Indigenous Health Research Monitoring, January 2025

In this issue:

Just Published

New scientific publications and articles

Chapola, J., Datta, R., Waucaush‐Warn, J., and Subroto, S. (2024). Climate change and its impact on the mental health well‐being of Indigenous women in Western cities, Canada. Journal of Community & Applied Social Psychology34(3), e2807.

Datta, P., Datta, R., Lewis, K., and Hurlbert, M. (2024). Youth response to climate change: Learning from Indigenous land-based camp at the Northern Saskatchewan Indigenous Communities, Canada. EXPLORE, 20(5), 102985.

Hatala, A. R., Morton, D., Deschenes, C., and Bird-Naytowhow, K. (2024). Access to land and nature as health determinants: A qualitative analysis exploring meaningful human–nature relationships among Indigenous youth in central CanadaBMC Public Health24(1), 2540.

Kolahdooz, F., Zakkar, M., Jang, S. L., Deck, S., Wagg, A., Corriveau, A., Kandola, K., Irlbacher-Fox, S., and Sharma, S. (2024). Indigenous mothers’ perspective on sexual health in Northwest Territories, Canada: Results from the Maternal and Infant Health ProjectJournal of Community Health.

Kuijper, L. E. N., Lacroix, E., Singh, G., Champagne, M., Beardy, B., Dubois, R., Wood, L., Harper, M. J., Muench, K., Kisselgoff, M., Mann, K., Waugh, A., Thériault, C., Tait, M., Bombak, A., and Riediger, N. D. (2024). Experiences and perspectives of sugar-sweetened beverage consumption among Indigenous adults living in ManitobaAppetite202, 107637.

McConkey, S., Iannace, J., Snyder, M., Bourgeois, C., and Smylie, J. (2024). Measuring Indigenous homelessness: Findings from Our Health Counts TorontoCanadian Journal of Public Health, 115(Suppl 2), 227–238.

Ng, R. D., Zhu, J., Kovesi, T., Ing, A., Fusco, M. N., Odele, V., Mallach, G., Kulka, R., Barwin, L., and Chan, H. M. (2024). A participatory study of indoor environment quality in homes of children and youth in Kanehsatake First NationScientific Reports14(1), 26022.

Owais, S., Ospina, M. B., Ford, C. D., Hill, T., Lai, J., Krzeczkowski, J., Burack, J. A., and Van Lieshout, R. J. (2024). Determinants of socioemotional and behavioral well‐being among First Nations children living off‐reserve in Canada: A cross‐sectional studyChild Development, 95(6), 1879–‍1893.

Snyder, M., McConkey, S., Brar, R., Anilniliak, J., Bourgeois, C., Dokis, B., Hardy, M., Joseph, S., Kilabuk, A., Mattina, J. A., McKnight, C., and Smylie, J. (2024). Unmasking population undercounts, health inequities, and health service access barriers across Indigenous populations in urban OntarioCanadian Journal of Public Health, 115(Suppl 2), 209–216.

Zambrano-Alvarado, J. I., and Uyaguari-Diaz, M. I. (2024). Insights into water insecurity in Indigenous communities in Canada: Assessing microbial risks and innovative solutions, a multifaceted reviewPeerJ12, e18277.

New publication from INSPQ

Bergeron, A., and Lefebvre, J. (2024). Déterminants de l’alimentation des Premières Nations et des Inuit au Québec. Institut national de santé publique du Québec.

Article Summaries: Subject Areas

Cultural safety

Anti-Indigenous racism in Canadian healthcare: A scoping review of the literature

Cooke, M., and Shields, T. (2024). Anti-Indigenous racism in Canadian healthcare: A scoping review of the literatureInternational Journal for Quality in Health Care36(3), mzae089.

Context

Discrimination and racism experienced by Indigenous peoples in the healthcare system is associated with a lower standard of care and adverse effects on health. Despite extensive literature on racism in other contexts, the scope of the existing literature on various aspects of anti-Indigenous racism in Canadian healthcare is unknown.

Objectives

1) Identify the types of anti-Indigenous racism that have been experienced in healthcare (geographic contexts, populations and clinical settings).

2) Determine whether there are intersecting aspects of social location (e.g., sex/gender, age, socioeconomic status and disability) affecting how racism is experienced.

3) Report the evidence regarding the prevalence of anti-Indigenous racism and its effects on health.

