BSCN 2508 OND: Critical

Conversations in
Indigenous Determinants
of Health In Canada
Week 4 Class 2: May 29, 2024
Dr. Bonnie Fournier
 Agenda
• Opening/Land Acknowledgment
• Rest in Power- Time to Reflect
• Module 3 Overview: + Proximal IDH
• Week 4 Class 2 Reading/Video
• Current Health Care Needs within Indigenous
Communities
• Proximal (Leaves) Indigenous Determinants of
Health
• Health Behaviors
• Physical Environment
• Aamjiwnaang First Nation Case Study
2
 Humber College Land
Acknowledgement

Humber College is located within the traditional and treaty

lands of the Mississaugas of the Credit, known
as Adoobiigok, the “Place of the Alders” ​in the ​
Michi Saagiig language. The region is uniquely situated along ​
Gaabikanang Ziibi (the place of the flat rocks) or the Humber
River and Humber River watershed, which historically provided
an integral connection for Anishinaabe, Haudenosaunee, and
Wendat peoples between the Ontario Lakeshore and the Lake
Simcoe/Georgian Bay regions. ​Now home to people of
numerous nations, Adoobiigok continues to provide a vital
source of interconnection for all. 3
 Rest in Power: Time to Reflect
• Brian Sinclair (2008)
• Juliette Tapaquon (2014)
• Keegan Combes (2015)
• Joyce Echaquan (2018)
• Heather Winterstein (2021)
• Brent Sky (2021)
• November Kelly (2022)

4
 Intermediate IDH: Cultural
Resurgence
• Cultural Resurgence or “Being Who We Are”
• Reclamation and regeneration of Indigenous languages, traditions, and relationships with
ancestral lands and waters

• Chandler & Lalonde (1998)

• Study done shows that cultural continuity (cultural resurgence) had impact on incidence of youth
suicide rates in BC
• Stronger cultural resurgence in community led to lower youth suicide rates

• Oster et al (2014)
• Research shows that cultural continuity (Being Who We Are) is important in development self-
determination
• First Nations that have been better able to preserve their culture may be relatively protected from
diabetes.
5
08/04/2024 6
 Intermediate IDH:
Environmental Stewardship
• Traditional ties to the natural environment are a major resource for the superior health enjoyed by Indigenous
Peoples prior to European colonization- NCCIH, 2022

• UNDRIP (2006), Article 25:

• Indigenous peoples have the right to maintain and strengthen their distinctive spiritual relationship with their traditionally owned or
otherwise occupied and used lands, territories, waters and coastal seas and other resources and to uphold their responsibilities to future
generations in this regard.

• Contamination from industry has further contributed to negative health outcomes for Indigenous people and their
traditional territories
• Grassy Narrows First Nation “Children of the Poisoned River”

• Indigenous people reasserting control over traditional territories through legislative mechanisms:
• Comprehensive Land Claim Agreements
• Self-Government Agreements
7
• First Nation Land Management Agreements
08/04/2024 8
 Intermediate IDH: Health Care
Systems
• Indigenous people’s Health Care in Canada is delivered by the
Federal Health Care System, but often administered by the
Provincial Government
• Limited accountability, fragmented delivery and jurisdictional
ambiguity
• Ie. Jordan’s Principle, Joyces Principles

• “Federal system of health care delivery for status First Nations

people resembles a ‘patch quilt’ of programs and services with
limited accountability, fragmented delivery, and jurisdictional
ambiguity (Diekmeyer, 2020). 9
08/04/2024 10
 Intermediate IDH: Health Care
Systems
• “April 14, 2016, the Supreme Court of Canada ruled that the Federal Government has
Constitutional responsibility for Métis and non-Status [people]. [Although] the decision does not
require the federal government to provide programs and services” – NCCIH, 2022

• Metis Nation of Ontario Health Care

• The Métis Nation of Ontario’s (MNO) Healing and Wellness branch facilitates and coordinates programs, services,
and activities to address the holistic needs of Métis people in Ontario at the provincial, regional, and local levels.

