Indigenous Health Topics and Themes

The following is a list of broad topics and themes outlining some of the important issues that residents should become familiar with during their year of training. While some education will come through readings, the resident should also reflect on the impact of these issues during core and elective rotations. In addition, particular topics are appropriate for discussion in rounds and seminars for the education of all health care workers.

Historical and Cultural Context

  • Aboriginal life before contact with Europeans, including health status
  • the nature and consequences of contact and colonization (on lifestyle, culture,
  • health of the people, etc.)
  • the Indian Act and treaties with the government, and their relationship to the current political (social/economic) struggles of Aboriginal peoples
  • the destructive role of the church and its residential schools on Aboriginal selfidentity
  • the important cultural norms of traditional Aboriginal society (including respect of elders, community consensus, etc.)
  • the impacts of racism, past and present
Health Status

  • differences in health status between Aboriginal Canadians and non-Aboriginals
  • current measures of health status (e.g. infant mortality rates) and their limitations
  • the social, political, and economic determinants of health (e.g. poverty, unemployment, poor housing, etc.), the strength of their impact on the health of Aboriginal peoples, and the reasons for their existence.
  • the specific conditions common to Aboriginal populations: e.g. community and personal mental health problems (substance abuse, family violence, child sexual abuse, suicide, depression), dental disease, infectious diseases including tuberculosis, non-insulin dependent diabetes, obesity, culture-bound syndromes, etc.
  • the reasons for the prevalence, incidence, and perpetuation of the conditions above (including genetic and acquired vulnerability); assessment and culturally appropriate management of these health problems
  • the connection between lack of control over one's life and poor self-esteem to poor health
  • the commonality of the issues facing various Aboriginal communities, and reasons for specific differences
  • the role of traditional Aboriginal medicine and spirituality in Aboriginal communities in the recovery of their health as a people (including an understanding of their need to heal mind, body and spirit, and hence the lack of effectiveness of Western medicine to "cure" them)
  • the global connections (ie. residents should develop some understanding of how Aboriginal Canadian health compares with the health status of Indigenous peoples
  • elsewhere in the world)
Delivery of Health Care

  • impact and role of high technology medicine in isolated communities (e.g. evacuation of women for childbirth, relocation for dialysis)
  • viable alternatives to high tech approaches that Aboriginal communities find unacceptable
  • political and economic approaches to Aboriginal health issues (e.g. management of health resources, "transfer of control" from federal government to Aboriginal communities)
  • what does transfer of health care to Aboriginal control mean practically, how can it be accomplished in the best interests of the people (ie. the community, the family, and the individual), and what are the problems of transfer
The Role of Health Care Providers

  • the importance and means of recognizing one's own cultural norms and values, in order to see another's
  • finding the balance between treating the symptoms and curing the disease (i.e. trying to have an effect on the roots of poor health)
  • awareness of the importance of the holistic approach, and the differences in perspectives and understanding this often entails (e.g. healing is very important in First Nations traditions, but is not the same as Western notions of "treatment")
  • the importance of working together with other health professionals (e.g. CHR's, nurses, mental health workers, Aboriginal medicine men/women), and how to do
    it effectively
  • the role of family and community as health care providers
  • the importance and means of demystifying professional practices for Aboriginal patients
  • strategies for culturally appropriate health promotion on a variety of issues (e.g. safe sex, prenatal care, nutrition, etc.)
  • the use of research for the benefit of the community: how to go about it, whom to consult, who develops the idea and has access to the results (community-based/ participatory research)
  • what is community development, and how should physicians be involved
  • means of encouraging Aboriginal Canadians to empower themselves to be a part of their own healing (individually and as a community), and ultimately take responsibility for it