Canadian Aboriginal Population Research Articles

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

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.

Investigating the Linkages between FASD, Gangs, Sexual Exploitation and Woman Abuse in the Canadian Aboriginal Population: A Preliminary Study

The purpose of this study, prepared for the Native Women’s Association of Canada (NWAC) and funded by Health Canada First Nations and Inuit Health Branch, is to provide an exploratory investigation into the linkages and to begin a journey into making the connection between FASD, sexual exploitation, gangs, and extreme violence in the lives of young Aboriginal women. Emerging data from Aboriginal gang intervention and exit projects in Canada suggest that many women experience sexual slavery and extreme violence in gangs, and that a disproportionate number also suffer from Fetal Alcohol Spectrum Disorder. Although much more research is required, preliminary data point to the importance of developing prevention strategies targeted at addressing family violence, drug and alcohol abuse, poverty, the social determinants of health and the history of colonization of Aboriginal Peoples. This work should focus on the strength and resiliency of Aboriginal peoples.

De/colonization: perspectives on/by indigenous populations in global Canadian contexts

ABSTRACT This article offers systematic review of literature on the educational colonization of Indigenous populations within global Canadian contexts. Questions guiding this study were, ‘What colonizing dynamics exist in education for Canadian aboriginal populations, and what decolonizing dynamics suggest progress or advancement?’ Across disciplines, sources were located with perspectives on decolonizing education for aboriginal populations, in addition to policy reforms and effects on aboriginal learning. Using a document analysis approach, 85 articles and reports identifying colonizing and decolonizing dynamics were analyzed. Four overarching themes revealing de/colonizing dynamics within Canada emerged: colonizing through testing cultures; building Indigenous education system-wide; unsettling colonial teaching and learning; and unpacking discourse central to decolonization. What Canadian Indigenous literature imparts about colonization and the future is socially, politically, and educationally important. Tribal justice – an enduring problem of humanity – is a collective and global responsibility for which interventions are needed. Social, political, and educational recommendations from the literature are advanced for building up a glocal perspective that enriches the contribution of this work to the wider literature.

Aboriginal Women and the Canadian Criminal Justice System

The purpose of this policy review was to critically examine the Aboriginal Justice Strategy (AJS), which is a federal governmental program founded in 1991 to combat the problem of high rates of criminality in the Aboriginal population in Canada. Considering the high recidivism rates of AJS program participants, we suggest the AJS is not as effective in achieving its objectives. Looking at this strategy through a lens of structural social work, we found that it is inattentive to the impact of structural factors on criminality in some Aboriginal communities, groups, and individuals. Also, the strategy does not take into consideration gender-based factors that influence the interaction of Aboriginal men and women with the criminal justice system, which is profoundly different. Moreover, the strategy is inattentive to the five pathways that often bring Aboriginal women into contact with the criminal justice system - poverty, violence, sex trade, mental illness, and addiction. These pathways are inherently linked to the primary structures of colonialism, racism, and sexism, which continue to oppress Aboriginal women in Canada. For these reasons, we proposed that gender-based analysis would be useful for an improved understanding of these pathways. We also provided several recommendations for lowering the rates of crime committed by Aboriginal women, which include, state supported economic investments for community development, job creation, education attainment, and employability skills as well as policies against homelessness and supports for trauma, addictions, and mental health issues.

Residential Schools and the Productivity of the Aboriginal Population in Canada: Issues, Intergenerational Impact and Solutions

It is important to note that the Aboriginal Population of Canada grew six times faster than Non-Aboriginal between 1996-2006 (Statistics Canada, 2009). It is projected to continue growing at this rate. According to statistics Canada (2009), the population will increase from 3.9% in 2006 to between 4.0% and 5.3% by 2031. This figure is translated thus: 1.3 million aboriginals in 2006 to 1.7 – 2.2 million aboriginals by 2031. This is a very significant increase in the population. If certain issues affecting productive capacity of the Aboriginal are not addressed, and effective policies not implemented to address the underlying issues, the society will be polarized. This article provides evidence to prove that resident schools is one of those government policies that continue impacting Aboriginal long after its closure. This paper is a perspective study which focuses on the views and agenda surrounding the topic. On the one hand, the agenda perspective emphasis of the study aims to provide answers to three fundamental questions that are essential for the robust positioning of a study within the context of existing literature: (i) what has been covered by extant literature in the light of the problem statement; (ii) what are shortcomings in the engaged literature and (iii) how does the present study aim to address identified shortcomings? On the other hand, the agenda dimension builds on the “view perspective” to propose policy measures and future research directions.

