Canadian First Nations People Research Articles

Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study.

First Nations people in Canada are overrepresented among those who have undergone nontraumatic lower extremity amputation, and are more likely to be younger, have diabetic foot infections and have no previous revascularization procedures than non-First Nations populations who have undergone lower extremity amputations. We sought to identify access barriers for high-risk First Nations patients, explore patients' experiences with health care systems and identify solutions. Employing a community participatory research design, we engaged representatives from 2 communities. They assisted with research design and data analysis, and approved the final manuscript. Using a hermeneutic phenomenological approach and purposeful sampling, we conducted 5 semistructured focus groups between August and December 2021 with community health care teams and patients at risk for, or who had previously undergone, a nontraumatic lower extremity amputation. Patients' (n = 10) and community health care providers' (n = 18) perspectives indicated that barriers to health care access led to delayed care and increased complications and risk for lower extremity amputations, leading to aggressive procedures upon receiving care. Barriers to care led to negative experiences at urban centres and aggressive procedures created further distrust, leading to care disengagement and poor outcomes. Patients and providers both suggested building stronger partnerships between urban and rural health care providers, improving education for patients and health care providers and identifying innovative strategies to improve patients' overall health. Systemic changes, health promotional program and reliable on-reserve primary care are needed to create equitable access for First Nation patients at risk for lower extremity amputations. The study results imply that health care delivery for First Nations patients at risk for lower extremity amputations can be improved through stronger partnership and communication between urban and community providers, and continued education and cultural competency training for urban health care providers.

Income-Related Inequities in Primary and Specialist Care Among First Nations Peoples Living Off-Reserve in Canada.

Improving equity in healthcare is a primary goal of health policy in Canada. Although the investigation of equity in healthcare utilization is common in the general population, little research has been conducted to assess equity in healthcare utilization within First Nations peoples living in Canada. To examine income-related inequities in primary care (family doctor/general practitioner and nurse practitioner care) and specialist care within status and non-status First Nations adults living off-reserve. Using the 2017 Aboriginal Peoples Survey (APS), a nationally representative survey of Indigenous peoples living off-reserve in Canada, we analyzed income-related inequities in healthcare among Indigenous adults (>18 years) who self-identified as a member of any First Nations group in Canada. Logistic regression analysis was performed to identify factors associated with the utilization of primary and specialist care. The Horizontal Inequity index (HI), which measures unequal healthcare use by income for equal need, was used to quantify and decompose income-related inequities for primary and specialist care for status and non-status, and total First Nations groups. The regression results revealed higher primary and specialist care use among females, high socioeconomic status (high income and more educated) and status First Nations peoples in Canada. The positive values of the HI suggested a higher concentration of primary care and specialist care utilization among higher income First Nations peoples after adjusting for healthcare need. These pro-rich inequities persisted for the total First Nations populations, and for those in each status group individually. The decomposition results suggested observed inequities in both primary and specialist care among First Nations peoples can be predominantly attributed to the unequal distribution of education and income. Although primary and specialist services in Canada are free at the point of the provision, we found pro-rich inequities in healthcare use among First Nations adults living off-reserve in Canada. These results warrant policies and initiatives to address barriers to healthcare use within and outside health system among low-income First Nations peoples living off-reserve.

A Jamaican Response to the Call to Act Together

AbstractThis article is an exploration of following the way of Jesus regarding apologies and restitution for slavery. Three stories of good practice from the North American Jesuits, the United Reformed Church, and the Church of England are contrasted with stories of the abuse of children from First Nations people in Canada, poor families in Ireland, and the transportation of allegedly indigent children from Britain to Australia. These accounts are used to examine critically how far the church is following the call of Jesus to care for the vulnerable and identify with the marginalized in interactions with those sexually abused in churches, in engagement with sex workers, and the treatment of the LGBTQ+ community. A poetic reflection from the voice of the man who lived outside his community of the Gadarenes concludes the article.

