Quality Healthcare in Canada is not Accessible to Everyone: An indigenous perspective

Image 1: Indigenous Medicine Wheel

Every Canadian has the right to healthcare which is accessible, comprehensive, universal, portable and led by a public administration. This is what is spelled out as the primary objectives in the Canada Health Act as

displayed in image 2.

Image2: Canadian Health Act

Throughout the last 13 weeks I have learned about the health of the general Canadian population and the various contributing factors that go into creating it. The glaring issue which has emerged is that Canadas’ indigenous population has been left behind when it comes to their health. There are a multitude of contributing factors which have left me both disappointed and fueled to help create change. Here I will explore one of the major the barriers to obtaining healthcare, the various health determinants as well as what influences indigenous healthcare. I will also discuss some reasons this population is so vulnerable. Lastly the discussion will focus on the future of health in Canada for the Indigenous people.

Barriers

In order to create change it is important to first look at one of the major barriers which is affecting this specific populations’ health. In my opinion the physical geography provides the largest obstacle for obtaining healthcare in a timely and comprehensive way. Working as a nurse in northern, fly in only, reserves in both Ontario and Manitoba provided me with first hand knowledge of just how large this factor is. Each community has a local health centre, some communities have health Canada run centres and others are run by the aboriginal health access centres. On remote reserves these centres are primarily run by advanced scope nurses. Physicians are always available by telephone and do spend time in the community. Personally speaking I had the best access to physicians while working in the Island Lake region in Manitoba as the doctors stayed on reserve weekly and the on call physician was dedicated to the nursing stations. This is different as in some communities the physician on call is also working in the emergency room, possibly in Timmins Ontario or Thompson Manitoba for example, so getting called back for orders and help can, at time,s take many hours. Considering the Canadian health act states that access must be accessible, portable and comprehensive I will have to argue that we are not upholding those three factors for this population.

Image 3: Barriers to Health

Image 3 above provides an excellent visual example of these barriers. The primary clinic in the community for basic needs is readily accessible. However, when required treatment exceeds the scope of this clinic there are multiple steps that one needs to take to achieve it. The example of having a readily accessible physician either by phone or on reserve, for me, determined which communities I would agree to work in. My reason for this is that I felt my patient care was safer and more comprehensive because of the physician access. Making this seemingly simple change, of having a physician dedicated call rotation covering when there is no doctor in the community, would be a small positive change in the right direction.

Health Determinants and Spears of Influence

The World Health Organization (WHO) provides a broad list of social determinants which influence ones health:

Income and social status

· Employment and working conditions

· Education and literacy

· Childhood experiences

· Physical environments

· Social supports and coping skills

· Healthy behaviors

· Access to health services

· Biology and genetic endowment

· Gender

· Culture

Image 4: Social Determinants · Race

This list is a generic list meant to apply to all persons. The indigenous population also uses a model to display their various health influences and determinants. Their model is referred to as a medicine whee,l shown in the opening image. This wheel can be used in many ways to depict physical health or mental health. The image below is an excellent representation of both personal, community and environmental determinants.

For healthcare providers and policy makers it is of utmost importance to become informed about the population you are serving. Noticing in this image that culture and language are be included in all aspects as well as the very spiritual feel to the needs laid out. Therefore, healthcare providers as well as those making policy regarding the delivery of programs and care to this population, should consider layering the two models. In doing so it will provide direction and understanding of the needs of the indigenous population in relation to the universal determinants of health; as the diagram above has already started doing by outlining the linkages. When I was working in the various northern communities as a nurse, I discovered decisions regarding programs to deliver, as well as how care would be provided to the elderly or palliative patients was frequently made over large group dinners. These dinners or meetings felt very informal in the traditional sense however, this allowed for ease of sharing, story telling and community involvement as well as input.

Vulnerability

A definition of what it means to be vulnerable is as follows; vulnerability is described as the result of interaction between the challenges a person faces and the resources that they can access when facing those challenges. Through decolonization, loss of traditions, values as well as language are just a few references which have led to the vulnerability of the indigenous population in Canada. This combination of events has greatly affected the health and perceived ability to make positive change within the culture. The multigenerational effects of the residential school atrocity can be heard today as a nurse counselling my patients who are dealing with anxiety, substance abuse and post traumatic stress syndrome. As a country there have been so many terrible mistakes made in the past that to attempt to capture the vastness of it in this forum would not give this disgrace the verbiage it deserves. What I will say is that my experiences working with this population has made me very aware of the issues and the confidence to create public awareness.

The Future of Indigenous Health In Canada

Presently there is no specific legislation or policy regarding the health of Canadas’ indigenous population. Over the years there have been committees and programs dedicated to advancing, advocating and including indigenous persons in the creation of these policies however there continues to be a patchwork of committees piecing together this framework. As recently as January 2021 the federal government held meetings with many of the provincial and territorial health ministers to begin the creation of specific indigenous healthcare legislation. This would be the very first of its kind in Canada. The disgraceful fact is that Canada continues to dodge many of the issues which as a nation we are responsible for. It is unfortunate that at this recent meeting it is reported that the current pandemic took centre stage which tabled movement on creating policy and laws. It is disturbing to me not only as a nurse but as a human being that we are seeing the life expectancy of the indigenous population decrease while the rest of the country is considered to be in the top 50 of the worlds best places to live.

Conclusion

Throughout this course I have found it very difficult to write about the many issues that are faced by Canadas’ indigenous population. I am frequently angry and upset by what I read and learned about the history and struggles. Too many times the government has been provided with the opportunity to admit their wrongs or apologize. However in so many articles there is passing of blame or making excuses. Having seen first hand during my work the mess that reserve life has come to be for so many, I too now struggle to see how we find the light at the end of this dark tunnel.

References

Aboriginal populations. (2013, March 13). Retrieved from https://en.healthnexus.ca/topics-tools/vulnerable-populations/aboriginal-populations

Canada, H. (2020, February 24). Government of Canada. Retrieved from https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act.html

Gouldhawke, M. (2021, February 05). The Failure of Federal Indigenous Healthcare Policy in Canada. Retrieved from https://yellowheadinstitute.org/2021/02/04/the-failure-of-federal-indigenous-healthcare-policy-in-canada/

Government of Canada; Indigenous Services Canada. (2020, April 20). Indigenous health. Retrieved from https://www.sac-isc.gc.ca/eng/1569861171996/1569861324236

Government of Canada, O. O. (n.d.). Report 4-Access to Health Services for Remote First Nations Communities. Retrieved from https://www.oag-bvg.gc.ca/internet/English/parl_oag_201504_04_e_40350.html

Social determinants of health. (n.d.). Retrieved from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1