Unmet health needs and discrimination by healthcare providers among an Indigenous population in Toronto, Canada

George Tjensvoll Kitching,Sara Wolfe,Janet Smylie,Patricia O’Campo,Michael Rotondi,Raglan Maddox,Michelle Firestone,Berit Schei,Cheryllee Bourgeois,Rosane Nisenbaum

doi:10.17269/s41997-019-00242-z

Abstract

ObjectivesInequalities between Indigenous and non-Indigenous peoples in Canada persist. Despite the growth of Indigenous populations in urban settings, information on their health is scarce. The objective of this study is to assess the association between experience of discrimination by healthcare providers and having unmet health needs within the Indigenous population of Toronto.MethodsThe Our Health Counts Toronto (OHCT) database was generated using respondent-driven sampling (RDS) to recruit 917 self-identified Indigenous adults within Toronto for a comprehensive health assessment survey. This cross-sectional study draws on information from 836 OHCT participants with responses to all study variables. Odds ratios and 95% confidence intervals were estimated to examine the relationship between lifetime experience of discrimination by a healthcare provider and having an unmet health need in the 12 months prior to the study. Stratified analysis was conducted to understand how information on access to primary care and socio-demographic factors influenced this relationship.ResultsThe RDS-adjusted prevalence of discrimination by a healthcare provider was 28.5% (95% CI 20.4–36.5) and of unmet health needs was 27.3% (95% CI 19.1–35.5). Discrimination by a healthcare provider was positively associated with unmet health needs (OR 3.1, 95% CI 1.3–7.3).ConclusionThis analysis provides new evidence linking discrimination in healthcare settings to disparities in healthcare access among urban Indigenous people, reinforcing existing recommendations regarding Indigenous cultural safety training for healthcare providers. Our study further demonstrates Our Health Counts methodologies, which employ robust community partnerships and RDS to address gaps in health information for urban Indigenous populations.

Highlights

The health status of Indigenous peoples in Canada must be understood within the context of current and historical colonial policies implemented by the Canadian government and other colonial institutions, from the loss of land and autonomy, to the creation of the reserves systems, the historical removal of Indigenous children into residential schools, and the current removal of Indigenous children by the child welfare system (Adelson 2005; Allan and Smylie 2015; Smylie et al 2011; Truth and Reconciliation Commission of Canada 2015; Smylie and Adomako 2009)
The aforementioned engagement processes align with the ethical guidelines used for the research conducted by the Royal Commission on Aboriginal Peoples (RCAP) and the principles of OCAP®, which assist to ensure Indigenous control over Indigenous research data (OCAP® is a registered trademark of the First Nations Information Governance Centre (FNIGC) 1998; Canada, Royal Commission on Aboriginal Peoples 1993)
The comprehensive population-based health assessment database for First Nations, Inuit, and Métis living in Toronto produced by the Our Health Counts Toronto (OHCT) study provides a unique opportunity to identify and address health inequalities

Summary

Introduction

Indigenous peoples of Canada experience enormous health disparities compared with the general population of Canada, stemming from current and historical health inequities (Adelson 2005; Allan and Smylie 2015; Smylie et al 2011; Truth and Reconciliation Commission of Canada 2015; Smylie and Adomako 2009). The health status of Indigenous peoples in Canada must be understood within the context of current and historical colonial policies implemented by the Canadian government and other colonial institutions, from the loss of land and autonomy, to the creation of the reserves systems, the historical removal of Indigenous children into residential schools, and the current removal of Indigenous children by the child welfare system (Adelson 2005; Allan and Smylie 2015; Smylie et al 2011; Truth and Reconciliation Commission of Canada 2015; Smylie and Adomako 2009) Despite these health inequities, critical gaps remain in our understanding of Indigenous health in Canada (Adelson 2005; Allan and Smylie 2015; Smylie et al 2011).

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