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In Canada, the rural elderly population is increasing in size, as is their need for palliative care services in these settings. This analysis aims to identify awareness-associated barriers to delivering rural palliative care services, along with suggestions for improving service delivery from the perspective of local health care providers. A total of 40 semi-structured interviews with various formal and informal health care providers were conducted in four rural and/or remote Canadian communities with limited palliative care resources. Interview data were thematically coded using Penchansky and Thomas’ five dimensions of access (i.e. availability, (geographic) accessibility, accommodation, acceptability and affordability). Saurman’s recently added sixth dimension of access – awareness – was also identified while coding and subsequently became the primary focus of this analysis. Identified barriers to palliative care awareness and suggestions on how to enhance this awareness, and ultimately palliative care delivery, corresponded with three key themes arising from the data: limited palliative care knowledge/education, communication and coordination. Participants recognized the need for more palliative care education, open lines of communication and better coordination of palliative care initiatives and local resources in their communities. These findings suggest that identifying the barriers to palliative care awareness in rural communities may be foundational to addressing barriers to the other five dimensions of access. A thorough understanding of these three areas of awareness knowledge, communication and coordination, as well as the connections between them, may help enhance how rural palliative care is delivered in the future.
In 2011, Huu‐ay‐aht First Nations became one of five Nuu‐chah‐nulth Nations on the west coast of Vancouver Island in Canada to implement the Maa‐nulth Treaty with the Province of British Columbia and Canada. Modern treaties are dense and lengthy legal documents that exhaustively set out the obligations of each signatory party. They are heavily criticised for being unjust extensions of colonialism that limit Indigenous self‐determination and transform homelands under settler colonial property regimes. Yet, some First Nations accept these agreements as their chosen path for self‐government in state structures. We document Huu‐ay‐aht First Nations’ decision‐making that resulted when the Maa‐nulth Treaty was implemented and replaced the Indian Act by analysing the Maa‐nulth Treaty and interviews conducted with Huu‐ay‐aht First Nations leadership. We demonstrate how ʔiisaak (respect) and ʔuuʔałuk (taking care of) guided Huu‐ay‐aht First Nations’ self‐government, while nesting this discussion in the complexities and critiques of modern treaties.
Including content on Indigenous health in medical school curricula has become a widely-acknowledged prerequisite to reducing the health disparities experienced by Indigenous peoples in Canada. However, little is known about what levels of awareness and interest medical students have about Indigenous peoples when they enter medical school. Additionally, it is unclear whether current Indigenous health curricula ultimately improve students’ beliefs and behaviours. A total of 129 students completed a 43-item questionnaire that was sent to three cohorts of first-year medical students (in 2013, 2014, 2015) at one undergraduate medical school in Canada. This survey included items to evaluate students’ sociopolitical attitudes towards Indigenous people, knowledge of colonization and its links to Indigenous health inequities, knowledge of Indigenous health inequities, and self-rated educational preparedness to work with Indigenous patients. The survey also assessed students’ perceived importance of learning about Indigenous peoples in medical school, and their interest in working in an Indigenous community, which were examined as outcomes. Using principal component analysis, survey items were grouped into five independent factors and outcomes were modelled using staged multivariate regression analyses. Generally, students reported strong interest in Indigenous health but did not believe themselves adequately educated or prepared to work in an Indigenous community. When controlling for age and gender, the strongest predictors of perceived importance of learning about Indigenous health were positive sociopolitical attitudes about Indigenous peoples and knowledge about colonization and its links to Indigenous health inequities. Significant predictors for interest in working in an Indigenous community were positive sociopolitical attitudes about Indigenous peoples. Knowledge about Indigenous health inequities was negatively associated with interest in working in an Indigenous community. Students’ positive sociopolitical attitudes about Indigenous peoples is the strongest predictor of both perceived importance of learning about Indigenous health and interest in working in Indigenous communities. In addition to teaching students about the links between colonization, health inequities and other knowledge-based concepts, medical educators must consider the importance of attitude change in designing Indigenous health curricula and include opportunities for experiential learning to shape students’ future behaviours and ultimately improve physician relationships with Indigenous patients.