Volcanoes in Old Norse Mythology: Myth and Environment in Early Iceland

Volcanoes in Old Norse Mythology: Myth and Environment in Early Iceland

Co-Constructing a Diverse Hybrid Simulation-Based Experience on First Nations Culture

BackgroundThe Truth and Reconciliation Commission of Canada [TRC]: Calls to Actions (2015) appealed to nursing schools to provide cultural training to address the cultural gaps between the First Nations people of Canada and registered nurses. MethodIn collaboration with First Nations social workers and Elders, a pre-existing simulation-based experience (SBE) was transformed into a diverse hybrid SBE. In the diverse hybrid SBE, a Knowledge Keeper, embedded actors, and a medium-fidelity manikin were used to present First Nations knowledge and cultural practices associated with end-of-life care. ResultsThis article is a self-report of the co-construction and implementation of the diverse hybrid SBE with First Nations cultural experts. ConclusionThe co-construction and implementation of this diverse hybrid SBE required great effort and resources. Although the student anecdotal feedback identified a heightened understanding of First Nations cultural practices, moving forward, alternative debriefing models and evaluation by valid and reliable measures are required.

The representation of Indigenous Australians in sport for development policy: what’s the problem?

ABSTRACT This research critically examines Sport for Development (SFD) policies targeting Indigenous Australians. While previous studies have sought to compare the impact of SFD policies on First Nations people in Canada and Australia, no research to date has provided a detailed investigation of the specific policy approaches underpinning SFD programmes, that target Indigenous Australians. Utilising thematic discourse analysis and Bacchi’s (2009) What’s the problem represented to be? (WPR) theoretical framework, this study seeks to expose the dominant representations within the policy approaches underpinning the use of SFD to achieve Closing the Gap (CTG) outcomes. Furthermore, this research seeks to question the policy ‘problems’ upon which these representations are based. Drawing on policy documents produced by the Australian Government between 2013 and 2019, the findings highlight a range of policy ‘problems’ associated with the use of sport to achieve CTG outcomes. Utilising a WPR approach, this study considers the impacts of these dominant representations and presents an argument for how these ‘problems’ may be considered differently. In doing so, this analysis reveals a policy approach underpinned by the ‘power of sport’ narrative, which draws its roots from the colonial era. Additionally, this research questions how sport may be understood for Indigenous Australians, and whether policy ‘problems’ such as the lack of participation in formalised sport by Indigenous Australians represents a new form of resistance. Finally, this paper calls for more Indigenous-led research to continue to disrupt potentially destructive narratives surrounding SFD for Indigenous Australians.

Health care costs associated with hepatitis C virus infection in First Nations populations in Ontario: a retrospective matched cohort study.

Background:Colonization and marginalization have affected the risk for and experience of hepatitis C virus (HCV) infection for First Nations people in Canada. In partnership with the Ontario First Nations HIV/AIDS Education Circle, we estimated the publicly borne health care costs associated with HCV infection among Status First Nations people in Ontario.Methods:In this retrospective matched cohort study, we used linked health administrative databases to identify Status First Nations people in Ontario who tested positive for HCV antibodies or RNA between 2004 and 2014, and Status First Nations people who had no HCV testing records or only a negative test result (control group, matched 2:1 to case participants). We estimated total and net costs (difference between case and control participants) for 4 phases of care: prediagnosis (6 mo before HCV infection diagnosis), initial (after diagnosis), late (liver disease) and terminal (6 mo before death), until death or Dec. 31, 2017, whichever occurred first. We stratified costs by sex and residence within or outside of First Nations communities. All costs were measured in 2018 Canadian dollars.Results:From 2004 to 2014, 2197 people were diagnosed with HCV infection. The mean net total costs per 30 days of HCV infection were $348 (95% confidence interval [CI] $277 to $427) for the prediagnosis phase, $377 (95% CI $288 to $470) for the initial phase, $1768 (95% CI $1153 to $2427) for the late phase and $893 (95% CI −$1114 to $3149) for the terminal phase. After diagnosis of HCV infection, net costs varied considerably among those who resided within compared to outside of First Nations communities. Net costs were higher for females than for males except in the terminal phase.Interpretation:The costs per 30 days of HCV infection among Status First Nations people in Ontario increased substantially with progression to advanced liver disease and finally to death. These estimates will allow for planning and evaluation of provincial and territorial population-specific hepatitis C control efforts.

The First Nations Food, Nutrition and Environment Study (2008\u20132018)\u2014rationale, design, methods and lessons learned

ObjectiveTo describe the rationale, the participatory nature of the methodology, and the lessons learned during the First Nations Food, Nutrition and Environment Study (FNFNES), a community-based participatory research project implemented in eight Assembly of First Nations regions, which includes the entirety of Canada south of the 60th parallel.MethodsFNFNES respected the First Nations principles of Ownership, Control, Access and Possession (OCAP®) (https://fnigc.ca/ocap). A random sampling strategy based on an ecosystem framework comprising 11 ecozones was adopted to collect representative nutritional and environmental health results for all First Nations adults living on-reserve south of the 60th parallel. Data collection occurred during the fall months from 2008 to 2016. Respective First Nations were involved in the planning and implementation of data collection for the five principal components: household interviews, tap water sampling for metals, surface water sampling for pharmaceuticals, hair sampling for mercury, and traditional food sampling for contaminants.ResultsA total of 6487 adults from 92 First Nations participated in the Study (participation rate 78%). A higher percentage of females (66%) participated than males (34%). The average age of males and females was similar (44 and 45 years, respectively). This study offers a novel body of coherent and regionally representative evidence on the human dimension of the ongoing environmental degradation affecting First Nations.ConclusionFNFNES serves as a good example of participatory research. We encourage public health professionals to develop policy and programs building on the participatory dimension of the research as well as on its results. The information collected by the FNFNES is also important for community empowerment, environmental stewardship and the general promotion of good health by and for First Nations peoples in Canada.

First Nations emergency care in Alberta: descriptive results of a retrospective cohort study

BackgroundWorse health outcomes are consistently reported for First Nations people in Canada. Social, political and economic inequities as well as inequities in health care are major contributing factors to these health disparities. Emergency care is an important health services resource for First Nations people. First Nations partners, academic researchers, and health authority staff are collaborating to examine emergency care visit characteristics for First Nations and non-First Nations people in the province of Alberta.MethodsWe conducted a population-based retrospective cohort study examining all Alberta emergency care visits from April 1, 2012 to March 31, 2017 by linking administrative data. Patient demographics and emergency care visit characteristics for status First Nations persons in Alberta, and non-First Nations persons, are reported. Frequencies and percentages (%) describe patients and visits by categorical variables (e.g., Canadian Triage and Acuity Scale). Means, medians, standard deviations and interquartile ranges describe continuous variables (e.g., age).ResultsThe dataset contains 11,686,288 emergency care visits by 3,024,491 unique persons. First Nations people make up 4% of the provincial population and 9.4% of provincial emergency visits. The population rate of emergency visits is nearly 3 times higher for First Nations persons than non-First Nations persons. First Nations women utilize emergency care more than non-First Nations women (54.2% of First Nations visits are by women compared to 50.9% of non-First Nations visits). More First Nations visits end in leaving without completing treatment (6.7% v. 3.6%).ConclusionsFurther research is needed on the impact of First Nations identity on emergency care drivers and outcomes, and on emergency care for First Nations women.

Places & Spaces: A Critical Analysis of Cancer Disparities and Access to Cancer Care Among First Nations Peoples in Canada

Despite advancements in research and medicine, health inequities and disparities among First Nations peoples (FN) in Canada are well documented and continue to grow. Once virtually unheard of, cancer now is a leading cause of death among FN. Many factors contribute to cancer disparities, but FN face unique challenges in accessing healthcare. In this critical review and analysis, we explore potential links between cancer disparities and poor access to cancer care among FN. Research suggests FN experience difficulty accessing cancer services in several ‘places’ of care, including screening, diagnosis, treatment, survivorship and palliative care. Furthermore, there are notable ‘spaces’ or gaps both within and between these ‘places’ of care likely contributing to cancer disparities among First Nations. Gaps in care result from jurisdictional ambiguities, geographical location, unsafe social spaces, and marginalization of FN ways of knowing, and can be linked to colonial and neocolonial policies and ideologies. By drawing attention to these broader structural influences on health, we aim to challenge discourses that attribute growing cancer disparities among FN in Canada solely to increases in ‘risk factors’.

