non-Indigenous Peoples In Canada Research Articles

Patriation and Section 35: The Role of Allan Blakeney in Securing Indigenous Rights

This paper will attempt to do four things. First, it will review some of the background essential to understanding how Indigenous leaders were involved in the patriation process and why section 35 was adopted as part of the patriation package. Second, it will elaborate on the role of former Premier Allan Blakeney of Saskatchewan in securing the adoption of section 35. Third, it will examine some of the expectations for significant structural change to the Canadian political system that were contemplated by the non-Indigenous participants involved in the patriation negotiations and, most importantly, why those expectations were never met. Finally, the paper will attempt to answer the fundamental question: are Indigenous peoples and their rights protected by the adoption of a general section 35, or has the existence of such a general provision actually hindered progress toward a more complete reconciliation between Indigenous and non-Indigenous peoples in Canada?

The Cedar Project: Racism and its impacts on health and wellbeing among young Indigenous people who use drugs in Prince George and Vancouver, BC.

Racism continues to drive health disparities between Indigenous and non-Indigenous peoples in Canada. This study focuses on racism experienced by young Indigenous people who have used drugs in British Columbia (BC), and predictors of interpersonal racism. Cedar Project is a community-governed cohort study involving young Indigenous people who use drugs in Vancouver and Prince George, BC. This cross-sectional study included data collected between August 2015-October 2016. The Measure of Indigenous Racism Experiences (MIRE) scale was used to assess experiences of interpersonal racism across 9 unique settings on a 5-point Likert scale, collapsing responses into three categories (none/low/high). Multinomial logistic regression models were used to examine associations between key variables and interpersonal racism. Among 321 participants, 79% (n = 255) experienced racism in at least one setting. Thirty two percent (n = 102) experienced high interpersonal racism from police, governmental agencies (child 'welfare', health personnel), and in public settings. Ever having a child apprehended (AOR:2.76, 95%CI:1.14-6.65), probable post-traumatic stress (AOR:2.64; 95%CI:1.08-6.46), trying to quit substances (AOR:3.69; 95%CI:1.04-13.06), leaving emergency room without receiving treatment (AOR:3.05; 95%CI:1.22-7.64), and having a traditional language spoken at home while growing up (AOR:2.86; 95%CI:1.90-6.90) were associated with high interpersonal racism. Among women, experiencing high interpersonal racism was more likely if they lived in Prince George (AOR:3.94; 95%CI:1.07-14.50), ever had a child apprehended (AOR:5.09; 95%CI:1.50-17.30), and had probable post-traumatic stress (AOR:5.21; 95%CI:1.43-18.95). Addressing racism experienced by Indigenous peoples requires immediate structural systemic, and interpersonal anti-racist reforms.

The Reconciliation Project of Labour Law

Historically, in Canada, labour law has not only failed to protect Indigenous working people from the exclusionary logic of (colonization-induced) market capitalism but also marginalized (peripheral and vulnerable) working people among the settlers. In spite of the Canadian judiciary’s attempt to articulate a broader vision of labour law through the values of justice, liberty, equity, and participatory democracy, the foundational private contractual rationale of labour law acts as a constraint on the judiciary’s ability to develop a broader – and more inclusive – regulatory justification. In this article, I suggest that this tension between expansive normative values and narrow (exclusionary) regulatory justification of labour law could be usefully addressed by employing the idea of reconciliation, originally conceived to fashion the relationship between Indigenous and non-Indigenous peoples in Canada. I argue that an appropriately formulated idea of reconciliation should be able to promote a more inclusive conceptual foundation of labour law, one that is receptive of non-Eurocentric world-views in its foundational narrative and democratic in its continued execution. In so aiding labour law, the reconciliation perspective can close the gap between normative values and regulatory justification of the discipline.

Indigenous and Non-Indigenous 2021 Unemployment, Employment and Participation Rates: Improved from 2020 — Education is Critical

Unemployment rates were lower, and participation and employment rates were higher for Indigenous and non-Indigenous peoples in Canada in 2021. The meaningful improvements in 2021 are in comparison with the COVID-19-induced negative rates of 2020. The employment and unemployment rates have not fully recovered from their 2019 pre-COVID rates. This is the case for both Indigenous and non-Indigenous peoples. Employment, unemployment, participation, and wage rates are and have been more favourable for non-Indigenous individuals than for Indigenous individuals. When educational levels increase, employment, unemployment, and participation rates improve. Employment measures are examined by gender, age, and education, and Métis and First Nations employment measures are compared.