First Nations Approaches to Childhood Obesity: Healthy Lifestyles in Canada Compared with Alternatives for Alaska Native Communities.

Alaska Native and American Indian children have among the highest prevalence of obesity in the United States. Canadian Aboriginal populations including First Nations also have high rates of obesity but obesity rates among children are noticeably lower. We highlight some of the important differences between American and Canadian approaches to healthy lifestyles and Aboriginal/Native health, including diet and physical activity, which may in part explain the differences in obesity prevalence. Specifically, the Canadian government provides a food subsidy program to bring perishable fruits and vegetable to remote, rural Canadian areas and secondly supports the use of traditional foods and harvesting/gathering through a number of government supported programs. Lastly, there may be a better sense of community and overall life satisfaction for Aboriginals compared with Alaska Natives, in part because of the incorporation of healthcare and other services within the larger overall community, as opposed to separate services as is the case for Alaska Natives. This perspective provides insight into some of these potential differences.

Epidemiology of prostate and kidney cancer in the Aboriginal population of Canada: A systematic review

Prostate and kidney cancer rates in the Aboriginal population of Canada is a growing issue. A systematic review of prostate and kidney cancer epidemiology in the Aboriginal population of Canada was performed with international comparison and evaluation of present epidemiological disparities. PubMed, Medline, and Embase (from January 1946 to June 2016), relevant government-published reports, and the websites of organizations contributing to prostate or kidney cancer guidelines were searched. We included studies that informed any of the three epidemiological questions this review is focused on answering. Two systematic reviews, two meta-analyses, five literature reviews, and 21 single-study papers were included. The incidence and mortality rates of kidney cancer were elevated among Canadian Aboriginals when compared to the provincial or national population and to several international regions. No studies reported data on survival. Prostate cancer incidence, mortality, and survival rates were lower in Aboriginals provincially, nationally, and internationally, with incidence and survival reaching statistical significance. Elevated rate of risk factors for kidney cancer was a significant finding among Canadian Aboriginals. Aboriginals were screened for prostate cancer less than the general Canadian population, a trend also observed in the U.S. The elevated incidence and mortality of kidney cancer among Canadian Aboriginals is most likely attributable to the rise in lifestyle-based risk factors. Two correlations concerning prostate cancer are made. However, due to temporal and regional disparities in data, further investigation is required to elucidate these observations.

Using culture to enhance mental health in a northern Canadian aboriginal population

IntroductionWe present three community case studies for how community development and cultural enhancement affected mental health as an epiphenomenon.MethodsAn initiative was undertaken in 3 Northern Canadian aboriginal communities to enhance spiritual and cultural fluency and to provide opportunities to healthy interaction among community members. We began each process with a narrative investigation of the community by eliciting stories about perceived problems in the community. We collected further narratives at the end of the intervention about how it had affected people personally. We reviewed the narratives for commonalities and themes using modified grounded theory and dimensional analysis. We measured numbers of patients presenting to behavioral health services with mental health diagnoses, number of people sent to hospital for mental health treatment, and number of suicide attempts. We collected quality of life data using the My Medical Outcome Profile 2.ResultsCommunity development and cultural enhancement efforts reduced all of the variables we were tracking. Follow-up interviews revealed common themes of people becoming more present-centered, feeling higher quality in their relationships; feeling more connected to god, creator, nature, or higher power; feeling more peaceful; feeling more accepting of death and change; and having a greater sense of meaning and purpose. As an interesting side effect, people began to eat more traditional diets and to be more active.ConclusionsCreating opportunities for community interaction and shared community projects and enhancing interactions with spiritual elders resulted in improvement in indices of mental health in three indigenous communities in Northern Canada.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Planning and Delivery of Health Services - An Article Review on Urban Aboriginal Mobility in Canada: Examining the Association With Healthcare Utilization

