Understanding barriers to health care access through ...

Understanding barriers to health care access through cultural safety and

ethical space:Indigenous people's experiences in

Prince George, Canada

Sarah Nelson and Kathi WilsonQueen’s University and University of Toronto MississaugaAnd Prince George community advisory group members

I would like to acknowledge that the land on which Prince George is located is the traditional unceded

territory of the Lheidli T’enneh.

I also wish to acknowledge that I live and carry out much of my work on the traditional unceded territory of the Anishinaabe and Haudenosaunee peoples, in

particular the Algonquin.

With these acknowledgements come gratitude and deep respect for the people, the land, our shared

histories and future relations.

Disclosures

•I have nothing to disclose.

•No conflicts of interest to declare.

Outline• About the research and about me• Background: Indigenous health policy in

urban areas• Methodology: Indigenous and decolonizing

research• Results: Some of the barriers to health care

access or use that people described• Contexts of cultural safety and ethical space

Study overview

Research questions

a) How do Indigenous rights to self-government and self-determination interact with Indigenous rights to health care in urban areas?

b) How does the settler colonial context in which health care is provided arise as a barrier to Indigenous people accessing health care services in urban areas?

c) What are the roles of Indigenous-led health organizations in fostering Indigenous community resurgence in urban areas?

About me & my relationship with Prince George

Background: Indigenous peoples in Canada

1,673,780 people in 2016(4.9% of Canadian population)

Statistics Canada. (2017). Aboriginal peoples in Canada: Key results from the 2016 Census. Retrieved November 29, 2017, from http://www.statcan.gc.ca/daily-quotidien/171025/dq171025a-eng.htm

Indigenous peoples in cities in Canada

44% of Status First Nations live on-reserve52% of Indigenous peoples live in cities

0

10

20

30

40

50

60

1951 1961 1971 1981 1996 2006 2011 2016

Per

cent

age

of I

ndig

enou

s pe

ople

s

Year

Indigenous people in urban areas

Report higher overall rates of “very good” or “excellent” health than people living on reserve.

Yet also report higher rates of discrimination in institutional settings such as health care.

National Aboriginal Health Organization. (2003). What First Nations people think about their health and health care: National Aboriginal Health Organization’s Public Opinion Poll on Aboriginal Health and Health Care in Canada. Ottawa, ON.

Health care policy and Indigenous peoples in Canada•Canada Health Act, 1970

• Provides standards for how publicly insured services work across the provinces

•Off-reserve health services for Indigenous people are provided by provinces

• Exception: Non-Insured Health Benefits (NIHB)

•On-reserve health services are provided by the First Nations Health Authority in BC

• In other parts of Canada, provided by the federal government or through Health Transfer Agreements• Only about 44% of Indigenous peoples are eligible to live on a

reserve and access these services

Indigenous health organizations

•Mainly not-for-profit organizations, often in urban areas.

•Provide services according to Indigenous knowledges, values and world views but do not restrict services to people of Indigenous descent.

•Governed by Indigenous peoples, responsive to Indigenous communities.

Indigenous health organizationsOffer health-related services:

•primary health care•dental care•vision care•emergency health services•addiction treatment•counseling•decision-making related to health care provision•other related services

Research questions

a) How do Indigenous rights to self-government and self-determination interact with Indigenous rights to health care in urban areas?

b) How does the settler colonial context in which health care is provided arise as a barrier to Indigenous people accessing health care services in urban areas?

c) What are the roles of Indigenous-led health organizations in fostering Indigenous community resurgence in urban areas?

Prince George, B.C.