Identifying priorities, directions and a vision for Indigenous mental health using a collaborative and consensus-based facilitation approach

BackgroundMental health disparities between Indigenous and non-Indigenous people in Canada are related to underlying economic, social, and political inequities that are legacies of colonization and the oppression of Indigenous cultures. It also widely acknowledged that mental health services currently available may not be culturally appropriate in supporting the health needs of Indigenous Canadians. A two-day Indigenous mental health forum examined mental health needs and gaps among Indigenous communities across the Regional Municipality of Wood Buffalo (RMWB) on Treaty 8 territory, in northern Alberta, Canada. This paper outlines the insights generated by stakeholder engagement at the forum to identify and prioritize directions for Indigenous mental health and build a vision and strategy for improving mental health services and programs for the region’s diverse Indigenous population.MethodsWe applied a modified nominal group technique (NGT) consensus method embedded within Indigenous knowledge to determine key priorities and directions for Indigenous-focused mental health and synthesize information from discussions that occurred at the forum. Following the NGT, a participatory community visioning exercise was conducted with participants to develop a vision, guiding principles, and components of an action plan for an Indigenous mental health strategy for the RMWB.ResultsFour key themes for setting priorities and directions for Indigenous mental health emerged from roundtable group discussions: 1) understand the realities of mental health experiences for Indigenous peoples, 2) design a holistic and culturally rooted mental health system, 3) foster cross-sectoral engagement and collaboration on mental health service delivery, and 4) focus on children and youth. The community visioning exercise helped stakeholders to visualize a direction or path forward for addressing existing gaps in the mental health system and opportunities for strengthening Indigenous mental health in the region.ConclusionsForum participants described mental health and well-being around holistic concepts of social and emotional well-being. Addressing Indigenous mental health and wellness involves multi-sectoral action in various settings including community and school through programs, policies, and other interventions that promote mental health for all Indigenous peoples, as well as for those at greater risk such as children and youth.

Not paid to dance at the powwow: Power relations, community benefits, and wind energy in M’Chigeeng First Nation, Ontario, Canada

The literature on wind energy developments upholds distributional and procedural justice as key drivers of community acceptance of wind turbines. However, this Eurocentric and settler-based literature routinely overlooks Indigenous contexts, causing concern that the energy transition might reproduce the socio-economic inequalities of the fossil fuel era. Through 32 semi-structured interviews conducted within a community-based approach, this paper examines the lived experience of people living with wind turbines in M’Chigeeng First Nation in Ontario, an Indigenous community who owns and operates two wind turbines. We examine what the turbines mean to M’Chigeeng members, how owning the turbines relates to the community’s values and goals, and to which extent M’Chigeeng’s engagement in renewable energy portends a redefinition of relationships between Indigenous and non-Indigenous people in Canada. The key themes in our findings are acceptance and support of the turbines, intra community communication, the importance of ownership, and relationships. While members expressed the need for clear and up-to-date communication on the project and are yet to see the generated financial benefits, intracommunity tensions remain manageable for the time being, tempered by a general pride from owning the turbines. Connecting relationships to restorative justice and recognition justice, we argue that these latter dimensions are equally, if not more meaningful, than procedural and distributional justice for understanding the meaning of turbines in M’Chigeeng First Nation. This study reaffirms the importance of attending to place histories at the broadest scale in examining communities’ responses to renewable energy, especially in settler countries like Canada.

Wellbeing of Indigenous Peoples in Canada, Aotearoa (New Zealand) and the United States: A Systematic Review.

