Health Status of Aboriginal Women in Canada

The Health Statuses of the Aboriginal Communities in

Canada: Barriers and Solutions

Semaak Malik

WGS 101

Dr.Simalchik

Aboriginal Health

Why do Aboriginal people in Canada consistently have lower health statuses than the

Canadian population? The purpose of this essay is to: 1) illustrate the lower health

statuses of Aboriginal peoples and to examine the barriers that Aboriginal people,

particularly women, face in accessing health care services; 2) to critique the barriers and

understand why they are existent (explore the past); 3) to develop applicable policies

(governmental, provincial, social, health) and to implement solutions in order to

improve the health of the Aboriginal community.

Health Care Barriers

Why do Aboriginal populations in Canada consistently have lower health statuses than

the Canadian population? The first part of answering this question is by demonstrating

that through multiple studies, both qualitative and quantitative, the health status of the

Aboriginal population is lower than the general Canadian population due to a lower

socio-economic status (Lee, 2003). Socio-economic status is arguable the most

imperative determinant of health and thus is essential to consider in discussions of

health care. Income, education, employment are all constituents of socio-economic

status and therefore influence the health of an individual and population. Many studies

time and time again have shown a linear relationship between socio-economic status

and health, that is, a higher socio-economic status is linked with better health (Marmot,

2008). Perhaps the most influential determinant of health is income. A higher income is

linked to superior living conditions, a better quality diet as well as healthy lifestyle

activities like exercise and sports. Aboriginal people in Canada have lower income

levels than the general population (Native Women’s Association of Canada, 2004). This

trend is even more pronounced in Aboriginal women who earn $15,654 annually as

compared to non-Aboriginal women who earn $20,640 annually. Within Aboriginal

women, Metis women earned the most at $17,520 while Inuit and First Nations women

earned $16,599 and $14,490 respectively (Statistics Canada, 2006). Food costs are a

serious concern for Aboriginals on and off reserves. For example, a 5 lbs bag of potatoes

in Clyde River, Nunavut cost $7.49 compared to $2.49 in Ottawa, Ontario. A higher

proportion of Aboriginal women (30%) live below the low income cut-off (LICO) in

contrast to 16% of non-Aboriginal women (Statistics Canada, 2006). Education and

income are intricately linked and therefore both influence one another. Familial

upbringing and socioeconomic status are positively correlated with a person’s chance

on enrolling at an educational institution. According to a Statistics Canada (2006)

report, 20% of students belonging to a family with a net income of less than $25,000

attend university in contrast to 46% of students who come from a family with an

income in excess of $100,000. Therefore, it is imperative to analyze education attainment

in all Aboriginal groups. In a Statistics Canada (2006) report 4.6% of Inuit women, 9.4%

Metis and 8.4% of First Nations women possessed University degrees compared to

20.3% of non-Aboriginal women.

With respect to the location-allocation model, it is well known that large health clinics

and hospitals are built in large cities (Luginaah, 2009). That is, a hospital is more likely

to be built in a city like Toronto or Vancouver, as opposed to a rural area like Fort

Nelson. The point of this is to reduce cost and to serve the largest number of people.

This type of planning however does have its downsides. For one, people who live in

rural areas therefore do not have access to specialized clinics like cancer clinics or

hospitals that perform special surgeries like mastectomy. Moreover, it is unrealistic to

expect those living in such areas to travel hundreds and sometimes even thousands of

kilometers in order to receive treatment, and this can be incredibly troublesome

especially for those who have scheduled treatments and who need to access specialized

services more frequently. As Asanin and Wilson (2008) argue, there are namely 3 types

of barriers that people can potentially face in accessing health care services;

geographical, cultural and economic. Geographical barriers as discussed earlier relates

to the difficulty in accessing health care to transportation related issues. About 52 Inuit

communities living in Inuit Nunaant experience transportation related issues because

road access is limited due to weather (Halseth & Ryser, 2006). Furthermore, only a small

portion of these communities have nearby hospitals and access to medical specialists

like dentists, cardiologists and neurosurgeons is limited because such specialists rarely

visit these areas or practice medicine there (Halseth & Ryser, 2006). Additionally, even

