Urban Indigenous populations face some of the most significant barriers to access to health services out of any population in Canada. The Indigenous community in Montreal developed a cultural safety training program to help decrease some of these barriers. An extensive review of published literature on cultural safety in health care was performed. A training program was developed to: describe the diversity of Indigenous populations in Montreal; explain historic and present-day determinants of health inequities in this population; develop competencies to respect clients’ diversity and promote cultural safety in care. A pre-test survey was circulated to participants to establish baseline knowledge and attitudes towards Indigenous populations. The program was divided into 3 half-day sessions. After each session, a satisfaction evaluation grid survey was circulated to participants. The Indigenous Cultural Safety Training Program was presented to a total of 45 nurses, social workers, and physicians with frequent interactions with the Indigenous community in Montréal. Having an Elder and community member present appeared to have been successful in increasing participants level of awareness of the importance of improving the quality of health care services provided. Challenges were identified regarding the transmission of the political aspect of the cultural safety concept, and the importance of decolonizing health care systems. Reflections on how to address these in the future will be discussed. Cultural safety training for health professionals is challenging, yet, a necessity to improve access to care and improve health outcomes in urban Indigenous populations.

OBJECTIVES: Following the onset of intensive colonial intervention and rapid social change in the lives of Inuit people, youth in Nunavik have experienced high rates of mental health problems and suicide. Inuit people describe a broad range of contextual influences on mental wellness based on lived experience, but most epidemiological studies have focused on individual risk factors and pathologies. This study aimed to assess the influence of multiple determinants of mental wellness among Inuit youth in Nunavik, including culturally meaningful activities, housing and community social characteristics. METHODS:Mental wellness was measured in the form of two primary outcomes: self-esteem and suicidal ideation. Using cross-sectional data from the 2004 Nunavik Inuit Health Survey and multilevel regression modelling, we estimated associations between these two outcomes and various independent individual-and community-level explanatory factors among Inuit youth. All variables were selected to reflect Inuit perspectives on determinants of mental wellness. The study design and interpretation of results were validated with Inuit community representatives. RESULTS:Pride in Inuit identity, traditional activities, community-level social support and community-level socio-economic status were found to be protective. Barriers to participating in traditional activities, household crowding and high community rates of violence were risk factors.CONCLUSION: These findings support Inuit perspectives, expand the scope of epidemiological analysis of Inuit mental wellness and reinforce the need for locally informed, community-wide approaches to mental wellness promotion for Inuit youth.KEY WORDS: Community psychiatry; Inuits; mental health; multilevel analysis; social conditions; social determinants of health La traduction du résumé se trouve à la fin de l'article.

Hiring local Indigenous workers is necessary to ensure that early childhood development programs are culturally safe. Success of such programs relies on team management, provision of culturally adapted training, and quality of the ongoing emotional support provided to the FSWs.

Organisation monDiale De la santé (2002). Stratégie de l'OMS pour la médecine traditionnelle. Genève, Organisation mondiale de la santé. Vonarx, N. (2012). Le vodou haïtien : entre médecine, magie et religion. Presses universitaires de Rennes. * EVCI : espérance de vie corrigée en fonction de l'incapacité Source : Présentation des auteurs d'après Mackellar (2005).

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