AN INTRODUCTION TO INDIGENOUS HEALTH AND HEALTHCARE IN CANADA BRIDGING HEALTH AND HEALING 2ND ED

AN INTRODUCTION TO INDIGENOUS HEALTH AND HEALTHCARE IN CANADA BRIDGING HEALTH AND HEALING 2 ND ED Vasiliki Douglas CONTENTS PART I INDIGENOUS CULTURE AND HEALTH 1. Introduction: First Nations, Métis and Inuit in Canada: Understanding the Issues 2. Western and Indigenous Ways of Knowing 3. Cultural Competency, Cultural Sensitivity and Cultural Safety 4. Historical Overview PART II INDIGENOUS HEALTH AND THE CANADIAN HEALTHCARE SYSTEM 5. Understanding the Determinants of Health and Canada’s Native Population 6. Diabetes, Diet and Nutrition 7. Chronic and Infectious Diseases 8. Women’s and Children’s Health 9. Mental Health 10. Hybridisation of Healthcare and the Way Forward for Indigenous Health Chapter 1 – Introduction: First Nations, Métis and Inuit in Canada: Understanding the Issues Test Questions 1. Why did the Canadian government devolve power to Indigenous governments after the Oka Crisis? a. Federal politicians wanted to evade responsibility for Indigenous affairs. b. It saved money by devolving costs onto other levels of government. c. Because Canadian politicians wanted to demonstrate their support for Indigenous selfgovernment. d. Possibly all of the above. 2. The Oka Crisis led to increased a. awareness of Indigenous issues in Canada among both Canadians and internationally. b. police surveillance of reserves in Eastern Canada. c. government repression of Indigenous peoples in Canada. d. anti-Indigenous sentiment among the non-Indigenous population. e. all of the above. 3. The Canadian Multiculturalism Act a. Entrenched biculturalism in the Canadian constitution b. Made assimilation part of Canada’s official cultural policy c. Established the concept of the cultural mosaic as an official part of Canadian identity d. Entrenched Indigenous culture as part of Canadian identity e. Made acculturation part of Canada’s concept of the cultural mosaic 4. When did the Government of Canada commit itself to multiculturalism? a. 1971 b. 1981 c. 1975 d. 1871 5. What are the implications of universal healthcare for the Canadian heath care system? a. There are no implications b. Everyone is treated for illness when they get sick c. Tertiary care services are very important d. If the health of a part of the population is allowed to suffer, the burden falls on everyone 6. The three founding nations of Canada are a. French, English and Métis. b. English, Scottish and the Indigenous peoples. c. French, English and the Indigenous peoples. d. French, English and American. 7. The Constitution Act of 1982 defined Indians as persons belonging to one of three groups a. Métis, Inuit, First Nations. b. Métis, Inuit, Status Indians. c. Status, Non-Status, Treaty. d. Status, Non-Status, Inuit. 8. The position of Indigenous peoples in Canada was entrenched in the constitution in a. 1867. b. 1982. c. 1992. d. 2016. 9. The range of individual and collective factors and conditions and their interactions that have been shown to be correlated with health status reflects the recognition that a. Health is a capacity or resource rather than a state b. Being able to pursue one’s goals, to acquire skills and education and to grow is a privilege rather than a right c. Factors within the healthcare system significantly affect health d. The correlation is specious 10. Health promotion is a way of a. improving population health. b. reducing the burden on the public healthcare system. c. an intrusion on the human rights of the population. d. a and b 11. What is population health? a. The overall health of a population b. The health of each individual in a population c. A statistical measure of average prescription drug consumption in a population d. All of the above e. None of the above 12. How does population health relate to individual health? a. Good population health means that every individual is healthy b. Poor population health means that every individual is in poor health c. Good population health facilitates individual health d. a and b e. None of the above 13. The approach that recognises there is a range of social, economic and physical environmental factors that contribute to health is a. social engineering. b. population health. c. affirmative action. d. harmful effects reductionism. 14. The Romanow Report identified two important long-term demographic trends a. Both the general population and the Indigenous population are increasing in numbers rapidly due to high birth rates b. The Indigenous population is increasing rapidly, but the general population is only increasing through immigration c. Both the Indigenous and the general population of Canada are in a state of long-term demographic decline d. None of the above 15. Why was the Royal Commission on Aboriginal Peoples (RCAP) created? a. Because the health of Canada’s Indigenous peoples is very poor b. To find ways to improve employment among the Indigenous population c. Because the government was embarrassed by the Oka Crisis d. All of the above 16. Why did both the RCAP report and the Romanow Report receive highly mixed receptions from the governments that commissioned them? a. Budget cutbacks meant that their recommendations were not followed b. Their recommendations were intrinsically unrealistic c. Federal-provincial quarrels over jurisdiction made them hard to implement in practice d a and c 17. The Ottawa Charter on Health Promotion a. identified the social and environmental roots of ill health. b. recognized that health is a by-product of a healthy environment. c. did not specifically mention the Canadian Indigenous population. d. all of the above. 18. What leads to a healthy population according to the Ottawa Charter on Health Promotion? a. Increased government spending b. Improved medical care c. Immunisations d. Improved determinants of health 19. What has changed in the healthcare environment in the last 25 years? a. Increased non-Western immigration to industrialised countries b. Increased population diversity c. More assertive populations, including ethnic minorities d. All of the above e. None of the above 20. Equity in health must be a central goal of healthcare professionals, citizens and their governments. An example of equity in health is a. locally produced and culturally appropriate health knowledge systems. b. treating everyone the same as you would treat yourself. c. implementing government developed health programs. d. health outcomes are omitted as part of the public infrastructure. 21. What does “Indian Status” mean? a. An individual is recognized by the Canadian government as the registered member of an official Indian Band b. An individual’s ability to publicly claim one is of Indigenous descent c. That an individual lives on a reserve or Indigenous community in the Canadian Arctic d. An individual is recognised as an Indian through quantum of status e. a and d 22. What distinguishes Status Indians from Non-Status Indians? a. Status Indians are officially recognised by the Canadian government as Indigenous b. Status Indians live on reserves, Non-Status Indians do not c. Status Indians have the right to vote, but Non-Status Indians do not d. All of the above 23. Non-Status Indians are a. not members of any First Nation. b. First Nations that are not recognised by the Canadian government. c. are the descendants of Europeans and First Nations. d. all of the above. 24. Non-Status Indians a. are one of the fastest-growing groups in the Indigenous population. b. are few in number and disappearing. c. mainly live on reserves. d. none of the above. 25. What was the title given to children born of one First Nations parent and one European parent? a. Métis b. Indian c. Status Indian d. First Nations 26. Métis are descendants of a. Viking colonists of Newfoundland who intermarried with the First Nations. b. a small First Nations on the Michigan Peninsula who worked for the Northwest Company. c. French, English and Scottish fur traders and their First Nations wives. d. French, English and Scottish farmers and their First Nations wives. e. none of the above. 27. Métis are one of the fastest growing Indigenous peoples in Canada because they a. have a very high birth rate. b. are growing through immigration. c. increasing numbers of Canadians are reclaiming their Métis heritage and selfidentifying as Métis. d. a and c 28. Where do the Inuit traditionally live? a. In the boreal forest b. In the Alpine regions of British Columbia c. In the circumpolar north d. In the sub-Arctic regions of Canada e. None of the above 29. The majority of First Nations and Inuit in the Northwest Territories and Nunavut live a. on reserves. b. as minorities in mixed communities with non-Indigenous peoples. c. in two major cities, Yellowknife and Iqaluit. d. in their own communities governed by elected local governments. e. none of the above. 30. Canada’s newest territory, Nunavut has a. a mostly Inuit population. b. both Inuit and Dene First Nations populations. c. a largely European population, with a large Inuit minority. d. no permanent population, only transient workers. e. none of the above. 