Indigenous Populations In Canada Research Articles

Life Expectancy at Birth and Infant Mortality Rates of Indigenous Populations in Canada from 2004 to 2016

Life expectancy and infant mortality rates are two important indicators of the well-being of a population. However, it is not possible to compute these indicators for specific Indigenous populations in Canada from vital statistics databases because information about the identity of individuals is lacking. We use alternative data sources, linkages between the long-form census questionnaire and the Canadian Vital Statistics, namely the Canadian Census Health and Environment Cohorts and the Canadian Birth Census Cohorts, to compute life expectancy at birth and infant mortality rates among Indigenous populations. We describe the data, explain the methodology, and analyze the results to demonstrate the usefulness of these databases for the regular reporting of these health outcomes and monitoring of trends.

Scoping review of current challenges and circumstances impacting Indigenous applications to Canadian medical schools

Introduction: Considering the relevant 2015 Truth and Reconciliation Commission recommendations, this paper reviews the current state of Canadian medical schools’ Indigenous admissions processes and explores continued barriers faced by Indigenous applicants. Methods: A summary of literature illustrating disadvantages for Indigenous applicants of current admissions tools is presented. A grey literature search of current admissions requirements, interview processes, and other relevant data from each medical school was performed. Tables comparing differences in their approaches are included. A calculation of Indigenous access to medical school seats compared to the broader Canadian population was conducted. Gaps in execution are explored, culminating in a table of recommendations. Results: Despite formal commitments to reduce barriers, Indigenous applicants to medical school in Canada still face barriers that non-Indigenous applicants do not. Most programs use tools for admission known to disadvantage Indigenous applicants. Indigenous applicants do not have equitable access to medical school seats. Facilitated Indigenous stream processes first ensure Indigenous applicants meet all minimum requirements of Canadian students, and then require further work. Discussion: Seven years after the Truth and Reconciliation Commission called on Canadian universities and governments to train more Indigenous health care providers, there has been limited progress to reduce the structural disadvantages Indigenous students face when applying to medical school. Based on best practices observed in Canada and coupled with relevant Indigenous-focused literature, recommendations are made for multiple stakeholders. Conclusions: The study was limited by the data available on numbers of Indigenous applicants and matriculants. Where available, data are not encouraging as to equitable access to medical school for Indigenous populations in Canada. These findings were presented at the International Congress of Academic Medicine 2023 Conference, April 2023, Quebec City, Canada.

The Impact Of The Zivot Limb Preservation Centre

Indigenous populations in Canada, including First Nations, Metis and Inuit peoples, often have limited access to health care, increasing the prevalence of many chronic conditions, including diabetes mellitus. Diabetic foot ulcers are a common problem. This presentation outlines the impact of the Zivot Limb Preservation Centre in Alberta, its use of the ‘Toe and flow’ model of care and its role in decreased major amputation rates.

FEET: First Nations Empowerment Through Enabling Technology: An Indigenous-led Health Pilot For Diabetic Foot Ulcer Prevention

Diabetes is a significant health challenge for Indigenous populations in Canada. Diabetic foot ulcers are common. Siksika Nation, a First Nation in Alberta, Canada provides healthcare to nearly 8,000 members through Siksika Health Services (SHS). This presentation highlights a 24-week pilot focusing on the prevention and early detection of diabetic foot ulcers and on promoting foot health within the Nation.

Estimating the Prevalence of Hypercholesterolemia in Indigenous Populations: A Systematic Review and Meta-Analysis

