Our People, Our Health: Envisioning Better Primary Healthcare in Manitoba First Nation Communities

Authors

  • Grace Kyoon-Achan University of Manitoba, Canada
  • Wanda Phillips-Beck First Nations Health and Social Secretariat of Manitoba, Canada
  • Kathi Avery Kinew First Nations Health and Social Secretariat of Manitoba, Canada
  • Josée G. Lavoie University of Manitoba, Canada
  • Stephanie Sinclair First Nations Health and Social Secretariat of Manitoba, Canada
  • Alan Katz University of Manitoba, Canada

DOI:

https://doi.org/10.18584/iipj.2021.12.1.13561

Keywords:

First Nations, community-based primary healthcare, transformation, self-determination, health

Abstract

Recognizing the right of self-determination of Indigenous Peoples is essential to improving the state of community-based primary healthcare of First Nations in Canada. Understanding communities’ priorities and local health agendas is critical for primary healthcare transformation. We used a community-based participatory research approach to engage our partners: Nanaandawewiwgamig, the First Nations Health and Social Secretariat of Manitoba, and eight First Nation communities. Community-based research assistants conducted 183 in-depth interviews in their respective First Nations. Key themes that emerged from these interviews include primary prevention focused on health and social determinants; an integrated healthcare system providing access to both Western and First Nations traditional health knowledge; infrastructure improvement; youth engagement; healthcare leadership; investing in community-based human resources; and promoting culturally respectful, responsive, geographically sensitive, and outcomes-oriented care. Policy approaches could implement some local priorities with direct impact on healthcare, while other social determinants will create indirect, albeit critical, conditions for health and healthcare changes over time.

References

Anderson, M. J., & Smylie, J. K. (2009). Health systems performance measurement systems in Canada: How well do they perform in First Nations, Inuit, and Métis contexts? Pimatisiwin, 7(1), 99-115. https://pubmed.ncbi.nlm.nih.gov/23450984

Assembly of First Nations. (2012). First Nations plan: Honouring our past, affirming our rights, seizing our future. https://www.afn.ca/uploads/files/cfng/2012-first-nations-plan.pdf

Auger, M., Howell, T., & Gomes, T. (2016). Moving toward holistic wellness, empowerment and self-determination for Indigenous Peoples in Canada: Can traditional Indigenous health care practices increase ownership over health and health care decisions? Canadian Journal of Public Health/Revue canadienne de santé publique, 107(4-5), e393-e398. https://doi.org/10.17269/cjph.107.5366

Ball, J. R., & Balogh, E. (2016). Improving diagnosis in health care: Highlights of a report from the National Academies of Sciences, Engineering, and Medicine. Annals of Internal Medicine, 164(1), 59-61. https://doi.org/10.7326/m15-2256

Baskin, C. (2005). Storytelling circles: Reflections of Aboriginal protocols in research. Canadian Social Work Review, 22(2), 171-187. http://www.jstor.org/stable/41669834

Benchimol, E. I., Kuenzig, M. E., Bernstein, C. N., Nguyen, G. C., Guttmann, A., Jones, J. L., Potter, B. K., Targownik, L. E., Catley, C. A., Nugent, Z. J., Tanyingoh, D., Mojaverian, N., Underwood, F. E., Siddiq, S., Otley, A. R., Bitton, A., Carroll, M. W., deBruyn, J. C., Dummer, T. J., . . . Kaplan, G. G. (2018). Rural and urban disparities in the care of Canadian patients with inflammatory bowel disease: A population-based study. Clinical Epidemiology, 10, 1613-1626. https://doi.org/10.2147/clep.S178056

Bhawra, J., Cooke, M. J., Guo, Y., & Wilk, P. (2017). The association of household food security, household characteristics and school environment with obesity status among off-reserve First Nations and Métis children and youth in Canada: Results from the 2012 Aboriginal Peoples Survey. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 37(3), 77-86. https://doi.org/10.24095/hpcdp.37.3.03

Boffa, J., King, M., McMullin, K., & Long, R. (2011). A process for the inclusion of Aboriginal People in health research: Lessons from the Determinants of TB Transmission project. Social Science and Medicine, 72(5), 733-738. https://doi.org/10.1016/j.socscimed.2010.10.033

Booz, A., & Hamilton of Canada, Ltd. (1969). Study of health services for Canadian Indians: Summary report. Department of National Health and Welfare.

