Incorporating First Nations, Inuit and Métis Traditional Healing Spaces within a Hospital Context: A Place-Based Study of Three Unique Spaces within Canada's Oldest and Largest Mental Health Hospital.

Globally and historically, Indigenous healthcare is efficacious, being rooted in Traditional Healing (TH) practices derived from cosmology and place-based knowledge and practiced on the land. Across Turtle Island, processes of environmental dispossession and colonial oppression have replaced TH practices with a colonial, hospital-based system found to cause added harm to Indigenous Peoples. Growing Indigenous health inequities are compounded by a mental health crisis, which begs reform of healthcare institutions. The implementation of Indigenous knowledge systems in hospital environments has been validated as a critical source of healing for Indigenous patients and communities, prompting many hospitals in Canada to create Traditional Healing Spaces (THSs). After ten years, however, there has been no evaluation of the effectiveness of THSs in Canadian hospitals in supporting healing among Indigenous Peoples. In this paper, our team describes THSs within the Center for Addiction and Mental Health (CAMH), Canada's oldest and largest mental health hospital. Analyses of 22 interviews with hospital staff and physicians describe CAMH's THSs, including what they look like, how they are used, and by whom. The results emphasize the importance of designating spaces with and for Indigenous patients, and they highlight the wholistic benefits of land-based treatment for both clients and staff alike. Transforming hospital spaces by implementing and valuing Indigenous knowledge sparks curiosity, increases education, affirms the efficacy of traditional healing treatments as a standard of care, and enhances the capacity of leaders to support reconciliation efforts.

Reclaiming Land, Identity and Mental Wellness in Biigtigong Nishnaabeg Territory.

Indigenous peoples globally are pursuing diverse strategies to foster mental, emotional, and spiritual wellness by reclaiming and restoring their relationships to land. For Anishinaabe communities, the land is the source of local knowledge systems that sustain identities and foster mino-bimaadiziwin, that is, living in a good and healthy way. In July 2019, the community of Biigtigong Nishnaabeg in Ontario, Canada hosted a week-long land camp to reclaim Mountain Lake and reconnect Elders, youth and band staff to the land, history, and relationships of this place. Framed theoretically by environmental repossession, we explore the perceptions of 15 participating community members and examine local and intergenerational meanings of the camp for mental wellness. The findings show that the Mountain Lake camp strengthened social relationships, supported the sharing and practice of Anishinaabe knowledge, and fostered community pride in ways that reinforced the community's Anishinaabe identity. By exploring the links between land reclamation, identity, and community empowerment, we suggest environmental repossession as a useful concept for understanding how land reconnection and self-determination can support Indigenous mental wellness.

Building structures of environmental repossession to reclaim land, self-determination and Indigenous wellness.

In Canada, Indigenous health inequalities are sustained by colonial structures that create social disadvantage and limit Indigenous self-determination to Land. Drawing on the concept of environmental repossession, this study explores how Indigenous communities are building local structures to reclaim their territories and renew the values, responsibilities and knowledges tied to these places for wellness. Specifically, this study examines the meanings of the everyday work of the Department of Sustainable Development in Biigtigong Nishnaabeg and shares lessons for other communities seeking to foster self-determination over Land, identity and wellness. Qualitative analysis of interviews with current and former department staff members support an advanced understanding of how repossession strategies are sustained by Indigenous communities to foster place-based goals and address structural barriers to wellness.

Reclaiming Mountain Lake: Applying environmental repossession in Biigtigong Nishnaabeg territory, Canada.

The concept of environmental repossession responds to a global movement led by Indigenous peoples to reclaim their territories and ways of life. As Indigenous wellness is intimately tied to relationships to land, processes of environmental repossession are a means to revitalize knowledge systems, identities and relationships that foster strong and healthy communities. Due to historic and ongoing forces of dispossession, the Anishinaabe community of Biigtigong Nishnaabeg has experienced limited access to Mountain Lake, a culturally and historically significant place in their ancestral territory. In the summer of 2018, the Chief and Council of Biigtigong constructed two cabins along the shores of Mountain Lake for community use and, one year later, hosted a week-long camp to bring Elders, youth and band staff together in this place. Drawing from 15 in-depth interviews with participating community members, this study documented the planning and implementation of the cabins and camp at Mountain Lake and examined the community meanings of this process. The findings suggest that the cabins and camp functioned as a local process of environmental repossession through multiple and interconnected steps to reclaim access to Mountain Lake, reintroduce the community to this place and begin remaking community relationships to this land. As Indigenous communities globally seek to reclaim their territories and rights to land, this article speaks to the tensions of this work and the structures that support its practice locally.

