I have had the honour of exploring Indigenous history and how it relates to marginalization and health outcomes within this course (#MHST601). Indigenous people in Canada are a marginalized group that are extremely vulnerable to hardship including higher rates of preventable/chronic disease, poverty, and food insecurity (Arriagada et al., 2020; Kolahdooz et al., 2015). One shocking statistic Indigenous Canadians face is a life expectancy that is 12 years shorter than non-Indigenous Canadians (Kolahdooz et al., 2015). But what is the correlation between marginalization and poor health outcomes within this population? In this blog post we will explore reasons as to why this is the case by understanding marginalization, how the determinants of health influence Indigenous health, and what the future holds for Indigenous health in Canada.
What does it mean to be marginalized?
Marginalization occurs when individuals are prevented from fully realizing their potential within society (Public Health Ontario, 2016). Marginalized groups are vulnerable to having a lower income, lower education and literacy levels, and poorer health as they face barriers in accessing employment, education, housing, health services, and more (Public Health Ontario, 2016). Two events that were caused by and added to the severity of Indigenous marginalization in Canada is the Indian Act and the residential school experience.
The Indian Act was instituted in 1876 to control the “Indian problem” by ways of limiting land access and ownership (including moving Indigenous peoples to reservations), imposing colonizers’ education and religious systems, forced relinquishment of Indigenous status, and more (Richmond & Cook, 2016). This act perpetuates racism and ensures that Indigenous individuals remain vulnerable and marginalized for years to come (Richmond & Cook, 2016).
In 1831, Canada opened its first of over 130 residential schools; its purpose was to assimilate Indigenous youth into Canadian society through ways of cultural genocide (Menzies, 2021; Miller, 2021). Over the next 165 years, approximately 150,000 children attended these schools, the last closed in 1996 (Miller, 2021). Children who attended residential schools were taken from their homes by force or coercion, separated from their families and communities, and banned from partaking in any cultural practices (Miller, 2021). Those who experienced residential schools (attended or knew someone who attended) were impacted so intensely that it has caused multi-generational trauma that continues to affect Indigenous health today.
The determinants of health and how they influence Indigenous health in Canada.
An individual’s health is influenced by a multitude of factors, many of which are out of their control (WHO, 2017). These factors are known as the determinants of health. The Government of Canada (2020) states that the determinants of health are: 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/racism. Let us take a moment to break down a few determinants to gain a better understanding of how they influence Indigenous health.
Income and social status: As you can likely imagine, income is a determinant that greatly affects how someone lives as the more you earn, the more you can afford. The median income for Indigenous populations aged 25-54 in 2005 was $11,000/year less than non-Indigenous populations of the same age range (Statistics Canada, 2015). Kolahdooz et al. (2015) determined that low-income neighbourhoods are 2.7 times more likely to be exposed to fast food establishments and convenience stores, thus increasing the access to unhealthy foods. Unhealthy foods contribute to higher prevalence of chronic health conditions such as obesity, diabetes, and poor heart health (Kolahdooz et al., 2015; Diabetes Canada, 2021).
Employment and working conditions: In order to make a living, you must work – plain and simple. Where you work has an impact on not only the income you will receive but how safe you will be while working. The average rate of employment for Indigenous Canadians is 4.8% lower than non-Indigenous Canadians (Statistics Canada, 2018). Indigenous men tend to find employment in construction, manufacturing, and public administration, where Indigenous women work in health care/social assistance, retail, and education (Statistics Canada, 2019). Construction and manufacturing jobs can be inconsistent and dangerous, thus increasing the likelihood of being laid off or injured. Job instability and injury can motivate individuals to seek social assistance which in turn causes a lower income, stress, and poor nutrition (National Collaboration Centre for Aboriginal Health, 2017). Stress caused by joblessness and low income can lead to drug and alcohol dependencies and other chronic health conditions (Johns Hopkins, 2021).
Education and literacy: Education is a determinant of health that is associated with life expectancy, income/stability, and health behaviours (The Lancet, 2020). In 2011, 48% of Indigenous people between the ages of 25 and 64 had completed post-secondary education whereas 65% of non-Indigenous people had (Statistics Canada, 2015). Colonization has played a significant role in diminishing literacy and education rates which directly affects employment opportunities (National Collaboration Centre for Aboriginal Health, 2017). Unskilled labourers face lower income, job instability, and higher rates of injury (National Collaboration Centre for Aboriginal Health, 2017).
