There are many groups that come to mind when we talk about vulnerable populations: the elderly, disabled, physically or mentally ill, single parents, racial and ethnic minorities, new comers to Canada, low income individuals, marginally housed or homeless, travelers/transient, domestic violence victims, sexual assault victims, women, children and the list goes on.
Due to variances in the social, biological and political determinants in health, certain populations have lower health status. In healthcare, populations with this worsened health status related to the determinants of health are often termed marginalized, vulnerable or underserved. In public health, these differences have often been called health disparities, inequalities or inequities (“Pursuing Health: Underserved Populations in Canada,” n.d.). Marginalized is a term that may capture similar individuals to those identified as vulnerable yet carries distinct connotations. The Oxford Dictionary defines marginalize as to “Treat (a person, group, or concept) as insignificant or peripheral” (“Marginalize” 2015).
In Canada, arguably one of the most vulnerable, and marginalized, populations are Aboriginal individuals. Perhaps the most shameful part of our Nation’s history is that Aboriginals people have been victims of more than 500 years of colonization and crimes including, but not limited to, theft of territory, identity, economy, lifestyle, culture, language, family, health, freedom, spirituality, and autonomy (First Nations Health Authority, n.d.). In the era of the Residential School System, Aboriginal culture was essentially criminalized, and the crimes enacted upon individuals, communities and entire Aboriginal Nations has resulted in inter-generational trauma that affects an Aboriginal individual’s social determinants of health so profoundly that “Aboriginal Status” is, itself, considered a social determinant of health (Raphael, 2009).
It is my opinion that the best way to support Aboriginal communities is for the government to promote increased self determination and move away from old colonial ideologies that the government knows best for this population, which further marginalizes these individuals. Capacity building, empowering and celebrating achievements is a good place to start.
As a country, we are starting to move forward. Below is a snapshot of some of the steps our country has made in the past two decades to acknowledge the wrongs of the past and create partnerships moving forward:
1991- Four Aboriginal and three non-Aboriginal commissioners were appointed to investigate, and to propose solutions to, the issues affecting Aboriginal peoples in Canada and advise the government on their findings (Canada, 2008). The result of the investigation was the Royal Commission on Aboriginal Peoples (1996).
1995- The federal government announced the Canada's Inherent Right Policy (Branch, 2008). This policy builds on section 35 of the Constitution Act, (1982) which states that Indigenous peoples have an inherent right of self-government to suit their particular historical, cultural, political and economic circumstances.
1999- The revised Indian Health Transfer Policy provided a framework for the assumption of control of health services by Aboriginal peoples, and set forth a developmental approach to transfer centred on self-determination in health. Through this process, the decision to enter transfer discussions with Health Canada rests with each community. Once involved in transfer, communities can take control of health programme responsibilities at a pace determined by their individual circumstances and health management capabilities (Canada, 2005).
Self-governance gives Bands more flexibility to establish program priorities in response to tribal needs rather than following Federal program objectives. Bands are able to expand, consolidate and create new programs to improve services to their communities and to make certain laws governing their community with respect to health. Furthermore, the range of resources for health programs which can be included in a Self-Government arrangement is greater than those included in a Health Service Transfer arrangement and may eventually include fixed assets and services under the Non-Insured Health Benefits Program. The flexibility in terms of how resources are allocated is also greater and reporting requirements are fewer (Canada, 2005).
2000- The National Aboriginal Health Organization (NAHO) is an Aboriginal-designed and-controlled not-for-profit body in Canada that works to influence and advance the health and well-being of Aboriginal Peoples (“National Aboriginal Health Organization,” n.d.).
2007- Jordan’s Principle, a bill passed in the House of Commons, but yet to be fully implemented, is a child-first principle named in memory of Jordan River Anderson. It calls on the government-of-first-contact to pay for child services, while it seeks reimbursement later, so the child does not get tragically caught in the middle of government red tape (“Indigenous Health,” n.d.).
2015- The Truth and Reconciliation Commission’s final report was accepted by Prime Minister Justin Trudeau, on behalf of all Canadians, which included 94 ‘Calls to Action’ to further reconciliation between Canadians and Indigenous peoples (Canada, 2015).
2016- The Minister of Indigenous and Northern Affairs announced Canada is now a full supporter of the United Nations Declaration on the Rights of Indigenous Peoples a document that describes both individual and collective rights of Indigenous peoples around the world. It offers guidance on cooperative relationships with Indigenous peoples to states, the United Nations, and other international organizations based on the principles of equality, partnership, good faith and mutual respect (Canada, 2011).
