Dissecting systemic racism: policies, practices and epistemologies creating racialized systems of care for Indigenous peoples.

In this paper we explore some of the ways systemic racism operates and is maintained within our health and social services. We look at a very specific context, that of Nunavik Quebec, land and home to 13,000 Nunavimmiut, citizens of Quebec and Canada, signatories of the James Bay and Northern Quebec Agreement. We operationalize some of the ways in which policies and practices create and support social hierarchies of knowledges, also called epistemic racism, and how it impacts our ability to offer quality care that Indigenous peoples can trust and use.

Characteristics of Indigenous healing strategies in Canada: a scoping review.

OBJECTIVE: The objective of this review was to identify the characteristics of Indigenous healing strategies in Canada and culturally relevant approaches within Indigenous contexts. INTRODUCTION: In responding to the Canadian Truth and Reconciliation Commission's Calls to Action, there is increasing interest in Indigenous healing strategies across clinical, policy, and community sectors. The high relevance of Indigenous healing has also encouraged exploration of new approaches to research that are responsive to, and inclusive of, Indigenous contexts. To date, there is no clear understanding of what characterizes Indigenous healing strategies in Canada. INCLUSION CRITERIA: This review considered healing strategies for First Nations, Inuit, and Métis in Canada. Strategies examined included those related to health services and programs, policies and guidelines, models and frameworks, and Indigenous narratives and expert opinion in any service setting. METHODS: This review employed the JBI approach to scoping reviews. Searches were performed in CINAHL Full Text, Sociological Abstracts, PsycINFO, MEDLINE, and Academic Search Premier in December 2018. Searches for gray literature were conducted in iPortal, Canadian Electronic Library, and a list of Canadian government and Indigenous organization websites in February 2019. This review was limited to publications from 2008 onward. Non-English articles and theses and dissertations were excluded. RESULTS: Among the 59 articles included in this review, 41 were journal articles and 28 were published within the previous five years (i.e., 2014 and onward). The healing strategies were most frequently implemented in Ontario (n = 13), British Columbia (n = 8), and Manitoba (n = 5). The majority of strategies were utilized in the health settings (n = 37), which included mainstream treatment modalities as well as community-based healing initiatives. Services and programs (n = 24) were the predominant type of healing strategies, followed by models and frameworks (n = 9), policies and guidelines (n = 8), Indigenous narratives and expert opinion (n = 7), and others (n = 11). The most frequent guiding principles were identified as Honoring Cultures and Traditions (n = 14), Medicine Wheel (n = 12), and Strength-Based/Empowerment (n = 12). The most widely used main components were Artistic Expression (n = 16), Ceremonies (n = 15), and Games and Exercises (n = 12). As for human resources, Community Members (n = 19) were most frequently engaged, followed by Local Agencies (n = 12) and Knowledge Keepers (n = 12). Eight culturally relevant approaches were identified from 29 primary research studies, with the most popular being Consultation/Participatory Research (n = 20) and Indigenous Protocols (n = 5). CONCLUSIONS: The findings of this review collectively support a decolonizing approach that upholds Indigenous knowledge, respects Indigenous rights to self-determination, and recognizes Indigenous resilience and agency. More research is needed with a focus on Inuit or Métis healing, and innovative knowledge synthesis methods inclusive of diverse Indigenous ways of knowing.

The Retail Food Environment, Store Foods, and Diet and Health among Indigenous Populations: a Scoping Review.