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Prince George

Prince Rupert

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Kelowna

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Vancouver

Island

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Smithers

Port AlberniNanaimo

720 Nazko

717 Yunesit'in

683 Iskut

624 K'ómoks

718 Toosey

721 Lhoosk'uz Dene

708 Spuzzum

682 Tahltan

666 Toquaht

628 Kwiakah

605 Shuswap

596 Osoyoos

561 Douglas552 Homalco

540 Kitasoo

728 Yekooche

722 Ulkatcho

711 Esk'etemc

703 High Bar

688 Tk'emlúps te Secwépemc

680 Kitselas

665 Tseshaht

662 Ditidaht

659 Ahousaht

633 Quatsino 616 Okanagan

610 Kwadacha

554 Tla'amin

538 Heiltsuk

537 Gitanyow

729 Skin Tyee

693 Coldwater

670 Skidegate

661 Hesquiaht

614 Nak'azdli Whut'en

597 Penticton

567 Samahquam

556 N'Quatqua

536 Gitwangak

716 Soda Creek

713 Canim Lake

709 ?Esdilagh

690 Neskonlith

673 Metlakatla

639 Nuchatlaht634 Ehattesaht

623 Cape Mudge

619 Burns Lake

602 ?aqam

548 Doig River

530 Moricetown

723 Stswecem'c Xgat'tem

681 Kitsumkalum

675 Gitga'at

618 McLeod Lake

504 Dease River

710 Alexis Creek

697 Upper Nicola

667 Uchucklesaht

636 Dzawada'enuxw

600 Splatsin

557 Lil'wat

726 Nee-Tahi-Buhn

719 Williams Lake

676 Haisla

674 Lax Kw'alaams

632 Tlatlasikwala

612 Nadleh Whuten

609 Tsay Keh Dene

539 Nuxalk

622 Campbell River

606 Lower Kootenay603 Tobacco Plains

562 Skatin

672 Gitxaala

637 Tlowitsis

627 Gwawaenuk

611 Lheidli T'enneh

599 Upper Similkameen

598 Lower Similkameen

715 Lhtako Dene

607 Lake Babine

501 Taku River Tlingit

691 Simpcw

689 Little Shuswap Lake

631 Namgis

630 Mowachaht/Muchalaht

1059 Daylu Dena

649 Nanoose

615 Saik'uz

668 Ucluelet

651 Qualicum

601 Westbank

553 Klahoose

542 Saulteau

664 Hupacasath

658 Pacheedaht

608 Takla Lake

604 ?Akisq'nuk

702 Whispering Pines/Clinton

663 Huu-ay-aht

620 Cheslatta Carrier

543 Fort Nelson

725 Wet'suwet'en

541 Wuikinuxv

671 Nisga'a Village of Gingolx

546 Halfway River

545 West Moberly

544 Prophet River

669 Old Massett

660 Tla-o-qui-aht

547 Blueberry River

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533 Glen Vowell

535 Gitsegukla

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573 Skwah

645 Halalt

586 Peters

585 Popkum

563 Katzie

655 Tseycum

565 Matsqui

551 Sechelt

549 Tsleil-Waututh

653 Tsartlip

646 Lyackson

642 Cowichan

559 Sts'ailes555 Squamish

550 Musqueam

650 Penelakut

644 Esquimalt

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569 Semiahmoo

652 Pauquachin

640 Beecher Bay

581 Seabird Island

566 New Westminster

654 Tsawout

647 Malahat

657 T'Sou-ke 656 Songhees

564 Kwantlen

641 Stz'uminus

648 Snuneymuxw

582 Skawahlook

577 Tsawwassen

571 Skowkale

575 Tzeachten

558 Aitchelitz576 Yakweakwioose

580 Kwaw-kwaw-Apilt

560 Kwikwetlem

587 Shxw'ow'hamel

578 Sumas

572 Soowahlie

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First Nations in First Nations in British ColumbiaBritish Columbia