Methods

A search of scientific and grey literature in English or French published between 2000 and April 2024 was conducted in several biomedical and Indigenous studies databases. The search strategy was based on the following concepts: Indigenous; Canada, use of health care; and experience of racism. Articles were selected using the Covidence review software, and the thematic analysis of data was prepared with the help of NVivo (version 14).

What was learned? 

A total of 66 scientific articles and 9 reports from the grey literature were selected. A majority of research specifications were qualitative, while eight were quantitative and eleven used a mixed-‍method approach. Most of the data came from patients, but 27 studies reported on the perspective of care providers. A majority of studies looked at urban settings, members of First Nations, and Western provinces, British Columbia in particular.

Most of the experiences reported were of “covert” racism, i.e. patients who felt:

  • Treated less well than non-Indigenous patients
  • Ignored, treated differently or treated more slowly
  • Not listened to or believed by clinicians, especially with regard to pain.

Participants in forty studies reported hearing stereotypes about Indigenous patients from care providers, specifically:

  • False assumptions that patients had been using alcohol or drugs;
  • The idea that they were potentially violent;
  • The view that they were difficult, uneducated about health issues or unwilling to comply with treatment;
  • The notion that they felt “entitled” and willing to “abuse the system,” which included drug-seeking behaviour.

Authors also reported Indigenous people feeling they had been “heavily scrutinized” as parents, leading to fears that a medical consultation would result in youth protection services removing their children.

No use of racist slurs by staff was reported other than comments such as “your kind” or “you people.” Moreover, it appears difficult to pin down experiences of covert racism. For example, it’s difficult to know with certainty that a long wait time was due to racism.

Patients reported that Indigenous approaches to healing and wellness were dismissed or treated with a lack of respect.

In terms of intersecting dimensions of social location, women and girls are at greater risk, specifically in a perinatal context, given that they are deemed to be poor mothers and sexually permissive or passive. Low socioeconomic status is also associated with a greater risk of discrimination in healthcare.

Ten mixed-methods studies included measures of the prevalence of racism. However, since different measurement instruments were employed, the data cannot be used to estimate the impact on a population. Qualitative studies cannot be used to establish an association between racism and health results or the incidence of disease. Nevertheless, several studies (23) reported reticence on the part of Indigenous patients to consult healthcare services. Patient perceptions of the impact of racism on their health reported by the authors include complications of an existing condition, diagnostic errors, pain resulting from lack of appropriate care, overly rough treatment causing pain, and even death. 

The authors conclude that experiencing racism in healthcare, or knowing Indigenous people who have, can hinder access to care by leading people to expect racist treatment in healthcare. The authors describe the situation as a form of structural violence, whether or not care providers have openly racist beliefs.

Limitations

Unlike the quantitative studies, the qualitative literature selected does not distinguish between First Nations, Inuit and Métis in their experiences of racism. Moreover, the search strategy may have overlooked some articles. Interpretation of the results was subject to the author’s personal bias. The involvement of two reviewers may have mitigated that bias, but the coding was prepared by just one person.

Social inequalities and determinants of health

“They talk about it like it’s an overdose crisis when in fact it’s basically genocide”: The experiences of Indigenous peoples who use illicit drugs in Vancouver’s Downtown Eastside neighbourhood

Lavalley, J., Steinhauer, L., Bundy, D. B., Kerr, T., and McNeil, R. (2024). “They talk about it like it's an overdose crisis when in fact it's basically genocide”: The experiences of Indigenous peoples who use illicit drugs in Vancouver's Downtown Eastside neighbourhoodInternational Journal of Drug Policy134, 104631.

Context

In Canada, an inflow of increasingly toxic drugs is behind an unprecedented drug poisoning crisis disproportionately affecting the Indigenous population. At the outset of the COVID-19 pandemic, the overdose mortality rate among that population in British Columbia increased 93% between January and May of 2020. In 2023, the mortality rate among First Nations was six times higher than for the rest of the population. This high overdose mortality rate is fuelled by social and health inequalities experienced by Indigenous peoples that are rooted in colonialism, racism and intergenerational trauma. 

Objective

Examine the experiences and perspectives of Indigenous peoples who use illicit drugs in the Downtown Eastside neighbourhood of Vancouver concerning the overdose crisis and the responsiveness of harm reduction programs within the context of colonialist practices in Canada. This framework is intended to help understand the structures perpetuating social inequalities in health.

