Indigenous People’s Health Equity in Canada
Abstract
The current policy governing Indigenous people health and social equity describes the inequality that is being experienced between the Canadian people and Indigenous people. Health inequality among the Indigenous people of Canada continues to increase. As a result, healthy public policy have become a prime agenda to recognize, and prioritize the individual privileges of all Canadians. There are different strategies that can be adopted by the government to promote equity in the provision of healthcare services considering the historical scope of the Indian Act in the definition of inequalities in the modern Canadian society. This research shows how inadequate efforts by the government towards the implementation of a national public health policy for the Indigenous people are a clear demonstration of racism in the modern society. It can be described as a clear indication of lack of political will among those in power thus promoting social inequality. There are different ways through which reforms can be implemented to address the inequity in the Indigenous people health. Through community self-determination and community-led research, the pertinent issues related to health can be addressed. The research paper also provides solutions to Indigenous people health inequity by drawing a conclusion from the 2015 research conducted by the Truth and Reconciliation Commission of Canada as a motivator for structuring healthy public policies aimed at achieving health equity among Indigenous people in Canada. – Thesis Writing Service In Canada
The Indian Act
The Indian Act took up an essential act by influencing the creation and implementation of native people healthy equity policy in Canada today. The Indian Act, which as legislated in 1876 based on Indian civilization motive ended up to create the assumption that Indigenous people people’s way of living is inferior, uncivilized and unequal. The Act which incorporated provisions of Indigenous people cultural, political, social, spiritual, economic, and gender rights in the Indian dimensions played a major role in encouraging Indigenous people to roguish their status and treaty rights to be able to access services provided by pre-existing governance (Miller, 2004). For instance, the measures enacted by the Indian Act promoted gender bias by disowning women who got married to a person that is not Indian by denying them their Indian status that included losing treaty benefits, right for family inheritance, right to live on their reserve, and health benefits.
On the contrary, the Indian men who married women outside the Indian ethnic retained their rights (Bourassa, McKay-McNabb, & Hampton, 2004). The measures provided by the Indian Act created a coherent structure that set a stage that continues in modern Canada where policies are developed based on the elimination of Indigenous people or assimilation them into Canadian mainstream against their will creating the inequality in services such as health access, social, and other services for Indigenous people (Sinclair, 2015). The current systems of care policy in Canada including education, health, justice, child welfare, and economic development reflect the continues use of racial discrimination stage set by the Indian Act that lacks recognition of the self-determined Indigenous people and governance their communities.
Indigenous people Health Patterns
The Canadian Constitution Act section 35(2) of 1982 identifies three major Indigenous people populations in Canada: Indian, Merits, and Inuit. The Indigenous people population reflects a young and quickly growing population that is characteristic of low life expectancy but with a high birth rate. The higher fertility rate of Indigenous people women has enabled the population to have a high growth rate compared to non- Indigenous people population in Canada with 5.2% growth rate compared to 20.1% of the Indigenous people population (Health Canada, 2013). According to Luo et al., (2007), despite the high growth rate in the Indigenous people population, the Métis and Inuit, also known as First Nations have recorded a twice higher infant mortality rate when placed in comparison with non-natives in Canada due to lack of access to healthcare services.
Indigenous people population mortality rate causes mainly include poisoning and injury, cancer, circulatory and respiratory diseases (Gershon, et al.). The Indigenous people population is also faced with chronic diseases with diabetes-related diseases affecting a high significance of the population. For instance, the diabetes rate in the First Nation is considered to be higher by 3 to 5 times against the average national rate, with Indigenous people living on-reserve and native women making up the population displaying higher rates (Ghosh & Spitzer, 2014). Indigenous people also experience morbidity through infection diseases such as hepatitis A, tuberculosis, pertussis, shillegosis, and chlamydia. Several studies also indicate that the diagnosis rate of HIV/AIDs among the Indigenous people population is on the rise with 12.2% of the Indigenous people population accounting for new HIV infection and 18.8% AIDS of the cases reported (PHACanada, 2013). When it comes to age, Indigenous people population aged 1-44 common death cause is due to injury and poisoning, young adults and adults of age up to 44 reported self-harm or suicide and as the major cause of death, while the circulatory disease is the cause of most deaths in adults aged 45 years and older (PHACanada, 2013). The healthy pattern portrayed by the Indigenous people population indicates that the population does not have adequate access to healthcare which results in most of them succumbing to death due to self-injury and poisoning which can be mitigated if adequate health policy that considers Indigenous people population was in place.