An article from Social Science and Medicine, written by Snyder and Wilson (2012), examined the use of healthcare services by urban Aboriginal populations in Canada. Using the Behavioural Model of Health Services Use (BMHSU), predisposing, enabling, and need factors were organized and used for data analysis. Specifically, a comparison was made between conventional (physicians and nurses) and traditional (traditional healers) health service utilization in Toronto and Winnipeg. In addition to the geographical and educational factors, the results of the research recognized mobility as a significant predisposing complement to healthcare utilization.

Prevalence of alcohol consumption during pregnancy and Fetal Alcohol Spectrum Disorders among the general and Aboriginal populations in Canada and the United States

Prenatal alcohol exposure may cause a number of health complications for the mother and developing fetus, including Fetal Alcohol Spectrum Disorders (FASD). This study aimed to estimate the pooled prevalence of i) alcohol use (any amount) and binge drinking (4 or more standard drinks on a single occasion) during pregnancy, and ii) Fetal Alcohol Syndrome (FAS) and FASD among the general and Aboriginal populations in Canada and the United States, based on the available literature. Comprehensive systematic literature searches and meta-analyses, assuming a random-effects model, were conducted. It was revealed that about 10% and 15% of pregnant women in the general population consume alcohol in Canada and the United States, respectively, and that about 3% of women engage in binge drinking during pregnancy in both countries. However, the prevalence of alcohol use during pregnancy in the Aboriginal populations of the United States and Canada were found to be approximately 3–4 times higher, respectively, compared to the general population. Even more alarmingly, it was estimated that approximately one in five women in the Aboriginal populations in both countries engage in binge drinking during pregnancy. Further, among the general population of Canada, the pooled prevalence was estimated to be about 1 per 1000 for FAS and 5 per 1000 for FASD. However, compared to the general population, the prevalence of FAS and FASD among the Aboriginal population in Canada was estimated to be 38 times and 16 times higher, respectively. With respect to the United States, the pooled prevalence of FAS and FASD was estimated to be about 2 per 1000 and 15 per 1,000, respectively, among the general population, and 4 per 1000 and 10 per 1,000, respectively, among the Aboriginal population. The FAS and FASD pooled prevalence estimates presented here should be used with caution due to the limited number of existing studies and their methodological limitations. Based on the results of the current study, it is evident that there is an urgent need for implementing more effective national prevention and surveillance strategies to monitor and lower the prevalence of alcohol consumption during pregnancy and FASD.

Implications of the nutrition transition for vitamin D intake and status in Aboriginal groups in the Canadian Arctic.

Aboriginal Canadians have low intakes of vitamin D and are shifting away from consumption of traditional foods. Higher body mass index, skin pigmentation, and geographic latitude of residence further predispose Canadian Aboriginal populations to low vitamin D status. Low vitamin D status could compromise bone health and other health outcomes. Studies assessing vitamin D status of different Aboriginal groups are limited. The aim of this review is to examine the literature on vitamin D status and intakes of Canadian Aboriginal populations living in the Arctic. PubMed was searched for relevant articles published from 1983 to 2013. The prevalence of 25-hydroxy vitamin D deficiency ranged from 13.9% to 76.0% among children and adults in the summer. Furthermore, mean vitamin D intakes among all age groups were below the estimated average requirement. As vitamin D deficiency has been recently associated with chronic diseases, and Aboriginal populations living in the Arctic are at high risk for low vitamin D status, their vitamin D status should be assessed regularly across seasons.