Despite the health improvements afforded to non-Indigenous peoples in Canada, Aotearoa (New Zealand) and the United States, the Indigenous peoples in these countries continue to endure disproportionately high rates of mortality and morbidity. Indigenous peoples’ concepts and understanding of health and wellbeing are holistic; however, due to their diverse social, political, cultural, environmental and economic contexts within and across countries, wellbeing is not experienced uniformly across all Indigenous populations. We aim to identify aspects of wellbeing important to the Indigenous people in Canada, Aotearoa and the United States. We searched CINAHL, Embase, PsycINFO and PubMed databases for papers that included key Indigenous and wellbeing search terms from database inception to April 2020. Papers that included a focus on Indigenous adults residing in Canada, Aotearoa and the United States, and that included empirical qualitative data that described at least one aspect of wellbeing were eligible. Data were analysed using the stages of thematic development recommended by Thomas and Harden for thematic synthesis of qualitative research. Our search resulted in 2669 papers being screened for eligibility. Following full-text screening, 100 papers were deemed eligible for inclusion (Aotearoa (New Zealand) n = 16, Canada n = 43, United States n = 41). Themes varied across countries; however, identity, connection, balance and self-determination were common aspects of wellbeing. Having this broader understanding of wellbeing across these cultures can inform decisions made about public health actions and resources.

Mental Health Interventions for First Nation, Inuit, and Métis Peoples in Canada: A Systematic Review

Higher rates of anxiety, depression, and attempted suicide are reported among First Nations, Inuit, and Métis people compared with non-Indigenous people in Canada. This systematic review summarises the key components of mental health interventions among Indigenous Peoples in Canada. We searched MEDLINE, PubMed, PsycINFO, and Web of Science between January 1,1970, and August 30, 2019. Studies needed to be an intervention addressing suicide, depression, or anxiety. There were 14 studies: 8 quantitative, 2 qualitative, and 4 mixed methods. By geographical location, 5 were urban, 5 non-urban, and 4 included multiple areas. Beneficial interventions included ceremony, being on the land, engaging in traditional food gathering, culturally grounded indoor and outdoor activities, and the sharing of Indigenous knowledge by Elders.

Postoperative outcomes for Indigenous Peoples in Canada: a systematic review.

Background:Substantial health inequities exist for Indigenous Peoples in Canada. The remote and distributed population of Canada presents unique challenges for access to and use of surgery. To date, the surgical outcome data for Indigenous Peoples in Canada have not been synthesized.Methods:We searched 4 databases to identify studies comparing surgical outcomes and utilization rates of adults of First Nations, Inuit or Métis identity with non-Indigenous people in Canada. Independent reviewers completed all stages in duplicate. Our primary outcome was mortality; secondary outcomes included utilization rates of surgical procedures, complications and hospital length of stay. We performed meta-analysis of the primary outcome using random effects models. We assessed risk of bias using the ROBINS-I tool.Results:Twenty-eight studies were reviewed involving 1 976 258 participants (10.2% Indigenous). No studies specifically addressed Inuit or Métis populations. Four studies, including 7 cohorts, contributed adjusted mortality data for 7135 participants (5.2% Indigenous); Indigenous Peoples had a 30% higher rate of death after surgery than non-Indigenous patients (pooled hazard ratio 1.30, 95% CI 1.09–1.54; I2 = 81%). Complications were also higher for Indigenous Peoples, including infectious complications (adjusted OR 1.63, 95% CI 1.13–2.34) and pneumonia (OR 2.24, 95% CI 1.58–3.19). Rates of various surgical procedures were lower, including rates of renal transplant, joint replacement, cardiac surgery and cesarean delivery.Interpretation:The currently available data on postoperative outcomes and surgery utilization rates for Indigenous Peoples in Canada are limited and of poor quality. Available data suggest that Indigenous Peoples have higher rates of death and adverse events after surgery, while also encountering barriers accessing surgical procedures. These findings suggest a need for substantial re-evaluation of surgical care for Indigenous Peoples in Canada to ensure equitable access and to improve outcomes. Protocol registration:PROSPERO-CRD42018098757

New Discourses on Energy Transition as an Opportunity for Reconciliation? Analyzing Indigenous and Non-Indigenous Communications in Media and Policy Documents

This article examines energy issues articulated by Indigenous and non-Indigenous people in Canada and analyzes the energy transition as a locus of reconciliation therein. Using content and discourse analysis of policy documents, white papers, and news media articles, we draw attention to reconciliation and energy discourses before and after 2015, the year that marked the release of the Truth and Reconciliation Commission of Canada (TRC) report and the Paris Agreement on climate change. We find a three-fold expansion of those discourses, which encompass issues of inclusion and exclusion, dependency, and autonomy, as well as colonial representations of Indigenous people, after 2015. We also find that non-Indigenous voices are more prominent in those conversations. We suggest that the prospects of mutual benefits could turn the energy transition into an opportunity to bring together Indigenous and non-Indigenous people in Canada.