Bourassa, C. (2018). Addressing the duality of access to healthcare for Indigenous communities: Racism and geographical barriers to safe care. Healthcare Papers, 17(3), 6-10. https://doi.org/10.12927/hcpap.2018.25507

Brunger, F., & Wall, D. (2016). “What do they really mean by partnerships?” Questioning the unquestionable good in ethics guidelines promoting community engagement in Indigenous health research. Qualitative Health Research, 26(13), 1862-1877. https://doi.org/10.1177/1049732316649158

Canada Health Act (R.S.C., 1985, c. C-6). https://laws-lois.justice.gc.ca/eng/acts/c-6/page-1.html

Canadian Diabetes Association. (2016). Report on diabetes in Manitoba.

Canadian Institutes of Health Research. (2010). CIHR guidelines for health research involving Aboriginal people (2007-2010). http://www.cihr-irsc.gc.ca/e/29134.html

Chilisa, B. (2012). Indigenous research methodologies. Sage Publications.

Colantonio, S., & Rivers, J. K. (2017). Botanicals with dermatologic properties derived from First Nations healing: Part 1—Trees. Journal of Cutaneous Medicine and Surgery, 21(4), 288-298. https://doi.org/10.1177/1203475417690306

Constitution Act, 1867. 30 & 31 Victoria, c. 3 (U.K.). https://laws-lois.justice.gc.ca/eng/Const/page-1.html

Constitution Act, 1982, Schedule B to the Canada Act 1982 (UK), 1982, c 11. https://laws-lois.justice.gc.ca/eng/Const/page-15.html#h-38

Cook, S. J. (2005). Use of traditional Mi’kmaq medicine among patients at a First Nations community health centre. Canadian Journal of Rural Medicine: The Official Journal of the Society of Rural Physicians of Canada, 10(2), 95-99.

Davy, C., Harfield, S., McArthur, A., Munn, Z., & Brown, A. (2016). Access to primary health care services for Indigenous Peoples: A framework synthesis. International Journal for Equity in Health, 15(1), 163. https://doi.org/10.1186/s12939-016-0450-5

Drost, J. L. (2019). Developing the alliances to expand traditional Indigenous healing practices within Alberta Health Services. Journal of Alternative and Complementary Medicine, 25(S1), S69-S77. https://doi.org/10.1089/acm.2018.0387

Fijal, D., & Beagan, B. L. (2019). Indigenous perspectives on health: Integration with a Canadian model of practice. Canadian Journal of Occupational Therapy, 86(3), 220-231. https://doi.org/10.1177/0008417419832284

First Nations Information Governance Centre. (2014). Ownership, Control, Access and Possession (OCAP™): The path to First Nations information governance. https://fnigc.ca/wp-content/uploads/2020/09/5776c4ee9387f966e6771aa93a04f389_ocap_path_to_fn_information_governance_en_final.pdf

Fisher-Owens, S. A., Soobader, M. J., Gansky, S. A., Isong, I. A., Weintraub, J. A., Platt, L. J., & Newacheck, P. W. (2016). Geography matters: State-level variation in children’s oral health care access and oral health status. Public Health, 134, 54-63. https://doi.org/10.1016/j.puhe.2015.04.024

Flicker, S., O'Campo, P., Monchalin, R., Thistle, J., Worthington, C., Masching, R., Guta, A., Pooyak, S., Whitebird, W., & Thomas, C. (2015). Research done in “a good way”: The importance of Indigenous Elder involvement in HIV community-based research. American Journal of Public Health, 105(6), 1149-1154. https://doi.org/10.2105/ajph.2014.302522

Frohlich, K. L., Ross, N., & Richmond, C. (2006). Health disparities in Canada today: Some evidence and a theoretical framework. Health Policy, 79(2-3), 132-143. https://doi.org/10.1016/j.healthpol.2005.12.010

Garces-Ozanne, A., Kalu, E. I., & Audas, R. (2016). The effect of empowerment and self-determination on health outcomes. Health Education and Behavior, 43(6), 623-631. https://doi.org/10.1177/1090198116667665

Geldhof, G. J., Bowers, E. P., & Lerner, R. M. (2013). Special section introduction: Thriving in context: Findings from the 4-H study of positive youth development. Journal of Youth and Adolescence, 42(1), 1-5. https://doi.org/10.1007/s10964-012-9855-7

George, J., MacLeod, M., Graham, K., Plain, S., Bernards, S., & Wells, S. (2018). Use of traditional healing practices in two Ontario First Nations. Journal of Community Health, 43(2), 227-237. https://doi.org/10.1007/s10900-017-0409-5

Government of Canada. (2018). Non-Insured Health Benefits (NIHB) Medical Transportation Policy Framework (Interim). Indigenous Services. https://www.canada.ca/en/indigenous-services-canada/services/first-nations-inuit-health/reports-publications/non-insured-health-benefits/non-insured-health-benefits-nihb-medical-transportation-policy-framework-july-2005-first-nations-inuit-health.html