Ethics of Biological Sampling Research with Aboriginal Communities in Canada

<p><strong>BACKGROUND:</strong> The objective of this paper is to identify key ethical issues associated with biological sampling in Aboriginal populations in Canada and to recommend approaches that can be taken to address these issues.</p><p><strong>METHODS:</strong> Our work included the review of notable biological sampling cases and issues. We examined several significant cases (Nuu-chah-nult people of British Columbia, Hagahai peoples of Papua New Guinea and the Havasupai tribe of Arizona) on the inappropriate use of biological samples and secondary research in Aboriginal populations by researchers.</p><p><strong>RESULTS:</strong> Considerations for biological sampling in Aboriginal communities with a focus on community-based participatory research involving Aboriginal communities and partners are discussed. Recommendations are provided on issues of researcher reflexivity, ethical considerations, establishing authentic research relationships, ownership of biological material and the use of community-based participatory research involving Aboriginal communities.</p><p><strong>CONCLUSIONS:</strong> Despite specific guidelines for Aboriginal research, there remains a need for biological sampling protocols in Aboriginal communities. This will help protect Aboriginal communities from unethical use of their biological materials while advancing biomedical research that could improve health outcomes.</p>

Dynamics of naturally acquired antibody against Haemophilus influenzae type a capsular polysaccharide in a Canadian Aboriginal population.

Severe infections caused by Haemophilus influenzae type a (Hia) have reached alarming rates in some Canadian Aboriginal communities. We sought to estimate the frequency of exposure to this pathogen and timelines for boosting protective antibodies.We developed a model of secondary antigenic challenge (natural exposure), and used data for anti-Hia antibodies in serum samples of healthy and immunocompromised adults in a population of Northwestern Ontario, Canada. We parameterized the model with available estimates from previous studies for the decay rate of antibody and its protective levels against both Hia carriage and invasive disease. Simulations were initialized using antibody concentrations from data. We investigated both the duration of immunity without secondary antigenic challenge and the average time between subsequent exposures to Hia.When there was no new natural exposure, serum antibody concentrations in healthy Aboriginal individuals decreased below the level (1 μg/ml) assumed for protection against invasive Hia disease 3 years after primary exposure. This period was shorter (about 2 years) for Aboriginal individuals suffering from chronic renal failure. We estimated that a new antigenic challenge occurs once in 5 and 2 years for healthy and immunocompromised Aboriginal individuals, respectively. More frequent natural exposure was required to maintain protective antibody levels for non-Aboriginal individuals compared to Aboriginal individuals.The findings suggest that frequent boosting of natural immunity is required to maintain the anti-Hia antibody levels protecting against invasive Hia disease, particularly in individuals with underlying medical conditions. This information has important implications for immunization when an anti-Hia vaccine becomes available.

Disparity in cancer prevention and screening in aboriginal populations: recommendations for action.

Historically, cancer has occurred at a lower rate in aboriginal populations; however, it is now dramatically increasing. Unless preventive measures are taken, cancer rates among aboriginal peoples are expected to soon surpass those in non-aboriginal populations. Because a large proportion of malignant disorders are preventable, primary prevention through socioeconomic interventions, environmental changes, and lifestyle modification might provide the best option for reducing the increasing burden of cancers. Such efforts can be further amplified by making use of effective cancer screening programs for early detection of cancers at their most treatable stage. However, compared with non-aboriginal Canadians, many aboriginal Canadians lack equal access to cancer screening and prevention programs. In this paper, we discuss disparities in cancer prevention and screening in aboriginal populations in Canada. We begin with the relevant definitions and a theoretical perspective of disparity in health care in aboriginal populations. A framework of health determinants is proposed to explain the pathways associated with an increased risk of cancer that are potentially avoidable. Major challenges and knowledge gaps in relation to cancer care for aboriginal populations are addressed, and we make recommendations to eliminate disparities in cancer control and prevention.