First Nations Food Environments: Exploring the Role of Place, Income, and Social Connection.

BACKGROUND: In Canada, few studies have examined how place shapes Indigenous food environments, particularly among Indigenous people living in southern regions of Ontario. OBJECTIVE: This paper examines and compares circumstances of food insecurity that impact food access and dietary quality between reserve-based and urban-based Indigenous peoples in southwestern Ontario. METHODS: This study used a community-based survey containing a culturally adapted food-frequency questionnaire and cross-sectional study design to measure food insecurity, food access, and dietary quality among Indigenous respondents living in urban (n = 130) and reserve-based (n = 99) contexts in southwestern Ontario. RESULTS: Rates of food insecurity are high in both geographies (55% and 35% among urban- and reserve-based respondents, respectively). Urban-based participants were 6 times more likely than those living on-reserve to report 3 different measures of food insecurity. Urban respondents reported income to be a significant barrier to food access, while for reserve-based respondents, time was the most pressing barrier. Compared with recommendations from Canada's Food Guide, our data revealed overwhelming trends of insufficient consumption in 3 food categories among all respondents. Close to half (54% and 52%) of the urban- and reserve-based samples reported that they eat traditional foods at least once a week, and respondents from both groups (76% of urban- and 52% of reserve-based respondents) expressed interest in consuming traditional foods more often. CONCLUSIONS: Indigenous Food Sovereignty and community-led research are key pathways to acknowledge and remedy Indigenous food insecurity. Policies, social movements, and research agendas that aim to improve Indigenous food security must be governed and defined by Indigenous people themselves. Indigenous food environments constitute political, social, and cultural dimensions that are infinitely place based.

Exploring First Nation Elder Women's Relationships with Food from Social, Ecological, and Historical Perspectives.

BACKGROUND: The ongoing negative health effects of colonization have disproportionately affected Indigenous women, who are disproportionately affected by diabetes, food insecurity, and undernutrition. Indigenous women also perceive their health less positively than men do. This article draws theoretically from the socio-ecological model to explore health inequalities experienced by Indigenous women associated with the intergenerational effects of the residential school legacy, specifically related to food practices. OBJECTIVES: Study objectives were to describe and compare the historical context of present-day urban and rural food environments, and explore the hypothesis that food insecurity may be associated with cultural loss resulting from the intergenerational trauma of residential schools in this region of southwestern Ontario, Canada. METHODS: Framed by a larger community-based participatory study, life history interviews took place with 18 Elder women living on- and off-reserve in southwestern Ontario, Canada. RESULTS: Women discussed painful circumstances of displacement from the land and social disconnection from families and communities. The 10 participants who were residential school survivors conveyed the intergenerational effects of loss, responsibility, lack of support, and an altered sense of identity as narratives of survival. Six women had moved away from their home communities, which created challenges to fully engage in local food procurement and sharing practices. These altered geographies present practical limitations, along with apparent mechanisms of social and cultural exclusion. CONCLUSIONS: Research on Indigenous Peoples' food systems requires further analysis of the root causes of disparities in the context of societal and gender relations. Food sovereignty has been the domain of women, who have led movements aimed at both social and environmental justice. Unraveling the historical, social, and environmental determinants of Indigenous food knowledge will support and guide community and policy recommendations, highlighting the ongoing effects of residential schooling and other indirect examples of environmental dispossession that have disproportionately affected Indigenous women.

Paddling the Biigtig: Mino biimadisiwin practiced through canoeing.

The land is critically important for the health of Indigenous peoples, as it is the place where Indigenous Knowledge originates to form strong and healthy relationships. In the wake of unprecedented processes of environmental dispossession, Indigenous communities around the world are revitalizing the land-based cultural practices and knowledge systems that have kept them strong and healthy. For the first time in a century, Biigtigong Nishnaabeg canoed the length of the Biigtig Ziibii (Pic River). With a greater purpose of reclaiming places (e.g., mountains, rivers, portages) along the route in Anishinabemoen (the Ojibway language) and restoring community history of the river and its meanings, this canoe journey was also developed to restore land-based learning about healthy relationships and mino bimadisiwin, or "the good life". Four adults and five youth participated in this journey. Framed theoretically by the concept of environmental repossession, this paper examined participants' perceptions (n = 9) of the canoe journey, with emphasis placed on the ways in which it fostered health and well-being. Specifically, this canoe trip supported spaces for learning and practice of Indigenous Knowledge, nurturing of social relationships and, stronger connections to the land. Participants defined the canoe journey as an important space for sharing intergenerational and ancestral understandings of Indigenous Knowledge, and for broadening understandings of the land as part of the community's history, culture and well-being. As other communities search for ways to both assert their Indigenous rights and identity, this case provides an important example to build from.

