The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 1948). This definition is out of date as it fails to include personal circumstances, something which the Social Determinants of Health touch on. The Social Determinants of Health are components that have an impact on an individual’s overall health (Public Health Agency of Canada, 2020). These determinants include 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, and race and racism (Public Health Agency of Canada, 2020). Unequal access to healthcare due to personal circumstances or, health inequity, can occur when these aspects have a negative connotation and place a hindrance on overall health (Public Health Agency of Canada, 2020). Specifically, in my province of British Columbia, the Indigenous community suffers greatly from health inequity caused by various Social Determinants of Health (Muller, 2022). Due to the massive difference in Indigenous and non-Indigenous health equity, the World Health Organization’s definition of health is not enough to explain poorer health among the Indigenous population (Muller, 2022). Therefore, the definition is too outdated and when analyzing the health of specific populations their social determinants have an immense impact and must be considered.
A clear indicator of Indigenous health inequity impacted by various Social Determinants of Health is the higher rates of chronic disease among Indigenous populations versus non-Indigenous (Gionet & Roshanafshar, 2015). The reason for higher rates of chronic diseases comes down to poorer overall health among Indigenous individuals versus non-Indigenous individuals, unhealthy behaviours, higher rates of obesity (graphic example below), and household food insecurity (Gionet & Roshanafshar, 2015). Each of these factors can fall into the many Social Determinants of Health mentioned before which are based on the individual’s circumstances. The higher rates of these chronic diseases illustrate that Indigenous health inequity exists and is detrimental. If nothing is done to help Indigenous individuals with their access, usage, and treatment within the healthcare system these rates will continue to rise, making Indigenous health even more inequitable.
After analyzing all the previous information, the key question is, what is the healthcare system in British Columbia doing to improve Indigenous health inequity? Of the above Social Determinants of Health, the facets that the healthcare system can help to improve are access to health services, decreased racism within healthcare, cultural acceptance and acknowledgement, and information about healthy behaviours (Muller, 2022). Purnell (2002) published a Cultural Competency Model, which provides healthcare workers advice on how to be culturally respectful to their patients. The model focuses on a patient-centred approach and provides patients with cultural autonomy (Purnell, 2002). It encourages healthcare workers to learn about other cultures and make their patients and their families as comfortable as possible during any hospital visit (Purnell, 2002). The Cultural Competency Model insists that cultural health and well-being are just as important as physical health (Purnell, 2002). In essence, cultural health needs to be treated with as much care and respect as physical health already is (Purnell, 2002). The Interior Health Authority in British Columbia has pushed forward initiatives to improve Indigenous health inequity based on models like Purnell’s (2002). Interior Health strives to teach its employees about the importance of cultural sensitivity and competency, especially among the Indigenous population (Interior Health Authority, 2021). The health authority does this by providing information, policies, and procedures to help staff navigate potentially culturally sensitive scenarios (Interior Health Authority, 2021). Interior Health also encourages its employees to become Indigenous allies and remove all potential biases (Interior Health Authority, 2019). The allyship is instilled to remove barriers and allow healthcare workers and Indigenous individuals to work together to create a safe space for those receiving healthcare and to provide superb patient care (Interior Health Authority, 2019). Lastly, the major initiative that Interior Health has instilled is the employment of Aboriginal Patient Navigators (Interior Health Authority, 2021). Patient Navigators are hired professionals of the health authority who are there to assist Indigenous patients with their quality of care (Interior Health Authority, 2021). They are an advocate for the patient and provide a linkage between patients, families, and healthcare workers when creating the patient’s care plan and discharge plan (Interior Health Authority, 2021). Their main purpose is to ensure that culturally competent care is occurring and that the patient is getting all the information they require (Interior Health Authority, 2021). The implementation of these initiatives promotes a culturally safe mentality within the healthcare system. Through these initiatives, the hope is that the gap between non-Indigenous and Indigenous health inequity will shrink.