Physical environment: Indigenous communities tend to be rural and remote. These rural/remote locations often have low populations which aid in the inability to find employment, access health services, achieve higher education, access to safe drinking water and healthy foods, and obtain adequate housing (National Collaboration Centre for Aboriginal Health, 2017; WHO 2017; Kolahdooz et al., 2015). Indigenous women who live in rural/remote areas have few options when seeking prenatal and birthing care, forcing them to access more urban centres often several hours away (Benoit et al., 2018). Women must re-locate to these urban centres weeks before delivery forcing them to be without family, friends, and traditional practices (Benoit et al., 2018). This practice has led to the destruction of traditional Indigenous birthing customs and teachings (Benoit et al., 2018). The concept of health for Indigenous people is overarching as it includes not just mental and physical well being, but spiritual and cultural well being (Kim, 2019). As these cultural practices are being denied, so is Indigenous health.
Race/racism: Indigenous people experience racism regularly and this is not spared in the health care setting (Benoit et al., 2019). McCallum & Boyer (2018) explain that Indigenous people in Canada have been and continue to be victims of over treatment, under treatment, and coercive treatment at the hands of the Canadian health care system. Racism in the health care system is evident with Indigenous women being coerced into sterilization and left to suffer and die instead of being respected and treated (McCallum & Boyer, 2018; Shingler, 2020). Due to this racism, Indigenous people are reluctant to seek medical assistance and often go without (Benoit et al., 2019). Racism continues in social services offered by the Children’s Aid Society (CAS). In 2016, over half (52.2%) of the children under 15 years old in foster care in Canada were Indigenous (Ontario Human Rights Commission, 2021). What makes this statistic even more shocking is that Indigenous children only make up 7.7% of Canada’s population (Ontario Human Rights Commission, 2021). In September of 2016, the Government of Canada launched an inquest into the Missing and Murdered Indigenous Women and Girls. It was found that birth alerts disproportionately impact Indigenous mothers and communities causing undo hardship and trauma.
What does the future hold for Indigenous health in Canada?
The future of Indigenous health in Canada lays in the hands of every Canadian. Without advocacy efforts made by Indigenous and non-Indigenous Canadians, improvements will not occur. The Canada Health Act is a piece legislation that states health care in Canada will be comprehensive, universal, accessible, portable, and administered by the pubic, but as you read above, that is not the case for all Canadians (Government of Canada, 2020). Health equity is a concept that allows more resources to be provided to those in need, such as to marginalized groups. In 2015, the Government of Canada released the Truth and Reconciliation Commission report that outlined 94 Calls to Action to improve health equity among Indigenous people. These calls to action include child welfare, education, language and culture, health, and more. Improving access to affordable technology would assist in providing equity to remote/rural communities. With technology, remote individuals would have the ability to lead or participate in virtual prenatal and parenting classes, virtual Indigenous language and faith programs and enable individuals to be assessed by medical specialists without having to leave their community. One way technology has been introduced in remote locations is through robotic technology. The photo below, captured by Holt et al. (2018), demonstrates how a pediatric specialist can visit a remote location virtually. Holt et al. (2018) concluded that if pediatric specialists are not able to be stationed in remote locations, that robotic technology is a potential solution in closing the gap between Indigenous and non-Indigenous health inequalities.
Conclusion
Indigenous Canadians are marginalized groups within Canada that experiences lower income, lower and more risky employment opportunities, lower education and literacy levels, poor access to safe food, water, and social supports, and racism. These factors influence health outcomes negatively and have shortened Indigenous life expectancy by 12 years. Indigenous health inequality can be improved through means of creating health equity. Advocacy efforts made by all Canadians will help demonstrate to the Government of Canada that the 94 calls to action outlined in the Truth and Reconciliation Commission report are necessary to implement. I encourage you to please further your education on Indigenous history and take part in Indigenous advocacy.
References
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Benoit, A., Cotnam, J., O’Brien-Teengs, D., Greene, A. (2018). Racism experiences of urban Indigenous women in Ontario, Canada: “We all have that story that will break your heart”. The International Indigenous Policy Journal, 10(2), 1-27. 10.18584/iipj.2019.10.2.1
Diabetes Canada (2021, April 2). Type 2 risks. https://www.diabetes.ca/about-diabetes/type-2
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