Barriers and Mitigating Strategies to Healthcare Access in Indigenous Communities of Canada: A Narrative Review.

Catherine B. Chan,Nam Hoang Nguyen,Kienan Williams,Fatheema B. Subhan

doi:10.3390/healthcare8020112

Abstract

The objective of this review is to document contemporary barriers to accessing healthcare faced by Indigenous people of Canada and approaches taken to mitigate these concerns. A narrative review of the literature was conducted. Barriers to healthcare access and mitigating strategies were aligned into three categories: proximal, intermediate, and distal barriers. Proximal barriers include geography, education attainment, and negative bias among healthcare professionals resulting in a lack of or inadequate immediate care in Indigenous communities. Intermediate barriers comprise of employment and income inequities and health education systems that are not accessible to Indigenous people. Distal barriers include colonialism, racism and social exclusion, resulting in limited involvement of Indigenous people in policy making and planning to address community healthcare needs. Several mitigation strategies initiated across Canada to address the inequitable health concerns include allocation of financial support for infrastructure development in Indigenous communities, increases in Indigenous education and employment, development of culturally sensitive education and medical systems and involvement of Indigenous communities and elders in the policy-making system. Indigenous people in Canada face systemic/policy barriers to equitable healthcare access. Addressing these barriers by strengthening services and building capacity within communities while integrating input from Indigenous communities is essential to improve accessibility.

Highlights

In Canada, universal coverage for healthcare services is a strategy for “improving the lives of all Canada’s People and to making this country’s population among the healthiest in the world . . . ” [1].The Canada Health Act’s primary objective “ . . . is to protect, promote, and restore the physical and mental wellbeing of residents of Canada and to facilitate reasonable access to health services without financial or other barriers” [2] while embracing diversity, creating healthy and respectful environments, and reducing health inequities [1]
The review questions were: (1) What are the barriers faced by the Indigenous communities in accessing healthcare in Canada? (2) What strategies have been implemented to resolve these barriers and are there any plans to implement any new strategies in the future? The concepts included were: Indigenous population of Canada; barriers to healthcare access, social determinants of health; healthcare programs and policies, interventions
Data extraction was carried out individuals on the 36 selected and findings were categorized healthcare access and distal barriers to equitable healthcare access

Summary

Introduction

In Canada, universal coverage for healthcare services is a strategy for “improving the lives of all Canada’s People and to making this country’s population among the healthiest in the world . . . ” [1].The Canada Health Act’s primary objective “ . . . is to protect, promote, and restore the physical and mental wellbeing of residents of Canada and to facilitate reasonable access to health services without financial or other barriers” [2] while embracing diversity, creating healthy and respectful environments, and reducing health inequities [1]. In Canada, universal coverage for healthcare services is a strategy for “improving the lives of all Canada’s People and to making this country’s population among the healthiest in the world . Is to protect, promote, and restore the physical and mental wellbeing of residents of Canada and to facilitate reasonable access to health services without financial or other barriers” [2] while embracing diversity, creating healthy and respectful environments, and reducing health inequities [1]. 44% of First Nations (FN) people living on-reserve report very good/excellent health versus ~60% of non-Indigenous people [4] and FN people have shorter life expectancy [5], as do Inuit [6]. Indigenous peoples officially account for 4.9% of the Canadian population [8] but, in certain urban centers, the numbers may be greatly underestimated [9].

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Conclusion