GRSJ224/Colonial Impact On Indigenous Healthcare and Substance Abuse

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Overview

Colonization and the desire of the Canadian government to assimilate the Indigenous population of Canada into Euro-Canadian society has led to wide ranging negative impacts on all aspects of Indigenous livelihood including health, culture, socioeconomic status, and addiction. Many of the challenges that Indigenous people currently face in their day to day lives can be traced back to the tragic consequences of colonial institutions such as the resident school system and racial discrimination.[1] Canada’s residential school system can thus be examined as an example of how colonial institutions rooted in systemic racial discrimination continue to negatively impact the health of Indigenous persons in a post-colonial context. Racial discrimination within Canadian healthcare established through colonial histories, federal laws and regulations is responsible for the systematic discreditation of Indigenous knowledge and practices—a colonial tactic of cultural genocide which remains in practice to-date.

Although the Canadian government has tried to reconcile many of these issues over the recent years, there still remains large discrepancies in the health care, social, and economic support provided for Indigenous communities. Some recent surveys that highlight the severity of the issues facing Indigenous individuals include 75% feeling alcohol use a problem in their community and 25% saying they have a personal alcohol problem.[2] Indigenous suicide rates are 3 times higher than the general Canadian population.[3]

The Indian Act and Reserve System

In 1876, the Indian Act law was passed, which allowed government control and regulation of Indigenous way of life, Indian Status, land, resources, education, and performance of religious and cultural practices.[4] With the legal power of this act, The Canadian government relocated Indigenous people to reserves without their consent. These were federal lands that were often less valuable and desirable due to poor soil conditions that were unsuitable for farming.[4] Limitations were placed on their traditional fishing and hunting economies and it became illegal for them to use traditional means of resource distribution in their communities.[4]

Impact of Reserves on Health

Many Indigenous people continue to live on small reserves controlled by the government. Reserve communities have unusually high rates of substance abuse, suicide, unemployment, poverty, and mortality. They have been described as "Third World Conditions" due to a lack of clean drinking water and access to adequate housing.[5] There are currently more than 100 drinking water advisories issued for Indigenous communities in Canada.[6] Not having access to clean water is a human rights violation and the health of these communities is at risk due to potential exposure to chemical contaminants and waterborne diseases.

Houses infected with mold lead to pulmonary infections like tuberculosis. Families are forced to live with extended family when homes are condemned due to mold infestation. Overcrowding contributes to the spread of tuberculosis, which is 20 times higher among the Indigenous compared to the rest of the country.[7]  Reserves located in extreme weather conditions and remote areas further exacerbate this problem. This housing crisis contributes to respiratory infections, chronic illnesses, increased rates of learning disabilities, and suicide attempts among the youth. Overcrowding and inadequate housing has been found to be associated with increased stress levels, particularly in women.[7]

Residential School System

In 1883, Prime Minister John A. Macdonald authorized the creation of residential schools, where Indigenous children were systematically removed from their families and prohibited from speaking their language and practicing cultural customs in an attempt to assimilate them into Euro-Canadian culture.[8] The purpose of the residential schools was stated bluntly by the head of the Department of Indian affairs Duncan Campbell Scott.[9] 

“I want to get rid of the Indian problem. I do not think as a matter of fact, that the country ought to continuously protect a class of people who are able to stand alone… Our objective is to continue until there is not a single Indian in Canada that has not been absorbed into the body politic and there is no Indian question, and no Indian Department, that is the whole object of this Bill.”
St. Paul's Residential School, Middlechurch, Manitoba

Over the next several decades the number of residential schools expanded throughout the country and in 1920 the Canadian government made it mandatory for all Indigenous children aged 7-16 to attend residential schools. There were some critics of the residential school system such as Dr. Peter Henderson Bryce who published an article called “A National Crime” in 1922 that detailed the unusually high death rates of students in residential schools. Despite pushback from individuals like Dr. Bryce, residential school expansion continued through subsequent decades. Approximately 150,000 Indigenous youth attended residential schools across several generations.[10]