BackgroundHypercholesterolemia is a common condition characterized by elevated levels of low-density lipoprotein cholesterol (LDL-C) and increased risk of atherosclerotic cardiovascular disease (ASCVD). Indigenous populations experience disproportionate rates of ASCVD, however, the extent to which hypercholesterolemia contributes to this burden is unknown. ObjectivesThis study aimed to estimate the prevalence of hypercholesterolemia, severe hypercholesterolemia, and familial hypercholesterolemia (FH) in Indigenous populations in Canada, the United States, Australia, and New Zealand. MethodsWe searched MEDLINE, EMBASE, Web of Science, Native Health Database, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for peer-reviewed studies reporting on hypercholesterolemia and elevated LDL-C in Indigenous populations. All diagnostic criteria used to classify hypercholesterolemia were included. Pooled prevalence and 95% CIs were calculated using a random-effects model. ResultsThere were no studies reporting the prevalence of FH and one study reporting the prevalence of severe hypercholesterolemia in Indigenous populations. The pooled prevalence of hypercholesterolemia was 28.9% or ∼1 in 3 to 1 in 4 individuals (95% CI: 22.4%-36.4%) and 12.6% (95% CI: 7.7%-19.9%) using an LDL-C cutoff of ≥3.5 mmol/L (135 mg/dL). The pooled prevalence in Indigenous populations in North America was 24.3% (95% CI: 17.1%-33.3%) compared with 40.0% (95% CI: 31.3%-49.3%) in Australia. Meta-regression showed diabetes had a significant effect on prevalence (P = 0.022). ConclusionsHypercholesterolemia is prevalent in Indigenous communities and may contribute to the high burden of ASCVD these populations face. There is insufficient research on FH and severe hypercholesterolemia in Indigenous populations worldwide.

An Overview of Traumatic Brain & Spinal Cord Injuries (TBI/TSCI) Among Indigenous Populations in Canada, United States, Australia, and New Zealand

An Overview of Traumatic Brain & Spinal Cord Injuries (TBI/TSCI) Among Indigenous Populations in Canada, United States, Australia, and New Zealand

Dietary Patterns of Off-Reserve Indigenous Peoples in Canada and Their Association with Chronic Conditions

Nationally representative nutrition surveys (Canadian Community Health Survey (CCHS) Cycle 2.2, Nutrition 2004 and 2015) were used to examine dietary patterns and their association with socioeconomic/sociodemographic factors and chronic conditions in off-reserve Indigenous population in Canada. A cluster analysis was used to identify dietary patterns (DPs), and the Nutrient Rich Food Index (NRF 9.3) was used as the diet quality score and stratified by age/gender groups. In 2004 (n = 1528), the dominant DPs among Indigenous adults (age = 41 ± 2.3) were "Mixed" (mean NRF = 450 ± 12) and "Unhealthy" among men (mean NRF = 426 ± 18), "Fruits" among women (mean NRF = 526 ± 29), and "High-Fat/High-Sugar" among children (age = 10.2 ± 0.5) (mean NRF = 457 ± 12). In 2015 (n = 950), the dominant DPs were "Unhealthy" (mean NRF = 466 ± 6), "Mixed" (mean NRF = 485 ± 21), Healthy-Like (mean NRF = 568 ± 37), and "Mixed" (mean NRF = 510 ± 9) among adults (age = 45.6 ± 2.2), men, women, and children (age = 10.9 ± 0.3) respectively. The majority of Indigenous peoples had the "Unhealthy" DP with a low diet quality, which may contribute to a high prevalence of obesity and chronic diseases. The income level and smoking status among adults and physical inactivity among children were recognized as important factors that may be associated with the dietary intake of off-reserve Indigenous population.

Intergenerational residential school attendance and increased substance use among First Nation adults living off-reserve: An analysis of the aboriginal peoples survey 2017.

The Truth and Reconciliation Commission of Canada (TRCC) published 94 Calls to Action in 2015 to address long-term, intergenerational effects of the residential school system, highlighting the pervasive impact of colonialism on the wellbeing of Indigenous peoples in Canada. Indeed, research with Indigenous populations in Canada has captured that prior experiences of residential schools contributes to the intergenerational transmission of mental and physical health disparities. Despite these studies, further research is needed that contextualizes the influence of residential schools within broader frameworks that consider Indigenous social determinants of health in Canada. As such, the purpose of the present study was to examine patterns of substance use and mental and physical health among individuals with a history of residential school attendance (RSA) and individuals reporting parent or two-generation (parent and grandparent) RSA. Data from the Aboriginal Peoples Survey (2017), involving 10,030 First Nations individuals living off reserve, were analyzed. Self-reported mental and physical health scores were significantly lower among those had attended residential schools, whose parents attended residential schools, and whose grandparents attended residential schools, when compared to those who did not. Further, family RSA was associated with increased substance use among participants, though the findings were variable based on sex and specific substance analyzed. Meanwhile, individual and family RSA was not associated with increased likelihood of a mental health diagnosis. These findings provide additional support for how both parental and two-generation family histories of RSA are associated with individual physical and mental health outcomes. Further, these findings articulate the need for the TRCC's Calls to Action to be actually implemented, including community-based approaches that harness the strength of Indigenous people and communities who aim to close the gap in these health disparities for their children and families.