Social Determinants of Health
Failure by the current health policy being conducted in Canada for the Indigenous people population is contributed by the social aspects of the population. The Indigenous people population which highly depends on traditionalism widens the disparity gaps associated with involvement in the workforce, sub-standard living conditions, low income, and poor education (Indigenous and Northern Affairs Canada, 2007). Research studies indicate that the unemployment rate of the Indigenous people population is 14% compared to the national population that is 8.1% (Statistics Canada, 2016). The average household income among the Indigenous people population was also noted to be lower than non- Indigenous people with individuals aged 2-54 average income being $22,366 compared to $33,394 of non- Indigenous people population (Statistics Canada, 2015). In the education system, it was noted that students from the Indigenous people population tend to stay in school longer than non- Indigenous people students across all levels of education. For instance, the Indigenous people Survey conducted in 2012 indicated that individuals aged 18-44 of First Nations Indigenous people populations had a 72% completion rate of diplomas offered at the high school level against the 89% non-native completions in the same age group (Bougie, Kelly-Scott & Arriagada, 2015).
Another social issue concerning health faced by the Indigenous people population is the living conditions. The Indigenous people population faces inadequate and insufficient housing with most houses suffering from lack of sanitary infrastructure, especially in rural and remote areas. Most families in Indigenous people Canada experience overcrowding and homelessness problems. The overcrowding conditions result in increased health risks including drinking water. Recent studies have indicated that the lack of availability of safe water for most of natives in the Canadian population significantly increases cases of waterborne diseases with a rate of 26 times higher than the national average (Bougie, Kelly-Scott & Arriagada, 2015). Therefore, the social structure of the Indigenous people population should be considered by the government when developing and implementing health policy.
Healthy Public Policy Challenges for Indigenous Canadians
Inequalities in social and health cases witnessed in native Canadians emanates from the historical to present social system affecting the efforts conducted to develop a health policy that can protect the right to healthcare of Indigenous people. The Indigenous people healthy policy remains characterized by jurisdictional ambiguity despite efforts through treaties and other Canadian Constitution protected rights for Indigenous people regarding health care access. In modern Canada, the available Indigenous people healthy policy lack clarity on health service delivery and financing both in federal and provincial government levels (Cook, 2003). The Canadian policy and legislation concerning Indigenous people health provision framework do not address the health care needs for Indigenous people adequately due to the Canada and Indians historical roots that live out most of Indigenous people that are not registered or those that are not living in reserve or traditional territory.
The current Indigenous people health policy also indicates high negligence and lack of political will for improving Indigenous people’s ability to access healthcare. For instance, according to a report conducted by the Auditor General, significant concerns regarding the healthcare quality in remote native communities in Canada illustrates several issues of negligence and lack of political support (Cook, 2003). Some of the issues indicated in the report include the government’s unwillingness to support service provision, the health care facilities’ safety being low, lack of timely record keeping on health benefits not covered by insurane, and poor consultation services (OAGCanada, 2015). The wide geographical variation has also been noted to significantly reduce the ability of Indigenous people Canadians to acquire their rights as per the constitution to healthcare access making it hard for contemporary Indigenous people healthy policy to be effective.
Political Will
The political will in Canada has been lacking behind in terms of supporting Indigenous people people’s health and health care accessibility. However, the political efforts that had been previously conducted did were not fully implanted due to political differences and will to support implementation. The noted efforts to address health inequity in Canada were provided in the Kelowna Accord and the Canadian Health Care Romanow Report. The Romanow Report claims that the inequity that was witnessed in Indigenous people health provision was a result of general mismanagement of funds and the system to provide health care was poorly established. The report recommended all government levels to cooperate in the restructuring of Indigenous people health care to confront health inequity towards Indigenous people (Romanow, 2002). Another political effort was seen through the Kelowna Accord, which recommended the improvement of Indigenous people’s living conditions, employment, health care, and education. The Accord also recommended a $5 billion dedication for implementing the recommendation that included reducing infant mortality, suicide among youth, and chronic illnesses in children by 20% then 50% within a span of five to ten years respectively. Despite the government pledge to support the implementation of the Kelowna, the actual execution faced limitations. The Accord then faced a huge challenged when the new Prime Minister Stephen Harper refused to endorse it as his predecessor, which resulted in the failure of Kelowna Accord action plans.
Challenges of Racism and Sexism to a Healthy Public Policy for Indigenous people Canadians
Racism’s impact on a population’s health and health status has been highlighted in several research studies. The inequality of access to health by the Indigenous people population in Canada based on the roots developed by the Indian Act is considered as a challenge to implementing the health policy for Canadian natives. The India Act legislation is part of what has led to emergence of systems encroached by a racism perspectives in structures of organizations impacting the Indigenous people population’s wellbeing such as economic development, education, governance, justice, and health care (Allan & Smylie, 2015). However, interventions for racial perspectives that can be applied include conducting early public education through the provision of education to medical and nursing students in all levels of academics.