Hampton, M., Baydala, A., Bourassa, C., McKay-McNabb, K., Placsko, C., Goodwill, K., McKenna, B., McNabb, P., & Boekelder, R. (2010). Completing the circle: Elders speak about end-of-life care with Aboriginal families in Canada. Journal of Palliative Care, 26(1), 6-14. https://doi.org/10.1177/082585971002600103

Health Council of Canada. (2012). Empathy, dignity and respect: Creating cultural safety for Aboriginal people in urban health care. https://healthcouncilcanada.ca/files/Aboriginal_Report_EN_web_final.pdf

Ho, L. S., Gittelsohn, J., Harris, S. B., & Ford, E. (2006). Development of an integrated diabetes prevention program with First Nations in Canada. Health Promotion International, 21(2), 88-97. https://doi.org/10.1093/heapro/dak003

Horrill, T., McMillan, D. E., Schultz, A. S. H., & Thompson, G. (2018). Understanding access to healthcare among Indigenous Peoples: A comparative analysis of biomedical and postcolonial perspectives. Nursing Inquiry, 25(3). https://doi.org/10.1111/nin.12237

Iseke, J. (2013). Indigenous storytelling as research. International Review of Qualitative Research, 6, 559-577. https://doi.org/10.1525/irqr.2013.6.4.559

Iwasaki, Y., & Hopper, T. (2017). Leisure, engagement, and meaning-making among high-risk youth. Loisir et Société/Society and Leisure, 40(3), 324-339. https://doi.org/10.1080/07053436.2017.1378504

Jordan's Principle Working Group. (2015). Without denial, delay, or disruption: Ensuring First Nations children’s access to equitable services through Jordan’s Principle. https://www.afn.ca/uploads/files/jordans_principle-report.pdf

Katz, A., Enns, J., & Kinew, K. A. (2017). Canada needs a holistic First Nations health strategy. CMAJ: Canadian Medical Association Journal, 189(31), E1006-e1007. https://doi.org/10.1503/cmaj.170261

Kyoon-Achan, G., Lavoie, J. G., Kinew, K., Phillips-Beck, W., Ibrahim, N., Sinclair, S., & Katz, A. (2018). Innovating for transformation in First Nations health using community-based participatory research. Qualitative Health Research, 28(7), 1036-1049. https://doi.org/10.1177/1049732318756056

Kyoon-Achan, G., Lavoie, J. G., Kinew, K. A., Ibrahim, N., Sinclair, S., & Katz, A. (2019). What changes would Manitoba First Nations like to see in the primary healthcare they receive? A qualitative investigation. Healthcare Policy, 15(2), 85-99. https://doi.org/10.12927/hcpol.2019.26069

Kyoon-Achan, G., Phillips-Beck, W., Lavoie, J. G., Eni, R., Sinclair, S., Kinew, K. A., Ibrahim, N., & Katz, A. (2018). Looking back, moving forward: A culture-based framework to promote mental wellbeing in Manitoba First Nations communities. International Journal of Culture and Mental Health, 11(4). https://doi.org/10.1080/17542863.2018.1556714

Lans, C. (2016). Possible similarities between the folk medicine historically used by First Nations and American Indians in North America and the ethnoveterinary knowledge currently used in British Columbia, Canada. Journal of Ethnopharmacology, 192, 53-66. https://doi.org/10.1016/j.jep.2016.07.004

Lavoie, J. G. (2013). Policy silences: Why Canada needs a national First Nations, Inuit and Métis health policy. International Journal of Circumpolar Health, 72(1). https://doi.org/10.3402/ijch.v72i0.22690

Lavoie, J. G., Forget, E., Rowe, G., & Dahl, M. (2008). Leaving for the city. Report of the Medical Relocation Project, Phase II. Centre for Aboriginal Health Research.

Lavoie, J. G., Forget, E. L., Prakash, T., Dahl, M., Martens, P., & O'Neil, J. D. (2010). Have investments in on-reserve health services and initiatives promoting community control improved First Nations’ health in Manitoba? Social Science and Medicine, 71(4), 717-724. https://doi.org/10.1016/j.socscimed.2010.04.037

Lux, M. K. (2010). Care for the ‘racially careless’: Indian hospitals in the Canadian West, 1920-1950s. Canadian Historical Review, 91(3), 407-434. https://doi.org/10.3138/chr.91.3.407

Miles, M., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Sage Publications.

Minore, B., Boone, M., Katt, M., Kinch, P., Birch, S., & Mushquash, C. (2005). The effects of nursing turnover on continuity of care in isolated First Nation communities. Canadian Journal of Nursing Research, 37(1), 86-100.