31. Where do Canadian Inuit live? a. In the Canadian Arctic b. All over Canada c. In the Yukon Territory d. a and b 32. Which of these are recognized as Indigenous people in Canada? a. Status Indians b. Métis c. Inuit d. Sami e. a, b and c. 33. Which province or territory of Canada has the greatest linguistic and cultural diversity of Indigenous peoples? a. Québec b. Alberta c. The Northwest Territories d. British Columbia e. None of the above 34. What percentage of the population of Canada is Indigenous? a. 1% b. 25% c. 4.9% d. 7% e. None of the above 35. Which of the following is one of the fastest growing populations in Canada? a. Non-Indigenous peoples under 30 years b. First Nations under 30 years c. First Nations elders d. Non-Indigenous over 30 years 36. What is the median age of the Indigenous population of Canada in the 2016 census? a. 31 b. 45 c. 40 d. 22 37. Which Indigenous population is the youngest in Canada (in the 2006 Census)? a. Métis b. First Nations c. Inuit d. Québecois 38. What is the largest-growing Indigenous group in Canada? a. Status Indians b. Inuit c. Métis d. Non-Status Indians 39. The Government of Canada traditionally only recognised a single type of Registered First Nation level of governance. a. The Tribe b. The Band c. The Nation d. The Village 40. Indian Bands are governed by a. elected band Councils. b. hereditary chiefs. c. government appointees. d. none of the above. 41. Complete the following statement. In the 2016 Census, the First Nations birth rate was a. less than the Canadian rate for non-Aboriginals. b. more than twice the Canadian rate for non-Aboriginals. c. steadily declining. d. less than half of what it was 10 years age. 42. “First Nations” refers to the fact that a. Indigenous peoples were in Canada first, before Europeans. b. Indigenous peoples had their own governments, cultures and national traditions. c. the British and Canadian governments both recognised that Indigenous peoples were sovereign – that they were nations and negotiated with them on that basis. d. all of the above. 43. In Canada, Indian Reserves are a. where all Indigenous people live in Canada. b. land reserved for Indigenous people. c. the place where non-Status Indians live. d. inhabited by some First Nations, but not Inuit or Métis. e. none of the above. 44. Indian Reserves are inhabited by a. all Indigenous peoples in Canada. b. Métis and Status Indians. c. Inuit. d. many, but not all Status Indians. 45. The reserve system in Canada a. requires all First Nations to live on reserves, though neither Métis nor Inuit are required do so. b. consists of land held by First Nations directly under the Crown. c. recognises the political status of First Nations as sovereign entities. d. none of the above adequately detail the realities. 46. The Canadian government a. is obligated by its own laws to negotiate treaties with First Nations and Inuit. b. is not obliged to negotiate treaties at all. c. negotiates treaties out of a sense of fairness. d. b and c. 47. The Transfer Agreement of 1988 was developed with the goal of a. transferring responsibility for healthcare to the federal government. b. transferring responsibility for healthcare to First Nations groups. c. transferring land from First Nations groups to the provincial government. d. transferring government control from the provincial governments to First Nations communities. 48. Self-government initiatives grew during the 1980s and 1990s and were encouraged by a. the political fallout of the Oka, Gustafsen Lake and other incidents of violent and non-violent resistance. b. the increasing demand of dependence of many First Nations. c. the evolution of the healthcare system in the 1980s. d. none of the above. 49. The Charter of Rights and Freedoms recognises the a. right of Indigenous peoples to self-government. b. the language rights of Indigenous peoples. c. the right of Indigenous peoples to be treated fairly. d. all of the above. 50. Why should nurses care about Indigenous health? a. This is an important and rapidly increasing component of the population. b. Most nurses will be responsible for Indigenous patients at some point in their careers. c. Nurses and the nursing profession bear a responsibility for health promotion in the population, Indigenous and non-Indigenous. d. All of the above Type: T 51. What were the five reasons for the “disconnect” that the Romanow Report identified as preventing Indigenous peoples from benefiting from the Canadian healthcare system? Type: T 52. How would improving the health of the Indigenous population benefit all Canadians? Type: T 53. Why should nurses and other healthcare professionals care about Indigenous health? Answers to Test Questions 1. d 2. a 3. c 4. a 5. d 6. c 7. a 8. b 9. a 10. d 11. a 12. c 13. b 14. b 15. d 16. d 17. d 18. d 19. d 20. a 21. e 22. a 23. b 24. a 25. a 26. c 27. d 28. c 29. d 30. a 31. b 32. e 33. d 34. c 35. b 36. a 37. b 38. d 39. b 40. a 41. b 42. d 43. d 44. d 45. b 46. a 47. b 48. a 49. c 50. d Chapter 2 – Western and Indigenous Ways of Knowing Test Questions 1. Epistemology is a. a way of knowing about the world and how it works. b. a field of spiritual and metaphysical inquiry. c. defined as a way of thinking about human identity and the fundamental nature of human existence. d. a theory of mind used extensively in philosophy. 