PURPOSE OF THE REVIEW: Describe the state of knowledge on how the retail food environment contributes to diet-related health and obesity among Indigenous populations, and assess how the literature incorporates Indigenous perspectives, methodologies and engagement throughout the research process. Outcomes included dietary behaviour (purchasing, intakes and diet quality) and diet-related health outcomes (weight-related outcomes, non-communicable diseases and holistic health or definitions of health as defined by Indigenous populations involved in the study). RECENT FINDINGS: Of fifty included articles (1996-2019), the largest proportions described Indigenous communities in Canada (20 studies, 40%), the USA (16, 32%) and Australia (9, 18%). Among articles that specified the Indigenous population of focus (42 studies, 84%), the largest proportion (11 studies, 26%) took place in Inuit communities, followed by Aboriginal and Torres Strait Islander communities (8 studies, 19%). The included literature encompassed four main study designs: type A, dietary intakes of store foods (14 studies, 28%), and type B, store food environments (16, 32%), comprised the greatest proportion of articles; the remainder were type C, store food environments and diet (7, 14%), and type D, store food environment interventions (13, 26%). Of the studies that assessed diet or health outcomes (36, 72%), 22 (61%) assessed dietary intakes; 16 (44%) sales/purchasing; and 8 (22%) weight-related outcomes. Store foods tended to contribute the greatest amount of dietary energy to the diets of Indigenous peoples and increased non-communicable disease risk as compared to traditional foods. Multi-pronged interventions appeared to have positive impacts on dietary behaviours, food purchasing and nutrition knowledge; promotion and nutrition education alone had more mixed effects. Of the nine studies which were found to have strong engagement with Indigenous populations, eight had moderate or high methodological quality. Eighteen studies (36%) did not mention any engagement with Indigenous populations. The literature confirmed the importance of store foods to the total energy intake of the contemporary diets of Indigenous people, the gaps in accessing both retail food environments and traditional foods and the potential for both new dietary assessment research and retail food environment intervention strategies to better align with and privilege Indigenous Ways of Knowing.

Tackling the question of micronutrients intake as one of the main levers in terms of Inuit food security.

PURPOSE OF REVIEW: The Inuit population living in North Canada is facing a drastic change in lifestyle, which has brought about a dramatic nutrition transition characterized by a decrease in the traditional foods consumption and an increasing reliance on processed, store-bought foods. This rapid dietary shift leads to a significant public health concern, as wild-harvested country foods are rich in many micronutrients including vitamins, trace elements and minerals while the most frequently eaten Western foods mainly provide energy, fat, carbohydrates and sodium. This review addresses the emerging strategies to tackle food insecurity in this population. RECENT FINDINGS: Recent studies indicate that diets with a higher fraction of traditional foods (and a lower fraction of ultra-processed foods) exhibit a better Healthy Eating Index. This provides a basis to develop new dietary policies anchored in contemporary food realities. SUMMARY: In Northern remote communities, improving food security requires holistic approaches. A mixed strategy that targets the revitalization of traditional foods systems and local food production initiatives seems the most promising strategy, to meet the dietary needs in terms of micronutrients, with respect to the cultural identity of local populations.

Health ethics and Indigenous ethnocide.

In colonial societies such as Canada the implications of colonialism and ethnocide (or cultural genocide) for ethical decision-making are ill-understood yet have profound implications in health ethics and other spheres. They combine to shape racism in health care in ways, sometimes obvious, more often subtle, that are inadequately understood and often wholly unnoticed. Along with overt experiences of interpersonal racism, Indigenous people with health care needs are confronted by systemic racism in the shaping of institutional structures, hospital policies and in resource allocation decisions. Above all, racism is a function of state law - of the unilateral imposition of the settler society law on Indigenous communities. Indeed, the laws, including health laws, are social determinants of the ill-health of Indigenous peoples. This article describes the problem of Indigenous ethnocide and explores its ethical implications. It thereby problematizes the role of law in health ethics.

Characteristics of Indigenous healing strategies in Canada: a scoping review protocol.