Canada celebrated its 150th anniversary since Confederation in 2017. At the same time, Canada is also entering an era of reconciliation that emphasizes mutually respectful and just relationships between Indigenous Peoples and the Crown. British Columbia (BC) is uniquely situated socially, politically, and economically as compared to other Canadian provinces, with few historic treaties signed. As a result, provincial, federal, and Indigenous governments are attempting to define ‘new relationships’ through modern treaties. What new relationships look like under treaties remains unclear though. Drawing from a comprehensive case study, we explore Huu-ay-aht First Nations—a signatory of the Maa-nulth Treaty, implemented in 2011—BC and Canada’s new relationship by analysing 26 interviews with treaty negotiators and Indigenous leaders. A disconnect between obligations outlined in the treaty and how Indigenous signatories experience changing relations is revealed, pointing to an asymmetrical dynamic remaining in the first years of implementation despite new relationships of modern treaty.
In 2015, the Liberal Party of Canada formed a majority federal government on a platform that included prioritizing Nation-to-Nation relationships with Indigenous (First Nations, Inuit, and Métis) peoples in the country and re-asserting global leadership in climate change action by moving away from fossil-fuel based extraction and toward renewable energy initiatives. It may be argued that addressing both of these issues, advancing Indigenous–Settler reconciliation, and mitigating climate change, can be done in the same space. Indeed, though Indigenous peoples in Canada and elsewhere have recently moved forward with renewable energy initiatives within their Territories, there has been very little critical analysis on just how such projects have been operationalized and whether renewable energy can or even should be considered a vehicle for reconciliation efforts. In this paper, we present a systematic review of Canadian literature (spanning from 1980 to 2017) concerning Indigenous peoples’ involvement in renewable energy to better understand the stated motivations and desires of Indigenous peoples in Canada taking leadership, partnering in, and (or) participating in the renewable energy sector. Using a series of keyword search strings across three academic databases, two theses databases, and a grey literature search, we retrieved literature (n = 980) that was subjected to four exclusionary forms and then thematically analyzed the included literature (n = 26). Our findings suggest Indigenous peoples’ experiences and motivations are varied, yet many are developing renewable energy in their Territories to: break free of colonial ties, move towards energy autonomy, establish more reliable energy systems, and reap the long-term financial benefits that clean energy can provide. Despite the apparent advantages seen throughout most of the literature reviewed here, we suggest further research in this area is necessary before this kind of positive rhetoric of renewable energy in Indigenous communities builds enough momentum that proponents become blind to possible shortcomings. We conclude with a broader discussion of the interactions between Indigenous–Settler reconciliation in the context of renewable energy projects as well as offering indicators for future research to fill current knowledge gaps.
This paper reports on the findings from a series of twenty in-depth, semi-structured interviews that explored how a group of leading Canadian health researchers who are recognized for their excellence in community-engaged Indigenous health research envision enacting an anti-colonial research agenda and the inherent tensions of doing so in institutional settings. Interview transcripts were thematically analyzed in order to explore how the different places that shape community-engaged scholarship (Community spaces, Offices of Research Ethics, and Office of Finance and Administration) 1) produce different, often conflicting understandings of responsibility; 2) how different spaces constrain and shape agency in terms of enacting forms of responsibility in research, and; 3) the role that settler subjectivities have in shaping acts of interpretation that are productive of institutionally mediated forms of responsibility. We organize themes of responsibility, relational ethics, and acts of refusal around the locales through which they are produced and mediated in order to display narratives relating to each site. Specifically, we highlight how relationally negotiated formulations of ethical responsibility, which occur between Indigenous community partners and researchers, can be circumscribed or marginalized by existing institutional structures. By making visible the ways in which conflicting responsibilities emerge and must be negotiated in working toward anti-colonial research relationships, our findings contribute to ongoing conversations regarding Indigenous-settler alliances in health research.
