Post on 20-Dec-2021
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
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
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?
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
Prince George, B.C.
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P A C I F I C
O C E A N
WillistonLake
Kootenay Lake
LowerArrowLake
Okanagan Lake
UpperArrowLake
Shuswap LakeChilko
Lake
Quesnel Lake
EutsukLake
Francois L
Stuart Lake
Takla Lake
DeaseLake
TeslinLake
Atlin Lake
Tagish Lake
Babine
Lake
Tatlatui Lake
Thutade Lake
Ootsa L
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Columbia
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Salmon R
Liard River Fort NelsonRiver
Atlin
Nelson
Masset
VANCOUVER
Skidegate
Dease Lake
Bella Coola
Fort Nelson
Fort St John
Williams Lake
Prince George
Prince Rupert
Port Hardy
VICTORIA
Kamloops
Kelowna
Haida
Gwaii
Vancouver
Island
Terrace
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
678 Nisga'a Village of Laxgalt'sap
625 Kwikwasut'inuxw Haxwa'mis
712 Tl'etinqox
714 Xeni Gwet'in
638 Ka:'yu:'k't'h'/Che:k:tles7et'h'
679 Nisga'a Village of Gitwinksihlkw677 Nisga'a Village of New Aiyansh
629 Mamalilikulla
724 Gwa'sala-Nakwaxda'xw
635 Da'naxda'xw
613 Stellat'en
534 Hagwilget
617 Tl'azt'en
695 Lower Nicola
533 Glen Vowell
535 Gitsegukla
684 Adams Lake
531 Gitanmaax
626 Kwakiutl
532 Kispiox
643 Lake Cowichan
595 Tsal'alh
589 Yale
590 Bridge River
648 Snuneymuxw _̂
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VANCOUVER 584 Cheam
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
588 Union Bar583 Chawathil
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
574 Squiala
570 Shxwhá:y Village579 Leq'a: mel
568 Sq'éwlets
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
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
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)
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
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!