The field of Indigenous health policy is a relatively novel branch of Canadian healthcare. It is constantly evolving; advancements are made every day. In order to remain up to date within the field, one must understand health and healthcare, the diversity within the population, chronic diseases, various approaches to health issues, current events, and future considerations, all while maintaining a well-developed network of interdisciplinary colleagues and resources. This skills and concepts contribute to becoming a health policy maker that creates equity in Indigenous healthcare. The Critical Foundations in Health Disciplines course has effectively illustrated these concepts and their applications to healthcare, facilitating my journey into health policy.
To begin, in order to make proper advancements, it is essential to understand the role of health policy within the Canadian health system. Policy makers and analysts, especially in Indigenous health, work closely with federal and provincial governing bodies such as Health Canada, Ontario Health, Public Health Ontario, Chiefs of Ontario, as well as Anishinabek Nation. Money is a large factor in policy making, and Indigenous communities receive funding annually, while Indigenous individuals are allocated Non-Insured Health Benefits (NIHB) as health care coverage (Government of Canada 2023). With the understanding of my place within the Canadian health system, I then proceeded to analyzing the definition of health and social determinants of health.
The definition of health is a concept that can be individualized and personal to many. While the World Health Organization offers a generalized definition, it has been viewed to be exclusive of those with disabilities and chronic illnesses (Van Druten et al. 2022). A more widely accepted definition of health is a person who is able “to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment” (Government of Canada 2008). The focus should be centered on adaptability when creating health policy, especially considering Indigenous communities, as they often “experience poorer health and greater health inequities on many indicators compared with the rest of the province” (Health Equity Ontario 2018).
Health indicators are also known as social determinants of health, and they encapsulate “the broad range of personal, social, economic, and environmental factors that determine individual and population health” (Government of Canada 2023). Unmet social determinants of health put people at a greater risk of developing chronic illnesses and having a lower quality of life. Indigenous peoples experience determinants that are specific to the lasting effects of colonialism (Greenwood et al. 2015). Canadian legislature is riddled with systemic colonial implications, which is why health policy must be rooted in decolonisation and reconciliation.
Modernizing the Canada Health Act is necessary and certainly should be considered by each and every healthcare professional. The Canada Health Act was brought into legislature in 1984 but has not been modified since (Flood & Thomas 2016). It required that each Canadian receives coverage for any health service deemed medically necessary, however the current scope of medically necessary practices is definitively not broad enough. Within the Indigenous health policy, there is a severe lack of equitable healthcare for rural and isolated Indigenous communities across Northern Ontario. Community members are often unable to afford travel costs and miss their appointments as a result, leading to chronic disease and severe health complications. Modernizing the Canada Health Act to ensure coverage for travel costs would fulfill the primary objective of Canadian health policy, which is “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers” (Government of Canada 1985). This change would be a positive step towards reconciliation, which is the most important aspect of working with Indigenous communities.
In addition, health policy encapsulates the surveillance and management of chronic disease. Within Indigenous populations, Type 2 Diabetes is the most prevalent chronic condition within the Indigenous population of Canada (Dyck et al. 2010). Indigenous health policy is therefore largely focused on diminishing the epidemic. The first steps in doing so are research and surveillance; policy makers must understand the epidemic from all aspects. Government funding collaboratives such as the Aboriginal Diabetes Initiative focus on community involvement, education, and screening services (Government of Canada 2021). This initiative in partnership with Indigenous communities and provides a great base for the creation and implementation of policy.
Approaching public health issues through multi-level processes is a very useful methodology that requires a multidisciplinary perspective, notably that of policy makers. Within the context of the Diabetes epidemic within Indigenous communities, it is evident that a multi-faceted approach is necessary. Throughout a portion of this course, I closely studied the Health Impact in 5 Years, or Hi-5 (CDC 2021) approach to health issues. This approach is based upon Frieden’s Health Impact Pyramid which delineates approaching an issue beginning with the largest population and closing in onto individual education and assessment (Frieden 2010). These multi-level concepts combine social determinants of health, public policy, and cultural understanding, creating a comprehensive and effective method to confronting public health issues. Studying this methodology provided incredibly useful insight and knowledge that can certainly be applied to my work in Indigenous health policy.