Creating conditions for Canadian aboriginal health equity: the promise of healthy public policy.

In the Canadian context, the persistence and growth of Aboriginal health and social inequity signals that we are at a critical public health policy juncture; current policy reflects an historic relationship between Aboriginal people and Canada that fails the contemporary health needs of Canada's Aboriginal peoples. In this review, we highlight the need for healthy public policy that recognizes and prioritizes the rights of Canada's Aboriginal people to achieve health equity. Drawing from a structural approach, we examine the historical scope and comprehensive breadth of the Indian Act in shaping modern Aboriginal health and social inequities. Canada's failure to implement a national public policy for Aboriginal health reflects the proliferation of racism in modern day Canada, and a distinctly lacking political will at the federal level. Despite these structural challenges, there is great promise in community self-determination in health care and the role of community-led research as advocacy for policy reform. In our conclusion, we turn to the Report on the Truth and Reconciliation Commission of Canada (2015) and draw upon the concept of reconciliation as a fundamental precursor for Aboriginal health equity. The burden of systemic change needed to promote healthy public policy cannot be carried by any single group of advocates; it is a shared responsibility that will require the collaboration and integration of various actors and knowledges.

"That land means everything to us as Anishinaabe .": Environmental dispossession and resilience on the North Shore of Lake Superior.

This article shares results of a community-based (CBR) study that qualitatively examined the perceived health impacts of environmental dispossession among Elders in two Anishinaabe communities in Ontario, Canada. Through in-depth interviews, Elders (n=46) recounted changes in health and well-being, specifically that related to reduced access to traditional foods and decreased capacity to participate in, and share knowledge of, land-based practices. Elders discussed the ways in which they have remained resilient to these changes in their ways of living. With a greater purpose of proposing solutions that will improve contemporary patterns of Indigenous health, this research underscores the importance of engaging theoretically in concepts of environmental dispossession and resilience.

Anishinabe youth perceptions about community health: toward environmental repossession.

This community-based research applied environmental dispossession as a theoretical framework for understanding Anishinabe youth perceptions about health, social relationships and contemporary Anishinabe way of life in Northern Ontario, Canada. Qualitative interviews with 19 youth reveal considerable worry about their community's health. Youth perceive changes in the Anishinabe way of life, including decreased access to their traditional lands, to be central to poor health at the community level. Youth emphasized the importance of social relationships for fostering healthy behaviours and developing community wide initiatives that will provide opportunities for reconnecting to land, and for learning and practicing Indigenous Knowledge. This study builds on the growing body of decolonizing research with Indigenous communities, and it concludes by offering the concept of environmental repossession as a way forward for studies on the Indigenous environment-health interface.

Hepatitis B in Ghana's upper west region: a hidden epidemic in need of national policy attention.

Like many countries in Sub-Saharan Africa, Hepatitis B virus (HBV) is highly prevalent in Ghana. Using qualitative methods, this paper draws from the political ecology of health theoretical framework to examine perceptions and understandings of HBV in the Upper West Region of Ghana. The findings reveal that extremely low levels of knowledge and pervasive lay misconceptions about the disease within this geographic context are shaped by large scale structural influences. Furthermore, in this context there is essentially no access to HBV immunizations, testing or treatment services which reinforces potential routes for the spread of HBV. An explosive spread of HBV is brewing with the potential to diffuse across space and time while, within the institutional contexts, it is the HIV epidemic that is largely consuming both policy attention and intervention.

Community-based participatory research (CBPR) with indigenous communities: producing respectful and reciprocal research.