OBJECTIVE: The objective of this review is to identify the characteristics of Indigenous healing strategies in Canada and approaches to improving cultural relevance to local Indigenous contexts. INTRODUCTION: In the previous 150 years, Indigenous peoples of Canada have experienced colonization, forced assimilation, cultural oppression and violence, and these are associated with high rates of social distress and health disparities. Today, legacies of colonization continue to marginalize Indigenous peoples, creating healthcare institutions devoid of Indigenous worldviews. Despite the growing number of Indigenous healing strategies currently in existence, literature describing these strategies has not been systematically scoped. To address this gap, this scoping review will identify characteristics of Indigenous healing strategies in Canada, and explore culturally relevant approaches used in research process. INCLUSION CRITERIA: This review will consider literature that describes Indigenous healing strategies in Canada and will include First Nations, Inuit and Métis as the population of interest. Strategies may include, but are not limited to, health services and programs, policies and guidelines, models and frameworks, and Indigenous narratives and expert opinions. Healing strategies delivered in all service settings are eligible for inclusion. METHODS: The databases/sources to be searched will include: CINAHL, Sociological Abstracts, PsycINFO, MEDLINE and Academic Search Premier. Searches for gray literature will be conducted in iPortal, Canadian Electronic Library, and a list of Canadian government and Indigenous organization websites. Retrieval of full-text studies and data extraction will be performed independently by two reviewers. Findings will be summarized in tabular forms accompanied by narrative text.

Seven Core Principles of Substance Use Treatment System Design to Aid in Identifying Strengths, Gaps, and Required Enhancements.

OBJECTIVE: System planners and funders encounter many challenges in taking action toward evidence-informed enhancement of substance use treatment systems. Researchers are increasingly asked to contribute expertise to these processes through comprehensive system reviews. In this role, all parties can benefit from guiding frameworks to help organize key questions and data collection activities, and thereby set the stage for both high-level and on-the-ground strategic directions and recommendations. This article summarizes seven core principles of substance use treatment system design that are supported by a large international evidence base and that together have proven applicable as a framework for several systems review projects conducted predominantly in Canada. METHOD: The methodology was based on a narrative review approach. RESULTS: The principles address a wide range of issues. Specifically, a broad systems approach is needed to address the full spectrum of issues; accessibility and effectiveness are improved through collaboration across stakeholders; a range of system supports are needed; need for services should be grounded in self-determination, holistic cultural practices, choice, and partnership; attention to diversity and social-structural disadvantages are crucial to equitable system design; systematic screening and assessment is needed to match people to appropriate treatment services in a stepped service framework; and, last, individualized treatment planning must include the right mix of evidence-informed interventions. CONCLUSIONS: By bringing researchers and stakeholders back to the high-level goals of substance use treatment systems, these principles provide a comprehensive, evidence-based, organizing framework that has the potential to improve the quality of system design and review internationally.

Experience of menopause in aboriginal women: a systematic review.

Every woman experiences the menopause transition period in a very individual way. Menopause symptoms and management are greatly influenced by socioeconomic status in addition to genetic background and medical history. Because of their very unique cultural heritage and often holistic view of health and well-being, menopause symptoms and management might differ greatly in aboriginals compared to non-aboriginals. Our aim was to investigate the extent and scope of the current literature in describing the menopause experience of aboriginal women. Our systematic literature review included nine health-related databases using the keywords 'menopause' and 'climacteric symptoms' in combination with various keywords describing aboriginal populations. Data were collected from selected articles and descriptive analysis was applied. Twenty-eight relevant articles were included in our analysis. These articles represent data from 12 countries and aboriginal groups from at least eight distinctive geographical regions. Knowledge of menopause and symptom experience vary greatly among study groups. The average age of menopause onset appears earlier in most aboriginal groups, often attributed to malnutrition and a harsher lifestyle. This literature review highlights a need for further research of the menopause transition period among aboriginal women to fully explore understanding and treatment of menopause symptoms and ultimately advance an important dialogue about women's health care.

Exploring policy driven systemic inequities leading to differential access to care among Indigenous populations with obstructive sleep apnea in Canada.

