Indigenous Health Equity and Wellness

Introduction Both health equity research and Indigenous health research are driven by the goal of promoting equitable health outcomes among marginalized and underserved populations. However, the two fields often operate independently, without collaboration. As a result, Indigenous populations are underrepresented in health equity research relative to the disproportionate burden of health inequities they experience. In this methodological article, we present Xpey’ Relational Environments, an analytic framework that maps some of the barriers and facilitators to health equity for Indigenous peoples. Methods Health equity research needs to include a focus on Indigenous populations and Indigenized methodologies, a shift that could fill gaps in knowledge with the potential to contribute to ‘closing the gap’ in Indigenous health. With this in mind, the Equity Lens in Public Health (ELPH) research program adopted the Xpey’ Relational Environments framework to add a focus on Indigenous populations to our research on the prioritization and implementation of health equity. The analytic framework introduced an Indigenized health equity lens to our methodology, which facilitated the identification of social, structural and systemic determinants of Indigenous health. To test the framework, we conducted a pilot case study of one of British Columbia’s regional health authorities, which included a review of core policies and plans as well as interviews and focus groups with frontline staff, managers and senior executives. Conclusion ELPH’s application of Xpey’ Relational Environments serves as an example of the analytic framework’s utility for exploring and conceptualizing Indigenous health equity in BC’s public health system. Future applications of the framework should be embedded in Indigenous research methodologies.

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‘Back to better’: amplifying health equity, and determinants of health perspectives during the COVID-19 pandemic

Global Health Promotion ◽

10.1177/17579759211000975 ◽

2021 ◽

pp. 175797592110009

Author(s):

Sume Ndumbe-Eyoh ◽

Pemma Muzumdar ◽

Claire Betker ◽

Diane Oickle

Keyword(s):

Health Promotion ◽

Social Justice ◽

Health Equity ◽

Emergency Preparedness ◽

Social Transformation ◽

Indigenous Health ◽

Social Systems ◽

Policy Research ◽

Determinants Of Health ◽

Structural Determinants

Introduction: Equity and social justice have long been key tenets of health promotion practice, policy and research. Health promotion foregrounds the pertinence of social, economic, cultural, political and spiritual life in creating and maintaining health. This necessitates a critical structural determinants of health perspective that actively engages with the experiences of health and wellbeing among diverse peoples. The inequitable impacts of pandemics are well documented, as are calls for improved pandemic responses. Yet, current pandemic and emergency preparedness plans do not adequately account for the social and structural determinants of health and health equity. Methods: Through five one-hour online conversations held in April 2020, we engaged 13 practice, policy, research and community leaders on the intersections of COVID-19 and gender, racism, homelessness, Indigenous health and knowledge, household food insecurity, disability, ethics and equitable futures post-COVID-19. We conducted a thematic analysis of speaker and participant contributions to investigate the impacts and influence of COVID-19 related to the structural and social determinants of health. We analyzed which policies, practices and responses amplified or undermined equity and social justice and identified opportunities for improved action. Findings: Analysis of the COVID-19 pandemic revealed four broad themes: • oppressive, unjust systems and existing health and social inequities; • health and social systems under duress and non-responsive to equity; • disproportionate impacts of COVID-19 driven by underlying structural and socioeconomic inequity; and • enhanced momentum for collective mobilization, policy innovations and social transformation. Discussion: There was a strong desire for a more just and equitable society in a post-COVID-19 world, going ‘back to better’ rather than ‘back to normal.’ Our analysis demonstrates that equity has not been well integrated into pandemic planning and responses. Social movement and systems theories provide insight on ways to build on existing community mobilization and policy openings for sustained social transformation.

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COMPLETING THE CIRCLE: TOWARDS THE ACHIEVEMENT OF IND-EQUITY- A CULTURALLY RELEVANT HEALTH EQUITY MODEL BY/FOR INDIGENOUS POPULATIONS

Witness: The Canadian Journal of Critical Nursing Discourse ◽

10.25071/2291-5796.59 ◽

2020 ◽

Vol 2 (1) ◽

pp. 97-110

Author(s):

Bernice Downey

Keyword(s):