With all these initiatives another question to ponder is, are we doing enough? There is hope that Indigenous health equity from a healthcare approach will improve, but there need to be plans made for the future to continue minimizing this gap. The Government of Canada has created an action plan that has continuously been updated since 2016 (Government of Canada, 2016). The action plan’s goal is to build a healthier future for the Indigenous population in Canada (Government of Canada, 2016). The most recent update from September 2021 provides a progress update of initiatives and future goals (Government of Canada, 2021). The update discusses the importance of community-based health research and provides information about the Canadian Institute of Health Research Strategic Plan for 2021-2031 (Government of Canada, 2021). This 10-year plan aims to build a healthier Canada for all Canadians (Government of Canada, 2021). One of the top priorities is to “Accelerate the Self-Determination of Indigenous Peoples in Health Research” (Government of Canada, 2021). Here they hope to increase the overall health and well-being of Indigenous individuals, increase health research from an Indigenous perspective, and remove barriers such as funding, for Indigenous-led health research (Government of Canada, 2021). By prioritizing Indigenous-led health research there is hope that the health equity gap between Indigenous and non-Indigenous Canadians will significantly subside. The September update also included the importance of governance and strategic leadership (Government of Canada, 2021). Here they ensure that the leadership supports Indigenous health initiatives through financial help and policy or program implementation (Government of Canada, 2021). They also provide all their employees with cultural safety training to ensure Indigenous culture is respected with any new programs or ideas that may be created (Government of Canada, 2021). Having leadership that supports the initiatives is a great step in the right direction because it provides certainty that issues will be resolved surrounding Indigenous health inequity. The final point this update touches on is increased engagement within the Indigenous community (Government of Canada, 2021). Community engagement is vital when change is occurring. The individuals in the community will be the ones who are feeling most of the changes and their input and opinions are a top priority. Overall, with the Federal Government’s implementation of a 10-year research plan, leadership who believes in and is willing to fix the problems of health inequity, and Indigenous community engagement, the solutions are expected to trickle down to a provincial and community level. These are all important steps toward making Indigenous health significantly better for generations to come.
Understanding why Indigenous health is inequitable due to the Social Determinants of Health that Indigenous individuals face is the first step to solving the problem of health inequity. The issue is a considerable multi-faceted concern both provincially and federally. It is not expected to be resolved overnight and it is essential to have initiatives and plans in place to help solve this problem as quickly as possible. Current initiatives in British Columbia’s Interior including, cultural sensitivity training of employees, promotion of Indigenous allyship, and employment opportunities based on Indigenous health have shown promise from a community and provincial framework (Interior Health Authority, 2021). There is also future hope that Indigenous health inequity will continue to decrease with the Government of Canada’s extensive action plan which places importance on Indigenous-led research, pro-Indigenous leadership, and community engagement (Government of Canada, 2021). It is promising that resources are being poured into the Indigenous health equity problem in Canada. I am optimistic about the future and hope that my children will grow up in a Canada where a person’s cultural and racial identity does not define their opportunities for equitable healthcare.
References
Gionet, L., & Roshanafshar, S. (2015, November 27). Statistics Canada: Health at a glance. Select health indicators of First Nations people living off reserve, Métis and Inuit. Retrieved April 4, 2022, from https://www150.statcan.gc.ca/n1/pub/82-624-x/2013001/article/11763-eng.htm
Government of Canada. (2016, November). Action plan: Building a healthier future for First Nations, Inuit, and Métis peoples. Canadian Institute of Health Research. Retrieved April 5, 2022, from https://cihr-irsc.gc.ca/e/50372.html
Government of Canada. (2021, February 26). CIHR Strategic Plan 2021-2031 A Vision for a Healthier Future. Canadian Institute of Health Research. Retrieved April 5, 2022, from https://cihr-irsc.gc.ca/e/52331.html#s_6_3
Government of Canada. (2021, September 29). Progress Update – Action Plan: Building a Healthier Future for First Nations, Inuit and Métis peoples. Canadian Institute of Health Research. Retrieved April 5, 2022, from https://cihr-irsc.gc.ca/e/52671.html
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
World Health Organization. (1948, April 7). Constitution of the World Health Organization. World Health Organization. Retrieved February 5, 2022, from https://www.who.int/about/governance/constitution
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