Unlocking the power of Indigenous knowledge to improve health, wellness and access to care

On 13 September 2007, the UN General Assembly adopted the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP). As a result, political governance and public service systems worldwide are being restructured to enable Indigenous Peoples to pursue their rights to recognition, survival, dignity and well-being enshrined by the declaration.

In 2016, Canada officially ratified UNDRIP to advance reconciliation and the health and wellness of Indigenous Peoples and three years later, in our province of British Columbia, the Declaration on the Rights of Indigenous Peoples Act was signed into law and reaffirmed its commitment to the application of UNDRIP. Our provincial government is also advancing the 94 calls to action from the Truth and Reconciliation Commission.

Several of UNDRIP’s articles uphold the right of Indigenous Peoples to health, including access to health care services, emphasizing the role health systems have in achieving UNDRIP’s objectives. Our organization, Fraser Health, is committed to improving health and wellness for the 62,000 First Nations, Métis and Inuit people (the three groups of Indigenous Peoples in Canada) in our region.

We see early but promising results achieved through self-determination, removing barriers to health equity and two-eyed seeing – “learning to see from one eye with the strengths of Indigenous knowledge and ways of knowing, and from the other with the strengths of Western knowledge and ways of knowing.”

In Canada, Indigenous Peoples have an increased disease burden and poorer health outcomes than non-Indigenous peoples. They are also less likely to access health services, often due to mistrust and fear of a system that has only recently begun to acknowledge a history of racism and discrimination. We are working to ensure that Indigenous Peoples feel safe, welcomed and able to access high-quality care by providing culturally appropriate services and expanding staff knowledge of how to provide culturally safe care.

If we can hardwire cultural humility into our work, we can change peoples’ values, beliefs and behaviour toward Indigenous Peoples and build a culture that has zero tolerance for racism and discrimination.

Training in cultural safety and humility helps people working within the health system deliver care and services with empathy, which comes from learning Indigenous Peoples’ histories in our region. Our staff and medical staff engage in diverse learning experiences to understand the cultural richness, resilience and diversity of Indigenous Peoples, as well as the intergenerational trauma carried from centuries of harmful policies and practices. We are partners in a new medical school that will embed Indigenous knowledge systems in learning, research and practices.

This work also ensures that Indigenous Peoples in our region see themselves reflected in our workforce. Recently, we created an Indigenous recruitment and retention team, a commitment within our Anti-Racism Action Plan, to support Indigenous job applicants as well as our 600-strong Indigenous staff and medical staff.

In the past few months, the team launched a leadership development programme and partnered with our Human Resources Consulting Services team to implement a five-day cultural leave benefit programme that enables Indigenous and medical staff to participate in cultural events.

In 2010, responsibility for health programmes within 203 First Nations in British Columbia was transferred from Canada’s federal government to a newly-created First Nations Health Authority. While still being the only organization of its kind in the country, the First Nations Health Authority provides various community-based health programmes and partners with regional health authorities such as Fraser Health to provide services that are culturally safe and responsive to the health needs of Indigenous Peoples.

During the first COVID-19 vaccine rollout, we saw the power of shared decision-making. Indigenous populations were designated a priority population for vaccine distribution because of their disproportionate likelihood of hospitalization and death from the disease. We partnered with 32 First Nations and six Métis Chartered Communities in our region as they planned vaccination programmes and outreach.

Almost 24,000 vaccine doses were administered at 200 clinics opened for Indigenous Peoples living in urban areas and clinics within First Nations communities. The clinics likely improved vaccine uptake and understanding of the disease while minimizing deaths within the communities. We found that this approach helped repair Indigenous People’s relationships with a health system that has significantly harmed and traumatized them in the past.

We are partnering with Métis Nation British Columbia, the government for Métis people in our province, to develop a health and wellness plan so our care and services are culturally appropriate and responsive to the unique needs of 26,000 Métis people in our region.

Métis Nation British Columbia and the First Nations Health Authority are represented on an Aboriginal Health Steering Committee, which includes the First Nations and Métis Chartered Communities in our region and oversees Indigenous health priorities, policies, budgets and services in our region.

What can health services look like when we equally value Indigenous and non-Indigenous knowledge and ways of knowing? Applying two-eyed seeing is another step in our journey.

Indigenous perspectives are embedded throughout the framework we use to plan, assess and measure the quality of our care and services. For example, care that is evidence-informed should include Indigenous Traditional Knowledge and practices, and care for Indigenous Peoples is considered safe when Indigenous clients tell us so.

We are fortunate to have diverse and engaged community partners. Like many areas of the world, we are seeking unique solutions to an opioid and fentanyl overdose epidemic (we call it a toxic drug crisis). We recently supported the First Nations Health Authority and a local First Nation in opening a mobile overdose prevention site so that individuals can use substances under the supervision of staff trained for overdose prevention and be surrounded by traditional cultural supports, wellness advocates and Elders.

Indigenous communities are uniquely sensitive to climate change. We coordinate with the First Nations Health Authority and Métis Nation British Columbia so they can share weather alerts and emergency event updates through their communication channels, add context to our information and guide how we respond to emergency events. We also recently launched a planetary health strategy that includes Indigenous traditional ecological knowledge. Indigenous Peoples have cared for the lands in our region for 10,000 years and beyond; partnering with them in this work will promote a sustainable health system and communities.

Self-determination, health equity, and two-eyed seeing are themes that encapsulate only a small percentage of the steps we have taken in our journey to support Indigenous Peoples’ rights to recognition, survival, dignity and wellbeing.