First Nation Community

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706 Siska

705 Lytton

707 Skuppah

698 Shackan

696 Nicomen

592 Xaxli'p

699 Nooaitch

685 Ashcroft

700 Boothroyd

686 Bonaparte

593 T'it'q'et

704 Kanaka Bar

687 Skeetchestn

694 Cook's Ferry

591 Cayoose Creek 692 Oregon Jack Creek

701 Boston Bar

594 Ts'kw'aylaxw

City or Town

Inset 1

Inset 2

0 150 30075 Km

Scale

0 20 4010 Km

Scale

0 25 5012.5 Km

Scale

Inset 1

Inset 2

June 23, 2016CIDMS #1909804

618 McLeod Lake

Example:Identifier

Name of First Nation

Location of First Nation's main community

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Park and Protected Area

Indian Reserve

Source: Museum of Anthropology, University of British Columbia, and Indigenous and Northern Affairs Canada

• Indigenous research

• Decolonizing research

• Relational accountability

• Qualitative methods

Methodological approach

Recruitment and Support

Community Advisory Group; 29 interviews; 4 focus groups

Central Interior Native Health

Society

Northern Health

Authority

Native Healing Centre

Lheidli T’EnnehFirst Nation

Prince George Native

Friendship Centre

Prince George Métis Elders

Society

First Nations Health

Authority

Carrier SekaniFamily Services

University of Northern

British Columbia

Community advisory group

Participants50 Indigenous community members; 15 health services workers

• 44 women, 21 men• Over the age of 18• Currently living in the city• Experience with using or

work in health services•Majority had a regular

health care provider• Range of socio-economic

statuses

29 individual interviews4 focus groups

Results: Quality of care

“[Sometimes] they just look at you and then they just give you something fast and then you’re gone and stuff. It’s not really... don’t seem like they really care too much.”

(Client 11)

Results: Wait times, wait lists, and restrictions on time

“The hospital's not really nice to you, but it's just like, they haven’t got the time to deal with certain things or whatever, like, sit there and talk about whatever I need today, all these pains and stuff like that.”

(Client 9)

Results: Perceived racism or discrimination

“I don't want to make the assumption that I wasn't being listened to because I'm from an Aboriginal agency. It did cross my mind. I don’t know – that was never said… it just felt that… I was ‘Other,’ so whoever that could be.”

(FG 3)

Cultural safety“Cultural safety has the potential for shaping health care practices, organizations, and policies by identifying social justice goals as integral to health care, and by shifting attention away from cultural differences as the source of the ‘problem’ and onto the culture of health care as the site for transformation.”

Browne, A. J., Varcoe, C., Lavoie, J. G., Smye, V., Wong, S. T., Krause, M., … Fridkin, A. (2016). Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study. BMC Health Services Research, 16, 544. https://doi.org/10.1186/s12913-016-1707-9

Ethical Space

Jeppe Hein: Unusual and Creative Park/Street BenchesFrom http://www.spicytec.com

Indigenous rights are treated as separate from health care.

Participants report violations of rights; strategies for upholding rights; and complex geographies and identities of Indigenous rights.

Speak to the impacts of large-scale (for example, national-level) colonial processes on individual people’s experiences in health care.

Indigenous Health, Health Services, And Rights In The City

Indigenous-led health organizations have an important role to play in supporting Indigenous clients’ access to urban health care services.

Indigenous community resurgence becomes a possibility in urban health care settings where community understandings of place are well incorporated into all aspects of the delivery of services.

Indigenous Health Organizations, Indigenous Community Resurgence, and the Reclamation of

Place in Urban Areas

Indigenous theory on relationships

Space is constituted by interconnected relationships:

“Relationships do not merely shape reality, they are reality.”

Wilson, S. (2008) Research is Ceremony: Indigenous Research Methods. Black Point, NS: Fernwood Publishers, p. 7.

Indigenous resurgence“It is ultimately our lived collective and individual experiences as Indigenous peoples that yield the clearest and most useful insights for establishing culturally sound strategies to resist colonialism and regenerate our communities.”

Alfred, T., & Corntassel, J. (2011). Being Indigenous: Resurgences Against Contemporary Colonialism. In M. J. Cannon & L. Sunseri(Eds.), Racism, Colonialism and Indigeneity in Canada. Don Mills, ON: Oxford University Press.

Thank you!

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