Another intervention is through cultural competency training whereby public re-education in communities, worship places, workplaces, governments, and schools is conducted about the history and position of Indigenous people in Canada (Dickason, 1997). Therefore, to develop a healthy public policy that lacks historical roots of Indigenous people inequity will require the integration efforts of all sectors concerned with public life and ensuring Canadians understand and appreciate the existence of Indigenous people in their domain. Also, the creation of a supportive healthcare environment would have a significant impact on how health improvement policy would be developed based on the native people’s rare culture, rights, and practices.
Native Health Care Practices
There are efforts being made to provide Indigenous people healthy policy equity in Canada. In 2011, the province of British Columbia (BC) made strides towards the Indigenous people self-determination by establishing the First Nation Health Authority (FNHA). This authority assumed the responsibility of the federal government, which was neglecting them such as delivering and coordinating health care programs and services (Allan & Smylie, 2015). The FNHA through corporation with the BC First Nations, were to ensure the health gaps that existed between the Indigenous people and non- Indigenous people were efficiently addressed alongside the help of the the Canadian federal and local governments. The self-governance discussions were to provide fundamental standards and instructions that would help in developing governance relationships for new health policy. The efforts of the FNHA include engaging urban First Nations communities and Indigenous people communities who do not reside on reserves or their home communities in the formation of health policies and procedures that would eradicate the inequality in health care provision of the Indigenous people Canadian population.
Research as Advocacy
Beyond the strategies laid down by the FNHA in taking into consideration the knowledge and preferences of the communities in the restructuring of the healthcare system, there is need for substantial information in the progression of a healthcare policy tthat focuses on community based approaches. Using community-based research approaches would mean that Indigenous communities would have a chance to participate in the shaping of the research that will be used to direct policy influence based on their perspectives (Louis, 2007). The research-based approach is based on collaboration whereby the researcher and the researched both benefit from information sharing such as on leadership structure, agreeing on decisions, and extensive knowledge aimed at advantaging the development of effective and efficient health policy for both native communities and non-native people.
There is an increase within indigenous people research approaches based on the needs of such societies and their vision that are led by communities themselves. The current ways of conducting research also feature the collaboration of Indigenous people communities, government, and academia creating an empowering force that encourages communities to achieve their goals of self-determination through research approaches (Canadian Institutes of Health Research, 2019). The research approaches such as the use of bio-metric are significant for monitoring and establishing the level of diseases that the Indigenous people experience and the situations they undergo in controlling some of the diseases, which helps in developing the right healthy public policy capable to provide the required level of interventions. Therefore, the partnership and collaboration emphasis will ensure that the research approaches act as significant mechanisms in enabling meaningful participation by Indigenous communities, hence integrating their unique culture, rights, perspectives, and knowledge developing of healthy public policy.
Conclusion
Having identified the critical juncture that Canada is in regarding healthy public policy, based on the widening gap concerning health inequality between native people and non- natives, there is a need for serious Assessment of the underpinning issues resulting in inequality such as the role of federal policy. The failure of the political system to uphold the Kelowna Accord and federal government’s actions against Indigenous people healthy policy in previous years portray how the government had an interest in supporting the Indian Act that is highly inequitable. Therefore, the content provided in this review provides the government with an advantage to ensure that public policy development continues through the approach provided in this context. The importance of a national healthy public policy on Indigenous people health includes providing accountability for addressing a vast of problems faced by Indigenous people communities such as youth suicide. Lack of healthy public policy that incorporates targets, action plan, and Assessment mean, the government would not have the ability to act on Indigenous people issues including social determinant of health and Indigenous people health care quality.
However, despite the challenges of implementing healthy public policy, the Truth and Reconciliation Commission (TRC) report under Justice Murray Sinclair identified several issues regarding Indigenous people. Some of the issues raised in the report include the racism and other discrimination forms that Indigenous people face result from the Indian act which creates an assumption that Indigenous people in Canada should not be respected, recognized, or offered equality in terms of service access. The report insists on reconciliation of various issues at the national level. The process should commence with the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) that seeks to establish a mutually equitable and respectful environment for all people. The reconciliation process is compared to the development of healthy policies for the public which call for a vital change in philosophy, re-education of attitudes in the public towards Indigenous people population, and the commitment of the federal government in acknowledging and upholding the rights of Canadian natives. Therefore, to achieve equality in healthy public policy for the Indigenous people population, the creation of evidence that can be used in developing and transforming healthy policy should be conducted by the government, health care professional, health administrators, academic communities, and Indigenous people communities in a collaborative way.