Our Shared Future: Windows into Canada’s Reconciliation Journey — A Review

The challenges and complexity of the reconciliation process are still not well understood by a large number of non-Indigenous people in Canada. As a nation, we are attempting to grasp the intricacy of how to unravel and atone for the damage that has been done in establishing and managing the more than 130 residential schools in Canada. This not only impacted more than 150,000 First Nations, Métis, and Inuit children but destroyed generations of families that are still and will continue to be impacted for years to come. The official apology from Prime Minister Stephen Harper on June 11, 2008, to all Indigenous people in Canada for the atrocities of the Indian Residential Schools was the start of a very long and painful continuous journey. The 94 calls to action released in 2015 by the Truth and Reconciliation Commission provide a road map to a complex recovery process for Indigenous people across the country. In January 2018, Health Canada held a national panel discussion with Indigenous leaders and experts on the question “Reconciliation—What Does it Mean?” One of the main themes of reconciliation revolves around education, and, in order to stay focused, we must continue to educate Canadians, including police leaders and new recruits, as we move through the meandering path of econciliation. The book Our Shared Future provides an outstanding in-depth look through the windows into a number of individual perspectives on the reconciliation journey.

Geographic Accessibility to Radiotherapy in Canada and Greenland for Indigenous Populations: A Quantitative Approach to Highlighting Inequities and Exploring Solutions

A high cancer burden exists among indigenous populations worldwide. Providing equitable delivery of cancer services can be challenging in Canada and Greenland given their geography. We sought to describe geographic access to radiotherapy for indigenous populations in Canada and Greenland. We used geospatial analyses to calculate distance and travel-time from indigenous communities in Canada and Greenland to the nearest radiotherapy center. In Canada, we calculated the proportion of indigenous communities and populations residing within a 1 and 2-hour drive of a radiotherapy center, and compared the proportion of indigenous versus non-indigenous populations residing within each drive-time area. We also calculated the potential distance and travel-time saved if radiotherapy was available in northern Canada (Yellowknife and Iqaluit), and Greenland (Nuuk). This took into consideration several assumptions, including that the new radiotherapy centers here would be similarly utilized and could offer all the same types of treatments available as in the current referral tertiary centers. We also assumed that patients would choose to receive radiotherapy within their own respective regions. Median one-way travel from indigenous communities to nearest radiotherapy center in Canada was 268 km (3 hours by plane or road), and 4,111 km (6 hours by plane) in Greenland. In Canada, 84% and 68% of indigenous communities were outside a 1 and 2-hour drive from a radiotherapy center, respectively. Only 2% of the total population in Canada resided outside a 2-hour drive from a radiotherapy center. However, indigenous peoples were 336 times more likely to live more than a 2-hour drive away, compared to non-indigenous peoples. Nearly 3 million km and 4,000 hours of travel could be saved for 1,000 patients with newly diagnosed cancers over a 10-year period in Canada, and 7 million km and 10,000 hours for 1,020 patients in Greenland, if radiotherapy was available in Yellowknife, Iqaluit, and Nuuk. Disparities in geographic access to radiotherapy exist between indigenous and non-indigenous peoples in Canada. Geospatial analyses can help highlight inequities in access to inform radiotherapy service planning, such as in Canada and Greenland where geography is an important potential barrier. Future work should involve a detailed economic evaluation involving the current costs associated with travelling, versus the implementation of local radiotherapy units.

Conceptualising cultural safety at an Indigenous-focused midwifery practice in Toronto, Canada: qualitative interviews with Indigenous and non-Indigenous clients.

