Margo Greenwood

Deviant Constructions: How Governments Preserve Colonial Narratives of Addictions and Poor Mental Health to Intervene into the Lives of Indigenous Children and Families in Canada.

Colonial projects in Canada have a long history of violently intervening into the personal lives and social structures of Indigenous peoples. These interventions are associated with elevated rates of addictions and mental health issues among Indigenous peoples. In this paper we employ an indigenized social determinants approach to mental health and addictions that accounts for the multiple, intersecting effects of colonial discourse upon the health of Indigenous peoples, and particularly the health effects of colonial interventions into the lives of First Nations Indigenous children in Canada. We focus on both historic and contemporary discourses about Indigenous peoples as deviant, discourses that include particular ideas and assumptions held by government officials about Indigenous peoples, the series of policies, practices, and institutional structures developed to ‘address’ Indigenous deviance over time (including contemporary child protections systems), and their direct impact upon healthy child development and overall Indigenous health. From a discursive perspective, addictions and mental health issues among Indigenous peoples can be accounted for in relation to the ideas, policies, and practices that identify and aim to address these issues, something that the social determinants literature has yet to incorporate into its model.

Troubling good intentions

We are unequivocally in favor of much, much, more space opening up for Aboriginal peoples and Indigenous ways of knowing and being in academic (and myriad other) spaces. We are worried, however, about a current lack of published critical engagement with policies and practices that appear, superficially, to support inclusivity and diversity of Indigenous peoples in academic institutions. We argue that, principally because such policies are inherently designed to serve settler-colonial subjects and powers, many inclusivity and diversity policies instead leave fundamentally unchanged an ongoing colonial relationship with Indigenous peoples, their epistemologies, and their ontologies. Indeed, we contend that individual Aboriginal peoples are suffering at deeply embodied levels as universities and other institutions rush to demonstrate well-intended “decolonizing” agendas. Drawing from examples in British Columbia, this paper provides a critical intervention into a rapidly ascending, and deeply institutionalized, dominance of policies and practices that claim to promote and open spaces for Indigenous peoples and perspectives within academic institutions. We draw from critical race theorists, including Sara Ahmed, and in our conclusion offer suggestions that aim to destabilize and trouble the good intentions of neo-colonial policies.

With Reserves: Colonial Geographies and First Nations Health

Health disparities between Indigenous and non-Indigenous peoples persist globally. Northern interior British Columbia, where many Indigenous people live on Indian 1 reserves allocated in the late nineteenth century, is no exception. This article reviews findings from fifty-eight interviews with members of thirteen First Nations communities in Carrier, Sekani, Wetsuwet’en, and Babine territories. The results suggest that colonial geographies, both physical and social, along with extant anti-Indigenous racism, are significant determinants of the health and well-being (or lack thereof) of many First Nations in the region.

Maternal and community predictors of gastroschisis and congenital diaphragmatic hernia in Canada

PurposeThe incidence of gastroschisis (GS) has increased globally. Maternal age and smoking are risk factors and aboriginal communities may be more commonly affected. Factors leading to this increased incidence are otherwise unclear. We investigate maternal sociodemography, air pollution and personal risk factors comparing mothers of infants with GS with a control group of infants with diaphragmatic hernia (CDH) in a large population-based analysis.MethodsData were collected from a national, disease-specific pediatric surgical database (May 2006–June 2013). Maternal community sociodemographic information was derived from the Canadian 2006 Census. Univariate and multivariable analyses were performed examining maternal factors related to diagnosis of GS.ResultsGS infants come from poorer, less educated communities with more unemployment, less pollution, fewer immigrants, and more aboriginal peoples than infants with CDH. Teen maternal age, smoking, and illicit drug use, are associated with GS.ConclusionMothers of infants with GS are younger, more likely to smoke and come from socially disadvantaged communities with higher proportions of aboriginal peoples but lower levels of air pollution compared to mothers of CDH infants. Identification of maternal risks provides direction for prenatal screening and public health interventions.