The oral health of Inuit children in Canada has been identified as a public health crisis. Although efforts are being made to identify and address ways to deal with this crisis, current policy and program approaches are largely entrenched within the prevailing paradigm of dental science to the exclusion of Indigenous people’s understandings of health. This article reports qualitative findings of a larger study aimed at identifying, understanding, and addressing rates of oral disease among children living in NunatuKavut, a cluster of small, coastal Inuit communities located in southern Labrador, Canada. Through 18 focus groups with youth (n = 86), caregivers (n = 22), and interviews with key informant (n = 13), this study begins to elucidate southern Inuit understandings of oral health. Theorized using Two-Eyed Seeing, an Indigenous approach to balancing both Indigenous and non-Indigenous understandings of the world, the findings reported here reveal 3 themes, each of which is crosscut by historical and contemporary dimensions: 1) (w)holistic conceptualizations of health are essential to good oral health, 2) achieving optimal oral health is prohibitive for Inuit communities, and 3) community-engaged oral health service delivery is needed. Our recommendations have implications for improved oral public health service delivery for Inuit communities, in that the inclusion of Inuit perspectives on oral health should form an instrumental element of oral public health service delivery.
BACKGROUND: This is the first national indigenous cohort study in which a common, in-depth protocol with a common set of objectives has been adopted by several indigenous communities across Canada. OBJECTIVES: The overarching objective of the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort is to investigate how the community-level environment is associated with individual health behaviors and the presence and progression of chronic disease risk factors and chronic diseases such as cardiovascular disease (CVD) and cancer. METHODS: CAHHM aims to recruit approximately 2,000 First Nations indigenous individuals from up to nine communities across Canada and have participants complete questionnaires, blood collection, physical measurements, cognitive assessments, and magnetic resonance imaging (MRI). RESULTS: Through individual- and community-level data collection, we will develop an understanding of the specific role of the socioenvironmental, biological, and contextual factors have on the development of chronic disease risk factors and chronic diseases. CONCLUSIONS: Information collected in the indigenous cohort will be used to assist communities to develop local management strategies for chronic disease, and can be used collectively to understand the contextual, environmental, socioeconomic, and biological determinants of differences in health status in harmony with First Nations beliefs and reality.
Proposed and actual developments of hydraulic fracturing, as a high-volume water user, have proven contentious in recent years. However, one point of agreement has emerged amongst all actors with regards to water use and hydraulic fracturing: we need more data. This consensus fits with a longstanding reification of the role of data in water governance, and yet we argue it hides a politically contested terrain. Based on a literature review, an empirical Delphi study and a workshop with a diverse array of participants from across Canada, we explore the data needs related to water governance and hydraulic fracturing. We then investigate three areas of deficiency that point to a lack of trust and oversight as well as the exclusion of community and Indigenous knowledge. We argue that in an era of neoliberal approaches to water governance, issues of trust, accountability and transparency all link back to a diminished role for data management within existing water governance arrangements. The challenge is that simply collecting more data will not help decision-makers navigate the complexity of water governance. Our findings suggest a growing call by participants for greater engagement by governments in data collection and knowledge management, new funding mechanisms for data collection and re- thinking how and what to monitor if including multiple ways of knowing and values.
Technology of the twenty-first century has transformed our ability to create, modify, store, and share digital media and, in so doing, has presented new possibilities for how social science research can be conducted and mobilized. This paper introduces the use of collaborative podcasting as a research method of critical inquiry and knowledge mobilization. Using a case study, we describe the methodological process that our transdisciplinary team engaged in to create the Water Dialogues podcast, a collaborative initiative stemming from a larger research project examining approaches to implementing Indigenous and Western knowledge in water research and management. We situate collaborative podcasting within an expanding field of collaborative and participatory media practice in social research, and consider how the method may align with and support research within a decolonizing agenda.