In healthcare, the future must always be considered. Within the scope of Indigenous health policy, the future is focused on Truth and Reconciliation. Creating policy centered upon cultural safety will ensure that respect for each individual through creating environments that actively fight against racism and discrimination (Northern Health Indigenous Health 2023). Striving to encourage individuals to take pride in their identity and culture within their healthcare will create culturally safe policy. The future involves culturally safe and ethical health policy, and I believe that incorporating Indigenous teachings will lead to a healthcare environment reflective of Truth and Reconciliation.
Over the course of the Critical Foundations in Health Disciplines class, concepts that were continuously focused upon were those of interdisciplinary networking and the curation of resources. Throughout each unit, discussions were facilitated amongst colleagues, each bringing perspectives from various fields in healthcare. These discussions, coupled with the creation of a professional ePortfolio have most certainly provided me with valuable networking skills as well as interdisciplinary perspectives. Additionally, the knowledge that I have synthesized throughout this blog post comes from the continual development of my resource curation skills over the course of this semester. These skills are highly transferrable to any career and will stay with me for the remainder of my academic and professional lives.
To conclude, the Critical Foundations in Health Disciplines course certainly lives up to its name. Over the past three months, I can definitively say that I have obtained an understanding of the critical foundations of working within the health disciplines. This course has made me analyze all aspects of healthcare, from the legislative to the clinical applications, all while considering my career in Indigenous health policy. It has provided me with a deeper understanding of the Canadian health system, as well as the intricacies involving interdisciplinary work. Critical Foundations in Health Disciplines was the perfect introduction to the Master of Health Studies, and I will forever carry the knowledge gained from this course along my journey.
References
CDC. (2021). HI-5: Health Impact In 5 Years. https://www.cdc.gov/policy/hi5/docs/hi5-overview-v6.pdf
Frieden, T. (2010). A framework for public health action: the health impact pyramid. Am J Public Health. 100(4): 590-5 https://doi.org/10.2105/AJPH.2009.185652
Flood, C.M., & Thomas, B. (2016). Modernizing the Canada Health Act. Dalhousie Law Journal, 39(2), 397-411 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2907029
Government of Canada. (2023). Indigenous health care in Canada. https://www.sac-isc.gc.ca/eng/1626810177053/1626810219482
Government of Canada. (2023). Social determinants of health and health inequities. Retrieved 12 October 2023 from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Government of Canada. (2021). Diabetes. Retrieved from https://www.sac-isc.gc.ca/eng/1569960595332/1569960634063
Government of Canada. (2008). What is health? Retrieved 4 October 2023 from https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health-approach/what-is-health.html
Government of Canada. (1985). Canada Health Act R.S.C., c. C-6. Retrieved 2 October 2023 from https://laws-lois.justice.gc.ca/eng/acts/C-6/page-2.html#docCont
Health Equity Ontario. (2018). Northern Ontario Health Equity Strategy. https://www.hqontario.ca/Portals/0/documents/health-quality/health-equity-strategy-report-en.pdf
Kennedy, T. (n.d.). Ka-Bzindaadmin (Voice to Voice) [Image]. Retrieved 5 December 2023 from https://www.lhsc.on.ca/patients-visitors/indigenous-health-and-wellness
Northern Health Indigenous Health. (2023). Cultural Safety. Retrieved 25 November 2023 from https://www.indigenoushealthnh.ca/cultural-safety#cultural-safety#cultural-competence#cultural-sensitivity#cultural-awareness#cultural-humility
Van Druten, V., Bartels, E., Van de Mheen, D., De Vries, E., Kerckhoffs, A., & Nahar-van Venrooij, L. (2022). Concepts of health in different contexts: a scoping review. BMC Health Services Research, 22(389) https://doi.org/10.1186/s12913-022-07702-2
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