A Vulnerable Canadian Indigenous Population

The Indigenous people of Canada experience a relatively low health status when compared to the general population, they carry a higher-than-average rate of cancer, infectious disease, respiratory disease, cardiovascular disease and diabetes (Richmond & Cook, 2016). In addition, Indigenous peoples average a high mortality rate and higher prevalence of mental illness and addiction (Hajizadeh, Bombay & Asada, 2018). Barriers to healthcare are commonly experienced by Indigenous people in the form of racism, substandard quality of care and discrimination (Vignealult et al, 2021). This health burden combined with lower socioeconomic status, higher than average unemployment rates, poor and over-crowded housing makes the Indigenous population a vulnerable one. The Truth and Reconciliation Commission (TRC) acknowledges the role that colonialism had to play in the challenges the Indigenous populations of Canada face. Indigenous people were effectively removed from their culture, their families separated, and their knowledge forbidden in an attempt at assimilation into Canadian mainstream culture. The repercussions are far reaching not the least of which is the mental health and addictions struggle Indigenous people now face. The Indigenous population of Labrador exhibiting a high rate of mental illness and suicidal ideation illustrate some of the struggles faced today due to the historical trauma (Pollock et al, 2016). Mending these consequences involves a culturally sensitive approach that returns power back to the Indigenous community and acknowledge colonialism as an Indigenous determinant of health.

The History

In 1920 the Indian Act made it mandatory for every Indigenous child to be taken from their families and communities and placed in residential schools (Hanson, Gamez & Manuel, 2020). Residential schools helped to destroy cultures by forbidding traditional activities and Indigenous languages, children were given a basic education and taught skills deemed useful by popular Canadian standards. Indigenous children were taken away from their elders and the knowledge of their people, removed from the chance to learn traditional skills like hunting, fishing and storytelling (O’Keefe et al, 2021). The purpose of these institutions created by the Canadian government and run by the catholic school was to assimilate these children into the predominant Canadian culture emphasizing Christian ways of living. This kind of systemic racism and the discrimination and barriers it produces makes colonialism an important determinant of health for Indigenous people (Nelson & Wilson, 2017). The practices and policies of the Canadian government under the Indian Act created unfair inequalities across ethnic groups and ignored aboriginal rights, terminating treaties leading to a loss of culture.

Though Newfoundland was not a part of Canada in 1920 when the Indian Act was in effect there were similar practices of colonization with the same detrimental effects. Newfoundland and Labrador (NL) is home to over 45 thousand Indigenous people according to the 2016 census. The Indigenous population is comprised of the Innu, the Innuit, the Mi’kmaq and the Southern Inuit of NunatuKavut. There were 5 residential schools in NL where sexual abuse, physical abuse, neglect and language and cultural loss reaped havoc on the children that were forced to attend. These schools were administered by the Newfoundland government and the Moravian mission. Children were punished if they spoke their own language and were separated by gender from their siblings (Hanson, Gamez and Manuel, 2020). The Moravian’s sought to settle the Inuit so that they could teach them Christian ways, they introduced them to an economic system involving trade of skins for European staples that gradually made them dependent on and in debt to the missionaries (Hanrahan, 2003). The Indigenous people were taught that their culture and way of living was barbaric, and they must be shown a more civilized way to live. They were refused the right to learn the healing practices of their elders, that of storytelling, praying, smudging and ceremony (O’Keefe, Cwik, Haroz & Barlow, 2021). With these practices the Indigenous culture and way of healing was threatened with extinction.

The Consequences

The Human Development Index is an indicator of the health of a population, this number is high for Canada but comparatively low for its Indigenous population (McNally & Martin, 2017). Mental health issues like PTSD, suicidal thoughts, addictions and depression are common for many residential school attendees (Nelson & Wilson, 2017). Just five years ago an alarmingly high rate of Suicide and suicidal ideation in a Labrador First Nations community was brought to the forefront of health issues raising concerns in NL. Having a strong sense of cultural identity is associated with psychological well-being, colonization removed this connection from Indigenous peoples which likely contributed to many mental health and addictions issues that are seen today (Hossain & Lamb, 2019).

Systemic racism has led to discrimination in healthcare which acts as a barrier to access for Indigenous populations. Indigenous people commonly report long wait times and substandard quality of care (Vigneault et al, 2021). With respect to mental health issues there is significant stigma attached preventing people from feeling comfortable accessing health care. Prejudice even exists in research where Indigenous mental health topics favour those with respect to o suicide and addictions instead of bipolar disorder or schizophrenia. Further, traditional biomedicine treatments for mental health and addictions have been found to be ineffective with this population as it does not consider spiritual and cultural practices and traumatic history of the Indigenous population (Nelson &. Wilson, 2017). There are strong links associating perceived racism with poor mental health outcomes, psychological stress and depression accompanied by substance use (Marrone, 2007).