ObjectiveCultural safety is an Indigenous concept that can improve how healthcare services are delivered to both Indigenous and non-Indigenous peoples in Canada. This study explored how Indigenous and non-Indigenous clients at an urban, Indigenous-focused midwifery practice in Toronto, Canada (Seventh Generation Midwives Toronto, SGMT) conceptualised and experienced culturally safe care.Design and settingInterviews were conducted with former clients of SGMT as a part of a larger evaluation of the practice. Participants were purposefully recruited. Interviews were transcribed and analysed thematically using an iterative, consensus-based approach and a critical, naturalistic, and decolonising lens.ParticipantsSaturation was reached after 20 interviews (n=9 Indigenous participants, n=11 non-Indigenous participants).ResultsThree domains of cultural safety emerged. Each domain included several themes: Relationships and Communication (respect and support for choices; personalised and continuous relationships with midwives; and being different from past experiences); Sharing Knowledge and Practice (feeling informed about the basics of pregnancy, birth, and the postpartum period; and having access to Indigenous knowledge and protocols), and Culturally Safe Spaces (feeling at home in practice; and having relationships interconnected with the physical space). While some ideas were shared across groups, the distinctions between the Indigenous and non-Indigenous participants were prominent.ConclusionThe Indigenous participants conceptualised cultural safety in ways that highlight the survival and resurgence of Indigenous values, understandings, and approaches in cities like Toronto, and affirm the need for Indigenous midwives. The non-Indigenous participants conceptualised cultural safety with both congruence, illuminating Black-Indigenous community solidarities in cultural safety, and divergence, demonstrating the potential of Indigenous spaces and Indigenous-focused midwifery care to also benefit midwifery clients of white European descent. We hope that the positive impacts documented here motivate evaluators and healthcare providers to work towards a future where ‘cultural safety’ becomes a standard of care.

Colonial Extractions: Oral Health Care and Indigenous Peoples in Canada, 1945–79

Indigenous Peoples in Canada currently experience much higher rates of oral health problems than their non-Indigenous counterparts. A number of recent reports have shown that Indigenous children have very high rates of tooth decay, that large numbers of Indigenous people report experiencing ongoing and persistent pain in their mouths, and that significantly more Indigenous people than non-Indigenous Canadians have no teeth at all. These oral health inequalities are important, not just because they have a profound impact on Indigenous Peoples’ quality of life but also because poor oral health is linked to other health issues that currently disproportionately impact Indigenous communities, including diabetes and heart disease. From 1945 to 1979, the federal government made only limited attempts to provide oral health care to Indigenous Peoples despite treaty promises of health care. The government did not believe that it had any obligation to provide oral health care, and as a result, the services provided were rushed, inadequate, inconsistent, and sometimes cruel. Indigenous Peoples experienced much higher levels of tooth extractions and lower rates of denture provision than was the case among non-Indigenous peoples in Canada, with ongoing consequences for their oral health today.

Examining geographic accessibility to radiotherapy in Canada and Greenland for indigenous populations: Measuring inequities to inform solutions

BackgroundA high cancer burden exists among indigenous populations worldwide. Canada and Greenland have similar geographic features that make health service delivery challenging. We sought to describe geographic access to radiotherapy for indigenous populations in both regions. MethodsWe used geospatial analyses to calculate distance and travel-time from indigenous communities in Canada and Greenland to the nearest radiotherapy center. We calculated the proportion of indigenous communities and populations residing within a 1 and 2-hour drive of a radiotherapy center in Canada, and compared the proportion of indigenous versus non-indigenous populations residing within each drive-time area. We calculated the potential distance and travel-time saved if radiotherapy was available in northern Canada (Yellowknife and Iqaluit), and Greenland (Nuuk). ResultsMedian one-way travel from indigenous communities to nearest radiotherapy center in Canada was 268 km (3 h when considering any transportation mode), and 4111 km (6 h by plane) in Greenland. In Canada, 84% and 68% of indigenous communities were outside a 1 and 2-hour drive from a radiotherapy center, respectively. Only 2% of the total population in Canada resided outside a 2-hour drive from a radiotherapy center. However, indigenous peoples were 336 times more likely to live more than a 2-hour drive away, compared to non-indigenous peoples. Nearly 3 million km and 4000 h of travel could be saved over a 10-year period for patients with newly diagnosed cancers in Canada, and 7 million km and 10,000 h in Greenland, if radiotherapy was available in Yellowknife, Iqaluit and Nuuk. ConclusionsGeography is an important barrier to accessing radiotherapy for indigenous populations in Canada and Greenland. A significant disparity exists between indigenous and non-indigenous peoples in Canada. Geospatial analyses can help highlight disparities in access to inform radiotherapy service planning.

