T he health status of First Nations people in Canada is well below the national average. [1][2][3] Contact with Europeans brought outbreaks of infectious diseases (e.g., influenza, measles and smallpox) to which First Nations people had no immunity. 4 First Nations people lost traditional lands to settlements for trade relationships based on harvesting furs. 5 The shift from a seasonal economy based on traditional food gathering to the fur trade led to exploitation of wildlife and land. 5,6 Locating reserve lands in remote areas served to isolate First Nations, impoverishing their communities by limiting access to traditional resources. 6,7 The British North America Act of 1867 8 allowed Canada to pass laws that subjugated all First Nations people and their land, replacing their traditional governments and taking control of valuable resources on reserve lands. 7 It also disrupted First Nations culture and families by imposing European concepts of marriage, parenting and land ownership 7 in the belief that First Nations people were "savage" and less than human. 7,9,10 The Indian Act 11 restricted First Nations people from leaving reserve lands and prohibited outsiders from doing business with First Nations people, thus marginalizing them. 7 It also disrupted the transmission of culture from generation to generation, reinforcing learned helplessness among First Nations people in Canada by making participation in traditional cultural events (e.g., the potlatch and sun dance) a criminal offence. 7,11 The residential school system was designed to assimilate First Nations people into the culture of the white majority. 7,12 The needs of First Nations children were neglected, and many were physically, sexually and emotionally abused in the schools. 13,14 Over 500 years of domination, displacement and assimilation have prevented First Nations from nurturing a model of health determinants congruent with their culture. 12 Although Health Canada has selected the key determinants of health, developed by the Agency (Table 1), as the benchmark model to address the health status of all Canadians, a growing body of work suggests that these determinants of health are not suitable for most First Nations peoples. 9,[15][16][17] In response, the Four Worlds Institute developed 14 determinants of well-being and health (14 health determinants) (Table 1) relevant to First Nations people using their guiding principles: Development Comes from Within; No Vision, No Development; Individual and Community Transformations Must Go Hand in Hand; and Holistic Learning is the Key to Deep and Lasting Change. 9,18 To improve the overall health status of First Nations people in Canada, it is vital that Health Canada adopt a model of health determinants that incorporates the worldview of Indigenous peoples. 9,[19][20][21][22]

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Introduction Physician services databases (PSDs) are a valuable resource for research and surveillance in Canada. However, because the provinces and territories collect and maintain separate databases, data elements are not standardized. This study compared major features of PSDs. Methods The primary source was a survey of key informants that collected information about years of data, patient/provider characteristics, database inclusions/exclusions, coding of diagnoses, procedures and service locations. Data from the Canadian Institute for Health Information's (CIHI) National Physician Database were used to examine physician remuneration methods, which may affect PSD completeness. Survey data were obtained for nine provinces and two territories. Results Most databases contained post-1990 records. Diagnoses were frequently recorded using ICD-9 codes. Other coding systems differed across jurisdictions and time, although all PSDs identified in-hospital services and distinguished family medicine from other specialties. Capture of non-fee-for-service records varied and CIHI data revealed an increasing proportion of non-fee-for-service physicians over time. Conclusion Further research is needed to investigate the potential effects of PSD differences on comparability of findings from pan-Canadian studies.

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BACKGROUND: Across Canada, graduates from several medical and surgical specialties have recently had difficulty securing practice opportunities, especially in specialties dependent on limited resources such as ophthalmology. We aimed to investigate whether resource constraints in the health care system have a greater impact on the volume of cataract surgery performed by recent graduates than on established physicians. METHODS:We used population-based administrative data from Ontario for the period Jan. 1, 19941, , to June 30, 2013, to compare health services provided by recent graduates and established ophthalmologists. The primary outcome was volume of cataract surgery, a resourceintensive service for which volume is controlled by the province. RESULTS:When cataract surgery volume in Ontario entered a period of governmentmandated zero growth in 2007, the mean number of cataract operations performed by recent graduates dropped significantly (-46.37 operations/quarter, 95% confidence interval [CI] -62.73 to -30.00 operations/quarter), whereas the mean rate for established ophthalmologists remained stable (+5.89 operations/quarter, 95% CI 95% CI -1.47 to +13.24 operations/ quarter). Decreases in service provision among recent graduates did not occur for services without volume control. The proportion of recent graduates providing exclusively cataract surgery increased over the study period, and recent graduates in this group were 5.24 times (95% CI 2.15 to 12.76 times) more likely to fall within the lowest quartile for cataract surgical volume during the period of zero growth in provincial cataract volume (2007)(2008)(2009)(2010)(2011)(2012)(2013) than in the preceding period (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). INTERPRETATION:Recent ophthalmology graduates performed many fewer cataract surgery procedures after volume controls were implemented in Ontario. Integrated initiatives involving multiple stakeholders are needed to address the issues facing recently graduated physicians in Canada.