Annotated Bibliography:

Alberta Health Services. [AHSChannel]. (2016, January 29). Traditional tobacco use [Video]. YouTube. https://www.youtube.com/watch?

     v=PXFPBD6k73I

​

     This video explains how traditional tobacco used in Indigenous rituals and ceremonies differs from commercial tobacco involved in addiction and recreational use.  Tobacco companies add harmful chemicals to their products, which is dangerous.  For example, smoking cigarettes increases the chances of developing lung cancer.  On the contrary, traditional use of tobacco in Aboriginal customs is not dangerous.  The tobacco leaves are dried and may be mixed with other natural ingredients, without the addition of hazardous toxins.  When tobacco is burned, the smoke is waved in each of the four directions, up towards the sky, down towards the earth, and around people or objects.  Tobacco leaves can be smoked in a pipe, burned on coals, or thrown in a fire.  The smoke itself is not inhaled.  Tobacco leaves can also be used as offerings without burning them.  Giving tobacco to an elder, medicine person, or spiritual is a gesture of appreciation and a way to ask for protection or assistance.  This gift initiates a contract with the hopes of receiving medicine, knowledge, or a ceremony in return.  Wearing tobacco leaves or hanging them around the house keeps away bad spirits.  Leaders in Indigenous communities want tobacco to remain sacred.  Tobacco can be used respectfully in prayer for healing, giving thanks to the Creator and Mother Earth, purifying the mind, and communicating with the spirits.  This video describes the spiritual benefits of traditional tobacco use.

Allan, B., & Smylie, J. (2015). First Peoples, second class treatment: The role of racism in the health and well-being of Indigenous peoples in

     Canada. Wellesley Institute. Retrieved from http://www.wellesleyinstitute.com/wp-content/uploads/2015/02/Summary-First-Peoples-

     Second-Class-Treatment-Final.pdf

​

     This discussion paper reviews the foundational role of racism in Canada.  Historically, First Nations people were portrayed as mentally inferior, child-like, unpredictable, untrustworthy, and violent as a way to justify colonial policies.  The reserve and pass card systems are highlighted as ways to restrict the movement and activities of Indigenous peoples.  The goal of assimilation, including residential schools, was to “civilize” Indigenous children by removing them from their “savage” families.  Their communities were viewed as inferior and their traditional knowledge or practices were not valued.  This discussion paper references articles that have explained various stereotypes of Indigenous people such as the “drunken Indian.”  The reputation of leaders from First Nations communities have also been tarnished, with media portrayals making them seem inept or corrupt.  These sorts of stereotypes impact how they are treated and have consequences on health and wellbeing.  The death of Brian Lloyd Sinclair is used as a case study of how racism can be fatal.  The authors explain the Indian Act and ways in which the Canadian government is oppressing Indigenous people.  Health inequities are discussed, with roots in racism and colonization.

​

Boyer, Yvonne (2017, November 20). Healing racism in Canadian health care. Canadian Medical Association Journal, 189(46).

     https://doi.org/10.1503/cmaj.171234

​

     Racism and discrimination exists in the Canadian healthcare system, especially against Indigenous peoples.  This commentary on this vulnerable population argues that health care systems are designed to ignore the colonial history of Indigenous patients.  The power imbalance between non-Indigenous health care providers and Indigenous patients is compared to the colonial perspectives of superiority with racist policies in residential schools.  It is further argued that most research studies align with this colonial framework, thereby preventing health equality.  Abolishing systemic racism requires structural changes in order to address failures.  For example, new policies need to be created with a commitment to investigate complaints filed by Indigenous patients or witnesses of anti-Indigenous racism.  The authors describe disturbing findings of recent reports, such as counts of Indigenous women being coerced into sterilization.  The impacts of being stereotyped and ignored were discussed.  A death of one Indigenous man was examined and later found to be a result of a sequence of racist events. 

