There are many facets that influence our health as Canadians. These facets are also known as, the Social Determinants of Health (Government of Canada, 2020). The Government of Canada (2020) lists 12 major Social Determinants of Health: “income and social status, employment and working conditions, education and literacy, childhood experiences, physical environments, social supports and coping skills, healthy behaviours, access to health services, biology and genetic endowment, gender, culture, race and racism.”
Many Canadians suffer from health inequity and struggle to fulfill each of these aspects of health, which leads to poorer health overall (Government of Canada, 2020). Health inequity is defined as health inequalities that are unjust and unmodifiable (Government of Canada, 2020). Specifically, in British Columbia, the Indigenous population suffers greatly from health inequity (Muller, 2022). Out of the Social Determinants of Health mentioned previously, Indigenous individuals in British Columbia may face hardships with access to health services, cultural acceptance and knowledge from healthcare providers, possible racism outside of their communities, and other factors that can negatively impact their health (Muller, 2022).
A lack of cultural competency is seen as one of the main reasons for health inequity among Indigenous populations in British Columbia (Clifford et al., 2015). Purnell (2002) created a Cultural Competency Model specifically to teach nurses how to be more culturally sensitive. He describes cultural competency as:
“Developing an awareness of one's own culture, existence, sensations, thoughts, and environment without letting them have an undue influence on those from other backgrounds; Demonstrating knowledge and understanding of the client's culture, health-related needs, and meanings of health and illness; Accepting and respecting cultural differences; Not assuming that the healthcare provider's beliefs and values are the same as the client's; Resisting judgmental attitudes such as "different is not as good;" and Being open to cultural encounters; Being comfortable with cultural encounters; Adapting care to be congruent with the client's culture; Cultural competence is an individualized plan of care that begins with performing an assessment through a cultural lens” (Purnell, 2002).
Through this model, health care workers can better understand their patients within a cultural framework (Purnell, 2002). However, a definition can only go so far. Having such a dry, textbook definition of bullet points to describe cultural sensitivity and competency may be making it difficult for healthcare workers to apply it to everyday practice.
The Interior Health Authority in British Columbia’s interior has been making strides to improve Indigenous health inequity through cultural competency. Interior Health has released a document titled: “Aboriginal Cultural Safety and Humility” (2021). Here, they not only outline policies and procedures for staff to help better Indigenous health inequity but also definitions of varying terminology (Interior Health Authority, 2021) These definitions include but are not limited to, cultural competency, cultural humility, cultural awareness, and cultural safety (Interior Health Authority, 2021). Definitions are vital to include when presenting any policy or procedure because it allows others to fully understand the topic on a base level. This document allows staff members to have a resource that they can address to ensure they are providing the best standard of care to Indigenous individuals (Interior Health Authority, 2021). Another way, the province and the Interior Health Authority promote health equity among the Indigenous population is through a role called an Aboriginal Patient Navigator (Interior Health Authority, 2021). Patient Navigators are individuals hired by the health authority who are there to assist Indigenous patients with their quality of care (Interior Health Authority, 2021). Interior Health (2021) defines the purpose of this role: “our purpose is to provide a communication linkage between the patient, family, community and health care provider, assisting the care team with health care, mental health, substance use and discharge planning.” Overall, Patient Navigators are there to assist with the care plan of the Indigenous patient and to ensure that they are a strong cultural advocate for the patient and their families (Interior Health Authority, 2021). Their goal is to ensure that Indigenous patients have culturally respectful health care that does not compromise their cultural identity (Interior Health Authority, 2021). Interior Health also encourages healthcare workers to become an ally to Indigenous peoples within the hospitals and the community (Interior Health Authority, 2019). To allow for a better understanding, Interior Health (2019) released a video explaining how to become an ally.
Here, they describe how non-Indigenous individuals may have a subconscious colonial narrative that can affect the standard of care provided to Indigenous individuals (Interior Health Authority, 2019). They place emphasis on an un-bias, patient-centred approach which removes all the confusing definitions of cultural competency (Interior Health Authority, 2019). Overall, Interior Health has made noticeable advancements to improving Indigenous health through a cultural approach. By implementing cultural competency into all healthcare workers and introducing roles dedicated to cultural safety, Interior Health hopes that health inequity among the Indigenous population will substantially subside.
Accordingly, Indigenous populations across Canada face a higher likelihood of struggling to meet the Social Determinants of Health (Muller, 2022). By not meeting these social determinants, Indigenous individuals face health inequity and inequalities (Muller, 2022). A major contributing factor for Indigenous health inequity is the lack of cultural competency among healthcare workers (Clifford et al., 2015). In British Columbia specifically, the Interior Health Authority is making strides into improving the health inequities that Indigenous people face (Interior Health Authority, 2021). By providing knowledge to staff about Indigenous health inequities, promoting cultural competency and Indigenous allyship, and implementing roles specific to Indigenous cultural health, Interior Health has shown that they are using a Cultural Competency Model much like Purnell’s (2002). Interior Health has taken this model, removed the dry definitions surrounding it and has ensured that it becomes instilled within varying roles through the health region. There is still lots of work to be done, but the implementation of cultural competency in everyday practice by Interior Health is a start. Solving a societal problem takes a great deal of understanding. By understanding and obtaining knowledge about Indigenous culture from a health perspective, there is hope that health inequities will start to diminish.
References
Amit, S. (n.d.). What are the determinants of health? Colleaga. Retrieved March 6, 2022, from https://www.colleaga.org/article/what-are-determinants-health
Clifford, A., McCalman, J., Bainbridge, R., & Tsey, K. (2015). Interventions to improve cultural competency in health care for Indigenous Peoples of Australia, New Zealand, Canada and the USA: A systematic review. International Journal for Quality in Health Care, 27(2), 89–98. https://doi.org/10.1093/intqhc/mzv010
Interior Health Authority. (2019, April 11). Aboriginal cultural safety: How to be an ally. YouTube. Retrieved February 26, 2022, from https://www.youtube.com/watch?v=cLDkA2RIeCM
Interior Health Authority. (2021, April). Aboriginal Cultural Safety & Humility. Interior Health. Retrieved March 6, 2022, from https://www.interiorhealth.ca/sites/default/files/PDFS/aboriginal-cultural-safety-and-humility.pdf
Interior Health Authority. (2021). Aboriginal patient navigator service. Interior Health. Retrieved March 6, 2022, from https://www.interiorhealth.ca/services/aboriginal-patient-navigator-service
Muller, M. K. (2022). Colonial geographies: Indigenous access to primary care in British Columbia. Medical Anthropology, 1–14. https://doi.org/10.1080/01459740.2021.2021901
Public Health Agency of Canada. (2020, October 7). Social determinants of health and health inequalities. Canada.ca. Retrieved February 13, 2022, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Purnell, L. (2002). The Purnell Model for Cultural Competence. Journal of Transcultural Nursing, 13(3), 193–196. https://doi.org/10.1177/10459602013003006
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