Explaining Low High School Attainment in Northern Aboriginal Communities: An Analysis of the Aboriginal Peoples' Surveys

Within the off-reserve Canadian Aboriginal population, high school graduation rates are about 45 percent lower in Northern communities (North) than the rest of Canada (South). Using data from the Aboriginal Peoples' Surveys for 2000 and 2005, we document that economic incentives do not appear to be important in explaining the North–South gap in graduation rates. We then consider individual-specific and schooling-related determinants of high school graduation and find that these factors can explain between 31 percent and 59 percent of the North–South gap in the probability of graduation for those who had graduated by the time of the survey. Further, much of the gap is attributable to a respondent speaking/understanding or being taught an Aboriginal language. We discuss the possible implications of these results for language and curricular programming in the North.

Substance Use and Related Harms among Aboriginal People in Canada: A Comprehensive Review.

There is evidence of increasing trends in substance use and related harms among Aboriginal populations in Canada. This paper provides a review of data on alcohol, tobacco, and illicit drug use and related harms. A comprehensive review of public data, journal publications, and grey literature published between 2000 and 2014 were reviewed if data included: people who self-identify as Aboriginal and who live in Canada; drug use; and morbidity and mortality related to drug use. Data were structured by major substance categories and compared with non-Aboriginal sample data where possible. Over 100 documents were reviewed and revealed a disproportionate burden of substance use and harms, particularly among Aboriginal youth. Significant gaps in data exist, specifically, for urban populations. This review reinforces concerns of many Aboriginal communities and organizations in Canada as well as highlights where prevention, programming, and policy efforts might be most effective.

Comparison of coping strategies and supports between aboriginal and non-aboriginal people living with HIV in Ontario

Complex historical and cultural factors have contributed to the HIV epidemic among Aboriginal populations in Canada. This study assesses social supports, adaptive and maladaptive coping mechanisms, stress, and mastery of Canadian-born Aboriginal and Canadian-born Caucasian people living with HIV in Ontario and posits that coping and social support are important micro- and meso-level factors associated with the epidemic. This cross-sectional analysis included questionnaire data collected from 2007 to 2011 at HIV clinics in Toronto. Categorical and continuous variables were compared using chi-square and Wilcoxon rank sum tests, respectively. Correlates of social support and coping were determined using univariate and multivariable linear regression. The analysis included 70 Aboriginal and 665 Caucasian participants. Aboriginal participants had lower levels of employment, education, and annual household income. Aboriginal participants reported more overall (7 vs. 4, p = 0.0003), ongoing (4 vs. 2, p = 0.0004), and early childhood (2 vs. 1, p = 0.02) stressors. Maladaptive coping, adaptive coping, and mastery scores were similar between Aboriginal and Caucasian participants. In multivariable analysis, injection drug use and lower education levels were significant correlates of higher maladaptive coping and lower overall support scores. Despite numerous socioeconomic challenges and personal stressors, Aboriginal people living with HIV who are accessing care exhibited comparable coping and mastery scores to Canadian-born Caucasian people living with HIV, suggesting remarkable strengths within Aboriginal people living with HIV and their communities.

Incidence and prevalence of chronic obstructive pulmonary disease among aboriginal peoples in Alberta, Canada.

BackgroundChronic obstructive pulmonary disease (COPD) is a major respiratory disorder, largely caused by smoking that has been linked with large health inequalities worldwide. There are important gaps in our knowledge about how COPD affects Aboriginal peoples. This retrospective cohort study assessed the epidemiology of COPD in a cohort of Aboriginal peoples relative to a non-Aboriginal cohort.MethodsWe used linkage of administrative health databases in Alberta (Canada) from April 1, 2002 to March 31, 2010 to compare the annual prevalence, and the incidence rates of COPD between Aboriginal and non-Aboriginal cohorts aged 35 years and older. Poisson regression models adjusted the analysis for important sociodemographic factors.ResultsCompared to a non-Aboriginal cohort, prevalence estimates of COPD from 2002 to 2010 were 2.3 to 2.4 times greater among Registered First Nations peoples, followed by the Inuit (1.86 to 2.10 times higher) and the Métis (1.59 to 1.67 times higher). All Aboriginal peoples had significantly higher COPD incidence rates than the non-Aboriginal group (incidence rate ratio [IRR]: 2.1; 95% confidence interval [CI]: 1.97, 2.27). COPD incidence rates were higher in First Nation peoples (IRR: 2.37; 95% CI: 2.19, 2.56) followed by Inuit (IRR: 1.92; 95% CI: 1.64, 2.25) and Métis (IRR: 1.49; 95% CI: 1.32, 1.69) groups.ConclusionsWe found a high burden of COPD among Aboriginal peoples living in Alberta; a province with the third largest Aboriginal population in Canada. Altogether, the three Aboriginal peoples groups have higher prevalence and incidence of COPD compared to a non-Aboriginal cohort. The condition affects the three Aboriginal groups differently; Registered First Nations and Inuit have the highest burden of COPD. Reasons for these differences should be further explored within a framework of social determinants of health to help designing interventions that effectively influence modifiable COPD risk factors in each of the Aboriginal groups.

