Canadian First Nations People Research Articles

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.

“Years ago”: reconciliation and First Nations narratives of tuberculosis in the Canadian Prairie Provinces

For First Nations tuberculosis (TB) patients in the Prairie Provinces, the past matters. In this paper, we draw on the analysis of historical statements made by 20 First Nations interviewees with infectious TB to explore the function of talking about the past in relation to a current diagnosis of TB and the implications of historicity on contemporary TB prevention, programming and care. Despite interviewees not being asked directly about past contexts of TB treatment, they talked about historical topics such as the removal of First Nations TB patients from communities for treatment in distant sanatoria, painful and invasive surgical procedures once used to treat TB, and the attitudes that persist due to the ongoing failure to eliminate TB from First Nations communities. In these narratives, past experiences of TB treatment are intimately connected to present-day experiences and context. What happened ‘years ago’ profoundly affects the health and well-being of people diagnosed with TB today. Attempts to eliminate TB among First Nations peoples in Canada must also address its historical legacy. Understanding the contemporary effects of past TB treatment and mistreatment among First Nations peoples in the Prairie Provinces can also be seen as part of a larger project of truth and reconciliation in Canada, which involves both Indigenous and non-Indigenous Canadians.

The time has come to fix the Non-Insured Health Benefits (NIHB) program.

In April 2015, the Auditor General of Canada released a report looking at the deplorable delivery of health care services in remote First Nations communities. The poor state of health care delivery to First Nations people in Canada should come as no surprise to pharmacists or any other health provider, regardless of the community setting. For many years, pharmacists and provincial pharmacy associations have raised concerns and issues with the operation of the Non-Insured Health Benefits (NIHB) program, the federal program that delivers health care to Canada’s First Nations people. These problems have included inadequate communication of policy changes, lack of standardized scope of practice and compensation models, lack of clarity regarding patient coverage benefits, inadequate travel arrangements and many others. Too many pharmacists have said that they are often put in the position of having to explain NIHB policy details or changes that should rightfully be communicated by NIHB themselves. Pharmacists have not been alone in raising concerns with NIHB. Many other health providers have raised similar and additional concerns as those expressed by pharmacists, and the Assembly of First Nations (AFN) has been particularly vocal in raising its concerns with the program. This is why in 2014, the federal Minister of Health and the Grand Chief of the Assembly of First Nations announced a full-scale review of the NIHB program. The purpose of this review, which is expected to last until 2017, is to conduct a thorough examination of NIHB operations and policies with the expectation of significant program reform. In spring 2015, the working group tasked with conducting this review (comprising representatives from AFN and the First Nations and Inuit Health Branch of Health Canada) issued a Critical Path document identifying the major sectors and issues that the review will address; pharmacy has been identified as one of the key sectors slated for specific examination starting in December 2015. In 2014, the Canadian Pharmacists Association (CPhA) brought together and has since led a coalition of 8 national health provider organizations looking to be engaged in the NIHB review. As a result of this leadership, the review has agreed that the perspective of health provider groups needs to be considered as part of this review process. CPhA has also engaged with provincial pharmacy associations to better understand their specific concerns and issues with NIHB from a pharmacy perspective and has communicated those concerns to the AFN. Regarding next steps, the health provider organizations, including CPhA, have agreed to consult individually with their own members to get thoughts and feedback on measures that could be taken to improve NIHB policy and operation. This feedback is expected to be collected over the summer and early fall of 2015 and will help inform the process moving forward, including the examination of pharmacy-specific issues. The challenges facing NIHB and delivery of health care to First Nations people in Canada are daunting, and therefore this process will take time. But with health outcomes that are significantly lower than the average Canadian, First Nations people in Canada should be a priority population when it comes to improving the delivery of health care in Canada. The voices of pharmacists and other health providers as part of this review will provide an invaluable contribution, as will their ongoing efforts to deliver improved day-to-day care. CPhA looks forward to continuing to lead health providers in adding their voices to this process. ■