​

Browne, A.J., Varcoe, C., Lavoie, J., Smye, V. Wong, S.T., Krause, M., Tu, D., Godwin, O., Khan, K., Fridkin, Al. (2016). Enhancing health care equity

     with Indigenous populations: evidence-based strategies from an ethnographic study. BMC Health Services Research, 16.

     https://doi.org/10.1186/s12913-016-1707-9

     This paper discusses the lasting effects of colonialism for Indigenous people in Canada and internationally.  The authors use an evidence-based framework to make recommendations for fostering health care equity and promoting a system that properly serves Indigenous populations.  Interviews were performed with 114 patients and staff at two Canadian Urban Aboriginal Health Centres located in inner cities.  Observational data was also collected, with over 900 hours of staff and Indigenous patient interactions monitored.  The authors identified four key dimensions of equity-oriented health services needed to support Indigenous communities: inequity-responsive care, culturally safe care, trauma- and violence-informed care, and contextually tailored care.  Examples of implementation for 10 strategies within different health care settings were provided.  Strategies targeting the key dimensions of equity-oriented health services act as guidelines for organizations, primary care practices, and individuals.  Following guidelines helps with culturally responsive changes at the organizational level.  It was found that interdisciplinary teamwork resulted in optimal operationalization.  The discussions were considered to be broadly applicable to Indigenous communities internationally due to similar experiences with the colonizing process.

​

First Nations Health Authority (2021a). Being active. Retrieved from https://www.fnha.ca/wellness/wellness-and-the-first-nations-health-

     authority/wellness-streams/being-active

​

     This webpage describes one of the wellness streams identified by the First Nations Health Authority, being active.  There are tips to achieving an active lifestyle with daily exercise recommendations.  The benefits of staying active are felt to be physical, mental, emotional, and spiritual.  For example, going on a walk is a great way to spend time with family and friends.  It is also an opportunity to reconnect to the land.  Exercising increases energy levels during the day and results in better sleep at night.  Walking not only reduces body fat and increases muscle tone, but it also help increase bone density to prevent osteoporosis.   Moreover, walking helps increase flexibility and coordination.  The First Nations Health Authority encourages people to wear a pedometer to track steps, and to aim for at least 10,000 steps per day.  It is also recommended that hand weights are placed near the television or phone as a way to encourage mild exercise during these activities.  Also, having a pair of walking shoes at work or workout clothes in the car allow for someone to be ready to exercise more easily.  Several fitness programs and physical activity resources are listed on this website.

​

First Nations Health Authority (2021b). Eating healthy. Retrieved from https://www.fnha.ca/wellness/wellness-and-the-first-nations-health-

     authority/wellness-streams/eating-healthy

​

     One of the wellness streams according to the First Nations Health Authority is eating healthy.  This webpage discusses nutrition tips for health and wellness.  Resources are provided with an emphasis on traditional foods.  Indigenous Peoples traditionally eat seafood, wild meats, berries, roots, and plants.  One of the factsheets listed on this website highlights traditional harvesting, nutrition messages, and traditional food use.  Salmon, eulachon, and herring are particularly important seafood to First Nations communities.  Other commonly eaten seafood include crab, shrimp, and bivalves such as clams, mussels and oysters.  Small mammals like beavers, squirrels, and rabbits are also traditional foods.  Moose and deer are good sources of protein, niacin, iron, riboflavin, and vitamin C.  Traditionally eaten birds include wild ducks, ptarmigan, and geese.  This website also recommends eating vegetables with every meal and drinking 6-8 glasses of water per day.  It is suggested to avoid sugary drinks, hydrogenated and trans-fats as well as reduced saturated fats.  The main tips are to eat in moderation a variety of foods with a balance between all nutrient groups, choosing foods close to nature with as little processing as possible.  The First Nations Health Authority encourages mindful eating, which involves sitting for meals, focusing on eating, and chewing food.

​

First Nations Health Authority (2012, May). First Nations perspective on health and wellness. Retrieved from

     https://www.fnha.ca/wellness/wellness-and-the-first-nations-health-authority/first-nations-perspective-on-wellness

​

     The First Nations Health Authority consulted with members of BC First Nations communities and researched other models before developing an illustration that visually depicts the First Nations perspective on health and wellness.  The middle circle is yellow, and represents the individual human beings.  The second circle is red and represents a balanced life with focus on all aspects of health including mental, emotional, physical, and spiritual.  The third circle is orange and represents the overarching values that support and uphold wellness.  Respect, wisdom, responsibility, and relationships are highlighted.  The fourth circle is green and represents the people that surround us, and the places from which we come.  Community, family, lands, and Nations are the main factors in this category.  The fifth circle is blue and represents the determinants of health including social, cultural, economic, and environmental factors.  Each of the components is described in detail from the perspective of First Nations.

​

First Nations Health Authority (2021c).  Nurturing spirit. Retrieved from https://www.fnha.ca/wellness/wellness-and-the-first-nations-health-

     authority/wellness-streams/nurturing-spirit

​

     This website describes how nurturing spirit is a main component to staying healthy and is considered a wellness stream. A holistic view of health values not only the physical, and mental aspects but also the emotional and spiritual aspects.  Connections to others, Mother Nature, and yourself are all improved by nurturing your spirit.  For example, building self-esteem is a way to care for the spirit.  It is important to provide a space for spirituality and activities such as drumming and dancing are encouraged.  Another recommendation is to manage stress through healthy outlets including yoga and meditation.  Learning a new hobby can help a person decompress and become happier.  A link to a wellness diary is provided on this website.  The wellness diary allows people to journal their goals, do self-assessments, write a food journal, and plan physical activities.  Healing the spirit is often ignored.  However, according to the First Nations perspective, supporting a healthy spirit is a key component to achieving wellness.

​

Leyland, A., Smylie, J., Cole, M., Kitty, D., Crowshoe, L., McKinney V., Green, M., Funnell, S., Brascoupe, S., Dallaire, J., & Safarov, A. (2016,

     February). Health and heath care implications of systemic racism on Indigenous Peoples in Canada. The College of Family Physicians of

     Canada. Retrieved from https://portal.cfpc.ca/ResourcesDocs/uploadedFiles/Resources/_PDFs/SystemicRacism_ENG.pdf

     This factsheet defines systemic racism and explains why it is often invisible.  Despite the expectation of professionalism from healthcare providers including physicians, unintentional anti-Indigenous racism is still pervasive in Canada.  The main manifestations of this are assumptions and stereotyping regarding a patient’s diagnosis or health behaviours.  Racism within systems is influenced by interpersonal or relational racism.  This factsheet references the Truth and Reconciliation Commissions final report.  It is argued that access to power and resources disproportionately favour one social group.  The consequences of colonial policies and systemic racism are discussed, including substandard health care, inadequate living conditions, and limited healthy food choices.  Recommendations for culturally safe care within a clinical practice are made in order to promote trust.  The importance of involving Indigenous patients in their health care decision-making process is highlighted.  Improving clinical skills to respect different cultures is considered to be a lifelong learning experience.  Self-reflection is encouraged to identify biases and misconceptions regarding Indigenous people.

​

Nguyen, N.H., Subhan, F.B., Williams, K., & Chain, C.B. (2020). Barriers and mitigating strategies to healthcare access in Indigenous

     communities of Canada: A narrative review.  Healthcare, 8(112). Retrieved from

     https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349010/pdf/healthcare-08-00112.pdf

​

     This review provides insight into the barriers that Indigenous people in Canada face when trying to access culturally sensitive healthcare.  The authorized categorized the barriers as proximal, intermediate or distal.  Proximal barriers include geography, education, and negative bias among healthcare professionals.  Employment, income inequities, inaccessible health systems are considered to be intermediate barriers.  Distal barriers are responsible for the lack of involvement of Indigenous people in policy making.  Colonialism, racism, and social exclusion are the three main distal barriers for Indigenous communities.  Strategies that address these concerns are outlined in this review with various mitigation approaches described.  In addition to improving the services that are offered with better cultural safety training for healthcare providers, the Indigenous communities need to be strengthened.  Examples of building capacity within Indigenous communities include infrastructure development, increases in employment, and academic achievement.  Moreover, it is argued that Indigenous communities and elders need to be involved in decision-making processes and the creation of policies.

