Work and health challenges of Indigenous people in Canada

Truth to Action: Lived Experiences of Indigenous Healthcare Professionals Redressing Indigenous-Specific Racism

STUDY BACKGROUND

The experience of discrimination through stereotyping, profiling, and bias-informed care not only leads to poor access to healthcare services, but low retention rates of Indigenous health professionals (IHP). As health systems transformation evolves, a significant gap remains in supporting IHP to safely address racism, to be supported culturally to bring their authentic selves and voices to work, and to attend to one's own intellectual, physical, relational, cultural and spiritual wellness within a westernized model of care.

PURPOSE

The aim of the study was to investigate the experiences of IHP working in mainstream healthcare in order to understand how their work environment impacts the delivery of cultural safe practices. What is reported in this manuscript, as an exercise in truth-telling, is findings about lived experiences of IHP working in one mainstream provincial healthcare region, and not the whole context and outcomes of the study.

METHODS

Using Indigenous research methodologies, we embodied our Indigeneity into every facet of the research process. We facilitated three talking circles with participants grounded in a distinct cultural and ceremonial context following Secwepemc protocols.

RESULTS

The collective voices of IHP revealed the following common experiences: confronting genocide; addressing Indigenous-specific racism; uprooting toxicity and inequities; and upholding Indigenous human rights while enhancing accountability of systems transformation.

CONCLUSIONS

The experience of IHP working in health systems goes beyond mere individual employment obligations, its often about a families and communities advocacy for Indigenous rights, culturally safe working environments and access to dignified and respectful healthcare service. This study highlights the need for IHP to be actively involved in health system transformation to ensure the redesigning and restructuring of healthcare service delivery by and for Indigenous Peoples remains centered on Indigenous health and human rights.

Employment equity groups' experience of inclusion and commitment to the CAF

The Canadian Armed Forces (CAF) are subject to the Employment Equity Act, which requires federally regulated employers to identify and eliminate barriers to the employment of designated groups (women, Indigenous peoples, persons with disabilities (PwD), and racialized members), and establish short-term, numerical goals to address underrepresentation. Addressing employment barriers experienced by these equity seeking groups is one of the CAF's key priorities. The objective of this study is to examine group differences in feelings of inclusion (i.e., relatedness, organizational inclusion, and microaggressions) and retention-related measures (i.e., job satisfaction, affective commitment, and intentions to leave), the contribution of feelings of inclusion to retention measures, and the effect of numerical representation and number of marginalized identities on these concepts. We analyzed data from the 2022 Your Say Matters survey, which was administered to a representative sample of CAF members, with oversampling of under-represented groups. Respondents included 4,483 Regular Force members (30.9% response rate). The groups under study included Indigenous members, persons with disabilities, racialized members, women not part of another group (non-Indigenous, non-racialized, women without disabilities), and everyone else (non-Indigenous, non-racialized, not women, without disabilities). Our hypotheses were supported overall, such that groups with less representation in the CAF scored lower on inclusion measures than groups with more representation. The number of marginalized identities held by military members predicted the inclusion measures, but did not predict retention-related measures. There were some group differences on retention-related measures, such that women not part of another group scored more favorably than other designated groups, and racialized members scored more favorably than PwD and Indigenous members. Inclusion measures predicted job satisfaction, affective commitment, and intentions to leave equally for all groups studied, suggesting that feeling included is important for all.

Food insecurity and its association with multiple health outcomes among Indigenous peoples in Canada: the buffering role of culture-based resources

OBJECTIVES

Despite growing interest in the health disparities associated with food insecurity, research focusing on Indigenous peoples has been limited, especially in studies using nationally representative samples. This study investigates the association between food insecurity and various health outcomes - self-rated general and mental health, chronic health conditions, suicidal ideation, and obesity - among Indigenous peoples in Canada. It also explores the potential moderating effects of culture-based resources, which include cultural identity affect, cultural group belonging, cultural engagement, and cultural exploration.

DESIGN

The study utilized data from the 2017 Aboriginal Peoples Survey, a nationally representative sample of First Nations individuals living off-reserve, Métis, and Inuit across Canada (N = 15,533). Logistic regression models were used to analyze the data.

RESULTS

Food insecurity was negatively associated with all examined health outcomes. Culture-based resources demonstrated a mixture of anticipated and unexpected effects on these relationships. Consistent with the stress process model, cultural group belonging mitigated the negative impact of food insecurity on all health outcomes. A similar pattern was observed for cultural engagement. However, contrary to expectations from the stress-buffering perspective, little evidence was found to support the moderating effects of cultural identity affect and cultural exploration.

CONCLUSION

The results underscore the detrimental effects of food insecurity on the health of Indigenous peoples in Canada and suggest that culture-based resources, particularly cultural group belonging, play a crucial role in mitigating health disparities.