Factors influencing H1N1 vaccine behavior among Manitoba Metis in Canada: a qualitative study.

BackgroundDuring the first wave of the H1N1 influenza pandemic in 2009, Aboriginal populations in Canada experienced disproportionate rates of infection, particularly in the province of Manitoba. To protect those thought to be most at-risk, health authorities in Manitoba listed all Aboriginal people, including Metis, among those able to receive priority access to the novel vaccine when it first became available. Currently, no studies exist that have investigated the attitudes, influences, and vaccine behaviors among Aboriginal communities in Canada. This paper is the first to systematically connect vaccine behavior with the attitudes and beliefs that influenced Metis study participants’ H1N1 vaccine decision-making.MethodsResearchers held focus groups (n = 17) with Metis participants in urban, rural, and remote locations of Manitoba following the conclusion of the H1N1 pandemic. Participants were asked about their vaccination decisions and about the factors that influenced their decisions. Following data collection, responses were coded into the broad categories of a social-ecological model, nuanced by categories stemming from earlier research. Responses were then quantified to show the most influential factors in positively or negatively affecting the vaccine decision.ResultsMedia reporting, the influence of peer groups, and prioritization all had positive and negative influential effects on decision making. Whether vaccinated or not, the most negatively influential factors cited by participants were a lack of knowledge about the vaccine and the pandemic as well as concerns about vaccine safety. Risk of contracting H1N1 influenza was the biggest factor in positively influencing a vaccine decision, which in many cases trumped any co-existing negative influencers.ConclusionsMetis experiences of colonialism in Canada deeply affected their perceptions of the vaccine and pandemic, a context that health systems need to take into account when planning response activities in the future. Participants felt under-informed about most aspects of the vaccine and the pandemic, and many vaccine related misconceptions and fears existed. Recommendations include leveraging doctor-patient interactions as a site for sharing vaccine-related knowledge, as well as targeted, culturally-appropriate, and empowering public information strategies to supply reliable vaccine and pandemic information to potentially at-risk Aboriginal populations.

Lifestyle modification for the primary prevention of type 2 diabetes mellitus in the Canadian Aboriginal population

Canada’s Aboriginal populations have significantly higher rates of type 2 diabetes compared to non-Aboriginal Canadians. In First Nations populations living on reserve, the rates are more than double. Large randomized controlled trials (RCTs) have shown that intensive lifestyle modification in individuals with impaired glucose tolerance can decrease the overall incidence of diabetes by up to 22%.
 Implementing lifestyle interventions into clinical practice remains a significant challenge because of both limited resources and uncertainly about optimal program design. Most studies have focused on translation into the primary care setting, and have shown moderate benefits. However, there have been no trials examining the feasibility and effectiveness of RCT-based lifestyle modification in Canadian Aboriginal communities. Canadian initiatives have so far focused on school-based healthy lifestyle curriculum and community awareness, but have had little success in reducing weight.
 Factors such as community remoteness, cultural diversity, poor retention of health care workers, and lack of access to healthy food are significant barriers to implementing lifestyle modification programs in Canadian Aboriginal communities. More importantly, these communities face systemic inequalities that must be addressed in order to achieve meaningful and sustained lifestyle changes.