Addressing inequities in access to care among Indigenous peoples with chronic hepatitis C in Alberta, Canada

Abstract

Indigenous peoples worldwide continue to suffer disproportionate health inequities resulting from ongoing and intergenerational colonial trauma, including psychological, social, physical, and spiritual effects. 1 Mitchell TL Maracle DT Post-traumatic stress and the health status of Aboriginal populations in Canada. Int J Indig Health. 2005; 2: 14-23 Google Scholar In Canada, contemporary colonial traumas include, but are not limited to, the displacement of Indigenous peoples (First Nations, Inuit, and Métis) from their land and resources, historical banning of cultural ceremony and language, forced removal and abuse of children via the residential school and child welfare systems, and the federal Indian Act (a paternalistic and racist imposition of colonial systems controlling access to food, land, resources, naming, health care, education, and even status as an Indigenous person). Although Canada is considered a wealthy nation, the continued impact of these abuses result in impoverished socioeconomic status and disruption of wellness for many Indigenous peoples. The compounding effect over successive generations has contributed to disproportionately higher rates of substance abuse, suicide, and many diseases, including liver disease resulting from chronic hepatitis C virus (HCV) infection, in these populations. 2 Mitchell T Arseneau C Colonial Trauma: Complex, continuous, collective, cumulative and compounding effects on the health of Indigenous peoples in Canada and beyond. Int J Indig Health. 2019; 14: 74-94 Crossref Google Scholar Health inequities in Indigenous peoples are often highlighted in health research without sufficient explanation of the role of systemic drivers, which further victimises or stigmatises Indigenous populations. 3 Fayed ST King A King M et al. In the eyes of Indigenous people in Canada: exposing the underlying colonial etiology of hepatitis C and the imperative for trauma-informed care. Can Liv J. 2018; 1: 115-129 Crossref Google Scholar In this Comment, we describe the creation and implementation of a co-design approach centred on respectful relationships with Indigenous communities in the province of Alberta, Canada, to address systemic and longstanding inequities regarding access to HCV care.