Self-determination and inclusion central to Indigenous health in Sask., say experts

Indigenous health research at the University of Saskatchewan (U of S) is set to receive $1.25 million from the Royal University Hospital Foundation to enhance self-determination in Indigenous health and create further capacity to include different world views.

The money will help research in that area continue for another five years. It's earmarked for the Cameco Chair in Indigenous Health and Wellness at the U of S College of Medicine. 

"For many Indigenous peoples, self-determination is a really critical part of who we are. This goes all the way back to our early treaties and continues on today," said Alexandra King, who is a Nipissing First Nation member, the Cameco Chair in Indigenous Health and Wellness, a researcher and an internal medicine specialist. 

The funding of the role at the U of S and similar initiatives across the country is aligned with efforts by the federal government to advance self-determination in health as defined through the Truth and Reconciliation Commission's Calls to Action and the United Nations Declaration of the Rights of Indigenous Peoples.

"A lot of the research that I'm doing is really supporting community to exert that self-determination in ways that they think is important," King said.

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Ensuring Indigenous peoples have a right to determine their needs, and engage health-care practitioners to work with them to meet those needs, is also essential for integrating Indigenous and western world views, King added.

She calls the practice of including seemingly different world views as central to Indigenous ethics — or, to echo terminology used by an Indigenous elder, to working within an ethical space.

"We could be talking about a medical doctor and a social worker," King said. "They have different ways of knowing. How do we come together and develop a way of communicating with each other so that we understand each other and we can uplift each other and build on each other's strength?"

Meet needs defined by Indigenous communities

Over the last five years, the research has investigated urban Indigenous women and families, national strategies for patient-oriented research education, Indigenous women and two-spirit people and the justice system, as well training and supporting gaps for hepatitis C and HIV workers in the province.

King's role in particular is part of the university's efforts to bring health services to meet needs as defined by Indigenous communities.

This practice of cultural capacity building is making gains in the field of medicine at a time when questions have arisen about what health services must be mandatory and what needs to be regulated in respect to cultural preference.

Recognizing cultural identity, through learning, sharing and understanding, is how the Saskatchewan Intercultural Association has been tending to the well-being of communities.

"When somebody cannot speak their own language or be themselves, it's very damaging to their own mental health," said Bobby-Jo Ouellette, Culture and Settlement Manager. "That's just like saying you can go out into the world but you can't be who you are, you have to be who we want you to be."

The Saskatchewan Intercultural Association seeks to encourage meaningful inclusion by celebrating multiculturalism through intercultural learning, starting with Indigenous education around the history of Canadian treaties. It also works with corporate leaders in a position to implement change on matter such as engaging better hiring practices.

In Canada, the health-care system has primarily been determined by the constitution, with roles and responsibilities divided between federal, provincial and territorial governments. This makes initiatives such as cultural capacity building in Saskatchewan self-determining in its own right.

The pandemic had a particular adverse effect on the mental health of Indigenous women, according to 2020 data from Statistics Canada. Forty-six per cent reported extreme stress and 48 per cent reported symptoms related to anxiety disorders.

While helping systems evolve past a competition and dominance-driven marketplace can't be implemented overnight, it's starting to take root, King said.

"It starts in relationship, it starts in respect, it starts in reciprocity and engaging in a good way and then continuing in a good way. When you are grounded in that, then it is amazing what work can happen."

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