Education and the Health of the First Nations People of Canada

The social determinants of health are those social and economic conditions in which people live that affect their health. As a social determinant, education has been shown to be a very robust predictor of health outcomes. In the global and public health literature, “education” is often used as a global construct with the implicit assumption that all forms of education are beneficial. However, this acontextual approach has serious limitations with respect to the First Nations people of Canada, where there has been a destructive legacy of colonialism and forced assimilation in the form of residential schooling. In this review paper, we examine the complexities of the relationship of education and health of the First Nations people. We advocate a more critical and nuanced approach that includes considerations of history, hegemony, and socio-cultural context as being crucial for appropriate First Nations education and health policies.

Analysis Grid for Environments Linked to Obesity (ANGELO) framework to develop community-driven health programmes in an Indigenous community in Canada.

Indigenous First Nations people in Canada have high chronic disease morbidity resulting in part from enduring social inequities and colonialism. Obesity prevention strategies developed by and for First Nations people are crucial to improving the health status of this group. The research objective was to develop community-relevant strategies to address childhood obesity in a First Nations community. Strategies were derived from an action-based workshop based on the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. Thirteen community members with wide-ranging community representation took part in the workshop. They combined personal knowledge and experience with community-specific and national research to dissect the broad array of environmental factors that influenced childhood obesity in their community. They then developed community-specific action plans focusing on healthy eating and physical activity for children and their families. Actions included increasing awareness of children's health issues among the local population and community leadership, promoting nutrition and physical activity at school, and improving recreation opportunities. Strengthening children's connection to their culture was considered paramount to improving their well-being; thus, workshop participants developed programmes that included elders as teachers and reinforced families' acquaintance with First Nations foods and activities. The research demonstrated that the ANGELO framework is a participatory way to develop community-driven health programmes. It also demonstrated that First Nations people involved in the creation of solutions to health issues in their communities may focus on decolonising approaches such as strengthening their connection to indigenous culture and traditions. External funds were not available to implement programmes and there was no formal follow-up to determine if community members implemented programmes. Future research needs to examine the extent to which community members can implement programmes on their own and whether community action plans, when implemented, lead to short- and long-term benefits in health outcomes.

IPad Audiometry in Canada's North: A Portable and Cost‐Effective Method for Hearing Screening

Objectives: Access to hearing health care is limited in many parts of the world. Specifically, many risk factors for hearing loss are present in the First Nations people of Canada’s North. No research has been done to assess this populations hearing in over 3 decades. The aims of the study were: (1) Determine the prevalence of hearing loss in children in Baffin Island. (2) Demonstrate the use of asynchronous tele-audiometry. (3) Conduct a cost-benefit analysis of iPad audiometry in the Canadian Arctic. Methods: iPad audiometers were used to test hearing in 220 children ages 5-11 years in Iqaluit, Nunavut, during 1 week in January 2014. Air conduction pure tones were obtained from each ear at frequencies of 500, 1000, 2000, and 4000 Hz. Children with hearing loss greater than 25 dB in at least 1 frequency were considered to have failed the hearing test and will be further tested with standard sound booth audiometry. Results: Preliminary analysis reveals a hearing loss prevalence of 15.5%. These children then received standard testing by an audiologist using standard sound booth audiometry and the results analyzed. A cost-benefit analysis assessed the use of iPad audiometry in this remote location. Conclusions: This is the first study in over 30 years assessing the hearing of children in this region, and the first telemedicine audiometry in Canada using iPads. This type of testing is valuable for providing hearing health care for high risk populations in rural and remote areas at an affordable cost.