• Metis National Council

• The Métis Nation is actively addressing the health and wellness of Métis people and communities through evidence-
and culture-based approaches.

11
 Intermediate IDH: Health Care
Systems
Non-Insured Health Benefits (NIHB)
• First Nation adults living on reserve often experience long wait lists for health care In addition, they are limited by
needed-services not being covered or approved by the federal Non-Insured Health Benefit Plan (NIHB) and by
doctors or nurses not being available in their area. Reports that health care provided was inadequate or not
culturally appropriate are also frequently mentioned barriers.”- NCCIH, 2022

Canada Health Transfer Act (1985)

• The act requires that all medically necessary hospital, physician and surgical dental services (such as, insurable
health services) be covered by provincial or territorial health care insurance plans for all eligible residents of the
province or territory, including Indigenous Peoples . 12
 Intermediate IDH: Community
Resources, Infrastructure and
Capacities
• Infrastructure
• There is a critical lack of community infrastructure within First Nations
communities due to underfunding by the Canadian Gov.
• Infrastructure Includes: buildings, schools, amenities, roads/ bridges, public
transportation, water and waste management), resource development (e.g., land
use, natural resource harvesting and use), and safety (e.g., fire, ambulance, and
police services)
• 2 Dead and 3 Injured in Weenusk FN House Fire (2024)
• Economic development is a key determinant, with control over land and natural
resources representing a foundation to the success of most economic
development initiatives (CCSDH, 2013)
• Long Term Drinking Water Advisories
• Part of the United Nations Declaration on the Rights of Indigenous People Act (2021)
• Ontario: 19 Remaining, 76 lifted
13
08/04/2024 14
 Intermediate IDH: Community
Resources, Infrastructure and
Capacities
• Resources
• Inequities in the distribution of financial and human resources continue to disadvantage many Indigenous
communities from optimizing collective health. – NCCIH, 2022
• Communities often experience fragmented, under-funded programs in which government bureaucracies promote
community responsibility without a parallel transfer of control (Canadian Council for Aboriginal Business, 2016;
McCartney, 2016; Warkentin & Parliament House of Commons, 2014).
• The Indian Act (1876) has historically controlled Indigenous people and their lands, limited economic development on
reservations lands
• 1988 Amendment to Indian Act- Increase access to band revenue through taxation or reserve lands
• Allowed Indigenous people to hold mortgages on reserves
• Through partnerships with private corporation, some Indigenous communities are experiencing economic growth
• Indigenous communities are overcoming challenges to achieving self-sustaining governance and economic success
(CCSDH, 2013).

15
16
 Intermediate IDH: Community
Resources, Infrastructure and
Capacities
• Capacities
• Community capacity within Indigenous communities looks as the capacity to provide employment,
to train and retain vital workers, and to develop and implement local, culturally relevant programs
and services is imperative. – NCCIH, 2022
• Wide spread racial inequities in First Nations communities can contribute to a diminished capacity
to address community level responses to health needs, NCCIH, 2022
• Financial inequities and lack of human resource continue to disadvantage Indigenous communities
from achieving optimal health
17
Module 3: Knowing-
Environment
1. Learn about how the Land acts
as a guide and a key
determinant of health for
Indigenous people
2. Examine Proximal Indigenous
Determinants of Health
(Western/Indigenous)
3. Integration of Western, and
Indigenous Knowledge systems
to create and informed cultural
lens of practice
18
Module 3: Knowing-
Environment
• Develop Understanding of Proximal
Determinants of Health
• Connect distal, intermediate and
proximal determinants of health
• Critically analyze ‘Trickle-Up’
effect of the Reading & Wein Tree
Model
• Examine the current health care
needs within Indigenous
communities
• Develop integrated lens of cultural
competency through understanding
ones environment (ie. Health Care
Setting, Canadian Society etc.)

