Places & Spaces: A Critical Analysis of Cancer Disparities and Access to Cancer Care Among First Nations Peoples in Canada

Despite advancements in research and medicine, health inequities and disparities among First Nations peoples (FN) in Canada are well documented and continue to grow. Once virtually unheard of, cancer now is a leading cause of death among FN. Many factors contribute to cancer disparities, but FN face unique challenges in accessing healthcare. In this critical review and analysis, we explore potential links between cancer disparities and poor access to cancer care among FN. Research suggests FN experience difficulty accessing cancer services in several ‘places’ of care, including screening, diagnosis, treatment, survivorship and palliative care. Furthermore, there are notable ‘spaces’ or gaps both within and between these ‘places’ of care likely contributing to cancer disparities among First Nations. Gaps in care result from jurisdictional ambiguities, geographical location, unsafe social spaces, and marginalization of FN ways of knowing, and can be linked to colonial and neocolonial policies and ideologies. By drawing attention to these broader structural influences on health, we aim to challenge discourses that attribute growing cancer disparities among FN in Canada solely to increases in ‘risk factors’

Implementing Indigenous community control in health care: lessons from Canada

Copyright the Authors, Journal compilation copyright AHHA 2016. Published under a CC-BY-NC-ND licence: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/deed.en_US).Objective Over past decades, Australian and Canadian Indigenous primary healthcare policies have focused on supporting community controlled Indigenous health organisations. After more than 20 years of sustained effort, over 89% of eligible communities in Canada are currently engaged in the planning, management and provision of community controlled health services. In Australia, policy commitment to community control has also been in place for more than 25 years, but implementation has been complicated by unrealistic timelines, underdeveloped change management processes, inflexible funding agreements and distrust. This paper discusses the lessons from the Canadian experience to inform the continuing efforts to achieve the implementation of community control in Australia. Methods We reviewed Canadian policy and evaluation grey literature documents, and assessed lessons and recommendations for relevance to the Australian context. Results Our analysis yielded three broad lessons. First, implementing community control takes time. It took Canada 20 years to achieve 89% implementation. To succeed, Australia will need to make a firm long term commitment to this objective. Second, implementing community control is complex. Communities require adequate resources to support change management. And third, accountability frameworks must be tailored to the Indigenous primary health care context to be meaningful. Conclusions We conclude that although the Canadian experience is based on a different context, the processes and tools created to implement community control in Canada can help inform the Australian context. What is known about the topic? Although Australia has promoted Indigenous control over primary healthcare (PHC) services, implementation remains incomplete. Enduring barriers to the transfer of PHC services to community control have not been addressed in the largely sporadic attention to this challenge to date, despite significant recent efforts in some jurisdictions. What does this paper add? The Canadian experience indicates that transferring PHC from government to community ownership requires sustained commitment, adequate resourcing of the change process and the development of a meaningful accountability framework tailored to the sector. What are the implications for practitioners? Policy makers in Australia will need to attend to reform in contractual arrangements (towards pooled or bundled funding), adopt a long-term vision for transfer and find ways to harmonise the roles of federal and state governments. The arrangements achieved in some communities in the Australian Coordinated Care Trials (and still in place) provide a model

Reciprocal accountability and fiduciary duty: Implications for indigenous health in Canada, New Zealand and Australia

Copyright remains with the AuthorsThere is growing interest among public servants, Indigenous organisations, and scholars in Canada, Australia, and New Zealand in the idea of shifting from dassical New Public Management accountability models to models that reflect mutual or reciprocal accountability as a means of delivering more effective and responsive health care to Indigenous communities. However, little progress has been made with respect to developing and implementing workable reciprocal accountability models. In this paper, we argue that a consideration of Indigenous perspectives on reciprocity and accountability is an essential, yet mainly overlooked, component of the development of effective and appropriate accountability models between Indigenous peoples and statebased funders. Indeed, many Indigenous peoples have long histories of engaging in reciprocity-based relationships with each other and their environments. Drawing from Indigenous knowledge in this regard offers novel insights that can inform how models of reciprocity are constructed and understood. More specifically, we argue that consideration of Indigenous perspectives on treaties and treaty-making as a way to interpret the substance of mutual roles and responsibilities enables a shift to models of reciprocal accountability that are based on the mutual building of long-term, trust-based relationships, while also providing a frame that emphasises the maintenance of the sovereignty of the entities that are party to such relationships