In order to reduce the sphere of influence of their heritage culture, the residential schools were strategically located far away from Indigenous communities. The schools were extremely underfunded with poor healthcare, nutrition, and sanitation.[11] These dire conditions were a major contributor to the spread of diseases like influenza and tuberculosis as mortality rates of students ranged from 11-50%. The residential school curriculum encouraged students to shed their heritage and identities. They were punished for talking in their native language and encouraged to abandon their culture.[12]

In 2008, Prime Minister Stephen Harper formally apologized to former students and their families for the operation of residential schools.[13] However, the intergenerational trauma from colonial institutions such as the residential school system continues to affect the health and well being of Indigenous Canadians today.

Nutritional Experimentation and Abuse

Canadian government scientists unethically conducted nutritional experiments on Indigenous children against their will between 1942-52.[14] Under the façade of providing nutritional meals, they conducted scientific studies even after it was determined that they were harmful.[15] The Canadian residential school system provided scientists with a vast pool of test subjects due to the widespread malnutrition of Indigenous children.[16] The experiments done on the children were used to develop Pablum infant cereal by Dr. Percy Moore (Indian Affairs Medical Services) and Dr. Frederick Tisdall (President of Canadian Pediatric Society).[17]

The residential school system subjected Indigenous children to a vast array of abuse. Students were punished for not following school regulations by whippings, humiliation, isolation, and confinement in abandoned areas and boiler rooms.[18] In 1928, the Alberta government passed the Sexual Sterilization Act. Girls in residential schools were involuntarily sterilized based on the judgement of the principal. There's documentation of 3500 Indigenous girls being mutilated using forced sterilization. This law was also passed in B.C. five years later.[19]

Mental Health

The residential school system exposed Indigenous children to verbal, psychological, physical, and sexual abuse.[20] Studies have shown that children separated from their families are highly vulnerable to developing mental disorders such as anxiety and depression.[21] Additional studies have shown that severe family stress can cause brain abnormalities and dysfunction later in life. Cultural pride and identity are a significant part of Indigenous communities and the colonization and forced integration of Indigenous individuals is considered the primary root cause of high levels of emotional and mental distress.[22]

Childhood abuse stemming from the experiences of Indigenous children in the residential school system has been associated with lifelong psychological damage and in some cases increased rates of suicide attempts.[23] The last remaining residential school in Canada was closed in 1996, but the devastating aftermath continues to this day through intergenerational trauma as many parents who attended these schools are unable to provide a safe and healthy environment for their children.[24]

Socioeconomic Impact

The majority of Indigenous people are in the lower socioeconomic category in Canada. This measure encompasses a wide range of indicators such as income, education, and health.[25] Many of these issues had their genesis in the structure and priorities of the residential schooling system. Instead of giving children educational training that would allow them to be successful as adults, the majority of their time was spent learning tasks that would lock them into a lifetime of menial and low paying jobs. For example, the focus of the education for boys was on construction, carpentry, and agricultural labour, while the girls were spending time on sewing, cleaning, cooking.[26] Compared to the rest of the country, the educational quality in residential schools was extremely poor. The rudimentary curriculum of the residential school system underscored the government belief that Indigenous children intellectually lacked the capacity to learn the educational material taught in the rest of the country. Most of the teachers in residential schools were inexperienced and poorly trained and didn’t understand Indigenous culture or needs.[26]

Foster Care

The lasting legacy of the residential schools is seen in many ways in the current provincially run foster care systems. These look to "civilize" Indigenous children by removing them from their homes and in the process losing their cultural connections.[27] Beginning in the 1960s, Indigenous children were almost always placed with non-Indigenous adoptive families.[28] A 2018 Ontario Human Rights Commission report concluded that Indigenous children are overrepresented in children's aid societies at 93% based on their proportion of the population.[29]

Discrepancies in Indigenous Healthcare

Substance Abuse

Residential school survivors and intergenerational survivors continue to heal from the trauma of colonial institutions such as residential schools. In the wake of cultural genocide, Indigenous persons remain burdened by colonial trauma; facing inadequate healthcare and discrimination within a post-colonial context. Consequently, Indigenous persons face poorer physical, mental, emotional, and spiritual health compared to non-Indiegenous persons.[30] These discrepancies are illustrative of the lasting impacts of systemic racism and colonial systems.[31] Hence, substance abuse has become a problem of heightened concern for this marginalised population.

