1136/bmjgh-2020-004052 ◽

2021 ◽

Vol 6 (2) ◽

pp. e004052

Author(s):

Cheryl Barnabe

Keyword(s):

Health Systems ◽

Indigenous Health ◽

Indigenous Rights ◽

Indigenous Communities ◽

Models Of Care ◽

Indigenous Populations ◽

Health And Wellness ◽

Financial Investments ◽

Dominant Society ◽

Significant Health

Colonial policies and practices have introduced significant health challenges for Indigenous populations in commonwealth countries. Health systems and models of care were shaped for dominant society, and were not contextualised for Indigenous communities nor with provision of Indigenous cultural approaches to maintain health and wellness. Shifts to support Indigenous health outcomes have been challenged by debate on identifying which system and service components are to be included, implementation approaches, the lack of contextualised evaluation of implemented models to justify financial investments, but most importantly lack of effort in ensuring equity and participation by affected communities to uphold Indigenous rights to health. Prioritising the involvement, collaboration and empowerment of Indigenous communities and leadership are critical to successful transformation of healthcare in Indigenous communities. Locally determined priorities and solutions can be enacted to meet community and individual needs, and advance health attainment. In this paper, existing successful and sustainable models that demonstrate the empowerment of Indigenous peoples and communities in advocating for, designing, delivering and leading health and wellness supports are shared.

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Virtual Care for Indigenous Populations in Canada, the United States, Australia, and New Zealand: Protocol for a Scoping Review (Preprint)

10.2196/preprints.21860 ◽

2020 ◽

Author(s):

Pat Camp ◽

Mirha Girt ◽

Alix Wells ◽

Adeeb Malas ◽

Maryke Peter ◽

...

Keyword(s):

United States ◽

New Zealand ◽

Indigenous People ◽

Scoping Review ◽

Full Text ◽

Indigenous Communities ◽

The United States ◽

Indigenous Populations ◽

Virtual Care ◽

Full Text Screening

BACKGROUND Indigenous people in Canada, the United States, Australia, and New Zealand experience an increased burden of chronic diseases compared to non-Indigenous people in these countries. Lack of necessary services and culturally relevant care for Indigenous people contributes to this burden. Many Indigenous communities have implemented systems, such as virtual care, to improve chronic disease management. Virtual care has extended beyond videoconferencing to include more advanced technologies, such as remote biometric monitoring devices. However, given the historical and ongoing Western intrusion into Indigenous day to day life, these technologies may seem more invasive and thus require additional research on their acceptability and utility within Indigenous populations. OBJECTIVE The objective of this paper is to present the protocol for a scoping review, which aims to map existing evidence. This study is based on the following guiding research question: What are the characteristics of virtual care use by Indigenous adult populations in Canada, the United States, Australia, and New Zealand? The subquestions are related to the technology used, health conditions and nature of the virtual care, cultural safety, and key concepts for effective use. METHODS This scoping review protocol is informed by the methodology described by the Joanna Briggs Institute and is supplemented by the frameworks proposed by Arksey and O’Malley and Levac et al. A search for published and gray literature, written in English, and published between 2000 and present will be completed utilizing electronic databases and search engines, including MEDLINE, CINAHL, Embase, Indigenous Peoples of North America, Australian Indigenous HealthInfoNet, Informit, and Native Health Database. Search results will be uploaded to the review software, Covidence, for title and abstract screening before full-text screening begins. This process will be repeated for gray literature. Upon completion, a data abstraction tool will organize the relevant information into categorical formations. RESULTS The search strategy has been confirmed, and the screening of titles and abstracts is underway. As of October 2020, we have identified over 300 articles for full-text screening. CONCLUSIONS Previous reviews have addressed virtual care within Indigenous communities. However, new virtual care technologies have since emerged; subsequently, additional literature has been published. Mapping and synthesizing this literature will inform new directions for research and discussion. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT PRR1-10.2196/21860

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Virtual Care for Indigenous Populations in Canada, the United States, Australia, and New Zealand: Protocol for a Scoping Review

JMIR Research Protocols ◽

10.2196/21860 ◽

2020 ◽

Vol 9 (12) ◽

pp. e21860

Author(s):

Pat Camp ◽

Mirha Girt ◽

Alix Wells ◽

Adeeb Malas ◽

Maryke Peter ◽

...

Keyword(s):

