The month of June is celebrated as the National Indigenous History Month in Canada. As a newcomer to Canada and having worked with indigenous communities in resource-poor settings in India, I have been particularly interested to understand the health inequities and social injustices faced by the indigenous populations in both Canada and India alike.
The first International Conference on Health Promotion was held in the capital city of Canada – Ottawa, more than three decades back on November 21st, 1986. The Ottawa Charter for Health Promotion called for action to achieve ‘Health for All’. Canadian contributions to the social determinants of health concept have been so extensive as to make Canada a ‘health promotion powerhouse’ in the eyes of the international health community. However, in my understanding the real picture is not exactly the same. It is astounding to see how even in a rich country (with a very high Human Development Index score) like Canada, certain sections of the society; especially Aboriginal populations (First Nations, Inuit, and Métis) are marginalized and neglected in terms of healthcare access and service delivery. This is in addition to the systemic inequalities, discrimination and poor socio-economic indicators (among Indigenous populations) such as high rate of poverty, low incomes, low educational attainment, unemployment, food insecurity, poor housing conditions, among others.
In the past, I have worked in Palghar district in the state of Maharashtra in India. Palghar district is a tribal district. My project interventions revolved around addressing health issues of indigenous communities. I lived in a village and worked with the indigenous communities on a day to day basis for 13 months. I observed that the most pressing community health concern was child and maternal malnutrition. However, the issue of malnutrition was pervasive not merely due to lack of nutrition, per se. There were other nutrition-sensitive factors, that is, the social determinants of malnutrition including socio-economic, socio-cultural, socio-demographic factors, among others, that exacerbated the malnutrition issue in the target villages. I observed three main factors that led to malnutrition. I called them the ‘3Ms of malnutrition’, namely, Child Marriage; Migration (seasonal migration of tribal farmers and their families due to lack of livelihood during post-harvest season); and Meal intake (inadequate food quantity and quality as well as erratic meal timings at the tribal residential schools). Thus, my project was based on addressing the social determinants of chronic malnutrition via health promotion, social behaviour change communication and community mobilization at the village households and residential schools. In essence, the factors leading to malnutrition and other health issues were a combination of various social, economic, cultural and demographic factors.
After moving to Canada and understanding the Canadian public health landscape, I observed that there are a myriad of similarities and a very high correlation between the various socio-economic/human development indicators and poor healthcare access in both Canada and India. The rates of both infectious and chronic diseases, non-communicable diseases, mental health illnesses (depression and suicide rates) are much higher in the Aboriginal population (in both Canada and India) than the general population.
The United Nations Declaration of the Rights of Indigenous Peoples (UNDRIP), approved by the UN General Assembly in the year 2007, identifies critical areas in which national governments could work to improve the situation of Aboriginal peoples. The Declaration includes articles concerned with improving economic and social conditions, the right to attain the highest levels of health, and the right to protect and conserve their environments. It has been more than a decade since the world’s Indigenous Peoples celebrated the adoption of UNDRIP. Canada agreed to adopt the declaration approximately 8 years back (on November 12, 2010). However, it’s been a slow process so far.
The recent impetus to the reconciliation process was the ‘Truth and Reconciliation Commission of Canada (TRC): Calls to Action‘ report. In order to redress the legacy of residential schools and advance the process of Canadian reconciliation, the TRC made calls to action on various parameters to uplift the living conditions and health profile of the Indigenous populations. These parameters include child welfare (in residential schools); Aboriginal education; language and culture; health; justice (equity for aboriginal people in the legal system), among others. One feature of the report that caught my eye was point 22 related to the Aboriginal language and culture stating – “We call upon those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.” I strongly believe this is one of the most critical actions that have been proposed in the report. This would provide much needed impetus to the time tested traditional medical practices, which is pertinent to ensure better healthcare among the Indigenous populations.
[Also Read: Traditional Healing Practices – Implications for Healthcare]
Furthermore, I attended ‘The Ontario Public Health Convention 2018’ held in March in Toronto. I really appreciated the fact that indigenous health issue was given due importance and laid much needed emphasis on decolonizing public health by ensuring Indigenous cultural safety as public health practice.
Lastly, both Canada and India need a lot to learn and unlearn from each other. These two great countries can become even greater if we, as a global community at large, ensure equal rights and opportunities for the indigenous populations not only in terms of healthcare but every aspect of human development. These two countries differ from each other on a lot of parameters, but this one critical connecting element would be mutually beneficial as far as knowledge sharing and achieving universal health care (in true sense of the word) is concerned.
In conclusion, as we celebrate the National Aboriginal Day on June 21st and prepare for the Canada Day celebrations on July 1st, lest we forget the crucial tasks and responsibilities that lay ahead to help bridge gaps and reduce discrimination, economic inequalities, health inequities and social injustices among the Indigenous populations, vulnerable sections of the society and marginalized communities in Canada and India alike.
Ankur Chhabra 