Drinking water in the vast Arctic Canadian territory of Nunavut is sourced from surface water lakes or rivers and transferred to man-made or natural reservoirs. The raw water is at a minimum treated by chlorination and distributed to customers either by trucks delivering to a water storage tank inside buildings or through a piped distribution system. The objective of this study was to characterize the chemical and microbial drinking water quality from source to tap in three hamlets (Coral Harbour, Pond Inlet and Pangnirtung—each has a population of <2000) on trucked service, and in Iqaluit (population ~6700), which uses a combination of trucked and piped water conveyance. Generally, the source and drinking water was of satisfactory microbial quality, containing Escherichia coli levels of <1 MPN/100 mL with a few exceptions, and selected pathogenic bacteria and parasites were below detection limits using quantitative polymerase chain reaction (qPCR) methods. Tap water in households receiving trucked water contained less than the recommended 0.2 mg/L of free chlorine, while piped drinking water in Iqaluit complied with Health Canada guidelines for residual chlorine (i.e. >0.2 mg/L free chlorine). Some buildings in the four communities contained manganese (Mn), copper (Cu), iron (Fe) and/or lead (Pb) concentrations above Health Canada guideline values for the aesthetic (Mn, Cu and Fe) and health (Pb) objectives. Corrosion of components of the drinking water distribution system (household storage tanks, premise plumbing) could be contributing to Pb, Cu and Fe levels, as the source water in three of the four communities had low alkalinity. The results point to the need for robust disinfection, which may include secondary disinfection or point-of-use disinfection, to prevent microbial risks in drinking water tanks in buildings and ultimately at the tap.
Abstract National and international policies have called for the inclusion of Indigenous peoples and the uptake of Indigenous knowledge alongside Western knowledge in natural resource management. Such policy decisions have led to a recent proliferation of research projects seeking to apply both Indigenous and Western knowledge in water research and management. While these policies require people with knowledge from both Western and Indigenous perspectives to collaborate and share knowledge, how best to create and foster these partnerships is less understood. To elicit this understanding, 17 semi-structured interviews were completed with academic researchers from Canada and Australia who conduct integrative water research. Participants, most of whom were non-Indigenous, were asked to expand on their experiences in conducting integrative water research projects, and findings were thematically analyzed. Our findings suggest that Indigenous and Western knowledge systems influence how one relates to water, and that partnerships require a recognition and acceptance of these differences. We learned that community-based participatory research approaches, and the associated tenets of fostering mutual trust and community ownership for such an approach, are integral to the meaningful engagement that is essential for developing collaborative partnerships to implement both Indigenous and Western knowledge systems and better care for water.
Abstract The implementation of Indigenous and Western knowledge systems in integrative water research and management is gaining prominence in the realm of academia, particularly in four countries with a shared, albeit different, history of British colonialism: Canada, Australia, New Zealand, and the United States. While integrative water research in particular is gaining popularity, currently there is a gap in our understanding regarding where, when, why, how, and for whom this type of research has been successful. A systematic review method was used to identify peer-reviewed literature from each of the four countries and to understand where and when integrative water research projects were taking place. Then, we used a realist review method to synthesize and analyze the included peer-reviewed literature to determine why, how, and for whom this type of research has been successful, or not. Our systematic literature search provided 669 peer-reviewed articles from across the four countries, of which 97 met our inclusion criteria and were analyzed. Our findings indicate that the total number of integrative water research projects has been increasing since 2009, though these projects are largely concentrated within the realm of social science and conducted by non-Indigenous authors. Recognition of the value of Indigenous knowledge systems, coupled with an understanding that the use of Western knowledge systems alone has not remedied the disparity in access to safe water sources in Indigenous communities, has led researchers to recommend collaborative partnerships and governance structures as a potential pathway to effective integrative water research. Our research was conducted to enhance contemporary understanding of the strengths of implementing Indigenous and Western knowledge systems and to encourage readers to continue working towards a common goal of reconciliation and equality in all partnerships.