The Indigenous population of Canada faces profound historical and present-day trauma which contributes to substance abuse and addiction. Significantly higher reports of overdose and substance abuse related hospitalizations occur for the Indigenous population compared to other Canadians. Historians and psychologists have theorized this is due to the Indigenous population being segregated into reserves, stripping of their cultural norms and beliefs, and the negative physical and emotional impact from the residential school system.[20] Recently there has been widespread media coverage of drug overdose deaths in British Columbia. While the Indigenous population of B.C. is 2.6%, they make up 10% of drug overdose deaths.[32]

Stigma and discrimination against substance users further marginalises Indigenous peoples who already face structural disadvantages as a repercussion of colonial histories. Within Canada, significant research has been conducted in the Downtown Eastside of Vancouver, BC. Within this area, Indigenous peoples who use drugs experience higher levels of homelessness and higher rates of HIV and hepatitis C compared to non-indigenous counterparts.[33] Additional evidence suggests that Indigenous persons are less likely to receive treatment for substance use and are more likely to leave treatment if accessed.[33] In addition to pre-existing trauma and barriers to success within a post-colonial context, Indigenous persons remain subject to racial discrimination within Canada’s healthcare system.

Racial Discrimination

Colonisation and racial discrimination are closely intertwined, and continue to harm the health of Indigenous persons.[34] Available research suggests that approximately one third of Indigenous adults experience racism at least once in their lives.[35] In addition, racism towards Indigenous peoples has been associated with a vast range of detrimental health effects. These are inclusive of psychological distress, decreased mental health (anxiety, depression, post traumatic stress disorder...etc), as well as physical illnesses (cardiovascular disease, increased blood pressure, excess body fat, poor sleep...etc). In addition, racism has been linked to increased substance abuse. Further, it is reported that Indigenous peoples are likely to underutilise medical and mental healthcare services compared to non-Indigenous peoples.[35] 

“In relation to indigenous peoples, colonial practices are closely intertwined with racism. These include ecological damage; displacement; (un)intentional transmission of disease; slavery; forced labor; removal of children; violence; massacres; the banning of indigenous languages; the regulation of movement and marriage; assimilation; and the suppression of social, cultural, and spiritual practices”[35]

Clinical encounters between nurses and First Nations women in a Western Canadian hospital reveals instances of racialization, culturalism and othering.[36] Racially motivated discrimination is revealed by allegations in British Columbia, suggesting that health-care staff in emergency rooms play a "game" to guess the blood-alcohol level of Indigenous patients, despite lack of medical evidence to suggest intoxication. In some instances, this has led to improper treatment and even death.[37] Racial discrimination in healthcare continues to be a barrier to accessing proper healthcare for Indigenous persons, particularly for those struggling with substance use and addiction.[38]

Indigenous Women

In addition to individual and institutional discrimination, First Nation women face additional barriers that result in poorer mental health and reduced quality of care. In addition, Canadian laws and regulations surrounding Indigenous women’s healthcare are responsible for the systematic discrediation of Indigenous knowledge and practices—a colonial tactic of cultural genocide which remains in practice to-date.

To illustrate the experience of Indigenous women in post-colonial healthcare systems, Niccols, Dell & Clarke review a qualitative study of ten rural First Nations women and their experiences of accessing healthcare. The results of this study determined that women identified invalidating encounters, being dismissed, having to “look white”, and encountering negative stereotypes. In addition to clear discriminatory practices within Canadian healthcare, Aboriginal women noted that negative stereotypes were particularly prevalent towards Indigenous women with substance abuse problems.[39] Studies such as this are indicative of post-colonial barriers to accessing healthcare. Indigenous peoples of Canada were subject to intergenerational abuse and trauma, resulting in poor health and substance abuse problems. Yet this same population is dismissed and discriminated against when attempting to seek help from the very institutions that perpetuate poorer health.