The Impact of Migration on the First Nations Community Well-Being Index

Migration of First Nations people in Canada can affect social and economic conditions of First Nations communities in different ways. Overall levels of migration might cause challenges for infrastructure or service delivery, and selective in- or out-migration might have implications for community human capital. Seen through the lens of social capital, migration could be important for maintaining bridging connections to outside institutions and communities, but might also disrupt social bonds within the community. We investigated the relationships between migration and well being of Canadian First Nations communities using 5-year (2001–2006) census migration rates and the 2006 Community Well-Being Index (CWB), which measures labour market, educational attainment, income and housing conditions in First Nations communities. We found that, on average, both in-migrants to and out-migrants from First Nations had more education and higher incomes than non-migrants, but the difference was greater for out-migrants. This did not strongly affect CWB scores, however. Regressions of CWB scores on in-, out-, net, and gross migration rates, controlling for geography, found small positive effects of both in- and out-migration, as well as gross migration, on CWB scores.

Design and development of culture-specific pictograms for type 2 diabetes mellitus education and counselling.

Diabetes mellitus is a metabolic disorder that is characterized by elevated blood glucose levels resulting in significant microvascular and macrovascular complications (1). Type 2 diabetes is an epidemic among Canadian First Nations. There are more than 800 000 First Nations people who live in Canada (2), with approximately 40% living on reserves. The growth rate of First Nations people is faster than the rest of the Canadian population, with a population increase of 29% between 1996 and 2006, 3.5 times the growth rate of 8% for the non-Aboriginal population (3). The proportion of First Nations with diabetes is especially marked among people who live on reserves, with a prevalence of 17.2% compared with 10.3% for First Nations off reserves and 5.0% in the general Canadian population (4). The high prevalence of diabetes in the First Nations population, especially among those who live on reserves, may be secondary to a combination of genetic (5) and lifestyle (6) factors leading to higher rates of overweight and obesity (7). The rapid rate of sociocultural changes has strongly impacted the lifestyles of First Nations people over the last 50 years, moving away from their traditional ways of life as hunters and food gatherers tomore sedentary activities and poorer eating habits, and also influenced by the high cost of imported fresh, healthy food. Furthermore, geographical remoteness often translates into lower access to healthcare and education opportunities, also contributing to the burden of disease (4). The factors that negatively affect the health of First Nations people in Canada are consistent with those reported for many indigenous populations worldwide (8,9). The higher prevalence of diabetes in First Nations communities on reserves makes the need for better patient education especially urgent, and should take into account their First Nations culture, language and literacy of English or French that may constitute barriers to efficient patient information, given the lack of education tools adapted to this situation. In Canada, patient information about diabetes is mainly available in text format (10), in English or French. This type of patient

Reconceptualizing determinants of health: barriers to improving the health status of First Nations peoples.

Comparing the key determinants of health articulated by the Public Health Agency of Canada (the Agency) with the spiritual and cultural knowledge systems of First Nations peoples, as expressed by the Four Worlds International Institute for Human and Community Development (Four Worlds) and their 14 determinants of well-being and health, reveals differing philosophical perspectives. The key determinants of health can be interpreted as lacking a holistic and inclusive approach to public health services. As a result, many public health programs in Canada marginalize, ignore and suppress the needs of First Nations communities and people. Incorporating the Four Worlds guiding principles and its 14 health determinants model within the context of Canadian public health services geared towards First Nations populations provides the opportunity to develop a deeper understanding of social determinants of health. Therefore, when implementing public health initiatives to address the health status of First Nations people in Canada, it is important that the Agency incorporate the guiding principles of the Four Worlds: Development Comes from Within; No Vision, No Development; Individual and Community Transformations Must Go Hand in Hand; and Holistic Learning is the Key to Deep and Lasting Change. Reconceptualizing the key determinants of health to encompass the worldview expressed by the Four Worlds acknowledges the cultural wisdom of First Nations people and offers the potential to develop more inclusive public health services.

