Post-colonial impact on indigenous health

Background

The indigenous health is inter-connected to the effects of post-colonialism in various dimensions of health. The modern indigenous health is impacted by the colonial history in Canada by a significant degree. It is majorly affected by the cross-generational effects of the residential schools and the Indian Act that was enacted in 1876. There has been a number of cases of hostility experienced in healthcare settings that discriminated against the indigenous populations. The indigenous population is over-represented in many diseases and illnesses that targets the marginalized populations such as the substance use disorder, mental illness, and HIV.

Effect of Residential school on Health

The last Residential school was shut down in 1996 after the first one opened in 1831, and after 165 years of affecting multiple generations of children in forced assimilation to non-indigenous cultures, the trauma experienced by the residential school victims is carried over to the next generation by the perpetuated cycles of trauma carry-overs. The intergenerational trauma is carried over, and the child's health outcomes heavily depends on the pregnant mother's mental health.

Substance use Disorder

Substance use disorder is not only prevalent in North America, but in other countries that also possess a colonial history in the world. Drug addiction and substance use disorders, as well as other health risk behaviours and diseases, have been linked to trauma in childhood as shown in Adverse Childhood Experiences (ACE) study.

Mental illness

While the Canadian average is around 4% of females and 2% of males reporting they’ve attempted suicide, in the Aboriginal survey, it was 19% of females and 13% of males.

HIV

HIV is a blood-born virus that is transmitted through sex or blood to blood contacts. While the HIV prevalence rate has significantly decreased in Canada, the indigenous population is over-represented in the HIV transmission rate. Indigenous people are 2.7 times more likely to get HIV compared to non-indigenous peoples in Canada. For HIV transmission among Indigenous people, Injection drug use is a significant risk factor. This relates back to the substance use disorder and drug addiction that's linked to the traumatic experiences caused by the effects of residential schools. The new HIV transmission rate for women is 3.3 per 100,000 and 11.2 per 100,00 for male in data that has not been stratified for the indigenous status. 36% of the new HIV infections were identified as aboriginal and 21% identified as white. It is important to note that this is a significant overrepresentation of indigenous women in the new HIV infection cases as the percentage of indigenous people in the Canadian population is only 4.3%.

Policy

There are World Health Organization's guidelines and Public Health Agency of Canada guidelines to target illness and health issues impact Indigenous population specifically, but due to the hostility in the society, the engagement to healthcare is still a difficult challenge for the public health authorities. Policies in Canada sometimes work agains to mitigate worsening the mental illnesses for indigenous population. Especially for indigenous women who have been victimized by domestic violence or intimate partner violence, the law and policies doesn't protect the victims well enough for the majority of the cases. There was one case in Alberta in 2015 where a women of a violent sexual abuse case was kept in jail during a preliminary hearing, and had to face her attacker in court again. This is an obvious thing to avoid from a healthcare provider's point of view, but the victim's mental health condition was neglected in this case.

Access to Healthcare

On reserves that are distant to the major health centres with specialized doctors, laboratories, or clinics, the access to healthcare could be limited for certain indigenous populations. For Indigenous people in certain provinces with complicated healthcare insurance and medical service plans that requires complex application process and deductibles, obtaining access to basic healthcare can be challenging as well.

Case 1

Due to the stereotypes believed by some healthcare providers in certain regions, there are challenges to get full access to healthcare and genuine consultation for the indigenous populations. There was a case in Ontario in 2010 where a First Nations man was seeking medical help at a nursing station, but his symptoms of shortness of breath was reported to police for "erratic behaviour." This First Nations man was killed while being tackled and arrested by two police officers. He died from chest compressions while being surrounded by a doctor and several nurses who did not take any actions to stop the police officers from the unnecessary force nor to provide medical support. None of the by-standing healthcare providers nor the police officers were found at fault or guilty by the jury.

Gender gap in Indigenous Health

Higher rates of suicide attempts, higher rates of mental illness. There are papers that show less adherence to treatment level for females living with HIV than male in all Canadian population, but in indigenous population, the effect is amplified. The adherence to treatment for women who are non-indigenous is about 10% higher than indigenous women. The percentage patients who are adherent to the treatment for non-indigenous men and non-indigenous women are 83.8% and 69.9% respectively. When the indigenous status is taken into account, the 2017 research paper shows that the percentage of treatment-adhering indigenous women is 59.5%, a significant drop in comparison to non-indigenous women and an even bigger gap from non-indigenous men.