In addition to social discrimination, Indigenous women of Canada face reduced reproductive mobilities due to federal and provincial jurisdictional policies. Health Canada’s ‘birth evacuation policy’, requires all First Nations women living on rural and remote reserves to relocate to urban hospitals for labour and birth.[40] This mandatory evacuation results in gradual erasure and discreditation of Indigenous midwifery knowledge, practices and culture. Additional impacts contributing to traumatic birth experiences includes language and cultural barriers, substantial personal medical costs, and disconnect from familial and community support. Ultimately, racial discrimination against Indigenous persons within Canadian healthcare is a consequence of the racist philosophy behind residential schools.

Traditional vs. Western

As a consequence of Canada’s colonial systems and institutions, Indigenous Canadians continue to face discrepancies in the Canadian healthcare system. While racism is one of the more prominent contributors to this disparity, cultural barriers and discrepancies in Worldviews must also be established as leading contributors to inadequate care.

Cultural barriers stems from dichotomous Worldviews and methods for physical, mental, emotional and spiritual healing. Western Worldviews are hierarchical and individualistic, resulting in isolation from one's community and surroundings. This in turn may perpetuate sickness and toxicity, manifesting as mental illnesses and poor well being. This is contrasted by the immense importance of community and shared connection in healing, of which is deeply ingrained in Traditional practices.

In Traditional health, the notion of balance between body and soul must be cared for and maintained in order to establish a healthy dynamic between body and mind, and social well-being of one’s community; a continual process and relationship.[41] Thus, an emphasis is placed upon the importance of community and soul. In contrast, modern day Western approaches to healthcare are more detached from individuals and communities than Traditional methods. This perpetuates a barrier to accessing the care that Indigenous persons need or seek, and further establishes a cultural disconnect between Indigenous peoples and healthcare professionals. This dichotomy between these two worldviews is illustrative of the extent of psychological trauma that may ensue for First Nations women as a consequence of federal and provincial jurisdictional policies such as Health Canada’s ‘birth evacuation policy’.

Mental Health and Substance Abuse Treatment Programs

Mental wellness and substance use issues are priorities for many BC First Nations communities. Mental wellness is not just the absence of mental illness, but incorporates factors that promote and maintain physical, mental, emotional, and spiritual balance.[42] Mental wellness goes beyond the individual level and incorporates the well being of Indigenous communities as a whole.[43] The following are some of the prominent programs and initiatives organized to help Indigenous people with their health, access to healthcare, and trauma related care.

Sheway Project

The Sheway project was started in Vancouver in 1993 and is an example of a woman centered, integrated, and comprehensive program that addresses the needs of parenting or pregnant Indigenous women with substance use issues in high risk neighbourhoods.[43] It takes a harm reduction and culturally focused approach, and is run by Indigenous staff who emphasize Indigenous health, healing practices, and culture. Research findings evaluating the Sheway program’s effectiveness suggests this integrated program has been helpful for Indigenous mothers with substance abuse issues and their children.[43]

First Nations Health Authority

FNHA is the only provincial health organization in Canada that is focused on transforming the delivery of healthcare to Indigenous people. They address service gaps and deliver programs and services like treatment centers, counselling, and crisis lines. Their vision is to support Indigenous people in achieving and maintaining wellness in ways that respects their customs, values, and beliefs.[42]

KUU-US Crisis Response Services

KUU-US services are for the Indigenous and run by Indigenous. All personnel are trained in Indigenous cultural safety and have an understanding of Indigenous history and trauma from residential schools. In 2020 they helped 10,000 individuals with crises such as addiction, child welfare, suicide, grief, crime, abuse, peer pressure, and financial distress.[42]

KUU-US Crisis Line Society (1-800-KUU-US17)

This is an Indigenous specific crisis line available 24 hours a day and 7 days a week for Indigenous people residing anywhere in British Columbia. All crisis responders are certified and trained in Indigenous cultural safety.