Methods

Conducted in Vancouver, this community-based participatory research project was a collaboration between researchers and an Indigenous-led harm reduction organization based in the Downtown Eastside neighbourhood. Recruitment and qualitative interviews were conducted by Indigenous research peers. A total of 16 Indigenous participants who use illicit drugs took part in the study. Indigenous methodologies were integrated into the study design. The interview guide was based on storytelling, and a thematic analysis was conducted of the interview transcripts.

What was learned?

  • The overdose crisis is perceived as a form of genocide directed at Indigenous peoples.

Participants see the overdose crisis as the result of deliberate negligence and systemic oppression aimed at gentrifying the neighbourhood by ousting Indigenous illicit drug users. They perceive the overdose crisis to be a genocide and are convinced that it was fabricated to eliminate them. They portray it as a plot targeting the poor and maintain that people in the Downtown Eastside are “dropping like flies” because of overdoses and violence affecting the Indigenous population disproportionately.

  • The overdose crisis is associated with a climate of distrust and adversarial relationships with law enforcement.

Participants describe having negative interactions with the police, which reinforces the idea that the police deliberately engage in intimidation and negligence when drug users are in distress. Those interactions are also associated with gentrification because of the disproportionate monitoring by authorities of outdoor drug use, the dismantling of itinerant encampments and the destruction of their material goods by the police. Participants reported trying to limit the probability of confronting the police by modifying their drug use practices, thereby reducing their ability to safely inject and ultimately increasing the risk of overdose.

  • Culturally safe care aimed at harm reduction should be the goal.

Participants underscored the need for culturally safe harm reduction programs that incorporate cultural and traditional practices. Their vision of such services begins with Indigenous staffing. They would also like to have access to treatment options other than those based on abstinence, which they see as a colonial approach that doesn’t work for everyone.

Limitations

Firstly, the study focused on Indigenous users of illicit drugs living in Downtown Eastside Vancouver. The results are therefore not transferrable to other Indigenous populations or contexts. Secondly, the study did not take into consideration the unique experiences of Indigenous women or trans and two-spirit populations. Finally, data collection was interrupted in March 2020, and so the study does not evaluate the impact of the COVID-19 pandemic on the Indigenous population that uses illicit drugs.

Traditional knowledge

Healing through tradition: The role of Indigenous Elder support in child and youth mental health in Canada

Doucette, M., Bove, C. A., and Hill, S. (2024). Healing through tradition: The role of Indigenous Elder support in child and youth mental health in CanadaAlterNative: An International Journal of Indigenous Peoples, 20(4).

Context

The intergenerational transfer of knowledge, wisdom and traditions from Elders to young people is critical to the wellbeing of Indigenous peoples. That process has been disrupted, however, by colonial and assimilationist practices, including the residential school system and the Sixties Scoop. Many Indigenous communities emphasize the importance of a holistic approach to the mental health of young people that takes into account individual, cultural and family needs. Elders play a vital role in Indigenous communities as knowledge keepers and spiritual leaders. Integrating Indigenous values and traditions into mental health services through the involvement of Elders could constitute an important step towards providing safer services for Indigenous young people.

Objective

Conduct a critical analysis of the scientific and grey literature looking at the mental wellness of Indigenous children and adolescents in Canada in order to understand the role Elders’ knowledge and practices might play in improving services.

Methods

In March 2023, seven databases were searched for Canadian studies on the mental health of Indigenous children and adolescents. To qualify, a study had to have been conducted by Indigenous academics or in collaboration with Indigenous communities. The selected studies were shared and discussed with one of the authors, who is an Elder. A thematic analysis was conducted of the data from the 22 studies selected.

What was learned?

  • Elders are knowledge keepers who share their wisdom.

The studies highlight a desire on the part of Indigenous children and adolescents to establish better relationships with their Elders, who share knowledge and advice with them, although not necessarily directly or explicitly. They tell colourful stories that help children and adolescents to better know themselves, while also guiding them through real-world experiences.

  • Need for cultural-based teachings, ceremonies, and land-based healing led by Elders.

The literature highlights the important role Elders play in promoting resilience and cultural pride as teachers of language, customs and traditional knowledge. While those traditions vary between Indigenous communities, they may include pipe ceremonies and sweat lodges, as well as drum making and basket weaving. Moreover, Indigenous cultures are deeply rooted in the land, and Elders strive to strengthen children’s and adolescents’ connection with the land.

  • Importance of relationships for increasing youth’s mental wellness.

