Indigenous Healthcare: Divergences between British Columbia and Ontario

Written by Holly Heximer and Tara Tarcza

As we have learned over the last few weeks in this course, the idea of health goes far beyond the 1948 WHO definition and certainly there are many factors that contribute to the concept and experience of health. Health equity is not equal across the country and Indigenous people in Canada face greater disparity than the general population (Richmond & Cook, 2016). As a result, there are increased rates of chronic diseases experienced by the Indigenous people (Kim, 2019.) Likewise, delving into a deeper understanding of the social determinants of health highlights the ways in which Indigenous people are more vulnerable to poor health (Cockerham et al., 2017). Colonialism has had a negative impact on the overall health and wellbeing of Indigenous people in Canada and little has changed in public health policy at the federal level for this population since the Indian Act was created in 1986 (Kim, 2019; Richmond & Cook, 2016). Multiple health models have been created to support improved outcomes for Indigenous people in British Columbia and Ontario (Alliance for healthier Communities (AHC), n.d; First Nations Health Authority (FNHA), n.d.).

British Columbia (BC) First Nations Health Authority (FNHA) was established in 2013 and plans, manages, funds and delivers First Nations health programming. This includes administering the Health Benefits program for dental, pharmacy, vision, medical supplies, medical related transportation as well as mental health. FNHA provides primary health care at over 130 medical health centres and nursing stations across BC. FNHA works in partnership with the regional health authorities in BC to provide culturally safe healthcare (FNHA n.d.). Currently FNHA is working on the COVID-19 vaccine rollout across First Nations communities and increasing awareness of the vaccine to help improve uptake. One example of healthy living programming FNHA supports is an Aboriginal Diabetes Initiative which provides community funding for promotion of healthy eating and activity initiatives targeted to diabetes prevention. Through this initiative there is also a focus on screening and management programs through three mobile health units that travel to rural and remote communities (FNHA,n.d.).

Specifically looking at cancer among indigenous people “survival from almost all cancer types is lower compared to non-First Nations residents” in BC (Blackadar, 2020). To address this disparity in 2020 the University of British Columbia, in partnership with FNHA, created a FNHA Chair in Cancer and Wellness position. This position was attached with 3 million in funding over five years to look at health outcomes and disparities between indigenous and non-indigenous people in BC (Blackadar, 2020).

Ontario

Aboriginal Health Access Centres (AHACs) were created in 1995 modelled after the Community Health centre (CHC) model of care to improve access to primary care for Indigenous People in Ontario. These centres are Aboriginal community-led providing primary care (AHC, n.d.). Their goal is to combine traditional healing and primary care, with a focus on health promotion and community development. Currently, there are ten AHACs that operate in Ontario, on-and-off reserve in urban, rural, and northern areas (AHC, n.d.). The traditional CHCs focus on capacity-building and service integration with a focus on social determinants of health and connect with various local agencies to support individuals and families. The AHACs goal was to do the same but with a focus on integrated chronic disease prevention and management with support for addiction and mental health specific to the First Nations populations to prevent barriers in accessing health care (AHC, n.d.).

Figure 1: Depicting the AHAC model of care.

Source: https://www.allianceon.org/sites/default/files/documents/Model%20of%20Wholistic%20Health%20and%20Wellbeing.pdf Despite these centres, a 2020 study revealed that First Nations people continue to have limited access to primary care (Shah et al.). The population-based study also revealed that First Nations people with diabetes were less likely to access a diabetes specialist than other people in Ontario which is concerning given the high prevalence of diabetes in this population (Shah et al., 2020). Overall diabetes care appears to be compromised in the Indigenous people, as the results also drew attention to the increased visits to hospital for reasons that could often be treated in a primary care setting (Shah et al., 2020). The study notes that many of the respondents lived in rural and remote areas, which leads me to wonder if the locations of AHACs need to be reconsidered. The continuity of care was reported as lower and those who lived in First Nations communities were less likely to have a family physician (Shah et al., 2020). Prior to the release of the Shah et al. study but during the same time period that the data was collected the Ontario government made a large investment in health care for Indigenous people (Ontario Government, 2016). This funding was to be spread over three years to allow for provision of more culturally appropriate care with an emphasis on improvements in the North as there had been gaps identified in health care service (Ontario Government, 2016). Prior to the end of this funding initiative, further support was promised to allow for improvements in home care to ensure First Nations communities can access culturally appropriate care at home as well as further increases in the number of Indigenous-governed care teams in primary care A partnership was created with the Northern Ontario School of Medicine and the Matawa First Nations Management to recruit and train up to four family physicians each year from the Remote First Nations Family Medicine Residency program to work in remote First Nations communities (Ontario Government, 2018). This collaboration can support improved access to family physicians which appears to be a gap in care for this population (Shah et al., 2020). Additional supports were added to increase palliative care at home, along with mental health and wellness. The main focus on these expansions in funding is to uphold the ability to meet the cultural needs of the communities, in both rural and urban settings (Ontario Government, 2018). Health outcomes are unduly lower in Indigenous people in Ontario compared to non-Indigenous people especially noted in relation to cancer (Cision Canada, 2012). Since 2004 Cancer Care Ontario (now referred to as Ontario Health) has been working hard to improve this, through creation of the First Nations, Inuit, Métis and Urban Indigenous Cancer Strategy (Cision Canada, 2012). To help with equity of cancer care a role called the Indigenous Patient Navigator was created to support Indigenous people on their journey through cancer screening, diagnosis, treatment, and end-of-life as indicated (Walkinshaw, 2011). Supporting Indigenous people with coordination and access to cancer services and ensuring care is culturally appropriate is extremely important and this role plays an instrumental role in achieving this (Cision, Canada, 2012). Ontario Health has a tremendous number of resources available to support the role and it appears that most of the Local Health Integration Units in the province have someone dedicated to the role (Cancer Care Ontario, n.d.).