Needing indigenous biometrics for health in Canada

This article presents a critical analysis of the use of biometrics in clinical practice and their inadequacies for Indigenous populations in Canada and globally. Misclassifications of health status based on biometrics have health implications across the lifespan, from gestation to older adulthood, which are also examined. The social determinants of health and of Indigenous health compound the impact of inaccurate biometrics on First Nations, Inuit and Métis populations. Moving forward, biometric use should be done in partnership with Indigenous peoples and with consideration of the surrounding context. Future research should consider bridging existing gaps in knowledge on this topic in culturally safe ways, to improve the quality and depth of information available and inform more equitable health care for Indigenous populations.

Workplace mental health characteristics of the Indigenous workforce in Canada: A descriptive study.

The Indigenous workforce in Canada is challenged by a history of Euro-Canadian colonialism that has presented deleterious health outcomes, including those in the workplace. The aim of this study was to describe the mental health of Indigenous workers in the workplace. We used the Canadian Community Health Survey (CCHS) between 2015 to 2016. Data were analyzed using the Public Use Microdata Files to profile the workplace mental health characteristics of First Nation Canadians (n = 6,297) and Canadians (n = 84,155). We utilized secondary data analysis design. The analyses included descriptive statistics (e.g., means and standard deviations) of self-reported mood disorders (depression, bipolar, mania, dysthymia), anxiety (phobia, OCD, panic) and occupational factors (e.g., demographic, days off work due to an acute mental health condition, job type, and job stress) in indigenous peoples living off-reserve and other Aboriginal settlements in the provinces. We examined the indigenous cohort between the ages of 18-64 who were employed. The sample was 53.1% male, married (34.8%), and obtained a post-secondary diploma or university degree (57.9%). The study reported statistically significant gender and age differences across mood and anxiety disorders (p < 0.05), job stress (p < 0.05) and workload (p < 0.05). To the best of our knowledge, this is the first study to describe the work profile of indigenous populations in Canada across various occupational mental health (e.g., mood disorders, anxiety) and demographic (e.g., age, education attainment) outcomes.

Mental health and cultural continuity among an urban Indigenous population in Toronto, Canada.

Mental health and psychiatric disorders significantly affect individuals on personal and social levels. Indigenous populations in Canada have disproportionately high rates of mental health diagnoses. Our Health Counts (OHC) Toronto assessed mental health, racism, family disruption, and cultural continuity among urban Indigenous people. The objectives of this study were to understand (1) the demographics and characteristics of Indigenous adults with a diagnosed psychological/mental health disorder and (2) potential associations of psychological/mental health diagnoses with experiences of colonization and cultural continuity among Indigenous adults in Toronto. Using community-based participatory research methods, Indigenous adults in Toronto were recruited by respondent-driven sampling (RDS) to complete a comprehensive health assessment survey. RDS-II weights were applied to calculate population-based estimates, and adjusted odds ratios with 95% confidence intervals were produced using logistic regression, controlling for age and gender. Among Indigenous adults, nearly half (45%) reported receiving a mental health diagnosis. Participants reported lifetime anxiety disorders (53%), major depression (51%), and high rates of suicide ideation (78%). Of Indigenous adults with a diagnosed mental health disorder, 72.7% reported participating in ceremony. Attending residential schools (OR: 7.82) and experiencing discrimination (OR: 2.69) were associated with having a mental health disorder. OHC Toronto responded to the gaps in health assessment data for urban Indigenous people. Despite historic and ongoing trauma, Indigenous people have maintained cultural practices and a strong sense of identity. Efforts aimed at supporting Indigenous well-being must respond to the roots of trauma, racism, and existing Indigenous community knowledge and strengths.

Adverse childhood experiences (ACEs) are increasing in indigenous populations in Canada: Now what?

Adverse childhood experiences (ACEs) are increasing in indigenous populations in Canada: Now what?

An Integrative Review of Barriers and Facilitators Associated With Mental Health Help Seeking Among Indigenous Populations.

