Aboriginal Cultural Competency
Presented by Terri Stewart
Aboriginal Cancer Care Coordinator
Overview
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Introductions
Role of the Aboriginal Cancer Care Coordinator
Definitions
Demographics in BC
Importance of Cultural Competency
Canadian Study
Cancer in Aboriginal Populations
Characteristics of Aboriginal Cancer Patients
Cultural Aspects to the Centre
Indigenous Cultural Competency Training
Questions?
Role of the Aboriginal Cancer Care Coordinator
• Support patients and families from Aboriginal Communities
• Help patients and families navigate the health care system
• Promote increased health care provider cultural competence
and bridge Western and First Nations approaches to health
• Work with an Aboriginal Cancer Care Advisory Committee to
implement an Aboriginal Cancer Care Strategy which has four
pillars:
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Early Detection
Navigation
Survivorship
Cultural Competency
Definitions
Aboriginal refers to First Nation, Metis or Inuit
First Nation means First Nations People - The term is not a synonym for
Aboriginal Peoples because it doesn't include Inuit or Métis. The term First
Nations People generally applies to both Status and Non-Status Indians
that are usually connected to an Indian Reserve or Indian Band
Metis The word Métis is French for
"mixed blood." The Constitution Act of
1982 recognizes Métis. Historically,
the term Métis applied to the children
of French fur traders and Cree women
Inuit are the Aboriginal People of
Arctic Canada. Inuit live primarily in
the Northwest Territories, Nunavut and
northern parts of Quebec and
throughout most of Labrador
Demographics
First Nations, Metis and Inuit in BC
59445
129580
795
First Nations
Metis
Inuit
Demographics
• Where do Aboriginal people live?
– Off-reserve: 145,000
– On-reserve: 51,000
• Regions with the largest concentrations of the offreserve Aboriginal population:
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Thompson/Cariboo/Shuswap
Northern Interior
South Fraser
Central Vancouver Island
Northwest NHA
46% of offreserve Aboriginal
population in BC
Demographics
Distribution of Aboriginal Population by Health Authority
24.5%
12.5%
22.9%
20.7%
19.4%
Demographics of Northern BC
• Northern BC is comprised of over 54 First Nations
communities. They make up 24.5% of the overall
northern BC population, which is the highest
proportion in British Columbia.
• Of the 24.5% (49,500 people), more than 55% live off
reserve. Those who live on reserve are typically
located in rural, remote and/or isolated communities
that vary in size from 150 to 1,200 people.
Source: Statistics Canada, 2006 Census data, provided by BC Stats; prepared by the Office of the Provincial
Health Officer and Corporate Support, Planning and Legislation, Ministry of Healthy Living and Sport, 2008
Why is Cultural Competence and Safety Needed?
• Aboriginal people generally have poorer health status and
health outcomes than other Canadians
– ex. Aboriginal people are more likely than other Canadians to live with
chronic conditions and infectious diseases, and to die prematurely
• Health status is closely linked to determinants of health
• Aboriginal people are more likely to live in poverty, which is
associated with:
Lack of
Transportation
Inadequate
Housing
Unemployment
Poor
Health
Lower Education
Levels
Emotional
Stress
First Nations Perspective of Wellness
Cultural Competence…..why is it needed?
In December 2012 the
Health Council published
a report on Creating
cultural safety for
Aboriginal people in urban
health care
Aboriginal participants talked
about the challenging balance
between the Aboriginal holistic
approach to health and the Western
medical world view that is represented
in the image by the turtle rattle in
one hand and a medicine bottle in the
other. The tears show the hurt that
happens when someone is not treated
with empathy, dignity, and respect.
The roots of the tree refer to how we
are all rooted in a common
experience.
There may be
identifiable
cellular
pathways by
which racial
discrimination
amplifies
cardiovascular
and other agerelated disease
risks.”
2010 Canadian Study – Aboriginal Peoples
Dr. Cheryl Currie
Faculty of Health Sciences, University of Lethbridge
Research Questions:
• In the past 12 months, have you ever experienced
discrimination, been prevented from doing something, or
been hassled or made to feel inferior getting medical care
because of your Aboriginal race, ethnicity or colour?
• Is there anything you would like to share about these
experiences?
2010 Canadian Study – Aboriginal Peoples
Racial Discrimination experienced by Aboriginal Canadians:
Societal
High levels
of racism
2010 Canadian Study – Aboriginal Peoples
Did you experience racism in any of these situations
in the past 12 months?
1.
2.
3.
4.
5.
6.
7.
8.
9.
In a public place
In school
In a store or restaurant
Trying to find work
Trying to find housing
From the police
At work
Trying to get medical care
At a bank
YES
50%
50%
43%
40%
38%
35%
33%
28%
15%
Canadian Aboriginal Children
Non
Aboriginal
First
Nations
Children
Inuit
Children
Teachers don’t treat
me fairly
15%
22%
32%
I don’t feel safe at
school
12%
20%
30%
I don’t feel part of my
school
15%
23%
23%
I don’t feel close to
people at my school
15%
25%
23%
Sample size: 45,000 Canadian children
Currie et al. (2012)
How does Racism impact Health
How does Canada Rank?
• UN Human Development Scale places Canada 6th out of 174
Nations (2006)
• Does not account for economic and social wellbeing of its
Aboriginal Population
• According to the information reported in the December 2004
report for the Commission on Human Rights, this population
would be ranked 48th among countries in the world.
• “Our First Nation People live in a 3rd world environment”
– Joe Gallagher, Chief Executive Officer of FNHA
Cancer in Aboriginal Populations
• Cancer rates amongst Aboriginal people are still below non
Aboriginal rates but increasing dramatically
• Aboriginal people have limited access to prevention and
screening
• Treatment and diagnosis takes longer due to limited access to
health care
• Social Determinants to Health contribute to increasing cancer
rates
• Cancer is often diagnosed in the later stages, which leads to
high mortality rates
Understanding Differences
• For providers, cultural competency
starts with the understanding that
they should not make assumptions
about people’s culture
• Culturally competent staff know to
ask questions about what their
patients need, find out how to get it,
and are willing to advocate for it
• They also recognize that Aboriginal
communities have different beliefs,
cultural practices, and languages,
and that not all Aboriginal people are
interested in following traditional
ways
Considerations of Aboriginal Patients in the
Cancer Centre
• We have large families and when a person is sick or dying we
don’t like to leave a family member alone…so expect a lot of
people involved in care
• Elders often speak English as a second language; speak slowly
or get assistance from a family member when helping
• Speak plainly and quietly
• Don’t expect eye contact
• Talking about ill health isn’t
common
• Speaking to strangers isn’t
always easy…there could be years of distrust
Spiritual Care Room
The Transformed Spiritual Care Room
Therapeutic Garden
Smudging Pavillion
Functional Organizational Chart
First Nations
Health Authority
Board of Directors
Internal Audit
Chief Executive Officer
Joe Gallagher
FNHC Secretariat
Harmony Johnson
FNHDA Secretariat
Christine Stahler
Medical Health
Officer
Health Benefits
John Mah
Innovation and IM/IT,
CIO
Joseph Mendez
A/Corporate
Services and
Transition
Michael Hilson
Community Health
Services
TBD
Chief Financial
Officer
TBD
Human Resources
and Org Dev
Elaine Wass
Policy, Planning and
Strategic Services
Richard Jock
Indigenous Cultural Competency Training
– It is strongly recommended for PHSA employees to
take a cultural competency training program such
as the Provincial Health Services Authority
Indigenous Cultural Competency online
Program
http://www.culturalcompetency.ca/
Questions?
Takla Lake First
Nation 2008