19
Determinants of 2009)
Indigenous
Health

Culture
Week 4 Class 2:
Reading/Video
 Week 8 Reading: Journal Article:
Health Inequalities and Social Determinants of
Indigenous Peoples Health (pg. 5-14)
• Proximal determinants of health include conditions that have a direct impact on physical,
emotional, mental or spiritual health (NCCAH, Pg.5)

• Unfavorable proximal determinants can contribute to stressors that in turn can generate or
exacerbate health problems (NCCAH, Pg. 6)

• Proximal Determinants Identified in the Article include:

• Health Behaviors
• Physical Environments
• Employment and Income
• Education
• Food Insecurity
NCCAH, 2009
Current Health Care Needs
within Indigenous
Communities
• Diabetes
• Cancer
• Heart Disease
• Infectious Disease
• Mental Health
23
 Disease Prevalence in Indigenous
Communities
1. Diabetes
• There are increased rates of Type 2 Diabetes in Indigenous communities in Canada (Loppie & Wein, 2009)

2. Heart Disease
• There are increased risk of a heart attack or cardiovascular event within Indigenous communities (Loppie & Wein, 2009)

3. Cancer
• Indigenous people in Canada have poorer cancer survival rates (Withrow et al., 2017)

4. Infectious Disease
• Indigenous people are at an increased risk to contracting infectious disease (Loppie & Wein, 2009)

5. Mental Health
• Overwhelmingly, Indigenous people have higher rates of mental health diagnosis compared to non-Indigenous people in Canada.
Intergenerational trauma and ongoing discrimination contribute to poor mental health in Indigenous communities (Firestone et al.,
2022)
 Disease Prevalence in Indigenous
Communities: Diabetes
Type 2 Diabetes (T2D)
• Increased glucose in blood. Caused by inadequate insulin
secretion, cellular resistance to insulin action, or both
• Has become a worldwide epidemic
• Forecasted to affect 300 million people by 2025
• Affects First Nations peoples in Canada 3 to 5 times more
frequently than non-Indigenous people
• One of the most common chronic diseases affecting First
Nation children and youth
Loppie & Wein, 2009
 Disease Prevalence in Indigenous Communities: T2D

Determinants of T2D
• Development of T2D is influenced by genetic, environmental, and social factors
• Effects of colonialism
• Suppression of traditional diet, community displacement, natural resource
exploitation, increasing sedentary lifestyle
• Ex. Introduction of the 5 White gifts by the Canadian Gov. to Indigenous
communities after moving them to Reserves in the early 1900s: Milk, Sugar,
Salt, Lard & Flour.
T2D and Social Determinants of Health
• Current T2D epidemic in Indigenous communities is a relatively recent
phenomenon
• Lifestyle and diet changes account for some prevalence
• Adverse social conditions (poverty, lack of adequate housing, lack of access to
White Lies

