Features  Unequal healing

The state of aboriginal women’s health in Canada

A recent McGill study found that Inuit women in Nunavik face a much higher risk of acquiring sexually transmitted infections like human papillomavirus (HPV) and consequently, cervical cancer, than other Canadian women. Up to one in three Inuit women may have HPV, and in women aged 16 to 20, this probability jumps to one in two.

With Inuit women three times more likely to die from cervical cancer than other Canadian women, it is clear that there is a vast health discrepancy here. The researchers conjectured that lack of awareness and lack of resources in many Northern communities could explain these poor health outcomes. They saw many women who were unable to get proper treatment for HPV, and many health professionals – themselves a scarce resource – who were unfamiliar with procedures such as Pap smears.

The prevalence of HPV among Inuit women is a symptom of widespread trends in aboriginal health throughout Quebec and Canada. Nearly every kind of illness is more prevalent in aboriginal communities, and women are at an even greater risk. Certain health concerns – diabetes, HPV, obesity – are becoming especially common among aboriginal people, occurring at rates two to six times that of the general population.

The prevalence of substance abuse, violence against women, and suicide in aboriginal communities contributes to poor health outcomes due to the connection between mental, physical, spiritual and overall community health. Access to care is inconsistent, and many women report experiencing discomfort, discrimination, and racism in the health care system.

The factors contributing to increased illness among Canadian aboriginals are diverse, and vary by region and commuity. As a result, there is no simple, straightforward solution.

Poverty is a major player in poor health outcomes for any group of people, especially those that are culturally marginalized. “Poverty and ill health go hand-in-hand, and aboriginal people are among the poorest in Canada,” the Royal Commission on Aboriginal Peoples declared in 1996. Poverty mediates broad health determinants, such as access to good nutrition, safe housing, running water, and electricity.

Geography can also contribute to health outcomes. In remote areas of the country, especially in the North, fresh food can cost significantly more than elsewhere. Communities in these regions may also only have access to doctors once every few weeks.

Another important consideration when looking at aboriginal health is that many First Nations view health much more holistically than traditional Westernized medicine, where the idea of health has often been limited to the body’s physical state.

“When you’re talking about health, one thing that aboriginal people and their leadership try to stress is that health is a fairly wide concept,” explains Professor Christa Scholtz, who specializes in aboriginal politics at McGill. While physical health is important, a more inclusive definition is crucial – what Scholtz describes as, “health of communities, healing, and forming better relationships both within the community and outside the community.” Not only are body, mind, emotions and spirit interconnected, but the individual and the community are linked as well. Well-being is said to flow from balance and harmony between all these elements.

For many aboriginal communities, these elements are not in balance because of a long history of political, socioeconomic, and cultural marginalization. Though illness rates have improved since the 1960s, the goal of equal health for all Canadians is far from being met. Income inequalities remain a fundamental source of health inequality for aboriginal communities, reflecting the need for a more holistic approach toward aboriginal health.

It is only in recent years that Canadian governments have recognized and addressed their role in perpetuating health inequality. The Residential School system’s legacy of physical and emotional abuse, as well as cultural destruction, has left indelible marks on many aboriginal people and their communities.

“A lot of [aboriginal] parents struggle with alcoholism and with lingering affects of residential schools. They have their own issues to deal with and can’t always intervene [for their children’s health],” says former McGill student Sarah Needles, speaking of her experience volunteering at a children’s literacy camp in the Nishnabi-Aski Nations, the treaty lands north of Thunder Bay, last summer. Her observation exemplifies the ways in which various aspects of health are interconnected.

And for aboriginal women – members of two marginalized groups – these health determinants can have even graver consequences. Erin Wolski, director of Health Programming at the Native Women’s Association of Canada, explains that “aboriginal women are impacted the most by the [health] determinants, and therefore have less access to services either because many just can’t afford things like childcare [and] transportation, or [because] health services may not be available on the reserve.”

Many women leave their reserves and their communities in search of an education or a better quality of life, but often end up living in poor conditions in unsafe neighbourhoods, vulnerable to illness and violence, says Wolski. Facing gendered racism, violence, single motherhood, and low rates of employment, many aboriginal women find themselves without access to culturally and gender-appropriate health care and often suffer poor health outcomes for it.

“Seventy per cent of women live off the reserve. If [aboriginal women] can’t afford to get around, how can we get access to our traditional land, where ceremony and traditions occur? Because there is no access to land, to community, and family, there is a disconnect which impacts health incredibly: mental, physical, spiritual and community health. It’s another one of those barriers created by poverty,” says Wolski.

Wolski believes bringing more aboriginal women into health care decisions will lead to more effective gender and culturally-appropriate health services. “I think it can be as simple as having aboriginal women at the table. Whether we’re talking about on or off reserve, I think that aboriginal women’s perspectives are not considered because they are not at the table. On a fundamental level [the Native Women’s Association of Canada] advocates for engagement in policy, programming… anything that impacts them,” she says.

The Canadian government has certainly tried in recent years to improve health among aboriginal people. In 2004, the nation committed to spending $700-million on improving aboriginal health. A look through Health Canada’s most recent First Nations and Inuit Health program compendium reveals projects as diverse as the Aboriginal Diabetes Initiative and the Health Careers Program. But a different approach may be necessary in order to achieve the goal of equal health for all Canadians.

There is some consensus among aboriginal communities, organizations, and individuals that there is a need to address broader ideas surrounding health and access to health care in the context of inequality, and today, more aboriginal people are speaking out about the broader health problems they face in their communities.