Peripheral Arterial Disease Among First Nations People with Diabetes in Ontario, Canada: Linkage of Population-Level Healthcare Data

IntroductionIndigenous people worldwide are overrepresented and adversely effected by diabetes. Peripheral arterial disease and amputation are among the most feared complications of diabetes, leading to profound impacts on patients’ quality of life. This study linked population-level healthcare data to assess the risk of peripheral arterial disease among First Nations people in Ontario with diabetes.
 Objectives and ApproachWe linked individual-level population-based healthcare administrative datasets with the Indian Register. The latter provides information on all registered or Status First Nations people in Canada. We compared First Nations people with diabetes with other people in Ontario with diabetes . Age and sex-adjusted rates peripheral revascularization procedures and lower-extremity amputations were calculated for each 12-month period from April 1, 1995, to March 31, 2015. Mortality among those with amputation was determined.
 ResultsFirst Nations people received revascularization procedures at a comparable rate to other people in Ontario. However, they had lower-extremity amputations at 3- to 5-times the frequency of other Ontario residents. First Nations people had increased mortality after lower-extremity amputation (adjusted hazard ratio 1.15, 95% confidence interval 1.05 to 1.26), with median survival of only 3.5 years.
 Conclusion / ImplicationsFirst Nations people with diabetes in Ontario had a comparable rate of revascularization but a markedly increased risk for lower-extremity amputation compared to other people in Ontario. This discordance suggests that peripheral arterial disease may be underdiagnosed or undertreated among First Nations people in Ontario, and demonstrates an important health inequity faced by First Nations people.

First Nations’ Survivance and Sovereignty in Canada during a Time of COVID-19

First Nations people in Canada have demonstrated and continue to demonstrate persistent and resilient cultural, linguistic, and traditional endurance: survivance. The devastation resulting from centuries of health pandemics such as smallpox, influenza, cholera, tuberculosis, measles, and scarlet fever reinforce the ongoing resilience of First Nations people, cultures, and traditions in Canada. Despite the history of pandemic-related trauma and a myriad of social, political, environmental, and health challenges, as well as the added burden that COVID-19 is placing on the healthcare system in Canada, First Nations’ organizations and leadership are enacting their inherent rights to sovereignty and governance. While First Nations are bracing for the expected negative impacts of COVID-19, they are doing so in ways that respect and honor their histories, cultures, languages, and traditions. First Nations are acting to protect some of the most vulnerable people in their communities including elders, knowledge keepers, and storytellers who carry with them irreplaceable traditional and cultural knowledges.

Mercury exposure and premature mortality in the Grassy Narrows First Nation community: a retrospective longitudinal study

Little is known about the influence of toxic exposures on reduced life expectancy in First Nations people in Canada. The Grassy Narrows First Nation community have lived with the consequences of one of the worst environmental disasters in Canadian history. In the early 1960s, 10 000 kg of mercury (Hg) was released into their aquatic ecosystem. Although Hg concentration in fish, their dietary staple, decreased over time, it remains high. We aimed to examine whether elevated Hg exposure over time contributes to premature mortality (younger than 60 years) in this community. We did longitudinal and case-control analyses with data for individuals of the Grassy Narrows First Nation community. In 2019, the community obtained their historical Hg biomarker data from a government surveillance programme, which was then shared with the authors. A matched-pair approach allowed us to compare longitudinal hair Hg concentration between cases (individuals who died aged younger than 60 years) and controls (individuals who lived beyond 60 years). Matching criteria included year of birth (allowing 2 years either side), sex, and a minimum of four hair Hg concentration measures, of which at least two were in the same year. Analyses included change-point detection, interrupted time series, mixed models, and Cox survival models. We analysed data collected between Jan 1, 1970, and Jan 31, 1997, for 657 individuals (319 women and 338 men, born between 1884 and 1991) for whom we assembled a retrospective database of yearly measures of hair Hg concentration (n=3603). Hair Hg concentration decreased over time. A subgroup of 222 individuals (107 women and 115 men) reached or could have reached 60 years old by August, 2019. There was an increased risk of dying at a younger age among those with at least one hair Hg measure of 15 μg/g or more (adjusted hazard ratio 1·55, 95% CI 1·11-2·16; p=0·0088). Among the deceased individuals (n=154), longevity decreased by 1 year with every 6·25 μg/g (4·35-14·29) increase in hair Hg concentration. Analyses of 36 matched pairs showed that hair Hg concentration of those who died aged younger than 60 years was 4·7 times higher (3·4-5·9) than controls. The consistent findings between our different analyses support an association between long-term Hg exposure from freshwater fish consumption and premature mortality in this First Nation community. There is a need to do risk-benefit analyses of freshwater fish consumption in environmentally contaminated regions. Canadian Institutes of Health Research.