The health disparities between Indigenous and non-Indigenous peoples in Canada continue to grow despite an expanding body of research that attempts to address these inequalities, including increased attention from the field of health geography. Here, we draw upon a case study of our own community-based approach to health research with Anishinabe communities in northern Ontario as a means of advocating the growth of such participatory approaches. Using our own case as an example, we demonstrate how a collaborative approach to respectful and reciprocal research can be achieved, including some of the challenges we faced in adopting this approach.

Formal dementia care among first nations in southwestern Ontario.

This article explores how dementia care is provided to First Nations communities in southwestern Ontario. Data were collected through in-depth interviews with health care providers and analysed using a constructivist grounded-theory methodology. Two interrelated frameworks for understanding dementia care were identified: a care delivery framework and a knowledge framework. The care delivery framework identified care goals, care elements being provided, care barriers, and strategies and solutions to deliver care and overcome barriers. The knowledge framework defined four groups of knowledge stakeholders: persons with dementia, informal care providers, formal care providers, and the First Nations community. It identified the knowledge each stakeholder held or needed and processes of sharing - or failing to share - knowledge in dementia care. Several barriers, many created by a lack of knowledge, negatively impacted dementia care. However, health care professionals had effective strategies for providing care, designed to overcome barriers and which encompassed elements of knowledge sharing.

The social determinants of Inuit health: a focus on social support in the Canadian Arctic.

OBJECTIVES: Societies that foster socially supportive networks produce healthier populations. Social support is a significant determinant of health among Canada's Inuit population; however, little is known about the characteristics that provide access to social support among Inuit. This exploratory analysis describes how 4 types of social support (namely, positive social interaction, emotional support, tangible support and affection and intimacy) differ in relation to various determinants of health. STUDY DESIGN: Micro-data from the Arctic Supplement of the 2001 Aboriginal Peoples Survey (n = 26,290) was used. METHODS: Cross-tabulations and multivariate logistic regression analyses were used to examine levels (high/low) of the 4 types of social support among the full Inuit sample (n = 26,290) as they relate to age, gender, geographic region, marital status, Aboriginal language use and participation in traditional harvesting activities. RESULTS: Certain subsegments of the Inuit population were less likely to report high levels of social support, including men, the elderly (aged 55+) and the unmarried. Some Inuit-relevant determinants were also found to decrease the odds of reporting high levels of social support, including being unable to speak or understand an Aboriginal language, not participating in traditional harvesting activities and living in Nunavik. CONCLUSIONS: Research that frames Inuit health within the social determinants of health is in its relative infancy; however, evidence from the social epidemiological literature indicates that those with diminished access to social support also suffer poorer health outcomes. Future research should build on the findings of this study to examine how the relationship between various health outcomes (e.g., respiratory disease, suicide attempts, self-rated health) and social support may respond along a social gradient. Such analysis will build on the paucity of literature specific to Inuit health and social conditions and set priorities for policy and programming efforts that will improve the social determinants of Inuit health.

The determinants of First Nation and Inuit health: a critical population health approach.

Environmental dispossession disproportionately affects the health of Canada's Aboriginal population, yet little is known about how its effects are sustained over time. We use a critical population health approach to explore the determinants of health in rural and remote First Nation and Inuit communities, and to conceptualize the pathways by which environmental dispossession affects these health determinants. We draw from narrative analysis of interviews with 26 Community Health Representatives (CHRs) from First Nation and Inuit communities across Canada. CHRs identified six health determinants: balance, life control, education, material resources, social resources, and environmental/cultural connections. CHRs articulated the role of the physical environment for health as inseparable from that of their cultures. Environmental dispossession was defined as a process with negative consequences for health, particularly in the social environment. Health research should focus on understanding linkages between environmental dispossession, cultural identity, and the social determinants of health.

Social support, material circumstance and health behaviour: influences on health in First Nation and Inuit communities of Canada.

An expansive literature describes the links between social support and health. Though the bulk of this evidence emphasizes the health-enhancing effect of social support, certain aspects can have negative consequences for health (e.g., social obligations). In the Canadian context, the geographically small and socially interconnected nature of First Nation and Inuit communities provides a unique example through which to explore this relationship. Despite reportedly high levels of social support, many First Nation and Inuit communities endure broad social problems, thereby leading us to question the assumption that social support is primarily health protective. We draw from narrative analysis of interviews with 26 First Nation and Inuit Community Health Representatives to critically examine the health and social support relationship, and the social structures through which social support influences health. Findings indicate that there are health-enhancing and health-damaging properties of the health-social support relationship, and that the negative dimensions can significantly outweigh the positive ones. Social support operates at different structural levels, beginning with the individual and extending toward family and community. These social structures are important as they reinforce an individual's sense of belonging, however, these high-density networks can also exert conformity pressures and social obligations that promote health-damaging behaviours such as domestic violence and smoking. The poor material circumstances that characterize so many First Nation and Inuit communities add another layer of complexity as limited resources can trap individuals within the confines of their immediate social contexts. Research and policy interventions must pay close attention to the social context within which social support, health behaviours and material circumstances interact to influence health outcomes among First Nation and Inuit communities.