BACKGROUND: In settler societies such as Australia, Canada, New Zealand and the United States, health inequities drive lower health status and poorer health outcomes in Indigenous populations. This research unravels the dense complexity of how historical policy decisions in Canada can influence inequities in health care access in the 21(st) century through a case study on the diagnosis and treatment of obstructive sleep apnea (OSA). In Canada, historically rooted policy regimes determine current discrepancies in health care policy, and in turn, shape current health insurance coverage and physician decisions in terms of diagnosis and treatment of OSA, a clinical condition that is associated with considerable morbidity in Canada. METHODS: This qualitative study was based in Saskatchewan, a Western Canadian province which has proportionately one of the largest provincial populations of an Indigenous subpopulation (status Indians) which is the focus of this study. The study began with determining approaches to OSA care provision based on Canadian Thoracic Society guidelines for referral, diagnosis and treatment of sleep disordered breathing. Thereafter, health policy determining health benefits coverage and program differences between status Indians and other Canadians were ascertained. Finally, respirologists who specialized in sleep medicine were interviewed. All interviews were audio-recorded and the transcripts were thematically analyzed using NVIVO. RESULTS: In terms of access and provision of OSA care, different patient pathways emerged for status Indians in comparison with other Canadians. Using Saskatchewan as a case study, the preliminary evidence suggests that status Indians face significant barriers in accessing diagnostic and treatment services for OSA in a timely manner. CONCLUSIONS: In order to confirm initial findings, further investigations are required in other Canadian jurisdictions. Moreover, as other clinical conditions could share similar features of health care access and provision of health benefits coverage, this policy analysis could be replicated in other provincial and territorial health care systems across Canada, and other settler nations where there are differential health coverage arrangements for Indigenous peoples.

Comparison of infant vitamin D supplement use among Canadian-born, immigrant, and refugee mothers.

PURPOSE: This study compares knowledge and practice of infant vitamin D supplementation among immigrant, refugee, and Canadian-born mothers. METHOD: Focus group discussions with 94 mothers of children aged 0 to 3 years recruited from early childhood centers and a refugee health clinic. FINDINGS: Both immigrant and Canadian-born mothers indicated good knowledge and use of infant vitamin D supplementation. In contrast, Canadian government-assisted refugees were less likely to supplement with vitamin D. The main source of information about vitamin D was public health prenatal classes. Many mothers reported inconsistent guidance from health care providers. DISCUSSION AND CONCLUSIONS: Exclusively breastfed infants of refugees may be more at risk of vitamin D deficiency. All mothers require clear recommendations, both in clinical and public health settings. IMPLICATIONS FOR PRACTICE: Mothers, both new Canadian and Canadian-born, require clear and consistent messaging from health professionals. Refugee mothers, however, require more educational support to promote infant vitamin D supplementation.

The genetic prehistory of the New World Arctic.

The New World Arctic, the last region of the Americas to be populated by humans, has a relatively well-researched archaeology, but an understanding of its genetic history is lacking. We present genome-wide sequence data from ancient and present-day humans from Greenland, Arctic Canada, Alaska, Aleutian Islands, and Siberia. We show that Paleo-Eskimos (~3000 BCE to 1300 CE) represent a migration pulse into the Americas independent of both Native American and Inuit expansions. Furthermore, the genetic continuity characterizing the Paleo-Eskimo period was interrupted by the arrival of a new population, representing the ancestors of present-day Inuit, with evidence of past gene flow between these lineages. Despite periodic abandonment of major Arctic regions, a single Paleo-Eskimo metapopulation likely survived in near-isolation for more than 4000 years, only to vanish around 700 years ago.

Clinical symptoms of psychotic episodes and 25-hydroxy vitamin D serum levels in black first-generation immigrants.