Abstract In Canada, environmental monitoring has been the responsibility of government for decades; however, funding cutbacks have left many agencies unable to provide comprehensive coverage. This has stimulated a rise in community-based water monitoring (CBWM) organizations. These organizations, operating at multiple scales, have tasked themselves with monitoring aquatic ecosystems. Additionally, they often engage in restoration projects stemming from their monitoring work. Despite the growing abundance of CBWM organizations, there is uncertainty as to whether their activities lead to aquatic ecosystem benefits. A thematic analysis of photographic and qualitative interview data was employed to examine restoration projects conducted by five CBWM organizations, and the projects’ potential impact on source waters. Findings show that while they are conducting activities that show physical change, which is indicative of ecosystem improvement, examples of measurable responses within aquatic ecosystems remain rare. Monitoring, restoration, and source water protection processes are challenged by a lack of funding, capacity, and monitoring procedures. Funding, particularly, restricted the extent to which monitoring could be conducted and influenced project scope and scale. This leads to a lack of capacity to conduct large-scale restoration and rigorous scientific monitoring. Consequently, our findings highlight the issues with detecting effects of small-scale projects at the watershed scale
Abstract Indigenous (First Nations, Inuit, and Métis/Metis) peoples in Canada experience persistent and disproportionate water-related challenges compared to non-Indigenous Canadians. These circumstances are largely attributable to enduring colonial policies and practices. Attempts for redress have been unsuccessful, and Western science and technology have been largely unsuccessful in remedying Canada’s water-related challenges. A systematic review of the academic and grey literature on integrative Indigenous and Western approaches to water research and management identified 279 items of which 63 were relevant inclusions; these were then analyzed using a realist review tool. We found an emerging trend of literature in this area, much of which called for the rejection of tokenism and the development of respectful nation-to-nation relationships in water research, management, and policy.
Abstract Despite innovative technological "solutions" to address ongoing water crises in Indigenous communities, significant disparities persist in Canada. Financial investment in infrastructure is necessary, but it is hardly sufficient to address the real problem: entrenched colonialism. One of the greatest challenges in decolonizing research is to prevent that research from reproducing the very categories it is seeking to critique and dismantle. We share findings from thematically-analyzed interviews with academic and community-based researchers who conducted water research with a stated intent to implement Western and Indigenous knowledge systems. Findings revealed that while there is co-learning, ontological and epistemological assumptions carried into these relationships often impede truly integrative practice. Respondents shared how they worked through these persistent barriers of a colonial system.
Abstract The 2010 edition of the Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans introduced a new chapter, titled "Research Involving the First Nations, Inuit and Métis Peoples of Canada." The goal of our study was to explore how this chapter is being implemented in research involving Mi’kmaw communities in Nova Scotia. Qualitative data from four groups—health researchers, research ethics board representatives, financial services administrators, and Mi’kmaw community health directors—revealed that while the chapter is useful in navigating this ethical space, there is room for improvement. The challenges they encountered were not insurmountable; with political will from the academy and with guidance from Indigenous community health and research leaders solutions to these barriers can be achieved.
Abstract Pictou Landing First Nation (PLFN), a small Mi'kmaw community on the Canadian east coast, has had a relationship with a tidal estuary known as A'se'k for millennia. In the 1960s, it became the site of effluent disposal from a nearby pulp mill. Almost immediately, health concerns regularly and consistently reverberated throughout the community. The Pictou Landing Native Women's Group (PLNWG) formed a community-based participatory research (CBPR) partnership with an academic team to conceptualize community well-being in the context of environment and human health connections. This paper documents Mi'kmaw Elders' stories of A'se'k before it became contaminated. Using narrative inquiry vis-à-vis oral histories, we carried out conversational interviews with 10 Elders from PLFN. These interviews were thematically analyzed and 're-storied' through a process of (w)holistic content analysis. Our findings present four broad story layers, recounting the themes that emerged through analysis and presenting a broad Mi'kmaw narrative of A'se'k. These story layers share: what A'se'k originally provided, the historical/cultural context of PLFN, changes to land and health after the mill was put in, and reflections on the past and future of A'se'k. Our research offers a novel contribution to the literature by showing how Mi'kmaw perspectives on the pollution at A'se'k reveal the close connection between Mi'kmaw livelihood, local ecologies, and health and well-being. Our research also provides insights into the way the research relationship developed between the PLNWG and the academic team, providing a pathway for others seeking to decolonize the research landscape.
“Our Ancestors Are in Our Land, Water, and Air”: A
Two-Eyed Seeing Approach to Researching
Environmental Health Concerns with Pictou Landing