Murdoch-Flowers, J., Tremblay, M. C., Hovey, R., Delormier, T., Gray-Donald, K., Delaronde, E., & Macaulay, A. C. (2019). Understanding how Indigenous culturally-based interventions can improve participants' health in Canada. Health Promotion International, 34(1), 154-165. https://doi.org/10.1093/heapro/dax059

National Inquiry into Murdered and Missing Indigenous Women and Girls. (2019). Reclaiming power and place: The final report of the National Inquiry into Missing and Murdered Indigenous Women and Girls. https://www.mmiwg-ffada.ca/final-report/

Oosterveer, T. M., & Young, T. K. (2015). Primary health care accessibility challenges in remote Indigenous communities in Canada’s North. International Journal of Circumpolar Health, 74(1). https://doi.org/10.3402/ijch.v74.29576

Pelletier, C., Dai, S., Roberts, K. C., Bienek, A., Onysko, J., & Pelletier, L. (2012). Report summary. Diabetes in Canada: Facts and figures from a public health perspective. Chronic Diseases and Injuries in Canada, 33(1), 53-54. https://doi.org/10.24095/hpcdp.33.1.07

Phillips-Beck, W., Kyoon-Achan, G., Lavoie, J. G., Krueger, N., Kinew, K. A., Sinclair, S., Ibrahim, N., & Katz, A. (2019). Negotiation, reciprocity and reality: The experience of collaboration in a community-based primary health care (CBPHC) program of research with eight Manitoba First Nations. The International Indigenous Policy Journal, 11(1). https://doi.org/10.18584/iipj.2019.10.4.8334

Redvers, N., Marianayagam, J., & Blondin, B. (2019). Improving access to Indigenous medicine for patients in hospital-based settings: A challenge for health systems in northern Canada. International Journal of Circumpolar Health, 78(1). https://doi.org/10.1080/22423982.2019.1577093

Richmond, C. A. M., & Cook, C. (2016). Creating conditions for Canadian Aboriginal health equity: The promise of healthy public policy. Public Health Reviews, 37(2). https://doi.org/10.1186/s40985-016-0016-5

Richmond, C. A. M., & Ross, N. A. (2009). The determinants of First Nation and Inuit health: A critical population health approach. Health Place, 15(2), 403-411. https://doi.org/10.1016/j.healthplace.2008.07.004

Royal Commission on Aboriginal Peoples. (1996). Gathering Strength (Vol. 3). http://data2.archives.ca/e/e448/e011188230-03.pdf

Smylie, J., & Firestone, M. (2015). Back to the basics: Identifying and addressing underlying challenges in achieving high quality and relevant health statistics for Indigenous populations in Canada. Statistical Journal of the IAOS, 31(1), 67-87. https://doi.org/10.3233/sji-150864

Standing Committee on Indigenous and Northern Affairs. (2018). The challenges of delivering continuing care in First Nation communities. 42nd Parliament, 1st Session. https://www.ourcommons.ca/Content/Committee/421/INAN/

Reports/RP10260656/inanrp17/inanrp17-e.pdf

Suleiman, A. B., Soleimanpour, S., & London, J. (2006). Youth action for health through youth-led research. Journal of Community Practice, 14(1-2), 125-145. https://doi.org/10.1300/j125v14n01_08

Truth and Reconciliation Commission of Canada (TRC). (2015). Truth and Reconciliation Commission of Canada: Calls to Action. http://trc.ca/assets/pdf/Calls_to_Action_English2.pdf

United Nations. (2008). United Nations Declaration on the Rights of Indigenous Peoples. https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf

Ventura, J., & Rueter, A. (2018, May 20). Indigenous health care workers use language to build trust and break down barriers. CBC News. https://www.cbc.ca/news/indigenous/indigenous-language-health-care-workers-1.4660009

Wakerman, J., Humphreys, J., Russell, D., Guthridge, S., Bourke, L., Dunbar, T., Zhao, Y., Ramjan, M., Murakami-Gold, L., & Jones, M. P. (2019). Remote health workforce turnover and retention: What are the policy and practice priorities? Human Resources for Health, 17(1), 99. https://doi.org/10.1186/s12960-019-0432-y

Webster, P. (2018). Language barriers restricting access to health care for Indigenous populations. CMAJ: Canadian Medical Association Journal, 190(24), E754-e755. https://doi.org/10.1503/cmaj.109-5613

Zubek, E. M. (1994). Traditional Native healing. Alternative or adjunct to modern medicine? Canadian Family Physician, 40, 1923-1931.

Downloads

Published

2021-02-04

Issue

Section

Research