Until the relationship improves between health providers and their patients, Indigenous people will continue to have high rates of chronic illnesses.
“The world of health and medicine has not always treated First Nations, Metis and Inuit people very well,” said Dr. Jo-ann Episkenew, director with the Indigenous Peoples Health Research Centre in Regina.
Racism, whether intentional or through ignorance, plays a key role in explaining the data collected in 2007-2010 and recently released by Statistics Canada in the Canadian Community Health Survey.
And if there is any doubt that racism isn’t a major factor in all walks of life, Episkenew says tune into the comments that have been made in the wake of the Idle No More movement.
“The health practitioner and their patient is a relationship that needs to be built on trust,” said Episkenew, but a history of colonialism and oppression makes it difficult for Aboriginal people to trust those in authority.
Lack of trust in the health system was also a prevalent finding in another recently released document. According to the Health Council of Canada’s 74-page Empathy, dignity and respect, “But one barrier to good health lies squarely in the lap of the health care system itself. Many Aboriginal people don’t trust—and therefore don’t use—mainstream health care services because they don’t feel safe from stereotyping and racism, and because the Western approach to health care can feel alienating and intimidating.”
The HCC report is the result of meetings held across the country in 2012. The majority of participants were Aboriginal. The meetings focused on the mainstream urban health care systems. Approximately half of Canada’s 1.3 million Aboriginal people live in cities.
While the issue of trust cannot be downplayed when it comes to the continuing health issues faced by Aboriginals, the health system is only one aspect.
“Poverty is a huge cause of ill-health,” said Episkenew.
Poor living conditions, poor education, high unemployment, and poor diets and lack of sufficient food also contribute to poor health.
Says the authors of the HCC report, “It is well documented that many underlying factors negatively affect the health of Aboriginal people in Canada, including poverty and the intergenerational effects of colonization and residential schools.”
StatsCan indicators found that compared to non-Aboriginals, the Aboriginal population had a smoking rate over two times higher; Aboriginal adults had a higher obesity rate; and Aboriginals were more likely to experience household food insecurity. However, Métis and First Nations people were more active during leisure time than their non- Aboriginal counterparts and Inuit reported a stronger sense of belonging to their community and a high satisfaction with life.
“The education of health care people needs to change,” said Episkinew “and they need to work with Aboriginal communities.”
While Aboriginal communities do not have the expertise to treat chronic disease or the academic training to back up their practises, they do know which strategies are practical and will be successful. Episkinew says IPHRC undertakes community-based participatory research for that very reason.
“The community is a partner from beginning to end because they have expertise that people at universities don’t,” she said.
That shift in the health care system is beginning, according to HCC. “We learned that cultural competency and cultural safety are becoming top-of-mind topics in many governments, health regions, and hospitals.”