The Solution

The Truth and Reconciliation Commission of Canada recognizes the impact culture has on health and well-being and calls for more inclusive collaboration between western biomedicine practices and Indigenous traditional ways of healing. There is evidence supporting the benefits of an approach to Indigenous healthcare that incorporates their culture and spiritual practices (McNally & Martin, 2017). First Nations people of North America view health holistically, believing that disease arises from an imbalance within a person’s spirit (Marrone, 2007). This type of thinking should be included when developing new healthy public policies and programs to address concerns among the Indigenous population. If colonialism and historical trauma are recognized as the identified problem leading to mental illness, it follows that interventions should focus on cultural revitalization for both the individual and the community (O’Keefe, Cwik, Haroz & Barlow, 2021). Incorporating traditional practices with western modalities of biomedicine therapies with input from community members is essential (Nelson & Wilson, 2017).

The federal government has heard the call to action and has responded with an Aboriginal Health Transition Fund meant to partner with the provinces to address 3 categories of action, to improve accessibility, adapt existing health programs to make them better suited to Indigenous needs and to increase the participation of Aboriginal people in design and implementation (Henderson et al, 2018). Newfoundland and Labrador has begun work with this fund with programs like the collaborative Mental Health Addictions Project in Mushuau Innu First Nation, the Labrador Integration Project in Labrador Grenfell Health and the Patient Navigator Project in Eastern health.

Eastern health a Regional Health Authority in NL has developed a program with the purpose of breaking down barriers related to accessing health care in the province. The Aboriginal Patient Navigator (APN) works with Indigenous clients and health care workers to prevent and mitigate misperceptions that are sometimes experienced in the healthcare setting. The APN is an interpreter, guide and confidant for Indigenous people that need to make use of the health care system. The APN also functions as an educator for healthcare staff and is an invaluable resource for safe, culturally appropriate care.

The Mental Health Addictions Project in the Mushuau Innu First Nation identifies the importance of culture in developing a framework to treat mental health challenges. It emphasizes treatment within the community in developing services and supports. This involves working with stakeholders at many levels; The regional health authorities, First Nations community health workers, First Nations Elders, Health Directors and Tribal Councils among them. When communities are in control of the intervention process a reduced prevalence of suicide and depression has been seen (Pollock et al, 2016).

These programs are steps forward in incorporating Indigenous teachings and communities in health care so that it is delivered in an appropriately culturally sensitive manner. Much work is still to be done. In the coming years it will be important to recruit and encourage retention of Indigenous healthcare workers in rural locations as well as continue to adapt and grow with input from the changing community.

Bingham, B., Moniruzzaman, A., Patterson, M., Distasio, J., Sareen, J., O'Neil, J. & Somers, J.M. (2019, April 8). Indigenous and non-Indigenous people experiencing homelessness and mental illness in two Canadian cities: A retrospective analysis and implications for culturally informed action. BMJ Open. https://doi: 10.1136/bmjopen-2018-024748

Hajizadeh, M., Hu, M., Bombay, A., & Asada, Y. (2018). Socioeconomic inequalities in health among Indigenous peoples living off-reserve in Canada: Trends and determinants. Health Policy,

122(8), 854–865. https://doi.org/10.1016/j.healthpol.2018.06.011

Hanrahan, M. (2003). The Omission of Aboriginal People from the terms of Union between Newfoundland and Canada and its Ongoing Impacts. Royal Commission on Renewing and Strengthening Our Place in Canada. https://www.gov.nl.ca/publicat/royalcomm/research/Hanrahan.pdf.

Hanson, E., Gamez, D., & Manuel, A. (2020, September). The Residential School System. Indigenous Foundations. https://indigenousfoundations.arts.ubc.ca/residential-school-system-2020/

Henderson, R., Montesanti, S., Crowshoe, L. & Leduc, C. (2018) Advancing Indigenous primary health care policy in Alberta, Canada. Health Policy. 122, 638-644.

Hossain, B. & Lamb, L. (2019). Cultural Attachment and Wellbeing Among Canada's Indigenous People: A Rural Urban Divide. Journal of Happiness Studies. 21. 1303-1324.

Marrone, S. (2007) Understanding barriers to health care: a review of disparities in health care services among indigenous populations. International Journal of Circumpolar Health, 66(3), 188-198, DOI: 10.3402/ijch.v66i3.18254

McNally, M., & Martin, D. (2017). First Nations, Inuit and Métis health: Considerations for Canadian health leaders in the wake of the Truth and Reconciliation Commission of Canada report. Healthcare management forum, 30(2), 117–122. https://doi.org/10.1177/0840470416680445

Nelson, S. E. & Wilson, K. (2017, January 18). The mental health of Indigenous peoples in Canada: A critical review of research. Social Science & Medicine. 176, 93-112.

O'Keefe, V. M., Cwik, M. F., Haroz, E. E., & Barlow, A. (2021). Increasing culturally responsive care and mental health equity with indigenous community mental health workers. Psychological Services, 18(1), 84–92. https://doi.org/10.1037/ser0000358

Pollock, N. J., Mulay, S., Valcour, J. & Jong, M., (2016, July). Suicide Rates in Aboriginal Communities in Labrador, Canada. American Journal of Public Health. 7(106). 1309-1315. https://bmjopen.bmj.com/content/bmjopen/9/4/e024748.full.pdf

Vigneault, L. P., Diendere, E., Sohier-Poirier, C., Abi Hanna, M., Poirier, A., & St-Onge, M. (2021). Acute health care among Indigenous patients in Canada: a scoping review. International journal of circumpolar health, 80(1), 1946324. https://doi.org/10.1080/22423982.2021.1946324