Aboriginals living in urban centers, there are socio-economic factors like housing and

employment that dictate their health status. As Hwang (2001) notes, Aboriginal people

experience up to 10 times higher rates of homelessness as compared to non-Aboriginal

people. In the study conducted by Hwang (2001), he found that while Aboriginal

people constitute 0.4% of Toronto’s total population, they also comprise 5% of the

homeless population. This trend is even more evident in the city of Edmonton where

the population representation of Aboriginal people is 3.8%, within the homeless

population, they tantamount to 35% of those that are homeless (Hwang, 2001). Cultural

barriers relate to how a patient interacts with a health care provider and how that

interaction influences their health outcomes (in this case negatively). Health for the 3

Aboriginal groups is defined uniquely, however, all 3 groups share a similar notion of

how health is not just related to our bio-medical state, but rather the spiritual dimension

is just as important (Birch et al, 2009). Within major Canadian health centers, the type of

health care model used is very biomedical. This creates problems not just for Aboriginal

people but also for people that come from distinct cultural and traditional backgrounds

(like immigrants) (Asanin and Wilson, 2008). This is issue of culturally competent care

will be discussed afterwards in more detail. It is clear now that Aboriginal people

experience lower socio-economic statuses due to lower levels of income and education

which then negatively impact their health statuses (Adelson, 2005).

Explore the Past

The disparities in health statuses between the Aboriginal and Canadian population is in

fact an indicator of inequities in other dimensions (Adelson, 2005). These dimensions

(as discussed earlier) can be income, education as well as socio-political factors. First

and foremost, if there is an intention to study and understand the lower health statuses

of Aboriginal peoples, it is vital to look into the past. Aboriginal people have poorer

access to health care facilities and services and this is tied into the historical interaction

between the ancestral Aboriginal communities and the colonizers (Birch et al, 2009).

Furthermore, this trend has continued to persist where the nation state has dominated

the Canadian society. As Adelson (2005) argues, the colonizers imposed racist and

discriminatory policies that disrupted the lifestyle, institutions and systems of the

Aboriginal population. The most well-known example of institutional damage done to

the Aboriginal community is that of the residential schools. Residential schools were

built to assimilate young Aboriginals into the Canadian way of life (whatever that

meant!). Aboriginal children were taught English/French and the Christian religion in

these residential schools thereby distancing them from their familial religion and

language (Kistabish, 2009). Many scholars consider the enactment of these schools as

examples of cultural genocide (Sinclair, 2004). Such was the extent of the damage done

by such policies and institutions, that many Aboriginals even today suffer from the

negative effects. The psycho-social effects of the residential schools are clearly evident

even in the Aboriginal community of today (Adelson, 2005). Many Aboriginals who

were children in residential schools experienced physical and emotional abuse.

Startlingly, some of the most frequently reported aspects of residential schools that

negatively impacted the health of those attending include isolation from family (81.3%),

verbal or emotional abuse (79.3%) loss of cultural identity (76.8%) and physical abuse

(69.2%)(Wien & Reading, 2009). Furthermore, 43% of respondents claimed that since

their parent was a victim of residential schools they consequently experienced bad

parenting (Wien & Reading, 2009). The legacy of colonialism is discussed by scholars

through many dimensions. Due to the colonization, Aboriginal communities were

relocated into unknown lands and the creation of the reserve system came about. Those

living on reserves were and still are looked upon as the other since they represent the

‘primal people’. Such racist and discriminatory beliefs and attitudes still hold today in

the Canadian society where Aboriginal people are marginalized (Sinclair, 2004).

Surprisingly, the Canadian government only recently apologized for the responsibility

it held in managing residential schools and how they harmed Aboriginal peoples

(McMullin, 2010). Furthermore, for Aboriginals living on reserves, the resources that are

available to them such as those relating to education and health are limited in

comparison to mainstream society. Reserve residences are also known to be of less

quality as compared to those in urban areas. For Aboriginal dwellings on reserves

33.6% needed major repairs while for Canadian dwellings the need for major repairs

was 7.5%. From an intersectional approach one finds differences between First Nations,

Inuits and Metis. According to a Statistics Canada report 28% of Inuit, 14% Metis and

28% of First Nations people live in a dwelling needing major repairs compared to 7% of

Canadian dwellings (Wien & Reading, 2009). Women have historically and traditionally

held a central position in Aboriginal communities. However, post colonization and

polices that came about henceforth, such as the Indian Act, led to the evolution of a

patriarchal system (UBC, 2009). Specifically, the Indian Act was sexist and particularly

discriminative towards women. Under the Indian Act, women were denied many

fundamental rights such as the loss of her status if she married a non-Aboriginal man

(Non Aboriginal or non-status). Moreover, if an Aboriginal woman belonging to a

particular community married a man from another community, she would be then

considered as belonging to the community of her husband and in a way lose her own

identity (UBC, 2009).

