Résumés
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.
Keywords:
- First Nations,
- community-based primary healthcare,
- transformation,
- self-determination,
- health
Parties annexes
Bibliography
- 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.