United States ◽

New Zealand ◽

Indigenous People ◽

Scoping Review ◽

Full Text ◽

Indigenous Communities ◽

The United States ◽

Indigenous Populations ◽

Virtual Care ◽

Full Text Screening

Background Indigenous people in Canada, the United States, Australia, and New Zealand experience an increased burden of chronic diseases compared to non-Indigenous people in these countries. Lack of necessary services and culturally relevant care for Indigenous people contributes to this burden. Many Indigenous communities have implemented systems, such as virtual care, to improve chronic disease management. Virtual care has extended beyond videoconferencing to include more advanced technologies, such as remote biometric monitoring devices. However, given the historical and ongoing Western intrusion into Indigenous day to day life, these technologies may seem more invasive and thus require additional research on their acceptability and utility within Indigenous populations. Objective The objective of this paper is to present the protocol for a scoping review, which aims to map existing evidence. This study is based on the following guiding research question: What are the characteristics of virtual care use by Indigenous adult populations in Canada, the United States, Australia, and New Zealand? The subquestions are related to the technology used, health conditions and nature of the virtual care, cultural safety, and key concepts for effective use. Methods This scoping review protocol is informed by the methodology described by the Joanna Briggs Institute and is supplemented by the frameworks proposed by Arksey and O’Malley and Levac et al. A search for published and gray literature, written in English, and published between 2000 and present will be completed utilizing electronic databases and search engines, including MEDLINE, CINAHL, Embase, Indigenous Peoples of North America, Australian Indigenous HealthInfoNet, Informit, and Native Health Database. Search results will be uploaded to the review software, Covidence, for title and abstract screening before full-text screening begins. This process will be repeated for gray literature. Upon completion, a data abstraction tool will organize the relevant information into categorical formations. Results The search strategy has been confirmed, and the screening of titles and abstracts is underway. As of October 2020, we have identified over 300 articles for full-text screening. Conclusions Previous reviews have addressed virtual care within Indigenous communities. However, new virtual care technologies have since emerged; subsequently, additional literature has been published. Mapping and synthesizing this literature will inform new directions for research and discussion. International Registered Report Identifier (IRRID) PRR1-10.2196/21860

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Community Organizing for Indigenous People in the Philippines: A Proposed Approach

10.1101/2021.06.24.21259509 ◽

2021 ◽

Author(s):

Jailah Bamba ◽

Cristela Candelario ◽

Rosarie Gabuya ◽

Lhearnie Manongdo

Keyword(s):

Indigenous People ◽

Community Organizing ◽

English Language ◽

Monitoring And Evaluation ◽

Indigenous Communities ◽

The Philippines ◽

Indigenous Populations ◽

Inclusion Criteria ◽

Private And Public ◽

The Republic

Cognizant of the special needs of indigenous people in the Philippines, the Republic Act No. 8371 of 1997 was established to promote and protect their rights. Over the years, a number of community organizing efforts for the improvement of these communities were conducted by stakeholders from the private and public sectors. However, resistance has been reported due to poor understanding and integration of these indigenous populations' varied cultures and traditions. This study aims to describe the predominant principles and frameworks used for community organizing among indigenous people. Specifically, it seeks to propose a community organizing approach that is culturally sensitive and appropriate for indigenous communities in geographically isolated and disadvantaged areas in the Philippines. A systematic review was conducted on four databases (PubMed, ScienceDirect, ResearchGate, Google Scholar) by four independent researchers. Inclusion criteria involved studies about community organizing protocols in the Philippines, published in peer-reviewed journals from 2010-2020, and written in the English language. Assessment of the quality of included studies was done using the Critical Appraisal Skills Program (CASP) checklist, and narrative synthesis was employed to summarize and report the findings. Thirteen studies met our inclusion criteria out of a total of fifty-five articles searched. Based on the evidence, our proposed approach builds on Groundwork, Indigenous Capacity Building, Community Participation and Ownership, Mobilization, and Sustainability. We highlight the emphasis of harnessing indigenous knowledge and Participatory Monitoring and Evaluation to involve them in all steps of the planning and decision-making processes. Furthermore, we distill tools and methodologies that could strengthen and precipitate successful community organizing endeavors.

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Support for Indigenous wildlife management in Australia to enable sustainable use

Wildlife Research ◽

10.1071/wr09130 ◽

2010 ◽

Vol 37 (3) ◽

pp. 255 ◽

Cited By ~ 12

Author(s):

George R. Wilson ◽

Melanie J. Edwards ◽

Jennifer K. Smits

Keyword(s):

Indigenous People ◽

Wildlife Management ◽

Rural Areas ◽

Management Practices ◽

Indigenous Health ◽

Minor Component ◽

Indigenous Communities ◽

Customary Law ◽

Indigenous Australians ◽

Wildlife Harvesting

Wildlife managers could play a greater role in ensuring that Indigenous wildlife harvesting is sustainable and helping to address community health and employment challenges facing Indigenous Australians in remote and rural areas. Wildlife managers need to listen more to what Indigenous people say they want from their country and for their people, such as increased game to supplement their diet and security for totemic species, to maintain culture. In pre-colonial Australia, adherence to customary law maintained wildlife species Indigenous Australians wanted. Today the long-term sustainability of Indigenous wildlife harvesting is threatened. Where Indigenous communities lack leadership and other social problems exist, their capacity to apply customary land-and sea-management practices and to operate cultural constraints on wildlife use is reduced. The Indigenous right to hunt should coexist with responsible management. Improved wildlife management that combines science and traditional knowledge has implications for Indigenous people worldwide. Western science can support Indigenous passion for caring for the land. It can draw on traditional Indigenous practice and, through reciprocal learning, help reinstate Indigenous law and culture in communities. In Australia, wildlife managers could be more engaged in supporting Indigenous Australians in activities such as surveying populations and estimating sustainable yields, identifying refuge areas, maximising habitat diversity, controlling weeds and feral animals, and exchanging information across regions. Although support for Indigenous land and wildlife management has risen in recent years, it remains a minor component of current Australian Government resource allocation for addressing Indigenous need. Wildlife management could be a stronger focus in education, training and employment programs. Proactive wildlife management conforms to both the western concept of conserving biodiversity and Indigenous wildlife management; it can support sustainable harvesting, provide employment and income, create learning and training opportunities and improve Indigenous health. If greater expenditure were directed to Indigenous wildlife management, wildlife managers, especially Indigenous wildlife managers, could become more engaged in cultural initiatives across traditional and scientific practices and so contribute to programs that address the health and motivational challenges facing Indigenous communities.

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