Schools as "Really Dangerous Places" for Indigenous Children and Youth: Schools, Child Welfare, and Contemporary Challenges to Reconciliation.

The Truth and Reconciliation Commission of Canada (TRC) final report called attention to the damage induced by government policies and practices and outlined a pathway toward reconciliation in which education and child welfare system reforms play a central role. Drawing from 61 interviews with teachers and parents of Indigenous children in Alberta, this paper addresses the question: what do intersections between schooling and child welfare systems contribute to prospects for meaningful reconciliation between Indigenous and non-Indigenous people in Canada? Findings suggest that, despite formal commitments to acknowledge and address colonial legacies of residential schooling, obligations to fulfill state child welfare and educational objectives continue to situate schools, for many Indigenous families, as "dangerous places."

What Will it Take for Them to Hear Us?: Reacting and Not Reacting to Inuit Youth Suicide.

Suicide among Inuit youth is a preventable public health crisis, but the question is: a crisis for whom? For nonIndigenous people in Canada, it may be known that suicide is a significant issue in Inuit communities. Regardless, what is the impact of reading that, in some areas, the rates for suicide are 25 times higher than the Canadian average, and in one small village of 1,800 up to 11 young Inuit died by suicide in one year? This is a decades-old issue, where one Inuk youth finally asked: What will it take for them to hear us? This article gets to the root of why we may not be listening, names what barriers there are to change, and elevates the voices of Inuit youth who are leading the way. It is through them that Inuit youth suicide can become a more meaningful, relevant and pressing concern for us all.

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

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

Unsettling the Settlers: Principles of a Decolonial Approach to Creating Safe(r) Spaces in Post-secondary Education.

In this paper we discuss the ongoing colonial relationship between Indigenous and non-Indigenous peoples in Canada with a consideration of how to align the principles and core values of community psychology in relation to Indigenous rights, decolonization, and social justice. In working with Community Psychology values toaddress issues of social justice it is necessary to recognize that empowerment alone is only one half of the solution. While our discipline focuses on oppression and the empowerment of vulnerable and disenfranchised populations we generally fail to consider the relational aspects of power and justice. Specifically, in recognizing power inequities the focus is often placed on empowerment among vulnerable or subjugated communities while neglecting the requisite counterbalance of consciousness-raising and de-powerment of dominant populations. The authors provide three personal accounts from a non-Indigenous faculty member, an Indigenous doctoral student, and a recently graduated non-Indigenous Masters student. We share our experiences of conscientization and decolonization within the post-secondary and graduate education systems. We describe an educational context, a pedagogical praxis, and our efforts to bridge the theories of Settler colonialism and community psychology. From our individual and collective reflections of engagement with decolonization in the education system we present an emergent framework that highlights four principles for decolonization. In implementing these principles we discuss the co-creation of safe(r), decolonized spaces within post-secondary institutions through deconstructing dominant narratives and illuminating Indigenous narratives of self-determination with attention to the de-powerment of non-Indigenous faculty and students.

A retrospective on reconciliation by design.

It is well-established that Indigenous Peoples continue to experience a lower level of health than non-Indigenous Peoples in Canada. For many health leaders, finding practical strategies to close the gap in health disparities remains elusive. In this retrospective study, we will illustrate our own experience of transformational change using design and systems thinking tools toward a primary outcome of multi-stakeholder alignment. Using this approach enabled three Indigenous Provincial/Territorial Organizations (IPTOs) representing more than 150 First Nations communities from Saskatchewan, Manitoba, and Ontario to establish the largest community-led, collaborative approach to health transformation in Canada at the time. These IPTOs have gone on to pursue some of the most ambitious health transformation initiatives in Canada and in September 2018, were granted $68 million in funding support by the Government of Canada. If health leaders are looking at an alternative approach to closing the gap in Indigenous health, alignment thinking has shown promising results.