27
 Disease Prevalence in Indigenous
Communities: Heart Disease
• Indigenous people at 2x as likely to get cardiovascular
disease(CVD) than non-Indigenous people in Canada (Loppie
& Wein, 2009)
• First Nation people are more likely to experience a
cardiovascular event earlier in life, than Non-Indigenous people
(Loppie & Wein)
• There are increased rate of smoking in Indigenous
communities, and this acts as a co-morbidity for cardiovascular
disease (Loppie & Wein)
 Disease Prevalence in Indigenous
Communities: Heart Disease
• Indigenous patients are less likely to undergo a coronary
angiogram and wait longer to receive an angiogram
compared to non-Indigenous patients (Vigneault et al.,
2021).
• The First Nations Health Authority in British Columbia (BC)
reported significantly higher rates of Ischemic Heart Disease
in First Nations people (6.7%) compared to the non-First
Nations BC population (5.9%).(British Columbia, 2020)
 Disease Prevalence in Indigenous
Communities: Heart Disease & Métis
• Approximately 7% of Métis self-reported “heart problems”.
• Métis women experienced approximately twice the rate of death
due to ischemic heart disease (IHD) and Métis men experienced
1.6 times the rate of death due to IHD, when compared to non-
Indigenous Canadians.
• The Métis Nation of British Columbia demonstrated significantly
higher rates of IHD in the Métis population (9.1%) compared to
the non-Métis population (7.1%) in British Columbia (Metis
Nation of British Columbia, 2021).
Disease Prevalence in Indigenous
Communities: Heart Disease &
Medication
• Cardiovascular medication use has been found to be
underutilized in Indigenous populations (Pace et al., 2020).
• Indigenous access to western forms of cardiovascular
medication is hindered by several factors:
• pharmacy locations, especially for rural, remote, and on-
reserve populations, limited transportation infrastructure, cost,
and cultural barriers, including a lack of Indigenous and
culturally safe healthcare providers (In Plain Sight, 2020).
 Disease Prevalence in Indigenous
Communities: Cancer
• Indigenous people have lower 5-year cancer survival rates,
compared to Non-Indigenous people (Withrow et al., 2017)
• First Nations people in BC have lower cancer rates, compared to
Non-Indigenous people but are more likely to be diagnosed with
colon and cervical cancer, and more likely to experience poorer
survival outcomes once diagnosed with cancer (McGahan, et al.,
2017)
• Indigenous women have lower rates of breast cancer screening
(OCC, 2017)
 Disease Prevalence in Indigenous
Communities: Infectious Disease
Strep Throat
Sandy Lake First Nation; Brody Meekis
Tuberculosis
Rate of tuberculosis are 5x higher in First Nations communities in Canada, and 50x
higher in Inuit communities
HIV/AIDS
HIV rates in First Nations communities in Saskatchewan are 11x higher than the
national average
Case Study: H1N1 (Swine Flu)
Body Bags sent to God’s River First Nations in Manitoba
Disease Prevalence in Indigenous
Communities: Mental Health
• Indigenous youth are less likely to report excellent or very good mental health than older age groups
(StatsCan, 2017)
• Indigenous peoples mental health during COVID-19 Pandemic
• Higher proportions of Indigenous participants reported fair/poor mental health than non-Indigenous
participants (38% compared to 23%) (StatsCan, 2022)
• Mental health and cultural continuity among an urban Indigenous population in Toronto, Canada (Fi
restone et al., 2022)
• Community based participatory research
• 45% of participants reported receiving a mental health diagnosis
• 53% reported lifetime anxiety disorders
• 51% reported major depression
• 78% reported high rates of suicidal ideation
• Attending Residential Schools or Experiencing Discrimination were associated with having a mental health disorder
 Disease Prevalence in Indigenous
Communities: Mental Health -Video:
Canadas Aboriginal Suicide Emergency
• Suicide rates in Indigenous communities in Canada, when compared to Non-Indigenous
communities in Canada are:
• 3x higher for First Nations people
• 5-6x higher for First Nations Youth
• 2x higher for Metis People
• 9x higher for Inuit people
• Overall, Indigenous women are at higher risk for suicide than Indigenous men
• Suicidal Behaviors
• 25% of Indigenous people reported thinking about suicide at some point in their life
• Also includes Indigenous people living off reserve
• 21% of Indigenous men, living off reserve, reported suicidal thoughts
• 26% of Indigenous women, living off reserve, reported suicidal thoughts
• 22 % of Inuit people (<18 yrs old) reported suicidal thoughts

(Canadian Encyclopedia, 2023)

Canadas Inuit Led Suicide Prevention Strategies

36
https://www.lifevoice.ca/suicide-prevention-resources/nispsframework#prettyPhoto[flexslider_2319]/1/
 Upcoming..

• Tuesday June 4th – 5% Class is on the land (will confirm via announcement)

• Wednesday June 5th online class–10% Module 3 Reflection due Friday June 7th 23:59

• Tuesday June 11 –working on Assignment 4 in your groups not in class

• Wednesday June 12 & Tuesday June 18th Presentations in class

• Last Class Wednesday June 19th: 2nd part of positionality 5% & Sharing Circle 5% in class
Contact
Information:
Please connect with me through
Humber Email. Please be sure to
include your name and course
section.
[email protected]