About Pathways to Health Equity for Aboriginal Peoples

The numerous health inequities between Aboriginal and non-Aboriginal peoples in Canada have been well described and are an important focus for the Canadian Institutes of Health Research. The root causes of poor health are well understood.¹ Factors such as income, education, employment, living conditions, social class, social support, and access to health services are all part of determining whether people are healthy or not.² Aboriginal peoples’ health is also affected by culture loss, racism and stigmatization, loss of language and connection to the land, environmental deprivation, and feeling spiritually, emotionally, and mentally disconnected from their Indigenous identity.³ Being disconnected from their Indigenous identity can damage Aboriginal peoples’ health.⁴

Just as important to acknowledge and understand, however, are the factors that have positive effects on Aboriginal health, such as personal and community resilience, restoring and promoting Aboriginal identity, keeping cultures and languages alive, and self-governance.

Trying to reduce the numerous health inequities between Aboriginal and non-Aboriginal peoples in Canada is a complex undertaking. Because the greatest potential to redress these inequities seems to lie in changing the social factors that have so much impact on the lives of Aboriginal peoples, the Pathways initiative incorporates a focus on practical interventions aimed at improving the social determinants of health.

Pathways research will use an approach called implementation science, which studies what works to bring about change, how, and under what conditions, and considers whether an intervention can be adapted to work differently in different places or conditions. It also looks at how an intervention that does work can be scaled up, to reach more people and share benefits equitably. To benefit the most people, all the projects will include plans for knowledge translation — compiling, distributing and sharing knowledge with communities and policy-makers.

Pathway projects will also encourage the use of Aboriginal Ways of Knowing, which includes knowledge of and experience with healing practices both ceremonial and physical, such as herbal treatments. These practices include the concepts of health, wholeness and resilience, and approaches to wellness and healing. Maintaining wellness, including mental, emotional and spiritual health, is often based on Aboriginal teachings and ceremony, which provide a basis for positive self-image and healthy identity. Aboriginal knowledge of the land and its ecology helps sustain health for many First Nations, Inuit and Métis peoples. Aboriginal Ways of Knowing must inform interventions for them to succeed, because they will be more culturally appropriate and more meaningful to Aboriginal peoples, and be more accepted than non-Aboriginal approaches.

The research and knowledge translation for the four exemplars will lead to:

1. Enhanced understandings of how to implement multilevel and scalable interventions that will contribute to reducing health inequities facing Aboriginal peoples;
2. Improved health of Aboriginal peoples across the four priority areas through adaptation and use of the interventions;
3. Better understanding of how to reduce health inequities and how this new knowledge can be adapted and applied to other populations and in other contexts (reverse innovation, reciprocal learning);
4. Increased research capacity in the area of implementation science related to the health of Aboriginal peoples and other vulnerable populations.

The four exemplars in Pathways - suicide, tuberculosis, diabetes/obesity and oral health - have been recognized as priorities by First Nations, Inuit and Métis communities and federal, provincial and territorial governments. They are all health challenges that can be prevented, or have their impacts reduced, through interventions.⁵

Although Pathways prioritizes four health challenges, knowledge gained from researching these exemplars will be useful for reducing inequities in other areas that affect Aboriginal peoples, including mental health (especially substance abuse, depression, and stigmatization), communicable diseases (such as HIV and sexually transmitted diseases), chronic diseases (including heart disease and cancer) and health systems research (such as the delivery of community-based primary health care in remote areas).