Through organizations and legislation more and more Aboriginal communities are taking back control over many aspects of their lives and trusting their traditional ways of knowing. Many inspirational Aboriginal leaders are being recognized for their contributions and are shattering old stereotypes in the wake of their success. Here are a few from my home province of British Columbia:
Chief Dr. Robert Joseph, hereditary chief of the Gwawaenuk First Nation, he was awarded the Order of British Columbia in 2015 and recipient of Indspire’s Lifetime Achievement award in 2016. He is an Ambassador for Reconciliation Canada, and a member of the National Assembly of First Nations Elders Council and has dedicated himself to the fight against racism and intolerance. (Joseph, n.d.)
Tishna Marlowe, a Dene woman from the originally from the Northwest Territories, started an indigenous fashion design company, Six Red Beads, promoting ‘Dene couture’ traditional-wearable art for the modern Aboriginal woman. She has showcased her talents on the international stage. She uses her social medial platforms to speak out about lateral violence within and between Aboriginal communities, her own personal pain resulting from inter-generational trauma in the aftermath of the residential school system, and to bring awareness about missing and murdered Aboriginal women in Canada through her fashion shows.
Dr. Nadine Caron, Canada’s first female First Nations general surgeon, is breaking through barriers and is helping put a spotlight on Aboriginal Health and Canadian health policy. Dr. Caron teaches at the University of Northern BC when not practicing as an endocrine surgeon at Prince George Regional Hospital and is continuously working on how to tackle institutional racism and encourage Indigenous youth to seek careers in health care. (“Nadine Caron | University of Northern British Columbia,” n.d.)
Slowly, but surely, the resiliency of Aboriginal individuals and communities are being highlighted by the success stories of many Indigenous peoples who are challenging the stereotypes and fighting against intolerance and marginalization, while embracing and promoting their culture, and making our nation proud. Through these trailblazers and many more like them, a paradigm shift is taking place and Canadians are seeing that these people are incredible because of their culture and heritage, not despite it. As healthcare providers, we must practice culturally competent care and I would argue that despite the diversity that comes with Aboriginal identity, the resilience of this populations has made Aboriginal status a true strength that we would be wise to acknowledge.
References:
2012_resolution_11_e.pdf. (n.d.). Retrieved from https://www.cna-aiic.ca/-/media/cna/page-content/pdf-en/2012_resolution_11_e.pdf?la=en&hash=EF84CA98D98983D6397F449931A20EB11EDC0535
Branch, G. of C. A. A. and N. D. C. C. (2008, November 3). Self-government [administrative page]. Retrieved March 19, 2019, from https://www.rcaanc-cirnac.gc.ca/eng/1100100032275/1529354547314
Branch, G. of C. I. and N. A. C. C. (2008a, November 3). The Government of Canada’s Approach to Implementation of the Inherent Right and the Negotiation of Aboriginal Self-Government [reference material]. Retrieved March 19, 2019, from https://www.rcaanc-cirnac.gc.ca/eng/1100100031843/1539869205136
Canada, G. of C. I. and N. A. (2011, June 29). United Nations Declaration on the Rights of Indigenous Peoples [administrative page; reference material; resource list]. Retrieved March 19, 2019, from https://www.aadnc-aandc.gc.ca/eng/1309374407406/1309374458958
Canada, G. of C. I. and N. A. (2015a, December 14). Truth and Reconciliation Commission of Canada [administrative page]. Retrieved March 19, 2019, from https://www.rcaanc-cirnac.gc.ca/eng/1450124405592/1529106060525
Canada, H. (2005, April 21). Ten Years of Health Transfer First Nation and Inuit Control [transparency - other]. Retrieved March 19, 2019, from https://www.canada.ca/en/indigenous-services-canada/services/first-nations-inuit-health/reports-publications/funding/years-health-transfer-first-nation-inuit-control-health-canada-1999.html
First Nations Health Authority (n.d.) Our History, Our Health. Retrieved February 22, 2019, from http://www.fnha.ca/wellness/our-history-our-health
Indigenous Health. (n.d.). Retrieved March 19, 2019, from https://www.cna-aiic.ca/en/policy-advocacy/indigenous-health
Joseph, B. (n.d.-a). National Aboriginal Day 21+ Important Indigenous People to Celebrate. Retrieved March 20, 2019, from https://www.ictinc.ca/blog/national-aboriginal-day-21-important-indigenous-people-to-celebrate
Nadine Caron | University of Northern British Columbia. (n.d.). Retrieved March 20, 2019, from https://www.unbc.ca/nadine-caron
National Aboriginal Health Organization | National Collaborating Centre for Determinants of Health. (n.d.). Retrieved March 19, 2019, from http://nccdh.ca/organizations/entry/national-aboriginal-health-organization
Raphael, D. (2009). Social Determinants of Health: Canadian Perspectives, 2nd edition. Toronto: Canadian Scholars’ Press. Retrieved February 12, 2019 from https://crofsblogs.typepad.com/files/sample-pages-chapter-sdoh-revised.pdf
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