Social support and thriving health: a new approach to understanding the health of indigenous Canadians.

OBJECTIVES: We examined the importance of social support in promoting thriving health among indigenous Canadians, a disadvantaged population. METHODS: We categorized the self-reported health status of 31625 adult indigenous Canadians as thriving (excellent, very good) or nonthriving (good, fair, poor). We measured social support with indices of positive interaction, emotional support, tangible support, and affection and intimacy. We used multivariable logistic regression analyses to estimate odds of reporting thriving health, using social support as the key independent variable, and we controlled for educational attainment and labor force status. RESULTS: Compared with women reporting low levels of social support, those reporting high levels of positive interaction (odds ratio [OR]=1.4; 95% confidence interval [CI]=1.2, 1.6), emotional support (OR=2.1; 95% CI=1.8, 2.4), and tangible support (OR = 1.4; 95% CI = 1.2, 1.5) were significantly more likely to report thriving health. Among men, only emotional support was significantly related to thriving health (OR=1.7; 95% CI=1.5, 1.9). Thriving health status was also significantly mediated by age, aboriginal status (First Nations, Métis, or Inuit), educational attainment, and labor force status. CONCLUSIONS: Social support is a strong determinant of thriving health, particularly among women. Research that emphasizes thriving represents a positive and necessary turn in the indigenous health discourse.

Narratives of social support and health in Aboriginal communities.

OBJECTIVE: Societies that foster high-quality social relationships and social support seemingly produce healthier populations. Existing research identifies social support as a significant dimension and determinant of Canadian Aboriginal health, yet patterns of morbidity and mortality overwhelmingly reflect social causes (e.g., violence, suicide), thereby suggesting that social support may not be widely accessible within this population. This paper seeks to understand how broader societal factors (e.g., colonialism) work to influence access to social support in the everyday social environments of Aboriginal communities. METHOD: Narrative analysis of interviews with 26 Aboriginal Community Health Representatives (CHRs) from across Canada. RESULTS: Sources of social support are institutional (e.g., those employed to provide support) and intimate (e.g., family). In terms of access to social support, CHRs' stories reflected a narrative detailing the post-colonial context. Key elements of this narrative include the child-parent relationship, group-belonging, trust, socio-economic dependence, and the changing nature of help. Findings suggest that features of the broader societal context (e.g., poverty) have manifested as local social conditions (e.g., providing help has come to be seen as a possible source of income), thereby reducing access to social support. Access to this resource is also affected as institutional and intimate supports tend to overlap in Aboriginal communities, many of which are small in terms of size and population. CONCLUSION: Research and policy options must recognize the post-colonial influences that affect the everyday realities of Aboriginal communities and study the complex interactions between these influences, and how health determinants--like social support--play out in local places as a result of this legacy.

Health disparities in Canada today: some evidence and a theoretical framework.

This paper documents contemporary evidence on patterns of health disparities in Canada and suggests theoretical mechanisms that give rise to these patterns. The overall health of Canadians, as measured by life expectancy or mortality, has improved dramatically over the past 30 years and some disparities have diminished slightly (e.g., life expectancy by income group for men), while others have increased (e.g., diabetes for Aboriginal peoples). Arguably the most egregious health disparities in Canada are those existing between Aboriginals and the rest of the Canadian population. This paper focuses specifically on three social determinants and their effects on disparities in health; Aboriginal status, income, and place. Overall we take the approach that disparities in health could be alleviated by reducing inequities in the distribution of these determinants. We further argue that these social determinants are proxies for opportunities, resources and constraints; all of which influence health outcomes. We suggest that policies focus on reducing the social inequities that lead to health disparities in Canada, rather than focusing on the disparities in health alone. Since the social determinants described here have been found to influence an array of disease outcomes, tackling them, rather than their outcomes, may have a greater overall influence on the health of the population.