OBJECTIVE: Dark-skinned immigrants have a higher risk for schizophrenia and other psychoses than other immigrants. The first British studies reported that first-generation immigrants (FGIs) from the Caribbean presented atypical psychoses. This study examines the characteristics of psychotic episodes in black FGIs to Canada. METHOD: The charts of 18 FGIs from Africa and Haiti, extracted from a series of 20 black patients consecutively admitted to Psychiatry, were retrospectively reviewed regarding clinical features, diagnoses and vitamin D levels. RESULTS: Young FGIs presented acute psychotic episodes with abrupt onset, florid positive symptoms, few negative symptoms and good evolution. The onset was more insidious in older FGIs. Overall, catatonia was very frequent (28%), and mood symptoms still more frequent (44%). No cognitive decline was observed during follow-up. Serum levels of 25-hydroxy vitamin D were in the insufficiency range. Supplementation at 1000 IU/day did not restore normal levels. CONCLUSION: The clinical features of psychotic episodes in black FGIs are similar to those reported in dark-skinned FGIs to other countries. They are also observed in other immigrants and in non-immigrants. These atypical psychoses are possibly related to a recent vitamin D deficit. This hypothesis should be tested by clinical trials of sufficient vitamin D supplementation.

Accounting for the contribution of vitamin B to Canada's WWII effort.

Canada began to fortify its flour and bread with vitamin B when it entered the Second World War. The decision was informed by the biology of vitamin B and therefore I suggest that the complexity of this political maneuver can best be understood by considering the specificity of the biochemistry of vitamin B. In this paper I will show that the specific biology of vitamin B allowed the Canadian government the possibility of a healthier population under wartime conditions but also allowed the government a variety of means by which to develop and organize food processing practices to this end.

Care for the "racially careless": Indian hospitals in the Canadian West, 1920-1950s.

In the 1930s, sanatorium directors and medical bureaucrats warned of the threat to Canadian society of "Indian tuberculosis." Long-standing government policy aimed to isolate Aboriginal people on reserves and in residential schools, while their access to medical care was limited by government parsimony and community prejudice. Characterized as "racially careless" concerning their own health, Aboriginal bodies were seen as a menace to their neighbours and a danger to the nation. By the 1940s state-run racially segregated Indian hospitals institutionalized Aboriginal people who were not welcome in provincial sanatoria or in the modernizing community hospitals. The opening of the Charles Camsell Indian Hospital in Edmonton in 1946, one of the first acts of the newly created department of National Health and Welfare, was a very public demonstration of the state's commitment to define and promote "national health" by isolating and institutionalizing Aboriginal people.

War's long shadow: masculinity, medicine, and the gendered politics of trauma, 1914-1939.

War is an inherently traumatizing experience, and during the First World War more than 15,000 Canadian soldiers were diagnosed with some form of war-related psychological wounds. Many more went unrecognized. Yet the very act of seeking an escape from the battlefield or applying for a postwar pension for psychological traumas transgressed masculine norms that required men to be aggressive, self-reliant, and un-emotional. Using newly available archival records, contemporary medical periodicals, doctors' notes, and patient interview transcripts, this paper examines two crises that arose from this conflict between idealized masculinity and the emotional reality of war trauma. The first came on the battlefield in 1916 when, in some cases, almost half the soldiers evacuated from the front were said to be suffering from emotional breakdowns. The second came later, during the Great Depression, when a significant number of veterans began to seek compensation for their psychological injuries. In both crises, doctors working in the service of the state constructed trauma as evidence of deviance, in order to parry a larger challenge to masculine ideals. In creating this link between war trauma and deviance, they reinforced a residual conception of welfare that used tests of morals and means to determine who was deserving or undeserving of state assistance. At a time when the Canadian welfare state was being transformed in response to the needs of veterans and their families, doctors' denial that "real men" could legitimately exhibit psychosomatic symptoms in combat meant that thousands of legitimately traumatized veterans were left uncompensated by the state and were constructed as inferior, feminized men.

The use of complementary and alternative medicine among Chinese Canadians: results from a national survey.