Indian Residential Schools Resolution Health Support Program

This program offers mental health, cultural and emotional support to residential school attendees and their families. The program aims to help families heal from the intergenerational trauma caused by residential schools.

Opioid Agonist Therapy Clinic Fees

The First Nation Health Authority can be directly billed by private clinics for OAT fees charged to those with First Nations status in British Columbia. Although the cost of the treatment is covered by the Medical Services Plan, some private clinics charge fees that are not covered. Fees charged by private clinics will be reimbursed to Indigenous people until March 31st, 2021.[42] This is a great opportunity for Indigenous people who are addicted to opioids and cannot afford treatment. Opioid agonist therapy (OAT) is an effective treatment for individuals who have become dependent on opioids. Methadone is a safer, legal, and less potent opioid drug that is used in OAT to treat opioid addictions.[44] It’s a drug replacement therapy and will reduce cravings for the more potent and highly addictive opioid drugs like heroin and reduce withdrawal effects. British Columbia is currently experiencing an opioid overdose crisis because drugs acquired from the streets are unregulated and often contaminated with highly potent opioids like Fentanyl.[44] Research shows that OAT helps reduce illicit opioid use, but it’s important for health professionals and individuals to plan for future therapeutic help as the OAT program has an end date.

Urban Indigenous Opioid Task Force

UIOTF is a response team focused on reducing overdose deaths, increasing access to immediate care, and facilitating transition into long-term support networks by collaborating with members to develop, create, and improve opioid response strategies.[45] UIOTF serves the 70 000 urban Indigenous people living in Metro Vancouver.

National Native Alcohol and Drug Abuse Program

This is a Health Canada program that is controlled by First Nations communities and organizations. It was started in the 1970s and aims to help First Nations and Inuit communities organize and run programs that will reduce the high levels of substance abuse among Indigenous people.[46] The program includes activities that address prevention, intervention, and aftercare.

Reconciliation and Reparations

Indigenous people have faced many decades of systemic racism and detrimental colonial interference in their lives and it might take equally as long to fully repair the damage done. In June 2008 the Truth and Reconciliation Commission of Canada was established to publicize the trauma of the residential school system and provide recommendations for the reconciliation process.[47] One of the impactful conclusions of the TRC was that the Canadian government’s actions in removing children from their homes and and trying to assimilate them into western culture should be considered cultural genocide.[48]

The TRC released a report in June 2015 to provide 94 concrete “Calls to Action”. Some of the reconciliation actions include youth programs, education, legal support, museums and archives, equitable healthcare access, and professional development programs.[48] The CBC has created an interactive website called Beyond 94 that tracks the developments of the proposed reconciliation actions. As of February 2021, 10 of the items have been completed, 61 are in progress, and 23 have not been started.[49]

