Indigenous Health | Family Medicine | School of Medicine

There are perhaps fifty million Indigenous people in North and South America, almost everywhere dispossessed, poor and powerless either today or in the past. In the past they refused to die; today they will not be assimilated or ignored.

In Canada in 2001 there were approximately 976,310 Indigenous people living in Canada, about half of whom live on reserves and half off (Statistics Canada 2001). This population includes First Nations, Inuit and Metis, whose relative proportions are shown in Chart 1. By many standards, life for Indigenous Canadians is much more difficult than for non-Indigenous. They are younger (Fig 2.2 from Health Canada, Statistical Profile of the Health of First Nations, 2001), more likely to live in rural or remote parts of the country (although many live in urban areas as well) and less likely to enjoy many of the privileges and amenities the majority of Canadians take for granted. In 1986 forty five percent of ‘Status Indians’ were without any high school education (compared with seventeen percent for Canada as a whole) (4) . A federal 1984 study of housing documented that forty seven percent of housing were inadequate; thirty eight percent lacked one or more of the following basic amenities: running water, indoor toilet and bath or shower, and thirty six percent were overcrowded (compared with less than three percent for Canada). (5) Twenty years later, little has changed. The preliminary results of the First Nations Regional Longitudinal Health Survey, the first major survey of the health of Indigenous Canadians by an Indigenously controlled organization (NAHO) found that 32% of Indigenous Canadians participating rated their water supply as unsafe, 24.6% reported overcrowded living conditions (vs 1% of the general population) and 32.9% were living in housing requiring major repairs (vs 8.2% of the general population)(NAHO 2004).

Health indices all clearly indicate that Indigenous Canadians are not as well as other Canadians (although many of these are likely inaccurate given the lack of a uniform and standard process for collecting and linking data on ethnic group status to the health information databases generally used for generating these statistics). In 2000 status First Nations men had a life expectancy 7.4 years shorter and women 5.4 years shorter than other Canadians (Health Canada, 2001). Indigenous Canadians have a higher incidence of such infectious diseases as gastroenteritis, tuberculosis, diptheria, pertussis, rheumatic fever, respiratory problems, STIs, and infectious hepatitis, many of which are preventable (Health Canada, 2001). Chronic diseases are also becoming an increasing problem with an epidemic of diabetes (3-4 times the national average), obesity (up to 90-95% of people over the age of 50 in some studies), metabolic syndrome and the subsequent cardiovascular (2-3 times higher) and renal complications of these diseases hitting many Indigenous people and communities with devastating results (Howard et al 1999, Shaw et al 2000, Young et al 2000, Ananad et al 2001, Green 2003, Tonelli et al 2004). Even more concerning than the prevalence of infectious and chronic diseases are the problems of intentional and unintentional injury, which are the number one causes of potential years of life lost for Indigenous people in Canada (Figure 3.8 from Health Canada, 2001).

This category includes a number of sub-categories, including motor vehicle accidents, fire and flames, drownings and suicides, all of which are major contributors. It is the number one cause of death for all age groups under 45, with all of the 3 top causes of death in these age groups being sub-categories of injury (Health Canada, 2001). The young ages of the victims is a major factor in its major contribution to the potential years of life lost. Within the general category of injury, that of suicide warrants particular attention. It results in more potential years of life lost than all cancers, and over 50% more than all circulatory diseases. Rates of suicide overall are about twice the national average, but in the younger age groups they are much higher (in the neighbourhood of 4-5 times the national average for 25-39 year olds and 5-8 times for those 15-24)(Health Canada, 2001). Social, cultural, economic and environmental influences are all important in this area, with some communities being relatively unaffected, while others experience rates of suicide up to 50X higher than the national average (Health Canada, 2001, Chandler and Lalonde, 1998).

Thus, there are many significant health and social issues facing Indigenous communities and their health care providers. Physicians interested in serving Indigenous populations need to be better prepared; not only should they be clinically competent, but also culturally safe and politically aware of the variety of issues that impact on the health of Canada's Indigenous peoples.

While Queen's University has trained health science students in Indigenous contexts for some time, (in particular through the Queen's University Weeneebayko program in Moose Factory), this optional third year of training for physicians in Indigenous Health is unique. The resident will have the opportunity to explore the historical roots of the health issues facing Indigenous communities as well as participate in the delivery of care in different Indigenous settings in Canada today. The potential benefits of this third year program are many. Firstly, family physicians who are specially trained in Indigenous health issues will be better prepared to serve Indigenous communities and provide more culturally sensitive care. Secondly, the existence of a unique program devoted to Indigenous Health will provide enhanced educational opportunities in crosscultural medicine for both the core two year residency program in Family Medicine as well as the undergraduate medical curriculum. The sensitization of all physicians to the broad social determinants of health should be a recognized educational objective. The knowledge base and skills developed in working with Indigenous people will be of use to physicians practicing in many areas of Canada among people of different cultures than themselves.

The following pages describe the objectives and curriculum of this unique enhanced skills program in Indigenous Health. One of the principle objectives of this program is to increase the number of well-trained and culturally attuned family physicians available and interested in establishing practices in Indigenous communities. Through this additional postgraduate education, residents will contribute their clinical expertise to communities in which they choose to do their clinical placements. Thus, commitment to Indigenous Canadians as well as resident educational needs, is a focus of the program. In summary, it is hoped that this document will stimulate thought and dialogue about Indigenous health issues and the appropriate education of physicians to deal with these issues.