Canada is a country with a low fertility rate and depends upon immigration for

population replenishment (Hiebert, 2006). Interestingly, the fertility rates for Aboriginal

women (2.6) are significantly higher than that of non-Aboriginal women (1.5). Within

Aboriginal groups, Inuit women have the highest fertility rate (3.4) followed by First

Nations (2.9) and Metis (2.2) (Statistics Canada, 2006). That is to say, the Aboriginal

population is increasingly quite steadily (20.1%) from 2006 to 2011 as the National

Household Survey (2011) suggests. However, the burden on Aboriginal women to

provide for their families especially if they are single mothers is augmenting as well due

to lower levels of income and higher unemployment rates. Furthermore, due to

historical as well as present discrimination, Aboriginal women experience poorer

mental and physical health as well as higher occurrences of drug use and domestic

violence (Johnson, 2006). Rates of spousal violence are also higher for Aboriginal

women in common-law relationships or marriages (15.6%) compared to 6% for non-

Aboriginal women. Sadly, according to a recent Statistics Canada (2006) report 48% of

Aboriginal women who were victims of spousal violence claim that they were sexually

assaulted, threatened with weapons (such as a knife), beaten and even choked.

Continuing on with regards to violence against Aboriginal women, it is now known

that there have been severe cases of abduction, sexual assault as well as disappearances

of Aboriginal women in Canada. Statistics Canada (2006) reveals that between the year

1997 and 2000, the rate of homicide for Aboriginal women compared to non-Aboriginal

women is 7 times higher (5.4% for Aboriginal women vs. 0.8% non-Aboriginal women).

All these problems experienced by the Aboriginal populations such as domestic

violence, sexual assault, missing persons as well as marginalization from mainstream

society is, as scholars argue, linked to the history of colonization and discrimination.

Solutions

Aboriginal people in Canada have a lower life expectancy and experience a

disproportionate share of mental and physical illnesses than the general Canadian

population (MacMillan et al, 1996). So the question arises: what can be done at the

individual and systemic levels in order to solve this unacceptable crisis? The concept of

health and how it relates to Aboriginal traditions, cultures and practices is immensely

important to comprehend if policies are to be set in place that aim to better the health of

the Aboriginal community of Canada. A poll conducted by the National Aboriginal

Health Organization (NAHO) found that 15% of respondents believed that Aboriginal

people are treated unfairly or inappropriately by health care workers simply because

they are Aboriginal (NAHO, 2004). Birch et al. (2009) argue for the development of

culturally competent health care services. By this, they mean that health care providers

such as nurses, physicians and midwives should acknowledge the intricate diversity of

people belonging to unique cultural and religious backgrounds and they should make

available health services that promote respect and acceptance (Dobbelsteyn, 2006). Birch

et al. (2009) focused on pregnant Aboriginal women and their experience with the

health care system pre and post birth. According to a NAHO study (2006), 93% of

Aboriginal women gave birth in a hospital setting. Furthermore, the feelings, practices,

beliefs of the Aboriginal community before and after childbirth is rarely understood

and therefore not respected in modern hospital settings (Birch et al, 2009). For

Aboriginal people, the relationship between the mother and child is existent before

birth and cannot be merely understood in the physical sense, rather the spiritual and

holistic spheres are just as crucial. Physicians should be trained to accommodate for

cultural and tradition beliefs so that they can provide health care that the patient

actually regards as ‘care’ (Asanin and Wilson, 2008). Care that is culturally competent

refers to care that addresses the cultural, traditional and religious beliefs and practices

that a particular person or group desires. Birch et al. (2009) discuss how in certain

Aboriginal families, it is a common practice for the grandmother to hold the baby first

and how this act is often misunderstood or overlooked by many health practitioners

such as nurses and physicians. Health care settings should be accommodative of people

from all cultures and traditions in order to deliver culturally competent care.