Comparison between BC and Ontario

• Community health centres, nursing stations or AHACs in remote and rural Indigenous communities

• BC has a provincial health authority, FNHA, that oversees indigenous health across the province

• Diabetes care among Indigenous people has been a priority among programming in both provinces including mobile units in BC.

• Poorer health outcomes for cancer in both provinces among Indigenous people with both identifying this as a priority with Ontario creating First Nations, Inuit, Métis and Urban Indigenous Cancer Strategy and University of BC creating and funding the FNHA Chair in Cancer and Wellness position.

References Alliance for Healthier Communities. (n.d.). Aboriginal Health Access Centres. https://www.allianceon.org/aboriginal-health-access-centres Blackadar, K. (2020, January 6). Dr. Nadine Caron named founding First Nations Health Authority Chair in Cancer and Wellness at UBC. University of British Columbia Faculty of Medicine. Retrieved March 21, 2021, from https://www.med.ubc.ca/news/dr-nadine-caron-named-founding-first-nations-health-authority-chair-in-cancer-and-wellness-at-ubc/ Cancer Care Ontario. n.d. Indigenous Navigators. https://www.cancercareontario.ca/en/find-cancer-services/aboriginal-navigator Cision Canada. (2012, Dec 4). Cancer Care Ontario Appoints Aboriginal Patient Navigators and Regional Cancer Leads in Four Regions. https://www.newswire.ca/news-releases/cancer-care-ontario-appoints-aboriginal-patient-navigators-and-regional-cancer-leads-in-four-regions-511322341.html Cockerham, W. C., Hamby, B. W., & Oates, G. R. (2017). The Social Determinants of Chronic Disease. American journal of preventive medicine, 52(1S1), S5–S12. https://doi.org/10.1016/j.amepre.2016.09.010 First Nations Health Authority (FNHA). (n.d.). FNHA Overview. Retrieved March 21, 2021, from https://www.fnha.ca/about/fnha-overview First Nations Health Authority (FNHA). (n.d.). Programs and Services 2020 / 2021. FNHA. Retrieved March 20, 2021, from https://www.fnha.ca/Documents/FNHA_Programs_Compendium.pdf Kim P. J. (2019). Social Determinants of Health Inequities in Indigenous Canadians Through a Life Course Approach to Colonialism and the Residential School System. Health equity, 3(1), 378–381. https://doi.org/10.1089/heq.2019.0041 Ontario Government. (n.d.). Cancer Care Ontario: First Nations, Inuit, Métis and Urban Indigenous Cancer Strategy 2019-2023. https://www.cancercareontario.ca/en/cancer-care-ontario/programs/aboriginal-programs/indigenous-cancer-strategy Ontario Government. (2016, May 25). Newsroom, News release: Ontario Launches $222 Million First Nations Health Action Plan. https://news.ontario.ca/en/release/38954/ontario-launches-222-million-first-nations-health-action-plan Ontario Government. (2018, Feb 14). Newsroom, News release: Ontario Taking Action on Indigenous Health Care – Partnership Between Province and Indigenous Communities Key to Efforts. https://news.ontario.ca/en/release/48193/ontario-taking-action-on-indigenous-health-care Richmond, C., & Cook, C. (2016). Creating conditions for Canadian aboriginal health equity: the promise of healthy public policy. Public Health Rev 37, 2 . https://doi.org/10.1186/s40985-016-0016-5 Shah, B. R., Slater, M., Frymire, E., Jacklin, K., Sutherland, R., Khan, S., Walker, J. D., & Green, M. E. (2020). Use of the health care system by Ontario First Nations people with diabetes: a population-based study. CMAJ open, 8(2), E313–E318. https://doi.org/10.9778/cmajo.20200043 Walkinshaw E. (2011). Patient navigators becoming the norm in Canada. CMAJ : Canadian Medical Association journal. 183(15), E1109–E1110. https://doi.org/10.1503/cmaj.109-3974