SOS, a week-long conference on suicide awareness, is put on every year by the community of Wapekeka, in Nishnabi-Aski Nations. Needles witnessed the conference while volunteering in Wapekeka this past summer. Almost 1,000 people came from all over the Nishnabi-Aski Nations for a week of workshops, seminars, and community meals. Although the conference dealt with a sombre topic, it emphasized positive attitudes toward community health.

Needles explains that the conference was started in the past two or three years in response to a suicide epidemic in Nishnabi-Aski. “Probably every child I worked with this summer knew or was close to someone who’d died or committed suicide,” she says, “But the people who I spoke to said that since then, they’d seen a change in the suicide rates.… Many said that Wapekeka was a very different place back then.”

Communities like Wapekeka are demonstrating an interest in taking control over health services to meet the needs of their communities, and Needles thinks that this is why the SOS conference has been successful. When programs and services come from within the community, they are likely to be best suited to its needs. One aspect of this is making programs more culturally relevant by embracing a return to tradition. “In [the community of] Nibinamik, there was an emphasis on returning to traditional foods – hunting, fishing, living off the land,” Sarah explains. “There was a moose for the summer festival feast. Watching these guys skin a moose in 30 minutes, it was incredible.” She tells me that there is even a version of the well-known Canada Food Guide that includes traditional foods like bannock, wild rice, and deer. Instead of the familiar rainbow food guide, the First Nations, Inuit, and Métis Food Guide is a circle, a shape that connotes balance, cycles of life, and nature. She expects that by reflecting traditional foods and values, literature like the Canada Food Guide will have a greater impact on nutrition and health in these communities.

These kinds of culturally-adapted services exist for urban native people as well. Pamela Shauk, an outreach worker at the Native Friendship Centre of Montreal, spoke with me about the Friendship Centre and its current programs. As an outreach worker, Pamela tries to promote health and healthy lifestyles, making sure that her clients have full access to the services to which they are entitled. She explains that even though they have been without health funding since last year, the Friendship Centre continues to supply health services, because it is such an important resource to the urban aboriginal community.

“[Aboriginals] can feel welcome, comfortable that someone aboriginal is helping them out…. In other places, they don’t always feel comfortable, maybe because they don’t speak the language,” Shauk says. “So we try to get programs going. We have posters that teach diabetics what to eat; we teach safe sex.… We teach those kinds of health issues, for people to take care of themselves.”

With HIV/AIDS on the rise in urban centres, the socio-economic conditions that many urban aboriginals experience have contributed to high rates of infection. Shauk runs prevention programs, and also does outreach for people with HIV/AIDS.

“When you’re really into alcohol and drugs, you know, sometimes [you] don’t give a shit…. You think, ‘I’m not gonna catch it’…but it’s not true. So [we] teach them about that. I work with a lot of HIV/AIDS clients. I refer them to places to go or I’ll go with them [to get tested] if they’re really scared to find out if they are or not. That’s the scariest part. I help them to calm down and think positively about it,” Shauk says.

Shauk knows there are barriers preventing aboriginal people from accessing mainstream health care. The Friendship Centre has a nurse who comes once a week and a doctor who comes once a month to give medical advice. The services are popular, Shauk explains. “Most people hate to go to the hospital,” she says. As a hospital liaison worker, she visited people who had come to the city from their communities for treatment. She explains that it is extremely hard for them to be away from their communities, often not knowing the language and encountering discrimination.

Although the Centre does not have any programs specifically for women, they coordinate with other organizations in Montreal to promote women’s health. “I work together with the Native Women’s Shelter…because they have women – urban natives who are living here, and are in need of shelter. They stay there for a few days, before getting back on their feet. The shelter helps them find an apartment, helps with groceries, with finding school for their children,” Shauk says.

Programs at the Friendship Centre are carried out within an aboriginal context, often combining traditional practices like the smudging ceremony – in which herbs like sage and sweetgrass are burned in a clam shell and dusted over the body – with the demands of urban life. The connection to tradition is important for many people, like Shauk, who may feel a disconnect between urban life and the traditions they grew up with.

“There are still a few people who prefer to use their own medicine,” she smiles, “Like me, I would prefer to use my own medicine. You know, going out to the country and picking up the herbs…. I learnt from my parents.”

Health has been part of the dynamic between aboriginal and non-aboriginal peoples since European settlers first brought their unfamiliar germs to the “New World,” wiping out nearly three-quarters of the indigenous population. In light of this legacy, health is seen as having an impact on politics.

“If you’re talking about land claim policy or self-government negotiations, or you’re talking about aboriginal justice, all of these things keep feeding into a wider definition of community health,” Scholtz explains. The argument goes that direct involvement in health-related policies produces more effective programs, leading to better health outcomes for communities. “Self-government negotiations are supposed to set up the conditions that will make it possible for aboriginal communities to function as strong, healthy communities,” Scholtz continues.

The Native Women’s Association of Canada, echoing the sentiments of many other aboriginal voices, has recommended transferring the heath services jurisdiction to First Nations, Inuit, and Métis communities. With greater control over the services delivered to them, these communities could expect better-designed services with better impacts, particularly for aboriginal women, who face discrimination, sexism, and violence both from within and outside of their communities. In a press release, the Native Women’s Association of Canada insisted that transferring jurisdiction over health to the communities will “ensure that health and social conditions that perpetuate aboriginal women’s inequalities will be eradicated rather than exacerbated.”

For practical reasons, self-government is not an option for each and every aboriginal community or nation. Yet, one of the most important ideas is incorporating more aboriginal voices into the generation of policy and the delivery services. And this is exactly what many aboriginal men and women are doing to combat health inequality. By taking matters into their own hands, they are empowering themselves to work toward health solutions for their communities.