Cardiovascular disease mortality among First Nations people in Canada, 1991–2001

To compare cardiovascular disease mortality patterns between First Nations people and non-Aboriginal adults by sex and by income adequacy quintile and level of educational attainment. A 15% sample of 1991 Canadian census respondents aged 25 years or older was previously linked to 11 years of mortality data. In this study, First Nations people were defined by North American Indian ethnic origin (ancestry), registration under the Indian Act, and/or membership in an Indian band or First Nation. The cohort included 62 400 First Nations people and 2 624 300 non-Aboriginal people. Compared to non-Aboriginal cohort members, the age-standardized cardiovascular disease mortality rate was 30% higher for First Nations men and 76% higher for First Nations women. This represented an excess of 58 deaths and 71 deaths per 100 000 person-years at risk, for First Nations men and women, respectively. Within each income adequacy quintile (adjusted for family size and region of residence) and level of educational attainment, the risk of dying from cardiovascular disease was higher for First Nations people compared to their non-Aboriginal counterparts. First Nations people had higher rates of death from cardiovascular disease than non-Aboriginal Canadians within each income quintile and level of education. Income and education accounted for 67% and 25% of the excess mortality of First Nations men and women respectively.

Challenges to the provision of diabetes care in first nations communities: results from a national survey of healthcare providers in Canada

BackgroundAboriginal peoples globally, and First Nations peoples in Canada particularly, suffer from high rates of type 2 diabetes and related complications compared with the general population. Research into the unique barriers faced by healthcare providers working in on-reserve First Nations communities is essential for developing effective quality improvement strategies.MethodsIn Phase I of this two-phased study, semi-structured interviews and focus groups were held with 24 healthcare providers in the Sioux Lookout Zone in north-western Ontario. A follow-up survey was conducted in Phase II as part of a larger project, the Canadian First Nations Diabetes Clinical Management and Epidemiologic (CIRCLE) study. The survey was completed with 244 healthcare providers in 19 First Nations communities in 7 Canadian provinces, representing three isolation levels (isolated, semi-isolated, non-isolated). Interviews, focus groups and survey questions all related to barriers to providing optimal diabetes care in First Nations communities.Resultsthe key factors emerging from interviews and focus group discussions were at the patient, provider, and systemic level. Survey results indicated that, across three isolation levels, healthcare providers' perceived patient factors as having the largest impact on diabetes care. However, physicians and nurses were more likely to rank patient factors as having a large impact on care than community health representatives (CHRs) and physicians were significantly less likely to rank patient-provider communication as having a large impact than CHRs.ConclusionsAddressing patient factors was considered the highest impact strategy for improving diabetes care. While this may reflect "patient blaming," it also suggests that self-management strategies may be well-suited for this context. Program planning should focus on training programs for CHRs, who provide a unique link between patients and clinical services. Research incorporating patient perspectives is needed to complete this picture and inform quality improvement initiatives.

Studies on the chronology of third molar mineralization in First Nations people of Canada

Forensic age estimation of living subjects has become increasingly important in recent years. One main criterion for dental age estimation in the relevant age group is the evaluation of third molar mineralization. In the present study, we determined the stages of third molar mineralization in 347 female and 258 male First Nations people of Canada aged 11 to 29 years based on radiological evidence from 605 conventional orthopantomograms. The results presented here provide useful data on the mineralization stages of third molars that can be used for forensic estimation of the minimum and most probable ages including the range of scatter of investigated persons.

Epidemiology of diabetes mellitus among First Nations and non-First Nations adults

