Indigenous people experience significant health disparities compared to non-Indigenous people, which are exacerbated by less accessible and poorer quality health care services. This research aimed to understand the specific barriers to health care that Indigenous patients and their families face, as well as to explore promising practices and strategies for improving the responsiveness of health services to the needs of Indigenous people. Through qualitative interviews with Indigenous and non-Indigenous health care and social services providers, we identified a range of challenges and successful approaches, and developed recommendations for improving policy and practice to address the gaps in culturally safe health care services. Our study shows that many of the barriers Indigenous people face when accessing health care are rooted in the broader social determinants of health, such as poverty, racism, housing, and education. These are complex problems that are outside of the traditional scope of health care practice. However, this study has also demonstrated that many barriers to equitable care actually stem from within the health care system itself. We found that health care gaps were often attributable to poorly funded on-reserve health care services and culturally unsafe off-reserve services.  Attitudes and practices among those working in health care and gaps in coordination between mainstream and Indigenous services are challenges related to the way the health care system operates. Solutions are needed that address these issues. Given the multifaceted nature of access barriers, strategies to improve health services for Indigenous people and communities require a comprehensive and systemic approach.  

中文翻译：

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殖民遗产和合作行动：改善加拿大原住民的医疗保健

与非原住民相比，原住民的健康状况存在显着差异，而更难获得和质量较差的医疗保健服务加剧了这种差异。这项研究旨在了解土著患者及其家人面临的医疗保健具体障碍，并探索有希望的做法和策略，以提高卫生服务对土著人民需求的响应能力。通过对土著和非土著医疗保健和社会服务提供者的定性访谈，我们确定了一系列挑战和成功的方法，并提出了改进政策和实践以解决文化安全医疗保健服务差距的建议。我们的研究表明，原住民在获得医疗保健服务时面临的许多障碍植根于更广泛的健康社会决定因素，例如贫困、种族主义、住房和教育。这些是超出传统医疗保健实践范围的复杂问题。然而，这项研究也表明，公平医疗的许多障碍实际上源于医疗保健系统本身。我们发现，医疗保健缺口通常归因于保护区内医疗保健服务资金不足和文化不安全的保护区外服务。卫生保健工作人员的态度和做法以及主流和土著服务之间的协调差距是与卫生保健系统运作方式相关的挑战。需要解决这些问题的解决方案。