School personnel and community members’ perspectives in implementing PAX good behaviour game in first nations grade 1 classrooms

ABSTRACT First Nations peoples in Canada have a history of poor mental health outcomes, as the result of colonisation and the legacy of residential schools. The PAX Good Behaviour Game (PAX-GBG) is a school-based intervention shown to improve student behaviour, academic outcomes, and reduce suicidal thoughts and actions. This study examines the use of PAX-GBG in First Nations Grade 1 classrooms in Manitoba. Researchers collected qualitative data via interviews and focus groups from 23 participants from Swampy Cree Tribal Council (SCTC) communities. Participants reported both positive effects and challenges of implementing PAX-GBG in their classrooms. PAX-GBG created a positive environment where children felt included, recognised, and empowered. Children were calmer, more on-task, and understood the behaviours that are expected of them. However, for many reasons, PAX-GBG is not being used consistently across SCTC schools. Participants described barriers in implementation due to teacher turnover, lack of on-going training and support, developmental and behavioural difficulties of students, and larger community challenges. Participants provided suggestions on how to improve PAX-GBG to be a better fit for these communities, including important cultural and contextual adaptations. PAX-GBG has the potential to improve outcomes for First Nations children, however attention must be given to implementation within community context.

Our Shared Relationship with Land and Water: Perspectives from the Mayangna and the Anishinaabe

The health and well-being of Indigenous communities are deeply connected to respect for the rights of nature. This relationship is informed by their unique knowledge systems which view the world as an interdependent unity of beings with their environment. Drawing on concepts from ecopsychology, interviews with Indigenous peoples and Elders in the Bosawas Reserve (Nicaragua) and the Kettle and Stony Point First Nation (Canada), and qualitative research conducted by the authors, this paper presents a comparative case study analysis of the experience of Mayangna communities around issues of forest protection and Anishinaabe perspectives on water. For the Mayangna peoples, the health of their communities is intrinsically connected to respect for Mother Earth. They struggle for enforcement of existing laws to prevent the deforestation of the Bosawas Reserve, home to their communities and to diverse ecosystems. Similarly, for First Nations peoples in Canada, water, the lifeblood of Mother Earth, is essential for the preservation of a traditional and contemporary way of life. For many of these communities, a lack of water security is a persistent problem which influences all aspects of life. Codified in Indigenous knowledge systems and taught by First Nations Elders are teachings for balanced relationships with creation—behavior necessary for survival and to ensure sustainability for future generations. These cases point to the need for a decolonizing framework to resource management, calling for holistic and participatory perspectives to governance, and recognition of spiritual and cultural relationships with nature.

Allies by Alan Gratz

Reviewed by: Allies by Alan Gratz Natalie Berglind Gratz, Alan Allies. Scholastic, 2019 [336p] Trade ed. ISBN 978-1-338-24572-1 $17.99 E-book ed. ISBN 978-1-338-24574-5 $10.99 Reviewed from galleys R Gr. 4-7 It's June 6, 1944, and in shifting perspectives, this fictional narrative shows multiple facets of the landing in Normandy. Dee Carpenter is a sixteen-year-old private, fighting on the U.S. side despite his German birth; Samira Zidane is an eleven-year-old French Algerian whose mother spies for the resistance; Corporal Henry Allen is a Black medic who patches people up even as they discriminate against him; and thirteen-year-old Monique Marchand joins up with another medic, a woman disguised as a man, to help soldiers on the front. The perspectives allow readers to see sides of World War II that they may not have explored in depth in school, such as the treatment of Black soldiers, antisemitism present within the American military against its own people, anti-Algerian sentiment in France, Cree Indians fighting for a country (Canada) in which they could not vote, and roles for women on the front. Though the fast-paced action and quick perspective shifts give little time to care for deaths Gratz manages to provide distinct, complex personalities and a nail-biting plot. An author's note at the end includes information on the "disaster" landing of the real D-Day, French colonialism in Algeria, battle facts, the treatment of First Nations people in Canada, and inspirations for representations of some of the characters—often showing the resolution dates for many of these issues are more recent than some readers might think. Copyright © 2019 The Board of Trustees of the University of Illinois

Spirituality in cancer survivorship with First Nations people in Canada.