A review of drinking water quality issues in remote and indigenous communities in rich nations with special emphasis on Australia

This review paper examines the drinking water quality issues in remote and Indigenous communities, with a specific emphasis on Australia. Access to clean and safe drinking water is vital for the well-being of Indigenous communities worldwide, yet numerous challenges hinder their ability to obtain and maintain water security. This review focuses on the drinking water-related issues faced by Indigenous populations in countries such as the United States, Canada, New Zealand, and Australia. In the Australian context, remote and Indigenous communities encounter complex challenges related to water quality, including microbial and chemical contamination, exacerbated by climate change effects. Analysis of water quality trends in Queensland, New South Wales, Western Australia, and the Northern Territory reveals concerns regarding various pollutants with very high concentrations in the source water leading to levels exceeding recommended drinking water limits such as hardness, turbidity, fluoride, iron, and manganese levels after limited treatment facilities available in these communities. Inadequate water quality and quantity contribute to adverse health effects, particularly among Indigenous populations who may resort to sugary beverages. Addressing these challenges requires comprehensive approaches encompassing testing, funding, governance, appropriate and sustainable treatment technologies, and cultural considerations. Collaborative efforts, risk-based approaches, and improved infrastructure are essential to ensure equitable access to clean and safe drinking water for remote and Indigenous communities, ultimately improving health outcomes and promoting social equity.

Indigenous Peoples' Experience and Understanding of Menstrual and Gynecological Health in Australia, Canada and New Zealand: A Scoping Review

There are a variety of cultural and religious beliefs and customs worldwide related to menstruation, and these often frame discussing periods and any gynecological issues as taboo. While there has been previous research on the impact of these beliefs on menstrual health literacy, this has almost entirely been confined to low- and middle-income countries, with very little information on high-income countries. This project used the Joanna Briggs Institute (JBI) scoping review methodology to systematically map the extent and range of evidence of health literacy of menstruation and gynecological disorders in Indigenous people in the colonized, higher-income countries of Australia, Canada, and New Zealand. PubMed, CINHAL, PsycInfo databases, and the grey literature were searched in March 2022. Five studies from Australia and New Zealand met the inclusion criteria. Only one of the five included studies focused exclusively on menstrual health literacy among the Indigenous population. Despite considerable research on menstrual health globally, studies focusing on understanding the menstrual health practices of the Indigenous populations of Australia, New Zealand, and Canada are severely lacking, and there is little to no information on how Indigenous beliefs of colonized people may differ from the broader society in which they live.

A Systematic Review and Meta-Analysis on Oral Health Disparities Among the Indigenous Paediatric Population

There is a knowledge gap in the literature regarding oral health disparities (OHD) in minority and indigenous (IG) paediatric cohorts that needs to be addressed. Disparities in oral health among children are a pressing concern, highlighting inequities in access to dental care and meeting needs. The current systematic review aims to provide a comprehensive synthesis of the prevailing understanding of OHD in the minority and IG strata. A meticulous search strategy was formulated by a team of reviewers to identify pertinent studies from databases of PubMed, MEDLINE, Scopus, Google Scholar and EMBASE. Data extraction and article selection strictly adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Newcastle-Ottawa Scale (NOS) was employed to evaluate the methodological quality of the studies included. Review Manager version 5.4 was used to synthesise quantitative data. A total of five cross-sectional studies were included in the final analysis. The findings consistently demonstrated the existence of racial and socioeconomic disparities in oral health across varying age groups and geographical locations in the defined population. Significant disparities in oral health outcomes were observed between IG and non-IG populations, with IG and minority groups exhibiting a heightened vulnerability to oral health challenges. Through a meta-analysis of the compiled data, a statistically significant association was established between children (being a member of a minority group) and unmet oral health needs. Socioeconomic status (SES) and maternal education were factors that showed a significant impact on oral health disparity. All studies were graded to be of the low-risk category based on the NOS risk of bias tool. This review successfully identified several influential factors contributing to oral health disparities, such as cultural practices, dietary patterns and access to oral healthcare services. Additionally, discernible differences in oral health status were evident between IG and non-IG children, with IG children enduring a greater burden of oral health difficulties. These findings underscore the imperative for targeted interventions and policy measures aimed at addressing the specific oral health needs of minority and IG paediatric populations, with the overarching goal of mitigating the existing disparities.

Where are Canada's PAs in 2023?

ABSTRACT

The physician assistant/associate (PA) role in Canada is slowly expanding from two provinces and 301 PAs in 2012 to five provinces with 959 PAs and 119 clinical assistants in 2022. This article reviews Canadian PA education, healthcare challenges, and future growth, providing a brief look at where in 2023 the 1,215 members of the Canadian Association of Physician Assistants are found, and some anticipated directions.