References
Allan, B., & Smylie, J. (2015). First Peoples, Second class treatment: The role of racism in the health and well-being of Indigenous peoples in Canada. Toronto: The Wellesley Institute. Retrieved from http://www.wellesleyinstitute.com/wp-content/uploads/2015/02/Summary-First-Peoples-Second-Class-Treatment-Final.pdf
Bougie, E., Kelly-Scott, K., & Arriagada, P. (2015). The Education and Employment Experiences of First Nations People Living Off Reserve, Inuit, and Métis: Selected Findings from the 2012 Indigenous people Peoples Survey. Statistics Canada. Retrieved from https://www150.statcan.gc.ca/n1/pub/89-653-x/89-653-x2013001-eng.htm
Bourassa, C., McKay-McNabb, K., & Hampton, M. (2004). Racism, sexism and colonialism: The impact on the health of Indigenous people women in Canada. Canadian Woman Studies. 24(1). https://cws.journals.yorku.ca/index.php/cws/article/viewFile/6172/5360
Canadian Institutes of Health Research. (2019). Institute for Indigenous people Health. Retrieved from http://www.cihr-irsc.gc.ca/e/8172.html
Cook, C. (2003). Jurisdiction and First Nations Health and Health Care [Dissertation]. Winnipeg: University of Manitoba
Dickason, P. (1997). Canada’s First Nations: A History of Founding Peoples from the earliest Times. Don Mills: Oxford University Press
Gershon , S., Khan, S., Klein-Geltink, J., Wilton, D., To, T., Crighton. J. …& Henry, D. (2014, April 23). Asthma and Chronic Obstructive Pulmonary Disease (Copd) Prevalence and Health Services Use in Ontario Metis: A Population-Based Cohort Study. PLoS ONE. 9(4). doi:10.1371/journal.pone.0095899.
Ghosh, H., & Spitzer, D. (2014). Inequities in Diabetes Outcomes among Urban First Nation and Métis Communities: Can Addressing Diversities in Preventive Services Make a Difference? International Indigenous Policy Journal. 5(1). https://ir.lib.uwo.ca/iipj/vol5/iss1/2/?referer=https%253A%252F%252Fwww.google.com%252F
Health Canada. (2013). Statistical Profile on the Health of First Nations in Canada: Vital Statistics for Atlantic and Western Canada, 2001/2002. Ottawa: Health Canada, First Nations and Inuit Health Branch, Health Information AaRD; 2011. Retrieved from http://www.hc-sc.gc.ca/fniah-spnia/alt_formats/pdf/pubs/aborig-autoch/stats-profil-atlant/vital-statistics-eng.pdf – Thesis Writing Service In Canada
Indigenous and Northern Affairs Canada. (2007). Assessment of the Income Helpance Program. Audit and Assessment Sector, Indian and Northern Affairs Canada. Retrieved from http://www.aadnc-aandc.gc.ca/DAM/DAM-INTER-HQ/STAGING/texte-text/eiap07_1100100011749_eng.pdf
Louis, P. (2007). Can You Hear us Now? Voices from the Margin: Using Indigenous Methodologies in Geographic Research. Geographical Research. 45(2):130–9. doi:10.1111/j.1745-5871.2007.00443.x.
Luo, M., Wilkins, R., Smylie, J., Martens, P., & Fraser, W. 2007). Community report: Community Characteristics and Birth Outcomes among First Nations and non-First Nations in Manitoba, 1991–2000.
Miller, JR. (2004). Lethal Legacy: Current Native Controversies in Canada. Toronto: McClelland and Stewart
Office of the Auditor General of Canada. (2015). Report 4: Access to Health Services for Remote First Nations Communities. Spring Reports of the Auditor General of Canada. Office of the Auditor General of Canada. Retrieved from https://www.oag-bvg.gc.ca/internet/English/att__e_40382.html
Public Health Agency of Canada. (2013). At a Glance – HIV and AIDS in Canada: Surveillance Report to December 31st, 2012. Retrieved from https://www.canada.ca/en/public-health/services/hiv-aids/publications/at-glance-hiv-aids-canada-surveillance-report-december-31-2012.html#wb-cont
Romanow, J. (2002). Building on Values: The future of health care in Canada – Final Report. Retrieved from http://publications.gc.ca/collections/Collection/CP32-85-2002E.pdf.
Sinclair, M. (2015). Honouring the Truth, Reconciling for the Future: Summary of the Final report of the Truth and Reconciliation Commission of Canada. Ottawa: Truth and Reconciliation Commission of Canada. Retrieved from http://www.trc.ca/websites/trcinstitution/File/2015/Findings/Exec_Summary_2015_05_31_web_o.pdf
Statistics Canada. (2016). Indigenous people Statistics at a Glance. Ottawa: Statistics Canada. Retrieved from https://www150.statcan.gc.ca/n1/pub/89-645-x/89-645-x2010001-eng.htm