Challenges in health equity for Indigenous peoples in Canada

Canada’s health-care system, like the country itself, is a complex entity. As the two papers in The Lancet’s Series on Canada make clear, the country’s healthcare landscape is made up of multiple people, places, and policies with often overlapping—and sometimes conflicting—jurisdictions, priorities, paradigms, and practices. These complexities are rooted in Canada’s fairly young colonial history that resulted in a nation comprised of a majority of settler and recent immigrants and their descendants, alongside a steady resurgence of Indigenous populations of First Nations, Inuit, and Métis peoples that are growing in numbers, political acumen, and agency. Our response to these Series papers is situated in this context. It is informed by our work as academics and researchers in Indigenous public health. We are, individually, an Indigenous grandmother, a daughter of a recent immigrant, and a descendant of early settlers raising a young family with a non-Canadian partner. Our perspectives represent a small slice of Canada’s diverse populations and the complexities of health-care users. The two Series papers raise important points about the strengths of Canada’s health-care system and the continuing health inequities the country must find ways to address. Some of the inequity challenges are persistent precisely because of their complexity and opacity. This year marks a decade since the watershed WHO report Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health, which set out a 20-year roadmap for improving health equity globally for marginalised populations and acknowledged complexity as a driver of inequity. Recognising dramatic improvements in health in the last 30 years, the WHO report nevertheless called for action to close the gap of population health inequities existing between and within countries. Canada has led health equity work domestically through its universal health-care system and internationally through alliance building and collective action. Still, deep inequities persist in wellness indicators and access to health care for Indigenous populations in Canada. As Danielle Martin and colleagues point out, pride in the Canadian health-care system is based on an “implicit social contract between governments, healthcare providers, and the public—one that demands a shared and ongoing commitment to equity and solidarity”. We remain curious about that implicit social contract: to whom it is implicit, who it serves, by whom it is taken up, and who lives the inequality gaps that persist despite decades of inquiries, reports, policies, and initiatives aiming to ameliorate them. The reality remains that Indigenous children, youth, and their families and communities continue to live with unacceptably disproportionate burdens of ill health, including higher rates of infant mortality, tuberculosis, child and youth injuries and death, obesity and diabetes, youth suicide, and exposure to environmental contaminants. Social determinants of health approaches remind us that First Nations, Inuit, and Métis peoples’ health status reflects the socioeconomic, environmental, and political contexts of their lives, a context inextricable from past and contemporary colonialism. Major disparities in the socioeconomic status and environmental contexts resulting from colonial policies and practices continue to drive inequities that have persisted for generations. These disparities include higher levels of substandard and crowded housing conditions, poverty, and unemployment, together with lower levels of education and access to quality health-care services. Taken together with the historic and ongoing impacts of residential schooling, loss of traditional lands, decimation of political and economic self-determination, aggressive social welfare policies that remove children from their families, and other marginalising and traumatising governance policies, these disparities and conditions continue to bear down on the lives of First Nations,

Ethical spaces and places: Indigenous cultural safety in British Columbia health care:

This article discusses transformations underway within Indigenous health in northern British Columbia and Canada. We highlight two organizations that are working to create ethical space and cultural safety at the intersections of Indigenous knowledge about health and wellness, Western medicine, and healthcare services for Indigenous peoples in Canada. The article argues that the cultural, organizational, and systemic transformations necessary to address the deep and ongoing health inequities experienced by Indigenous populations should be rooted in Indigenous knowledges and should prioritize Indigenous voices, values, and concepts. Cultural safety, ethical space, and Two-Eyed Seeing are three examples of ideas anchored in Indigenous knowledges that speak to relationships at the interface of different systems of knowledge. We offer some examples of how a public health knowledge translation centre and a regional health service delivering organization are actualizing these concepts in their work nationally and regionally in northern British Columbia, Canada.

Turning a new page: cultural safety, critical creative literary interventions, truth and reconciliation, and the crisis of child welfare:

Despite the recent Truth and Reconciliation Report in Canada, rates of Indigenous children being apprehended by the state remain disproportionality high when compared to non-Indigenous children. Starting with a critical decolonizing methodology, this article charts connections between historic and contemporary settler-colonial state interventions into lives and places of Indigenous families. We interrogate resiliencies of false settler-state logics based on “for their own good” logics about Indigenous peoples. We then turn to the recent ascendance of cultural safety, considering the concept’s positive possibility, and potential limitations, with reference to child-welfare and apprehension of Indigenous children. Finally, based on established evidence that child welfare is a crucial determinant of broader Indigenous health and well-being, the article concludes with thoughts about how those working with settler-colonial state apparatuses might achieve culturally safe engagements with Indigenous cultures in the contemporary colonial present. Our solutions are located in literary arts, where the article begins.