Health Equity ◽

Indigenous Peoples ◽

Indigenous Health ◽

Ways Of Knowing ◽

Truth And Reconciliation Commission ◽

Structural Reform ◽

Indigenous Populations ◽

Truth And Reconciliation ◽

Health Practitioners ◽

Equity Model

Health equity is defined in ways that espouse values of social justice and benevolence and is held up as an ideal state achievable by all. However, there remains a troubling gap in health outcomes between Indigenous Peoples and other Canadians. Public health stakeholders aspire to ‘close the gap’ and ‘level the gradient’ to reduce inequities though the implementation of various health equity focused strategies. The Truth and Reconciliation Commission of Canada echoes this objective and calls for self-determining structural reform to address health inequity for Indigenous Peoples. This paper proposes an IND-equity model as a reconciliation inspired response that upholds Indigenous self-determination and is informed by diverse Indigenous ways of knowing. When adopting this model, the goal is to complete the circle and foster wholistic balance. Further development and implementation of an IND-equity model requires advocacy by all health practitioners. Nurses hold potential to lead and engage in structural reform through an Indigenous health ally role.

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Implementing Universal and Targeted Policies for Health Equity: Lessons From Australia

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2021.157 ◽

2021 ◽

Author(s):

Matthew Fisher ◽

Patrick Harris ◽

Toby Freeman ◽

Tamara Mackean ◽

Emma George ◽

...

Keyword(s):

Policy Implementation ◽

Health Equity ◽

Indigenous Health ◽

Three Dimensions ◽

Governance Structures ◽

Access To Health ◽

Health Related ◽

Equity In Access ◽

Context Specific ◽

Equity Of Access

Background: Debate continues in public health on the roles of universal or targeted policies in providing equity of access to health-related goods or services, and thereby contributing to health equity. Research examining policy implementation can provide fresh insights on these issues. Methods: We synthesised findings across case studies of policy implementation in four policy areas of primary health care, telecommunications, Indigenous health and land use policy, which incorporated a variety of universal and targeted policy structures. We analysed findings according to three criteria of equity in access – availability, affordability and acceptability – and definitions of universal, proportionate-universal, targeted and residual policies, and devolved governance structures. Results: Our analysis showed that existing universal, proportionate-universal and targeted policies in an Australian context displayed strengths and weaknesses in addressing availability, affordability and acceptability dimensions of equity in access. Conclusion: While residualist policies are unfavourable to equity of access, other forms of targeting as well as universal and proportionate-universal structure have the potential to be combined in context-specific ways favourable to equity of access to health-related goods and services. To optimise benefits, policies should address equity of access in the three dimensions of availability, affordability and acceptability. Devolved governance structures have the potential to augment equity benefits of either universal or targeted policies.

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Cultural Safety within the Indigenous Health Context: Findings from a Review of Reviews

Innovation in Aging ◽

10.1093/geroni/igab046.3143 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 869-869

Author(s):

Juanita-Dawne Bacsu ◽

Christina Chakanyuka ◽

Andrea DesRoches ◽

Jennifer Walker ◽

Jessy Dame ◽

...

Keyword(s):

Older Adults ◽

First Nations ◽

Health Equity ◽

Indigenous Health ◽

Healthcare Providers ◽

Healthcare Services ◽

Cultural Safety ◽

Care Providers ◽

Safety Interventions ◽

Review Of Reviews

Abstract First Nations, Inuit, and Métis older adults often face systemic barriers to accessing culturally safe and equitable healthcare, including racism, structural injustice, and a historical legacy of colonialism. However, there is a paucity of knowledge on cultural safety interventions and implementation strategies in care for older adults. This presentation aims to: 1) explore persistent barriers to achieving health equity and advancing cultural safety in healthcare; and 2) identify cultural safety interventions to improve healthcare for Indigenous older adults. Guided by Arksey and O’Malley’s scoping review framework, we conducted a review of reviews published between January 2010 to December 2020 on Indigenous cultural safety in healthcare. We searched five databases (CINAHL, PubMed, Scopus, Web of Science, and Google Scholar) and hand-searched reference lists of relevant articles. We conducted a thematic analysis to identify patterns and themes in the literature. Key barriers to achieving health equity and advancing cultural safety in healthcare included care providers lacking knowledge of Indigenous culture, power imbalances, racism, and discrimination. A range of cultural safety interventions were identified, from education and training initiatives for healthcare providers (emergency physicians and occupational therapists) to collaborative partnerships with First Nations, Inuit, and Métis communities. As First Nations, Inuit, and Métis populations age, there is a growing need for safe healthcare services for Indigenous older adults, and these findings suggest focusing on healthcare providers knowledge and attitudes is key. Research is necessary to develop, implement, and evaluate cultural safety interventions aimed at healthcare providers to improve healthcare for Indigenous older adults.

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