Indigenous populations, compared with majority populations, have a reduced likelihood of receiving professional help for mental health, contributing to health disparities. To increase use of and access to mental health services for Indigenous people, specific factors that affect service use need to be examined. An integrative review was undertaken of the barriers to and facilitators of help seeking and service use for Indigenous populations in Canada, the United States, Australia, and the Pacific Islands. Five databases-PsycINFO, PubMed, Web of Science, Social Services Abstracts, and Bibliography of Native North Americans-and gray literature were searched to identify original studies with data specific to Indigenous people. A qualitative analysis of common themes among the studies was conducted, along with a quality appraisal of included articles. Of the 1,010 records identified, the final synthesis included 41 articles. Six main themes emerged: informal supports, which were often used as a first choice for help seeking compared with formal services; structural obstacles and supports; stigma and shame; self-reliance and uncertainty about services; cultural factors and mistrust of mainstream services; and the need for outreach and information regarding mental illness and services. Policy implications include needed structural changes to decrease mistrust of mainstream systems and services and increased funding and resource availability. Along with technology-facilitated treatment, programs for Indigenous people, families, and communities that enhance education and foster positive relationships can serve as a first step toward Indigenous people becoming comfortable with the idea of talking about mental health and with seeking treatment.

The anatomy of social capital of a Canadian indigenous community: Implications of social trust field experiments for community-based forest management

The design of a community-based co-management system requires a nuanced understanding of social trust resources in the community involved. Unfortunately, however, there is a serious gap in our understandings concerning the distinct characteristics of social trust in Canadian indigenous communities. Such knowledge is essential to inform the design of management systems and processes that respect, accommodate and mobilize a community's unique culture and social resources. Our study contributes to filling the gap in our understanding of social trust patterns in Canadian First Nations, the largest indigenous population in Canada, by developing, testing and applying a systematic experimental framework for in-depth study of social trust of a First Nation community. It also explores the implications of our findings for improving the design of community-based co-management systems. We conducted our field-experiments in a community located in the northwestern forests of Ontario, Canada using a modified Investment Game (IG) as a core method in combination with survey instruments and games designed to trigger and measure behaviors related to specific motives that underpin IG allocations. Our methodology was designed to uncover fissures in the community's social trust related to gender and age. Our findings revealed that ‘others-regarding’ motives for trust are prevalent in the community and thus the bonding social capital is dominant and therefore social trust is rarely extended to individuals and institutions beyond the community. The findings also showed that cultural norms, especially with regard to the roles played by Elders and women as trustees and trustors in the community, do matter. We conclude with the implications of our study for the design and implementation of forest resources co-management agreements of the First Nation communities.

Integrative review protocol for Indigenous youth participation in health equity promotion

IntroductionIndigenous youth participation in decision-making is internationally recognised as a pathway to promote health equity, decolonisation and social inclusion. Hearing Indigenous youth voices and actively involving them in decisions that...

Recreational tobacco consumption and food insecurity among First Nations in Canada.

Crowding-out effects of tobacco consumption refers to the situation in which tobacco consumption reduces a household's spending on other commodities. In this paper, we test for the crowding-out effects of recreational tobacco consumption on food expenditures among on-reserve Indigenous communities in Canada. We use data from household expenditure surveys (N=469) to investigate tobacco consumption behaviour of on-reserve households of six First Nation communities in Canada. Using conditional Engel curves, we estimate the crowding-out effects of spending on tobacco on budget share of other expenditure categories with a focus on food expenditures. Our analysis showed that crowding-out effects of consuming tobacco on consumption of goods and services are minimal with an estimated impact of -0.00004 on the budget share of food expenditures in the remaining budget excess of expenditures on tobacco. While crowding-out effects are not statistically significant in general, the budget share of store-bought food expenditures is significantly lower (i.e. 5%) among tobacco consumer households. This study sheds new light on some of the indirect impacts of recreational tobacco use and Indigenous food insecurity in Canada. This study is the first attempt to test for crowding-out effects of tobacco consumption among Indigenous populations in Canada. Our findings are important and highlight areas for substantial improvements in health and well-being outcomes given the alarming rates of food insecurity experienced by Indigenous communities in Canada.

Exploring Biologic Treatment Hesitancy Among Black and Indigenous Populations in Canada: a Review.