Advancements in cancer survivorship care have shown that holistic approaches, tailored to people's unique survivorship needs, can decrease cancer burden and enhance well-being and quality of life. The purpose of this study was to explore the meanings of spirituality in cancer survivorship for First Nations people, the largest Indigenous population in Canada, and describe how spiritual practices are incorporated into healing. This study is part of a larger arts-based project about cancer survivorship with First Nations people. Thirty-one cancer survivors discussed spirituality as part of their cancer survivorship experiences. Data were generated through sharing sessions (n = 8) and individual interviews (n = 31). Qualitative descriptive analysis was conducted. Three themes emerged about the meaning of spirituality in cancer survivorship. Spirituality was expressed as a complex phenomenon that (1) interconnected self with traditional roots and culture, (2) merged the body and mind, and (3) gave meaning, strength, and faith in the cancer journey. First Nations people incorporated spirituality into cancer survivorship by giving thanks, attending places of spiritual connectedness, singing, praying, speaking to the Creator, and engaging the sun and moon. First Nations cancer survivors have viewed cancer as an opportunity for emotional and spiritual growth that enabled healing. Understanding the role of spirituality in cancer survivorship is important to develop and deliver culturally safe health services that reduce the burden of cancer and ultimately improve outcomes for First Nations people in Canada.

Structural Genocide and Institutionalized Racism in Canada: The Department of Indian Affairs and Framing of Indigenous Peoples

This review problematizes the health and socio-economic disparity between Indigenous and non-Indigenous communities, which I argue is due to the role of the Canadian government. Specifically, I analyse the continuous process of Indigenous administrative subjugation under Canadian rule to uncover the intrinsic racial predilections of Canadian government policy toward First Nations peoples in Canada’s Prairie West provinces through the application of diagnostic frame analysis as a multidisciplinary research method to analyse how people understand situations and activities. My research results reveal the racialized marginalization of First Nation peoples through the administrative regimes in Canada as a continuous contemporary process established in the late nineteenth and twentieth century. In exposing the structural discrimination of First Nations peoples, my research introduces the reader to the concept of political master narratives, or ‘imaginaries’. These imaginaries foster the health and socio-economic disparities between Indigenous and non-Indigenous groups in Canadian society. The critical analysis of these historically structural government instituted imaginaries and the indirect, exponentially higher chances of tuberculosis and related diseases and deaths among Indigenous peoples’ challenge conclusions of the Truth and Reconciliation Commission (TRC) on cultural genocide. This study proposes structural genocide as a more accurate and inclusive term for the continuous institutional marginalization of not only Indigenous peoples as seen in this case study of the Department of Indian Affairs (DIA) but for all Indigenous peoples in Canada.

The Old Wounded: Destructive Plasticity and Intergenerational Trauma

This article addresses a significant gap in trauma theory and philosophy; namely, it develops a partial theory of the subject of intergenerational trauma. This is accomplished through a close examination of Catherine Malabou’s theory of the subject of trauma, as well as by contact with the research in epigenetics of Rachel Yehuda, and the research on intergenerational trauma among First Nations people in Canada conducted by Amy Bombay and colleagues. It presents original work that is responsive to recent advances in a variety of fields, including philosophy, psychology, social science, and biology.

Representations of Indigenous Peoples and Use of Pain Medication in Canadian News Media

Using media coverage of the withdrawal of OxyContin in Canada in 2011 and 2012 as an example, this article describes a systematic analysis of how news media depict First Nations peoples in Canada. Stark differences can be seen in how First Nations and non-First Nations individuals and communities are represented. In First Nations communities, problematic substance use is discussed without considering the context of pain management, broad generalizations are made, and language of hopelessness and victimization is employed. An analysis of the differences in language, tone, sources of information, and what is left unsaid, makes visible the ways in which misinformation about First Nations peoples and communities is constructed and perpetuated in media discourses.