What all students in healthcare training programs should learn to increase health equity: perspectives on postcolonialism and the health of Aboriginal Peoples in Canada

Abstract

BackgroundThe ongoing role of colonialism in producing health inequities is well-known. Postcolonialism is a theoretical approach that enables healthcare providers to better understand and address health inequities in society. While the importance of postcolonialism and health (PCH) in the education of clinicians has been recognized, the literature lacks guidance on how to incorporate PCH into healthcare training programs. This study explores the perspectives of key informants regarding content related to PCH that should be included in Canadian healthcare training programs, and how this content should be delivered.MethodsThis qualitative study involved in-depth, semi-structured interviews with nineteen individuals with insight into PCH in Canada. Data were analyzed collaboratively to identify, code and translate key emergent themes according to the six phases of the DEPICT method.ResultsThree themes emerged related to incorporating PCH into Canadian healthcare training programs: (1) content related to PCH that should be taught; (2) how this content should be delivered, including teaching strategies, who should teach this content and when content should be taught, and; (3) why this content should be taught. For the Canadian context, participants advised that PCH content should include a foundational history of colonization of Aboriginal Peoples in Canada, how structures rooted in colonialism continue to produce health inequities, and how Canadian clinicians’ own experiences of privilege and oppression affect their practice. Participants also advised that this content should be integrated longitudinally through a variety of interactive teaching strategies and developed in collaboration with Aboriginal partners to address health inequities.ConclusionsThese findings reinforce that clinicians and educators must understand health and healthcare as situated in social, political and historical contexts rooted in colonialism. Postcolonialism enables learners to understand and respond to how colonialism creates and sustains health inequities. This empirical study provides educators with guidance regarding PCH content and delivery strategies for healthcare training programs. More broadly, this study joins the chorus of voices calling for critical reflection on the limits and harms of an exclusively Western worldview, and the need for action to name and correct past wrongs in the spirit of reconciliation and justice for all.

Wâhkôhtowin: The Governance of Good Community–Academic Research Relationships to Improve the Health and Well-Being of Children in Alexander First Nation

“…Health research conducted by non-Indigenous researchers has, until relatively recently, been a colonial practice resulting in the stigmatization and discrimination of First Nations and other Indigenous Peoples (Willows, 2013). Historically, health research has advanced negative stereotypes, divorcing health statistics from discussions of the social determinants that underlie health and socio-economic inequities such as poverty, unemployment, low educational attainment, inadequate access to health services, lack of food security, and poor and overcrowded housing conditions (Beavis et al, 2015;Greenwood & de Leeuw, 2012;Loppie Reading, & Wien, 2009;Trumper, 2004). However, there has been a justified reluctance on the part of First Nations communities to participate in research that purports to address health and socio-economic disparities, as the direct benefits of such research to community members may not be apparent or because communities are skeptical that such disparities can even be addressed by research (Edwards, Lund, Mitchell, & Anderson, 2008;Willows, 2013).…”

“…In Canada, First Nations children, along with other Indigenous children (i.e., Métis and Inuit) experience significant health and social disparities as a result of colonial legacies (Greenwood & de Leeuw, 2012;Smylie & Adomako, 2009). Colonialism is therefore an important determinant of First Nations children's health (Beavis et al, 2015;Greenwood & de Leeuw, 2012;Smylie & Adomako, 2009). …”

Approaches to incorporating indigenous health into the Canadian medical school curriculum

“…An understanding and acknowledgement of the residual effects of colonialism can help ensure that medical professionals can more effectively address the health inequities that disproportionately affect Indigenous communities. 8 Medical students need to recognize the historical structures rooted in colonialism that continue to produce health disparities for Indigenous peoples, such as the Indian Act, the reservation system, and discriminatory practices in employment, education, and housing. In addition, medical students need to understand how their personal privileges can affect clinical practice, and how ignorance to the social contexts of Indigenous patients and families can lead to inappropriate recommendations for care.…”

“…In addition, medical students need to understand how their personal privileges can affect clinical practice, and how ignorance to the social contexts of Indigenous patients and families can lead to inappropriate recommendations for care. 8 There are three key questions that need to be taken into consideration when incorporating post-colonial perspectives into Canadian healthcare training programs: (i) what content relating to post-colonialism and health should be taught; (ii) how this content should be taught, including teaching strategies and who should teach the content, and; (iii) why this content is being taught. 8 Collaboration with Indigenous partners to answer these three questions is key in developing teaching strategies and training programs.…”

Examining the climate for Aboriginal mothers in neonatal intensive care units (NICUs): an exploratory qualitative study about views of health care professionals

“…Colonialism, as I use the term in this research, refers to the process that began when Aboriginal peoples were displaced from their traditions lands by European settlers: it stretches over a time-frame of at least two centuries and, as others have argued, continues with ongoing territorial displacement and other violences today (Beavis et al, 2015;Lawrence et al, 2016). Colonialism continues to have a significant influence on the health, social, and economic status of all Indigenous peoples in Canada (Browne & Fiske, 2001;.…”