Indigenous Peoples’ Health Care: New approaches to contracting and accountability at the public administration frontier

© 2013 The Author(s). Published by Taylor & Francis. This is an Open Access article. Non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly attributed, cited, and is not altered, transformed, or built upon in any way, is permitted. The moral rights of the named author(s) have been asserted.This article analyses reforms to contracting and accountability for indigenous primary health care organizations in Canada, New Zealand, and Australia. The reforms are presented as comparative case studies, the common reform features identified and their implications analysed. The reforms share important characteristics. Each proceeds from implicit recognition that indigenous organizations are ‘co-principals’ rather than simply agents in their relationship with government funders and regulators. There is a common tendency towards more relational forms of contracting; and tentative attempts to reconceptualize accountability. These ‘frontier’ cases have broad implications for social service contracting

Responding to health inequities: Indigenous health system innovations

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.Over the past decades, Indigenous communities around the world have become more vocal and mobilized to address the health inequities they experience. Many Indigenous communities we work with in Canada, Australia, Latin America, the USA, New Zealand and to a lesser extent Scandinavia have developed their own culturally-informed services, focusing on the needs of their own community members. This paper discusses Indigenous healthcare innovations from an international perspective, and showcases Indigenous health system innovations that emerged in Canada (the First Nation Health Authority) and Colombia (Anas Wayúu). These case studies serve as examples of Indigenous-led innovations that might serve as models to other communities. The analysis we present suggests that when opportunities arise, Indigenous communities can and will mobilize to develop Indigenous-led primary healthcare services that are well managed and effective at addressing health inequities. Sustainable funding and supportive policy frameworks that are harmonized across international, national and local levels are required for these organizations to achieve their full potential. In conclusion, this paper demonstrates the value of supporting Indigenous health system innovations

Documenting First Nations Access to COVID Vaccines: A whole-population linked administrative data study.

Objectives First Nations (FN) organizations worked with public health and governments to improve FN access to COVID-19 vaccines by prioritizing FN communities in vaccination initiatives. FN researchers and data scientists partnered to test whether these efforts were associated with increased access to COVID-19 vaccines among FN compared with all other Manitobans. Approach This retrospective cohort study linked whole-population administrative data from (i) the First Nations research file, (ii) COVID testing and vaccination data, and (iii) health and social services for sociodemographic data and information on potential confounders. Several public health policies were created to improve access to COVID vaccines among FN; we tested whether FN received their 1st and 2nd vaccines sooner than all other Manitobans (AOM) using restricted mean survival time models. We adjusted for sociodemographic characteristics, comorbidities, and whether FN lived on- or off-reserve. We conducted sex-specific and effect modification analyses to test whether associations differed by sex. Results Prioritizing FN to receive vaccines was associated with increased vaccine uptake compared with AOM. After adjusting for various confounders, FN received their first dose 15.5 (95% CI 14.9 – 16.0) days sooner than AOM and their second dose 13.9 (13.3 – 14.5) days sooner than AOM. Sex-stratified and subsequent effect modification analyses using interaction terms, found that differences were greater for males than for females: FN males received their first dose 18.1 (17.3 – 18.8) days sooner than AOM males and FN females received their first dose 12.9 (12.2 – 13.7) days sooner than AOM females. This pattern held for second doses as well. FN with comorbidities also received vaccines sooner than AOM with similar comorbidity levels 20.9 days (23.1 – 18.8) among those with 3+ comorbidities. Conclusion Partnerships between public health entities and FN organizations that respect FN community sovereignty were instrumental in supporting FN health and well-being during COVID-19. Policies and programs that prioritized FN people for vaccines improved uptake saving lives. This partnership-based COVID-19 response can provide a framework for future public health efforts

Le paternalisme organisationnel et l’employabilité des personnes ayant des incapacités : les retombées paradoxales de l’autorité et de la bienveillance déplacées

Deux études ont été effectuées afin d’évaluer une mesure de paternalisme organisationnel (PO) à l’endroit des personnes ayant des incapacités. Dans la première étude, une échelle de PO a été élaborée, évaluant, à l’aide d’un sondage en ligne, deux composantes des représentations de 266 étudiants universitaires n’ayant pas d’incapacité : 1) l’autorité déplacée et 2) la bienveillance déplacée. Les résultats démontrent que ces deux sous-dimensions du PO sont actives chez la population étudiée. Elles permettent aux participants, dans le cas de l’autorité déplacée, d’exprimer leur supériorité par rapport aux personnes ayant des incapacités et, dans le cas de la bienveillance déplacée, de soutenir leur impression d’être respectueux du principe d’égalité envers ce groupe spécifique. La seconde étude avait pour objectif d’examiner le lien entre les deux composantes du PO retenues dans l’étude précédente et l’évaluation de la candidature d’une personne ayant une incapacité motrice. L’étude invitait de façon aléatoire les participants de la première recherche à évaluer cette candidature en fonction de deux offres d’emploi dont la seule variation dans la description était que le poste se situait dans un milieu intégré (n = 33) ou dans un milieu protégé (n = 28). Les résultats de cette deuxième étude démontrent que dans le cadre d’un poste menant à un emploi dans un milieu intégré, plus les participants avaient exprimé une autorité déplacée, moins ils accordaient une correspondance entre le profil du candidat et les exigences de l’emploi; le candidat est perçu comme moins compétent. Toujours dans le cadre d’une demande d’emploi dans un milieu intégré, les participants qui manifestaient une bienveillance déplacée, ont évalué le candidat comme davantage chaleureux; qualité n’ayant aucun lien avec les compétences visées par l’offre d’emploi. Or, le PO n’a pas été un enjeu dans l’évaluation de la candidature pour un poste dans un milieu protégé. Les retombées de ces résultats sur l’employabilité d’une personne ayant des incapacités seront abordées.Two studies were conducted to evaluate a measure of organisational paternalism (OP) directed toward people with disabilities. In the first study, a measure of OP was developed, designed to tap into two dimensions: 1) inappropriate authority; 2) inappropriate benevolence, and administered by an online survey to 266 university students. Results reveal that these two dimensions are relevant features for the sample under study. Both dimensions allow participants to express their superiority toward people with disabilities, in the case of inappropriate authority, and to maintain an impression of respecting the equality principle, as in the case of inappropriate benevolence. The object of the second study was to examine the link between the two dimensions of OP that were retained in the previous study and the evaluation of a candidate of a person with a physical disability. The study randomly placed participants in one of two job opportunities whereby both varied in terms of whether the employment was situated in an integrated (n = 33) or protected (n = 28) work environment. Results of this second study revealed that in an integrated employment situation, participants who reported high levels of inappropriate authority were less likely to report that the candidate was a good fit for the job and perceive the candidate as competent. Furthermore, in the integrated employment situation, participants who expressed inappropriate benevolence were more likely to evaluate the candidate as warm, a quality that was not associated with the job requirements. However, the OP was not an issue in the evaluation of the candidate when the job was situated in a protected work environment. Implications of these results for the employment of people with disabilities are discussed

Child Maltreatment and Intimate Partner Violence Among Indigenous and Non-Indigenous Canadians

© 2016, Springer Science+Business Media New York. Indigenous peoples of Canada face an elevated risk of intimate partner violence (IPV) compared to non-Indigenous Canadians. Few empirical studies have been conducted to understand this elevated risk, and none have examined child maltreatment (CM) as a predictor. This study used data on a nationally representative sample of 2 0,446 Canadians to examine CM and proximal risk factors for IPV against Indigenous and non-Indigenous respondents. Results showed that Indigenous respondents had greater risk of experiencing both CM and IPV. All three forms of CM (exposure to violence, direct physical and/or sexual abuse victimization, as well as both exposure and direct victimization) were associated with increased odds of IPV in adulthood. CM along with proximal risk factors accounted for Indigenous peoplesâ elevated odds of IPV (AOR = 1.62; NS). These results were consistent with the theory that Indigenous peoplesâ elevated risk of IPV is largely due to effects of historical trauma from past and continuing colonization. Reducing Indigenous peoplesâ disproportionate risk of IPV requires efforts to reduce CM and its negative developmental effects among Indigenous peoples as well as resolving the manifestations of historical and contemporary trauma within Indigenous society.Link_to_subscribed_fulltex