References

  1. ↑ MacDonald, Cathy (May 2015). "The Impact of Colonization and Western Assimilation on Health and Wellbeing of Canadian Aboriginal People". International Journal of Regional and Local History. 10: 32–46.
  2. ↑ Khan, Saman (2008). "Aboriginal Mental Health: The statistical reality". Retrieved March 15, 2021.
  3. ↑ Kumar, Mohan (June 28, 2019). "Suicide among First Nations people, Métis and Inuit (2011-2016): Findings from the 2011 Canadian Census Health and Environment Cohort (CanCHEC)". Retrieved March 15, 2021.
  4. ↑ 4.0 4.1 4.2 Wilson, Kory (2014). "The Reserve System". Retrieved April 09, 2021. Check date values in: |access-date= (help)
  5. ↑ Harris, Cole (2002). "Indian Reserves". Retrieved April 09, 2021. Check date values in: |access-date= (help)
  6. ↑ "SAFE WATER FOR FIRST NATIONS". Canadians.org. 2021. Retrieved April 09, 2021. Check date values in: |access-date= (help)
  7. ↑ 7.0 7.1 Webster, Paul (February 7, 2015). "Housing triggers health problems for Canada's First Nations". The Lancet. Retrieved April 09, 2021. Check date values in: |access-date= (help)
  8. ↑ Reading, Charlotte (2009). "Health Inequalities and Social Determinants of Aboriginal Peoples' Health" (PDF). Retrieved March 29, 2021.
  9. ↑ McDougall, Robert (2018). "Duncan Campbell Scott". The Canadian Encyclopedia. Retrieved March 30, 2021.
  10. ↑ Maximilian, Smith (2019). "Peter Henderson Bryce". The Canadian Encyclopedia. Retrieved March 31, 2021.
  11. ↑ Curry, Bill (2007). "Natives died in droves as Ottawa ignored warnings". The Globe And Mail. Retrieved March 31, 2021.
  12. ↑ Milloy, John (1999). A National Crime: The Canadian Government and the Residential School System 1879–1986. University of Manitoba Press. pp. 82–90. ISBN 0-88755-646-9.
  13. ↑ Parrott, Zach (April 24, 2015). "Government Apology to Former Students of Indian Residential Schools". The Canadian Encyclopedia. Retrieved April 02, 2021. Check date values in: |access-date= (help)
  14. ↑ Moon-Riley Kat, Copeland Jennifer, Metz Gerlinde, Currie Cheryl (2019). "The biological impacts of Indigenous residential school attendance on the next generation". SSM - Population Health. 7.
  15. ↑ Porter, Jody (July 29, 2015). "Residential school nutrition experiments explained to Kenora survivors". CBC News. Retrieved April 08, 2021. Check date values in: |access-date= (help)
  16. ↑ Owens, Brian (July 23, 2013). "Canada used hungry indigenous children to study malnutrition". Nature.com. Retrieved April 08, 2021. Check date values in: |access-date= (help)
  17. ↑ Macdonald NE, Stanwick R, Lynk A (2014). "Canada's shameful history of nutrition research on residential school children: The need for strong medical ethics in Aboriginal health research". Paediatr Child Health. 19: 64.
  18. ↑ "Stolen Lives: The Indigenous Peoples of Canada and the Indian Residential Schools". Facinghistory.org. 2020. Retrieved April 09, 2021. Check date values in: |access-date= (help)
  19. ↑ Reimer, Amelia (October 8, 2015). "The colonial roots of mental health and addiction among Indigenous Peoples in Canada". The Independent. Retrieved April 09, 2021. Check date values in: |access-date= (help)
  20. ↑ 20.0 20.1 Maina, Geoffrey (2020). "A scoping review of school-based indigenous substance use prevention in preteens (7–13 years)". Substance Abuse Treatment, Prevention, and Policy. 15: 74.
  21. ↑ Gilman, Stephen (May 2003). "Family disruption in childhood and risk of adult depression". Am J Psychiatry. 160: 939–46.
  22. ↑ Kim, Paul (July 2019). "Social Determinants of Health Inequities in Indigenous Canadians Through a Life Course Approach to Colonialism and the Residential School System". Health Equity. 3: 378–81.
  23. ↑ Elias B, Mignone J, Hall M, Hong SP, Hart L, Sareen J. (March 2012). "Trauma and suicide behaviour histories among a Canadian indigenous population: an empirical exploration of the potential role of Canada's residential school system". Soc Sci Med. 74: 1560–9.
  24. ↑ Rheault, D’Arcy (2011). "Solving the "Indian Problem" Assimilation Laws, Practices & Indian Residential Schools" (PDF). Retrieved March 10, 2021.