This study examines the relationship between Chinese Canadian ethnicity and the use of complementary and alternative medicine (CAM) and explores some of the factors that contribute to CAM use among this visible minority group. Using data from cycle 2.1 of the Canadian Community Health Survey (2003), we use multivariate logistic regression to investigate the extent to which CAM use varies among Chinese Canadians and non-Chinese Canadians. Two three-way interactions, which demonstrate how the combination of certain identity markers increases their predictive value within the model, are also examined. The use of CAM varies according to ethnicity, with Chinese Canadians being more likely to use than non-Chinese Canadians. The findings also indicate that cultural factors play a key role in establishing the necessary conditions for increasing the likelihood of CAM use for Chinese Canadians. Findings are discussed in terms of their implications for health care policy and program development.

Low dietary nutrient intakes and respiratory health in adolescents.

BACKGROUND: Epidemiologic studies have indicated that a diet rich in fruit, antioxidants, and n-3 fatty acids may contribute to optimal respiratory health. We investigated whether low dietary nutrient intakes were associated with lower pulmonary function and higher reporting of respiratory symptoms in adolescents. METHODS: We examined the association of dietary factors (fruit, vegetables, vitamins C and E, beta-carotene, retinol, n-3 fatty acids) with respiratory health in a cohort of 2,112 twelfth-grade students in 13 communities in the United States and Canada during the 1998 to 1999 school year. We assessed the associations between dietary factors and pulmonary function with linear mixed models, and respiratory symptoms with logistic regression using a generalized estimating equation adjusted for individual and group-level covariates. RESULTS: Low dietary fruit intake was associated with lower FEV(1) (- 1.3% of predicted; 95% confidence interval [CI], - 2.4 to - 0.2% of predicted), and increased odds of chronic bronchitic symptoms (odds ratio [OR], 1.36; 95% CI, 1.03 to 1.73) compared with higher intake. Low dietary n-3 fatty acids intake was associated with increased odds of chronic bronchitic symptoms (OR, 1.37; 95% confidence interval [CI], 1.05 to 1.81), wheeze (OR, 1.34; 95% CI, 1.06 to 1.69), and asthma (OR, 1.68; 95% CI, 1.18 to 2.39) compared with higher intake. Smokers with lower dietary vitamin C intake had higher ORs of respiratory symptoms compared with smokers who had higher intake. CONCLUSIONS: Adolescents with the lowest dietary intakes of antioxidant and antiinflammatory micronutrients had lower pulmonary function and increased respiratory symptoms, especially among smokers, suggesting that adequate dietary intake may promote respiratory health and lessen the effects of oxidative stress.

Antioxidant activity in medicinal plants associated with the symptoms of diabetes mellitus used by the indigenous peoples of the North American boreal forest.

Thirty-five plant species were selected from the published literature as traditionally used by the Indigenous Peoples of the boreal forest in Canada for three or more symptoms of diabetes or its complications. Antioxidant activities in methanolic extracts support the contribution of these traditional medicines in a lifestyle historically low in the incidence of diabetes. In a DPPH assay of free radical scavenging activity 89% of the methanol extracts had activity significantly greater than common modern dietary components, 14% were statistically equal to ascorbic acid and 23% had activities similar to green tea and a Trolox positive control. Superoxides produced with an NBT/xanthine oxidase assay found scavenging was significantly higher in 29% of the species as compared with the modern dietary components and Trolox. The methanol extracts of Rhus hirta, Quercus alba and Cornus stolonifera performed similarly to green tea's in this assay. Assessment of peroxyl radical scavenging using a DCF/AAPH assay showed 60% of the plant extracts statistically similar to Trolox while R. hirta and Solidago canadensis extracts were greater than green tea, ascorbic acid and Trolox. The majority of the species (63 and 97%, respectively) had scavenging activities similar to ascorbic acid in the superoxide and peroxyl radical scavenging assays.