First Nations people in Canada experience a disproportionate burden of type 2 diabetes mellitus. To increase our understanding of this evolving epidemic, we compared the epidemiology of diabetes between First Nations and non-First Nations adults in Saskatchewan from 1980 to 2005. We used administrative databases to perform a population-based study of diabetes frequency, incidence and prevalence in adults by ethnic background, year, age and sex. We identified 8275 First Nations and 82,306 non-First Nations people with diabetes from 1980 to 2005. Overall, the incidence and prevalence of diabetes were more than 4 times higher among First Nations women than among non-First Nations women and more than 2.5 times higher among First Nations men than among non-First Nations men. The number of incident cases of diabetes was highest among First Nations people aged 40-49, while the number among non-First Nations people was greatest in those aged 70 or more years. The prevalence of diabetes increased over the study period from 9.5% to 20.3% among First Nations women and from 4.9% to 16.0% among First Nations men. Among non-First Nations people, the prevalence increased from 2.0% to 5.5% among women and from 2.0% to 6.2% among men. By 2005, almost 50% of First Nations women and more than 40% of First Nations men aged 60 or older had diabetes, compared with less than 25% of non-First Nations men and less than 20% of non-First Nations women aged 80 or older. First Nations adults are experiencing a diabetes epidemic that disproportionately affects women during their reproductive years. This ethnicity-based pattern suggests diverse underlying mechanisms that may include differences in the diabetogenic impact of gestational diabetes.

A Different Tenor: Glimpses and Critical Reflections

Abstract: Fifty years ago, a young China-born Katharine B. Hockin, a United Church of Canada (UCC) diaconal minister and missionary, reflecting on the harmful implications of “mission to others” through her experience of listening to Chinese Christians and First Nations peoples in Canada, learned that right relations with companions had to start with her own healing, a gift of the spirit received through “listening to others in context,” developed her “missiology of companionship.” Today, a young Korean-born UCC diaconal minister explores the missiology and mission practice of Katharine B. Hockin and two of her former diaconal students and critiques the missiology of the contemporary scholar Robert J. Schreiter's mission as “healing of others” with that of Marilyn J. Legge's mission as “healing ourselves with others.” She finds Hockin's transformation from “mission as healing of others” to “mission as companionship” compellingly appropriate for the diakonia of the UCC today.

Cross‐cultural constructions of work, leisure and community responsibility: Some first nations reflections

This paper approaches the habitual mis‐communication of Native and non‐Native cultural traditions within Canadian society interms of the fundamental distinction between main stream peoples who are settled farmers and First Peoples who move around to exploit resources. I argue that the ‘nomadic legacies’ of the latter persist today in patterns of seeking employment, education and social or medical services even though most First Nations people in Canada no longer live on Reserves. Aboriginal identity, however, remains closely tied to capacity to return, periodically or permanently, to the Reserve as homeplace. The place‐ and community‐based nature of contemporary First Nations identity entails unfamiliar concepts of work and leisure, and the relationship between social community and environment. I suggest some modes of healing consistent with respect for these traditions.

Intergenerational Trauma: Convergence of Multiple Processes among First Nations peoples in Canada

Stressful events may have immediate effects on well-being, and by influencing appraisal processes, coping methods, life styles, parental behaviours, as well as behavioural and neuronal reactivity, may also have long lasting repercussions on physical and psychological health. In addition, through these and similar processes, traumatic experiences may have adverse intergenerational consequences. Given the lengthy and traumatic history of stressors experienced by Aboriginal peoples, it might be expected that such intergenerational effects may be particularly notable. In the present review we outline some of the behavioural disturbances associated with stressful/traumatic experiences (e.g., depression, anxiety, posttraumatic stress disorder, and substance abuse disorder), and describe the influence of several variables (age, sex, early life or other experiences, appraisals, coping strategies, as well as stressor chronicity, controllability, predictability and ambiguity) on vulnerability to pathology. Moreover, we suggest that trauma may dispose individuals to further stressors, and increase the response to these stressors. It is further argued that the shared collective experiences of trauma experienced by First Nations peoples, coupled with related collective memories, and persistent sociocultural disadvantages, have acted to increase vulnerability to the transmission and expression of intergenerational trauma effects.