Biologics are becoming an increasingly important part of patient care across Canada. Recent studies from the USA show that Black patients are less likely than White patients to receive biologic treatment for several medical conditions. The relative lack of race-based data in Canada makes it difficult to replicate such studies in Canada. As a result, there is a paucity of literature that explores the association between biologic usage and race in Canada. Our review aims to explore the factors that might be driving racial treatment disparity in Canada that likely parallels the inequalities found in the USA. We provide a summary of the available literature on the factors that contribute to biologic treatment hesitancy among Black and Indigenous populations in Canada. We highlight several solutions that have been proposed in the literature to address biologic treatment hesitancy. Our review found that biologic treatment decision at the individual level can be very complex as patient’s decisions are influenced by social inputs from family and trusted community members, biologic-related factors (negative injection experience, fear of needles, formulation, and unfamiliarity), cultural tenets (beliefs, values, perception of illness), and historical and systemic factors (past research injustices, socioeconomic status, patient–physician relationship, clinical trial representation). Some proposed solutions to address biologic treatment hesitancy among Black and Indigenous populations include increasing the number of Black and Indigenous researchers involved in and leading clinical trials, formally training physicians and healthcare workers to deliver culturally competent care, and eliminating financial barriers to accessing medications. Further research is needed to characterize and address race-based new treatment inequalities and hesitancy in Canada.

P.188 Neurotrauma in Indigenous populations of Canada: challenges and future directions: A Scoping Review

Background: Neurotrauma accounts for over 24 000 hospitalizations annually in Canada. Among those affected, Indigenous peoples are disproportionately impacted. The goal of this scoping review is to identify factors underlying these disparities. Methods: A scoping review was conducted to collect papers pertaining to neurotrauma in Indigenous populations of Canada. Using MEDLINE, 676 articles were screened with MeSH terms including ‘Indigenous’, ‘spinal cord injuries’, ‘brain injuries, traumatic’ and ‘Canada’ as of April 2021. Results: Studies report over twice the incidence of traumatic brain injury and traumatic spinal cord injury in Indigenous populations compared to non-Indigenous populations. The burden of neurotrauma is attributable to infrastructure disparities in rural communities and reserves, elevated rates of substance use and violence, and inequities in treatment and rehabilitation following injury. These issues are deeply rooted in the trauma endured by Indigenous peoples through the course of Canadian history, owing to government policies that severely impacted their socioeconomic conditions, culture, and access to healthcare services. Conclusions: Systems-level interventions guided by Indigenous community members will help to address the disparities that Indigenous peoples face in the care and rehabilitation of neurotrauma. This study will inform further research of culturally appropriate approaches to reduce neurotrauma burden among Indigenous peoples.

Group A streptococcal pharyngitis: A practical guide to diagnosis and treatment.

Group A Streptococcus (GAS) pharyngitis is a common clinical syndrome in primary care, yet controversy remains regarding the best approach to diagnosis and treatment, including the benefits of antibiotics. Children who are likely to have GAS pharyngitis based on history or physical examination should have a throat swab and, when positive, be treated with amoxicillin or penicillin. The disproportionate burden of acute rheumatic fever in Indigenous populations in Canada and special considerations for testing and treatment are discussed.

Assessing the contribution of traditional foods to food security for the Wapekeka First Nation of Canada.

The food security crisis and disproportionately high burden of dietary related disease amongst northern Indigenous populations in Canada continues to be a troubling reality with little sign of improvement. The Government of Canada is responding by developing programs to support local food initiatives for northern isolated communities. While such investments appear commendable, the impact of local food harvesting to improve food security has yet to be determined. While there are clear nutritional and cultural benefits to traditional food sources, communities face considerable barriers acquiring it in sufficient amounts because of historically imposed lifestyle changes that have increased food insecurity rates. This study responds by providing a novel multidisciplinary approach that draws from firsthand experiences working with First Nations community members in a remote subarctic region in northwestern, Ontario, to estimate their community's total food requirement and the amount of wild animal food sources needed to sustain yearly food intake. This transferrable energy demand approach will be critical for policy makers to put into perspective the amount of wild food needed to have an impact on food security rates and ultimately improve dietary related diseases. Novelty: Provide government policy makers information about current harvest yields in a remote northern First Nation to understand the potential contribution of traditional food to improve local food security. Provide Indigenous communities a means to assess local food resources to measure the caloric contributions of traditional foods toward household food security.