A series of interviews conducted by Wilson (2005) reveal that Aboriginal people view

the state of their health in reference to their relationship with Mother Nature. Wilson

(2005) conducted a series of interviews of Anishinabek men and women and how their

bond to the natural world is quite unique and beneficial for the discourse in gender

studies. Many eco-feminists regard the linking between women and nature as a

patriarchal idea. They rest this assumption upon the notion that people associate nature

as a passive thing that can be controlled or manipulated just like sexist ideals of

patriarchy. However, as Wilson (2005) argues this is not the way Anishinabek people

view nature. Instead, for the Anishinabek community, nature is not passive but rather

active and the relationship between nature and humans in not just limited to women,

but rather men have an equally intimate relationship. Such discourse of gender

relations is essential in order for Aboriginal/non-Aboriginal men and women to

understand how patriarchy is harmful and most importantly not prevalent in such

communities. Furthermore, this is linked to how medicine is practiced in most health

care settings. Within a bio-medical framework which is predominantly used in

hospitals and clinics, the presumption is that the patient is passive and that doctors are

the ones playing the active role. This can be compared to how some people disregard

the value of nature and consider it passive as well. Perhaps, since Aboriginal

perspectives on health encompass the community and environment, these views will be

of great benefit to creating health care models that provide better care for physicians.

Wadden (2014) discusses remarkable women who themselves are Aboriginal and have

spent their lives improving the conditions of the Aboriginal community in Canada. Dr.

Cornelia Wieman who is Canada’s first Aboriginal psychiatrist and the co-director of

the Indigenous Health Research Development Program exemplifies excellence. She

wholeheartedly believes in helping her fellow Aboriginals, especially those that are

young. Sadly, as Dr. Wieman points out, she was given educational opportunities

similar to non-Aboriginal children and that many of her fellow community members on

reserves possess the same potential yet are not given the chance to showcase it. After

her mother passed away due to alcohol related illness, she was adopted by a Dutch

family living in Thunder Bay. This story shows how discrimination and social barriers

to education and wellbeing can disrupt those who can potentially be amongst the best

Canadians. There are without doubt many Aboriginal children on reserves who can, not

just make Canada, but the world a better place, if only they had the opportunity. This

point is stated by Dr. Wieman quite eloquently when she says “We have been given

certain gifts…, to make things better for our young people especially…I would like to

be part of the solution (Burton, p.112).” Another woman who demonstrates agency in

the face of adversity is Mary Sillett. Mary Sillett happens to be the first Inuit woman to

receive a university degree. Similar to Dr. Wieman, Mary Sillett advocates for special

care of Aboriginal youth so that the future of the Aboriginal community can become

safeguarded. Moreover, the focus of Mary Sillett’s work is in the community of

Hopedale where she aims to ensure that all Aboriginal children receive excellent

education.

Without doubt, as the central theme of this paper suggests, the improvement of an

individual or more broadly a community depends enormously to how the individual or

community functions in dimensions of income, education and socio-political power.

Therefore the health status improvement of the Aboriginal people can only be achieved

through the betterment of their education, employment and representation in Canadian

political and social spheres. Such is the road ahead, as Adelson (2005) argues for.

Education, income and socio-political power fall outside the domain of what we regard

as health, yet there influence on health is irrefutable (Adelson, 2005). The National

Aboriginal Health Organization (NAHO) has played a central role in highlighting the

troubles that the Aboriginal community faces. Furthermore, specialized organizations

such as the National Native Alcohol and Drug Abuse Program are focused upon

treating particular issues faced by the Aboriginal community. Funding these

organizations and many other that are focused upon improving the health statuses of

Aboriginals should be a priority (Adelson, 2005). Clearly, governmental policies should

be set in place that emphasizes the education of the Aboriginal community. Racism and

discrimination in employment should be eradicated so that Aboriginal people in

Canada have equal chances at finding work. Hospitals and specialized clinics should be

allocated to areas where Aboriginal people reside so that their health does not suffer

(NCCAH, 2011). Conclusively, the emphasis of policies should not focus solely on

health, but rather on other social determinants such as education, income, employment,

appropriate care and most importantly socio-political recognition and empowerment.

All in all, the purpose of this essay was to showcase the many troubles faced by the

Aboriginal community and in particular women, such as higher rates of

unemployment, lower levels of education and income and how these compound to

result in a lower health status. Additionally, the purpose of this essay was to also

propose solutions at the individual and community levels as well as in the dimension of

health care deliverance. Programs such as those run by the National Aboriginal Health

Organization should be supported greatly by the government. Furthermore, the way in

which hospitals and clinics provide medical services should be revised as to become

more sensitive and accommodative for people of diverse backgrounds. Culturally

appropriate (competent) care should be implemented within the healthcare system. All

of these solutions will hopefully result in the betterment of the wellbeing of the

Aboriginal community in all spheres of life and therefore make Canada a much better

place.

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Semaak Malik

999206185

WGS101

Dr. Simalchik