First Nations Communities at Risk And in Crisis: Justice and Security

This paper argues that colonialism is far too often overlooked or dismissed in designing security and justice remedies in First Nation communities. Yet, as a process of domination, colonialism has proven destructive to the peoples of the world who have suffered colonization. For First Nations peoples in Canada, the colonial regime has applied pressure against their cultures, practices and traditions. In naming colonialism as a major and central source of harms, models for the future must address systemic structures of colonialism. A decolonizing approach is highly challenging both for the individuals who take these steps and for the communities who undertake collective transformations. Healing means setting out on un-walked paths to decolonization. The paper’s framework starts with examining the current stressors for First Nation communities at risk or in crisis. Reviewing the currently published findings on justice and security related stressors, this research paper looks closely at: on-research health, education, poverty reduction and social assistance, child welfare, youth gang issues, policing services, crime rates, and safety of health workers. The research finds that Aboriginal traditions and approaches to health, healing, knowing, and doing can exist within other institutions and frameworks, to help alleviate community stressors. The authors of this study outline five decolonizing recommendations for ways to move forward in building models for the future; then, provides practical advice on how to build preventive and proactive community plans, support community capacity and infrastructure, build relationships, and model positive development.

Libraries and the First Nations People of Canada

Plenary address presented at the World Library and Information Congress: 74th IFLA General Conference And Council, 10—14 August 2008, Québec City, Canada. Describes the author's childhood as a member of the First Nations People of Canada and his discovery of the value of books and libraries. Describes the social conditions of young people living in poor First Nation communities in Canada and his efforts to establish libraries, summer reading camps, reading clubs and creative writing literary awards for children and youth in these communities.

Lead shot contribution to blood lead of First Nations people: The use of lead isotopes to identify the source of exposure

Although lead isotope ratios have been used to identify lead ammunition (lead shotshell pellets and bullets) as a source of exposure for First Nations people of Canada, the actual source of lead exposure needs to be further clarified. Whole blood samples for First Nations people of Ontario, Canada, were collected from participants prior to the traditional spring harvest of water birds, as well as post-harvest. Blood-lead levels and stable lead isotope ratios prior to, and after the harvest were determined by ICP-MS. Data were analyzed by paired t-tests and Wilcoxon Signed-Ranks tests. All participants consumed water birds harvested with lead shotshell during the period of study. For the group excluding six males who were potentially exposed to other sources of lead (as revealed through a questionnaire), paired t-tests and Wilcoxon Signed-Ranks tests showed consistent results: significant ( p < 0.05) increases in blood-lead concentrations and blood levels of 206Pb/ 204Pb and 206Pb/ 207Pb towards the mean values we previously reported for lead shotshell pellets; and a significant decrease in 208Pb/ 206Pb values towards the mean for lead shotshell pellets. However, when we categorized the group further into a group that did not use firearms and did not eat any other traditional foods harvested with lead ammunition other than waterfowl, our predictions for 206Pb/ 204Pb, 206Pb/ 207Pb and 208Pb/ 206Pb hold true, but there was not a significant increase in blood-lead level after the hunt. It appears that the activity of hunting (i.e., use of a shotgun) was also an important route of lead exposure. The banning of lead shotshell for all game hunting would eliminate a source of environmental lead for all people who use firearms and/or eat wild game.

Blackfoot ways of knowing: the worldview of the Siksikaitsitapi

Blackfoot Ways of Knowing:The Worldview of the Siksikaitsitapi is a journey into the heart and soul of Blackfoot culture. In sharing her personal story of home to reclaim her identity within that culture, Betty Bastien offers us a gateway into traditional Blackfoot ways of understanding and experiencing the world. As a scholar and researcher, Bastien is also able to place Blackfoot tradition within the context of knowledge building among indigenous peoples generally, and within a historical context of precarious survival amid colonial displacement and cultural genocide. In mapping her own process of coming to know, Bastien stresses the recovery of the Blackfoot language and of the Blackfoot notions of reciprocal responsibilities and interdependence. For the Siksikaitsitapi, knowledge is experiential, participatory, and ultimately sacred, rather than objective and inert. Rekindling traditional ways of knowing is essential if First Nations people in Canada are to heal and rebuild their communities and cultures. By sharing what she has learned, Betty Bastien hopes to ensure that the next generation of First Nations people will enjoy a future of hope and peace.