Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study

PHC is the principal vehicle for the delivery of health care at the most local level of a country's health system, and is the first level of contact for individuals, families and communities, constituting the first element of a continuing health care process.

Our use of the terms ‘marginalization’ or ‘marginalized’ in relation to Indigenous peoples recognizes that marginalization is entrenched in the history of relations between Indigenous peoples and the nation-state, resulting in a disproportionate burden of ill health and social suffering within Indigenous populations. Marginalized therefore refers to the conditions that continue to result in structural, social and health inequities. Our use of the term is also inclusive of the many strengths and capacities accumulated in the context of people’s history and circumstances, and people's agency, resistance and resilience.

Consistent with accepted terminology used in landmark international reports, we use the term Indigenous peoples to refer to the diversity of populations throughout the world. In Canada, over 1.4 million people of the total population of ~ 32.9 million (4.3 %) identify as Indigenous [119], and the term Indigenous peoples refers to the original inhabitants of the land [120], including First Nations, Métis, and Inuit people. The term Aboriginal is also commonly used, and the colonial term ‘Indian’ is still used in federal government policy documents (e.g., The Indian Act). Approximately 50 % of Indigenous peoples are registered with the federal Department of Indigenous and Northern Affairs, and are therefore considered ‘Status’ Indians (First Nations). Thirty percent are Métis, 15 % are unregistered First Nations, and 4 % are Inuit. There are currently 617 First Nations ‘bands’ or tribal groups in Canada representing over 50 cultural groups [119]. Approximately 78 % of Indigenous peoples live off-reserve [121].

In British Columbia (BC), Canada, for example, Indigenous children are 14 times more likely to be taken into the ‘care’ of the child welfare system than non-Indigenous children during their school-aged years [122].

In Canada, visible minority refers to persons who are identified according to Canada’s Employment Equity Act as "persons, other than Aboriginal peoples, who are non-Caucasian... or non-white in colour" [82].

Friendship Centres have formed in many Canadian cities under the auspices of the National Association of Friendship Centres. Initially, these Centres were developed to provide supports related to employment, housing, health and education. Over the decades, the number of Centres and their range of services have increased significantly.

Culturalism is a form of stereotyping whereby culture, defined very narrowly and often in stereotypical ways, becomes the primary explanation for why certain groups of people may be experiencing particular health or social issues. Research continues to show that healthcare professionals frequently attribute people’s social problems to their cultural characteristics, for example, leading them to wrongly assume that violence toward women may be acceptable in particular cultural groups, or that some people are more prone to using drugs or alcohol because of ‘their culture’.

Smudging is a practice common to many Indigenous groups in North America. It usually involves ceremony and using the smoke of sacred herbs, grasses or tree branches to cleanse one’s self and thoughts.