Elders are described as embodying love, acceptance and patience. Building authentic relationships with Elders encourages children and adolescents to participate more in cultural activities and fosters a belief that they deserve to be loved and respected. Those relationships are associated with a sense of personal growth and the development of an Indigenous identity.

  • Barriers to Elder engagement in the mental wellness of young people.

Difficulty in finding funding for land-based healing programs led by Elders stands out as a major barrier. Another barrier is the difficulty in obtaining recognition by health institutions, a setting where some Elders may feel uncomfortable or not respected. A further barrier lies in the fact that Indigenous approaches to mental wellness are holistic, making it a challenge to integrate them into a mental health services system centred on the individual. Finally, Elders are often solicited to participate in various community events, thereby limiting their availability to be involved with mental health services. 

Limitations

Although the authors conducted a thorough search of the literature, it is possible that some relevant studies were overlooked. Moreover, the results may not be pertinent to every Indigenous community, given that they are all distinct and unique, and have specific concepts of mental health, wellness and the role of Elders.

Keeping birth at home: Community and service provider visions for perinatal wellness and continued Inuit childbirth in Nunavik

Silver, H., Padlayat, E., Saviakjuk, P., Sarmiento, I., Budgell, R., Cockcroft, A., Vang, Z. M., and Andersson, N. (2024). Keeping birth at home: Community and service provider visions for perinatal wellness and continued Inuit childbirth in NunavikWomen and Birth37(6), 101839.

Context

Midwifery services in Nunavik have led to a greater number of births taking place within communities, which has brought cultural, social and health benefits. Rapid population growth, however, risks exceeding local capacities. Since the 1970s, pregnant women have been transferred thousands of kilometres from their home to give birth in the province’s southern urban centres. There is a demand for local solutions to keep deliveries within the communities.

Objectives

Explore the perspectives of community members and service providers on: 1) supportive factors for giving birth in a good way in Nunavik; 2) Inuit perinatal maternal and family wellness; and 3) strategies for continued community-based childbirth in Nunavik.

Methods

This participatory research project employed fuzzy cognitive mapping, a method that uses visual representations of causes and effects connected by arrows. Between 2021 and 2023, two Inuit research partners led mapping sessions pertaining to the three study objectives. Participants were invited to share their perspectives on those issues while the session leaders drew maps, which were then subjected to inductive synthesis. The strength of the associations described by participants was calculated as a function of the number of times that a given theme was mentioned compared with all issues raised.

What was learned?

A total of 54 maps were created by 72 participants, comprising 23 women, 16 men, 16 perinatal service providers (e.g., nurses and midwives), and 17 young people aged 14 to 17.

With respect to perspectives on giving birth in a good way in Nunavik, all maps taken together indicate that well-equipped facilities and medical services have the greatest impact. Participants emphasized the strong need for new medical facilities in the region, especially hospitals with surgical services. The second most impactful factor is Inuit-managed local midwifery services, with participants identifying many benefits for individuals, families and the community. With respect to families, for example, participants underscored a greater family presence during the pregnancy and delivery, as well as the elimination of a financial burden associated with evacuation to urban centres.

The perspectives of young people on the perinatal wellness of mothers and their families were also collected. The most influential factors were grouped under the theme of support for mothers. This included, for example, supporting women in performing domestic tasks, social support, and paying special attention to ensure that women are well.

Finally, three main influencing factors work to keep births in the communities: 1) local Inuit‑run maternity services that are 2) well-equipped and 3) staffed with qualified professionals. Furthermore, having Inuit-managed services would positively impact the allocation of resources to perinatal programs, the hiring and retention of staff, and the integration of traditional practices.

Limitations

The research team points out that although the mapping sessions were held in English and Inuktitut, the maps were translated entirely into English, which may have limited the interpretation of certain concepts. Moreover, while care was taken to represent different communities and realities within Nunavik, the research results cannot be applied more broadly—to the rest of Canada, for example. Finally, logistical constraints made it impossible for participants to be involved in the final thematic analysis, a practice that is strongly encouraged with the fuzzy cognitive mapping method.


If you are experiencing emotional distress, you can call the Hope for Wellness Help Line (1‑855‑242‑3310) or chat online. This service is available 24/7 for Indigenous people in Canada.

For other available services, see the list of Centres d’Écoute par région (regional support lines).

The inclusion of articles presented in this monitoring newsletter does not represent their endorsement by the Institut. Professional judgment remains essential in assessing the value of these articles for your work. You can also consult the Methodology for Indigenous Health Research Monitoring.