  25. ↑ "Socio-economic Gaps on First Nations Reserves—Indigenous Services Canada". Office of the Auditor General of Canada. 2018. Retrieved April 08, 2021. Check date values in: |access-date= (help)
  26. ↑ 26.0 26.1 Miller, J.R. (September 2, 2020). "Residential Schools in Canada". The Canadian Encyclopedia. Retrieved April 08, 2021. Check date values in: |access-date= (help)
  27. ↑ Postmedia News (December 14, 2015). "Residential schools to blame for problems plaguing aboriginals: Truth and Reconciliation Commission". Retrieved April 9, 2021.
  28. ↑ Pourghassemi, Sabrina (October 27, 2020). "Indigenous children overrepresented in Canada's child welfare system, research says". Retrieved April 9, 2021.
  29. ↑ Ontario Human Rights Commission (2018). "Interrupted childhoods" (PDF). Retrieved April 9, 2021.
  30. ↑ Gionet Linda, Roshanafshar Shirin (Statistics Canada). "Health at a Glance". Check date values in: |date= (help)
  31. ↑ Boyer, Yvonne (November 20, 2017). "Healing racism in Canadian health care". cmaj. 189(46).
  32. ↑ Lavalley Jennifer, Kastor Shelda, Valleriani Jenna, and McNeil Ryan (December 2018). "Reconciliation and Canada's overdose crisis: responding to the needs of Indigenous Peoples". CMAJ. 190: 1466–67.
  33. ↑ 33.0 33.1 Urbanoski, Karen (2017 Nov 6). "Need for equity in treatment of substance use among Indigenous people in Canada". CMAJ. 189(44). Check date values in: |date= (help)
  34. ↑ Allan, Billie, Smylie, Janet (2015). First Peoples, Second Class Treatment. www.wellesleyinstitute.com: Li Ka Shing Knowledge Institute.
  35. ↑ 35.0 35.1 35.2 Paradies, Yin (26 September 2018). "Racism and Indigenous Health". Oxford University Press.
  36. ↑ Browne, Annette J. (May 2007). "Clinical encounters between nurses and First Nations women in a Western Canadian hospital". Social Science & Medicine. 64(10) – via ELSEVIER.
  37. ↑ Sterritt, Angela (Jun 23, 2020). "Indigenous people not surprised by reports of racist game played in hospitals".
  38. ↑ Schmunk, Rhianna (Jun 19, 2020). "B.C. investigating allegations ER staff played 'game' to guess blood-alcohol level of Indigenous patients".
  39. ↑ Allison Niccols, Colleen Anne Dell, and Sharon Clarke (2010 Apr 1). "Treatment Issues for Aboriginal Mothers with Substance Use Problems and Their Children". Int J Ment Health Addict. 8(2). Check date values in: |date= (help)CS1 maint: multiple names: authors list (link)
  40. ↑ Lawford, Karen M (Feb 10, 2018). "Canada's evacuation policy for pregnant First Nations women: Resignation, resilience, and resistance". PubMed. 31(6) – via ELSEVIER.
  41. ↑ Borré, K. (1994). The Healing Power of the Seal: The Meaning of Intuit Health Practice and Belief. Arctic Anthropology, 31(1), 1-15. Retrieved March 20, 2021, from http://www.jstor.org/stable/40316345
  42. ↑ 42.0 42.1 42.2 42.3 First Nations Health Authority (2021). "Mental Wellness and Substance Use". Retrieved April 1, 2021.
  43. ↑ 43.0 43.1 43.2 Niccols A, Dell CA, Clarke S (2010). "Treatment Issues for Aboriginal Mothers with Substance Use Problems and Their Children". Int J Ment Health Addict. 8: 320–335.
  44. ↑ 44.0 44.1 First Nations Health Authority. "Opioid Agonist Therapy (OAT) Clinic Fees". Retrieved April 1, 2021.
  45. ↑ Metro Vancouver Aboriginal Executive Council (2021). "Urban Indigenous Opioid Task Force". Retrieved April 2, 2021.
  46. ↑ Government of Canada (2021). "National Native Alcohol and Drug Abuse Program". Retrieved April 2, 2021.
  47. ↑ CBC News (June 14, 2010). "FAQs: Truth and Reconciliation Commission". Retrieved April 08, 2021. Check date values in: |access-date= (help)
  48. ↑ 48.0 48.1 Truth and Reconciliation Commission of Canada (2012). "Truth and Reconciliation Commission of Canada: Interim Report" (PDF). Retrieved April 08, 2021. Check date values in: |access-date= (help)
  49. ↑ CBC News (February 8, 2021). "Beyond 94". Retrieved April 08, 2021. Check date values in: |access-date= (help)
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