Redvers, N., Marianaygam, J., Blondin, B. (2019). Improving access to Indigenous medicine for patients in hospital-based settings: a challenge

     for health systems in northern Canada. International Journal of Circumpolar Health, 78. https://doi.org/10.1080/22423982.2019.1589208

     This commentary points out that healthcare spending in the Northwest Territories is more than double the Canadian average per capita ($12,791 versus $6,069).  Approximately 50% of the population in the Northwest Territories are Indigenous.  The Indigenous peoples include First Nations, Inuit, and Métis.  Although healthcare spending is very high in this region, these residents have one of the lowest life expectancies in the country.  This is attributable to social, economic, geographic, and colonial factors.  Health inequity is discussed with recommendations to promote culturally competent care and to implement the Truth and Reconciliation Commission’s calls to action.  This commentary highlights the importance of traditional medicine for Indigenous peoples.  It is argued that as a part of the continuum of medical care, Indigenous patients should have access to traditional medicine and traditional practitioners.  The authors recommend that Northern health systems shift to include traditional medicines.  This integration will respectfully appreciate the Indigenous perspective.  Involvement of Indigenous peoples in the development and implementation of policy were also considered to be a key aspects of minimizing barriers.

Richmond, C.A.M., & Cook, C. (2016). Creating conditions for Canadian aboriginal health equity: The promise of healthy public policy. Public 

     Health Reviews, 37(2). https://doi.org/10.1186/s40985-016-0016-5 

​

     This review focuses on the need for public policy that aims for health equity.  Canada’s policies do not prioritize the rights of Aboriginal peoples and have been based in racism since the early days of colonialism.  The underlying and overt racism in governing legislation and public policy are highlighted.  The historical trauma face by Indigenous peoples is discussed as well as the contribution of the Indian Act in creating social inequities.  The authors refer to the report on the Truth and Reconciliation Commission of Canada in the discussion on policy reform and health equity.  Infant mortality, diabetes rates, suicide among youth and teens are disproportionately high in Indigenous communities.  This burden is highly influenced by social determinants of health such as sub-standard living conditions, low income, unemployment, and low educational attainment.  The comparison in health measures between Indigenous peoples and non-Indigenous Canadians highlights Canada’s failure in terms of meeting the healthcare needs of this vulnerable population.

​

Stewart, Briar. [CBC News: The National] (2020, November 30). Evidence of widespread racism against Indigenous peoples within B.C. health

     care: investigation [Video]. YouTube. https://www.youtube.com/watch?v=-NNDGiENobs

​

     Reports of hospital emergency staff playing a “game” that involved guessing the blood-alcohol content of Indigenous patients resulted in an investigation lead by Turpel-Lafond.  The findings of this investigation, “In Plain Sight”, and examples of discrimination in healthcare against Indigenous people are highlighted in this video from CBC news.  Although the allegations regarding the “game” in ER rooms were not substantiated, the investigation revealed how stereotypes can lead to discriminatory care.  Profiling of Indigenous patients based on stereotypes about addiction can harm health outcomes.  “In Plaint Sight” surveyed 9000 participants about racism, including patients, witnesses, and healthcare workers.  There were 11 key findings and 24 recommendations for change.  The recommendations called for better support for those that speak up about racism, increased training, and recruitment of Indigenous students into healthcare programs.  According to the findings, 52% of Indigenous healthcare workers experienced racism at work and an overwhelming 84% of Indigenous patients reported discrimination in the provincial healthcare system.  Fear of racism can discourage Indigenous people from seeking medical treatment.

​

Vancouver Coastal Health. [aboriginalhealthVCH]. (2014, January 31). What is cultural competency? [Video]. YouTube.

     https://www.youtube.com/watch?v=xw9BBb8LhYw

​

     This video highlights the importance of cultural safety.  The main message is First Nations peoples want culturally competent care from their healthcare providers.  This quality assurance measure requires changes at the individual and organizational levels.  The video asks for healthcare organizations and its staff to pursue continuous education on how to be culturally sensitive.  This results in modifications to attitudes and behaviours.  Considering Canada’s multiculturalism, this video stresses the relevance of cultural competence among caregivers.  Similarities and differences exist between cultures.  Given that there are hundreds of Aboriginal cultures within Canada, it is unrealistic to have extensive knowledge about each one.  However, it is an expectation that healthcare providers attempt to learn about their local First Nations communities through experience and study.  Self-reflection is one of the steps in committing to provide culturally competent care.  Healthcare workers  are encouraged to recognize their own thoughts and behaviours in regards to their clients. Understanding one’s cultural world view and attitudes towards cultural differences are important.  These attitudes influence value systems, capacity for learning, and behavioural changes.