2. Ontology is a. the way we are, our state of being. b. the science of cranial topography. c. how we think about the world and how it works. d. a variety of factors enabling nurses to heal others through prayer. 3. Health is a. a matter of both physical and mental well-being. b. the absence of disease. c. how we live every day. d. all of the above. 4. Why are health and food security often a problem in Aboriginal communities? a. Traditional hunting and gathering can no longer feed everyone. b. Remote and impoverished communities lack the resources of prosperous urban areas. c. Government cutbacks have affected community health. d. All of the above. 5. Traditional Indigenous health views differ from traditional Western medicine in that a. Indigenous view is that health is holistic; Western view is that medicine is not holistic. b. Indigenous view is that health is earned; Western belief is that health is bought. c. Indigenous view is that health is a gift; Western belief is that health is holistic. d. both share the same philosophical underpinnings. 6. Culture influences health through a. the cultural stereotypes that society imposes upon individuals. b. the cultural roles individuals internalize and incorporate into their lives. c. providing a secure social identity with which to navigate society. d. all of the above. e. none of the above. 7. The traditional ceremony most often used by those participating in the spiritual purification of the body, mind and soul with the intended purpose of prayer and healing of the individual holistically is called: a. smudging. b. sweat lodge. c. medicine wheel. d. midewiwin. 8. Smudging is a. a traditional practice among many First Nations and Métis peoples. b. the burning of traditional herbs to purify the body and soul. c. increasingly popular among Indigenous peoples across Canada. d. all of the above. 9. A shaking tent ceremony would be performed by a a. herbalist. b. medicine man. c. Shaman. d. witch doctor. 10. One therapeutic benefit of a sweat lodge is a. high temperature stimulates the body’s natural reactions to toxins. b. heat and scratching numerous lines on the skin drains the infection. c. the belief that the sucking horn removes the poison. d. the smell of herbs inhibits endorphin release. 11. The shape of the sweat lodge typically represents a. the shape of the Mother Earth. b. the Circle of Life. c. the womb of the Mother. d. the shape of the Turtle shell. 12. What is the social basis for traditional Inuit society? a. Consensus and group survival b. Individual profit and competition c. Material success of each family d. All of the above 13. The ritual most often used prior to any major ceremony or celebration, or to cleanse an individual, for the purpose of clearing away negative energy, to invite in peace and harmony is called: a. smudging b. medicine wheel c. sweat lodge d. midewiwin 14. Traditional Indigenous epistemology or “ways of knowing” is based on a. human culture and the natural world being distinct and separate from each other. b. modern medicine having the solution to all possible health problems. c. god-like animals punishing humans for their transgressions against nature. d. the holistic interaction of human beings with the natural world. 15. Modern culture perceives the world as a. divided into separate and mutually exclusive spheres of human and natural knowledge. b. a living, unified and interconnected whole in which everything influences everything else. c. a flat disc floating through space, with the sun orbiting around it. d. inanimate matter that can be manipulated for the benefit of human being. e. a and d. 16. Traditional Indigenous epistemology a. divides the world into human and non-human spheres of knowledge. b. believes in the existence of a “Great Spirit.” c. sees the natural and human world as a unified whole. d. believes that the non-human world exists for humans to exploit for their own benefit. 17. Indigenous patients may see their health in a. traditional terms. b. in terms of biomedicine. c. as a mixture of both ways of knowing. d. all of the above. 18. What was an important ingredient in Sophie Thomas’ anti-cancer medicine? a. Aspirin b. red Alder c. cedar root d. stinging Nettle e. all of the above 19. What do Sophie Thomas’ patients attribute her success to? a. Her herbal medicines b. Red willow bark c. Her capacity for caring for her patients d. All of the above