Lost in Maps: Regionalization and Indigenous Health Services

Lavoie, Josée G.; Kornelsen, Derek; Boyer, Yvonne; Wylie, Lloy

doi:10.12927/hcpap.2016.24773

Cited by 10 publications

(13 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While a growing impetus to integrate comprehensive mental health care into PHC services is occurring globally, integration has been fraught with challenges (39,40). Challenges vary but are commonly characterized by fiscal constraints, organizational issues, availability of medical technologies and public health surveillance systems, the cultural and technical competence of health professionals working with marginalized groups and urban rural bias (39,41,42). Nevertheless, integrating mental health services into PHC, could reduce stigma, improve access to mental health care services and improve social integration (39)…”

Section: Discussionmentioning

confidence: 99%

Is geographical isolation associated with poorer outcomes for Northern Manitoba First Nation communities?

Lavoie¹,

Philips-Beck²,

Kinew³

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: For First Nations, geographical isolation is often simultaneously presented as protective (less direct exposure racism, colonial encroachment on land, dispossession, and colonial imposition) and as a risk factor (lack of opportunities to participate in the formal economy, poorer access to services including healthcare). Our study sought to test the assumption that geographical isolation is associated with poorer population health outcomes among First Nations in Manitoba. Methods: We conducted a population-based retrospective time-trend analysis using administrative data housed at the Manitoba Centre for Health Policy. The study included all Manitoba residents eligible under the Manitoba Health Services Plan (1984-2014). We measured premature mortality rates (PMR), and trends in hospitalization rates and length of stay (LOS) for Ambulatory Care Sensitive Conditions (ACSC) in northern and southern First Nations (FN) communities in Manitoba.Results: The PMR was significantly higher in northern FN compared to southern FN. Hospitalization rates for mental health-related conditions were significantly higher in the northern First Nation communities compared to all Manitoba, and rising (southern, change=1.52%, P=0.015; northern, change=5.49%, P<0.0001), and significantly higher in northern compared to southern FN communities. The LOS for all ACSC increased significantly for all Manitoba (change=0.63%, P=0.0011) but not for FN communities. The LOS for mental health-related conditions increased only for the southern FN communities (% change=1.67, P=0.0032). Conclusions: Our results show higher PMR in northern communities, declining slower than for any other Manitoba communities. Our results also show lower hospitalization rate for ACSC in the north, suggesting barriers to prevention and early diagnosis. There remains a large gap in ACSC hospitalization rates between FN and all Manitobans. Further research is warranted to understand the relationship between the changes in the rates of ACSC and the difference in the rates between northern and southern communities.

show abstract

Section: Discussionmentioning

confidence: 99%

Is geographical isolation associated with poorer outcomes for Northern Manitoba First Nation communities?

Lavoie¹,

Philips-Beck²,

Kinew³

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…FN access health services through a complex jurisdictional maze of federal, provincial and FN community-based services. This maze is informed by a policy and legislative patchwork that has to date failed to clarify what services FN are entitled to and from whom ( Lavoie 2013 ; Lavoie et al 2012 , 2016 ). Even where there is some clarity as to what is available and who should be providing services, policies and funding do not support the effective provision of those services.…”

Section: Introductionmentioning

confidence: 99%

What Changes Would Manitoba First Nations Like to See in the Primary Healthcare They Receive? A Qualitative Investigation

Kyoon-Achan¹,

Lavoie²,

Kinew

et al. 2019

hcpol

Self Cite

View full text Add to dashboard Cite

Background: First Nations (FN) have unique perspectives and experiences of health and healthcare services, which are critical to the provision of effective community-based primary healthcare (CBPHC). Objective: This paper shares FN perspectives on primary healthcare (PHC), taking geographical, cultural and historical realities into account, to elucidate opportunities to improve current healthcare services. Methods: Semi-structured in-depth qualitative interviews were completed with 183 residents of 8 Manitoba FN communities. Grounded theory-guided data analysis was conducted. Results: Improving PHC performance requires delivering timely and holistic healthcare that integrates traditional health knowledge, comprehensive CBPHC increasing services such as healthcare and medical transportation, healthy food as an important preventative measure and a culturally informed workforce backed by local leadership and promoting cultural respect. Conclusion: The relationship between self-determination and health is a critical factor in the implementation of CBPHC. FN must be respected to decide healthcare priorities that reflect the needs and visions of each community.

show abstract

“…Notably excluded by the CHA and its predecessors is Canada's '14th health care system' (see Lavoie et al, 2016a for a detailed discussion). This $1.7 billion system, 2 funded by the federal government and overseen by the First Nations and Inuit Health Branch (FNIHB) of Health Canada, functions primarily in First Nations communities located in all provinces and the Yukon, and in Inuit communities located in Nunavik (Québec) and Nunatsiaq (Labrador), serving a population of~800,000 peoples.…”

Section: Introductionmentioning

confidence: 99%

“…A number of First Nation and Inuit communities in Labrador, Northern Québec, Manitoba and British Columbia have signed tripartite self-government agreements and are no longer funded through or overseen by FNIHB for their health services. As a result, funding flows directly to the Indigenous communities but to the extent that health care programmes are included as part of that transfer, the health care programmes funded under self-government agreements remain largely defined by FNIHB (see Lavoie et al, 2016a). For the purpose of this paper, I am including 1 Medicare is only one part of Douglas' legacy, which included the old age pension, family allowance, the 40-hour work week, the Saskatchewan Art Board (the first on the continent), the labour code, minimum wages, free textbooks in schools, unemployment insurance, the first Bill of rights (which preceded the UN's Bill of Rights by a decade) and many other accomplishments.…”

Section: Introductionmentioning

confidence: 99%

“…The past decades of research and inquiries have highlighted continued Indigenous 3 health inequities related to differential access to health services, unresponsive care and racism (see Romanow, 2002;The Jordan's Principle Working Group, 2015;Lavoie et al, 2016aLavoie et al, , 2016b, for examples). Canada's 14th health care system is unique in that it is entirely focussed on rural and remote First Nation and Inuit primary health care, with an emphasis on prevention.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation