“Nothing About Us Without Us”: Taking Action on Indigenous Health
This letter is part of series of Open Letters from Canadian leaders in Healthcare. To see the complete series please click here
The inequities in the health of First Nations, Inuit and Métis are well-known and long-standing. They are built on Canada’s colonial past, and fed by the on-going resistance to reconcile with the injustices of the past and the present. Reconciliation as a pathway to Indigenous health equity requires relationship building between Indigenous and non-Indigenous people, as well as fostering better understanding of each other's world views and ways of knowing.
- Malcolm King, Scientific Director - CIHR Institute of Aboriginal People’s Health, Keynote Speaker, CAHS Forum on Indigenous Health, September, 2016
On September 15, 2016, the Canadian Academy of Health Sciences (CAHS), presented a Forum entitled “Solutions to Inequities in Indigenous Health: what works and why?”. The day was aimed at identifying key issues surrounding Indigenous health today and developing insights for how to move the conversation and research agenda away from a problem-based discourse towards solution-oriented research. Presentations were both moving and informative as Indigenous leaders and non-Indigenous research partners described historical antecedents of current issues in health as well as examples of successful community-based programs, including self-governance of health affairs in British Columbia through the First Nations Health Authority.
Health inequities among Indigenous peoples are recognized as among the most significant issues in Canadian life. The gap in life expectancy between Indigenous and other Canadians is seven years; Indigenous people are more likely than other Canadians to have hearing, sight and speech disabilities; and Indigenous people have significantly higher rates of diabetes, HIV and other diseases than the rest of Canadians.
The social determinants of poor health are also recognized and include inadequate access to health services, income, education, employment, living conditions, clean water, food security and social support. Racism, culture loss, disconnection from ancestral lands and identity, and stigma further compound these inequities between Indigenous peoples and other Canadians. While health researchers and scientists have been working with Indigenous communities for decades, successes and effective solutions have not been successfully shared, understood or integrated broadly.
Four messages from the day particularly resonated for me. First, “nothing about us without us”: self-determination and participatory approaches to health promotion are essential to move past the effects of colonization and facilitate sustainable change with Indigenous peoples. It is essential that well-intentioned healthcare providers or policymakers partner with Indigenous communities to define problems and solutions. Health researchers need to incorporate Indigenous ways of knowing, true collaboration and cultural humility, and wellness/strength-based approaches into their work on Indigenous health.
Second, the importance of context and relationships to the success of programs: while it is appealing to think we can copy a successful program from one community into another community, the reality is that co-creation is essential to a solutions-oriented approach. As we try to determine what works and why in particular communities, rather than assuming that a program can simply be copied from one community to another, we should look for approaches and processes that led to solutions and share those approaches. I believe there are learnings that can be shared, while respecting differences between communities.
Third, racism remains an issue in Canada: we must speak out when racist statements are made, particularly if we occupy positions of authority and privilege. Well-meaning liberals such as myself need to learn the history, work to understand the experience of Indigenous peoples over the past 150 years, and confront our own and others’ prejudices as they are expressed explicitly or implicitly.
Fourth, and perhaps most important, the time is now for change to occur in how health and social services are organized and delivered in Indigenous communities. There is a convergent moment for transformative action on Indigenous health. The federal government has declared Indigenous health a priority. The Minister of Health has Indigenous health as a priority on her agenda as defined in her Mandate letter. The findings of the Truth and Reconciliation Commission included 94 calls to action, nine of which were directly health related, and 70 relate to social determinants of health. Organizations such as CIHR’s Institute of Aboriginal People’s Health and BC’s First Nations Health Authority are making progress in generating knowledge and action about improving the health of First Nations, Inuit and Métis people, by bringing together scientists, policymakers and indigenous communities and leaders.
What can we do differently today to change the outcomes for Indigenous health, improve equity and reduce disparities? Indigenous people in Canada are tired of waiting for change. We need to eradicate systemic racism by confronting racist actions and language personally, organizationally, and politically – including our own unwitting contributions to continuing post-colonial trauma. We need to build self-governance into the health system as a promising strategy that can ensure application of both health science and Indigenous knowledge. As health researchers, we need to engage with communities to co create solutions to their identified key health issues.
About the Author(s)Carol P. Herbert, President, Canadian Academy of Health Sciences; Senior Associate, In-Source ; Professor Emerita, Western University and Adjunct Professor, UBC School of Population and Public Health
Thanks to: Cate Creede, John O’Neil and Jeff Reading for their contribution to my thinking and expression regarding these issues. The views expressed are my personal views and do not represent the views of the Fellows of the Canadian Academy of Health Sciences.
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