Aboriginal Peoples and the Canadian Healthcare System

“I got my degree in physiology, but I didn’t want to do research for the rest of my life, so I went into nursing, because I thought nurses are the point of entry into the healthcare system,” says Rhonda Goodtrack, an advisor to Aboriginal students at the Native Access Program to Nursing and Medicine at the University of Saskatchewan. “So I applied, got in, went through the four years, got my degree and went to work in public health right out of nursing school.”

Goodtrack grew up in southern Saskatchewan in the Wood Mountain First Nation community. As an Aboriginal registered nurse, she is among the few. Despite the progressive and accessible nature of the Canadian healthcare system, many Aboriginal peoples have extraneous barriers impeding their access to careers as nurses and doctors.  These include cultural barriers, geographic isolation, and federal and provincial jurisdictional disputes.

Those who have succeeded in overcoming the challenges faced by Aboriginal health professionals are giving back to their communities by creating and participating in a number of organizations and associations. They aim to bridge the gap that has been created through tense relations between First Nations in Canada and the various levels of government.

The Aboriginal Nurses Association of Canada (ANAC), for whom Goodtrack is the Director of Education, Treasurer, and Secretary, was initially formed by two nurses: Jocelyn Bruyere and Jean Goodwill.  These two pioneering healthcare workers strived to identify and contact other nurses of Aboriginal descent in 1973, with the intention of pooling the skills and cultural heritages of Aboriginal nurses to improve the appalling health conditions faced on the First Nations reserves of Canada.

Goodtrack says she was lucky to be supported in her bid to attend university.  “The community I was from was slowly dying away because people were moving on, like going into the city and the birthrate was really low,” she explains.  “My mom and dad knew that there would be no real economic development in our area so they really pushed me to pursue my post-secondary education and finish my schooling.  They wanted us to be self-sufficient.”

There are extreme health disparities between the First Nations, Inuit, and Métis peoples, and the general Canadian population.  Among Aboriginal peoples, there are high rates of mental illness, alcoholism, fetal alcohol syndrome, domestic violence, diabetes, tuberculosis, sexually transmitted diseases, obesity, and hypertension. Relative to the general Canadian population, the life expectancy of Aboriginal peoples is 7.4 and 5.2 years shorter for males and females, respectively.

Suicide rates are five to seven times higher for Aboriginal youth than the national average, and suicide is also one of the greatest causes of injury-related deaths. Infectious diseases impact Aboriginal peoples at rates two to seven times higher, depending on the disease, than the overall Canadian population. Extensive research has been conducted into the intergenerational effects of trauma endured by the First Nations of Canada, but no consensus has been drawn, other than the obvious: the poor health of Canadian Aboriginal peoples is a complicated interplay of multiple factors.

Canada has the second largest proportion of indigenous peoples of any country in the world, with over 1 million people, representing almost 4% of the Canadian population. There are over 600 distinctive First Nations communities, each with their own culture, language, arts, and music. Almost half of the Aboriginal peoples are distributed in major centers, living amongst the general population of Canada, while others live in rural communities and on reserves.

A partnership between the Association of Faculties of Medicine of Canada and the Indigenous Physicians Association of Canada through a broad consultation process has produced the set of First Nations, Inuit, and Métis Health Core Competencies meant to combat healthcare issues in Aboriginal communities. Barbie Shore, a project manager on this initiative with the Association of Faculties of Medicine of Canada explains that the purpose of this framework for undergraduate medical education is to ensure all the physicians are well-trained.

“They must be able to provide culturally safe care with indigenous patients, their families, and communities,” says Shore.  There are seven core competencies with associated enabling objectives. “The competencies are what you are teaching to.  For example, to describe what culturally safe care is for First Nations, Inuit, and Métis peoples, the students have to have had some experience or training in order for them to be able to do that.”

To facilitate the implementation of this curriculum, there is a working group with representatives and educators from each of the schools, as well as the community partners who are working with them. “At the national level they look at how to implement those competencies and again there is very good work at quite a number of schools,” explains Shore.  “Others are just getting started.”

North America - Canada