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Introduction
The rise of Coronavirus disease (COVID-19) has exposed many barriers to healthcare experienced by Indigenous people and emphasized the “Social Determinants of Health.” COVID-19 has disproportionately impacted marginalized Indigenous communities, resulting in poorer overall health outcomes. This includes Indigenous peoples who live on-reserve or off-reserve and who might be status or non-status. The social determinants of health (SDoH) are a set of conditions that influence or shape health (Mikkonen & Raphael, 2010). The Government of Canada has identified and outlined twelve main determinants of health. These determinants include “income/social status, employment/working conditions, education, childhood experiences, physical environments, social supports/coping skills, healthy behaviours, access to health services, genetics, gender, culture and race/racism” (Public Health Agency of Canada, 2020). These conditions are difficult to change as one is often born into them. For example, culture is an intangible factor that is passed through many generations; it is a circumstance that one is born into and raised by (NEJM Catalyst, 2017). This article will primarily focus on “access to healthcare” and “physical environments” as social determinants of health.
Physical Environment as an SDoH
Physical environment is one of the twelve determinants of health outlined by the Government of Canada; it greatly contributes to shaping one’s health. Poor living conditions can directly place a burden on one’s lifestyle whether it is mentally or physically. Adverse living conditions (e.g. areas with air pollution, near factories) can have a direct influence on one’s physiological health and can lead to many illnesses. An example of environmental racism in Nova Scotia is demonstrated by a corporation in Nova Scotia. The corporation’s project aimed to create a means to store natural gas without proper consultation with the nearby communities. Instead, they contaminated the Shubenacadie River with high salinity levels and toxic chemicals, threatening the health and wellbeing of Mi’kmaw communities and the Shubenacadie River ecosystem (Page et al., 2020; Beaton, 2018). Thus, on-reserve Indigenous peoples’ vulnerability to pre-existing health conditions is a result of adverse living conditions. These pre-existing health conditions can make Indigenous people more vulnerable and susceptible to contracting viruses such as the coronavirus.
A big component of staying safe during a pandemic involves having a proper physical environment to safely self-isolate and quarantine. Unfortunately, the physical environments in which Indigenous people reside are overcrowded. Housing shortages and poor quality of existing homes are some of the most detrimental issues experienced by the Indigenous community (Reading & Wien, 2009). The housing shortage instigates many Indigenous people to share homes leading to overcrowding. Many Indigenous homes are also “multi-generational”; thus, if one member of the household develops the virus, the risk of transmitting it to other members of the household and the immediate community drastically increases (especially the Elders) (United Nations, n.d.). Additionally, the fact that housing is unaffordable makes it very difficult for those with the virus to self-isolate by themselves.
Poor physical environments can also manifest as poor-quality homes. As discussed by (Reading & Wien, 2009), these homes often have a lack of ventilation, leading to the development of excessive moulding. This presents a health risk and comprises the respiratory system, leading to conditions such as asthma and various allergies (Reading & Wien, 2009). Residents living in such homes face more vulnerability to contracting the virus. Evidently, safe physical environments and living spaces directly influence one’s health. The pandemic has exposed the importance of having proper physical environments as a means of having better health.
Access to Healthcare as an SDoH
Access to health services is a social determinant that can contribute greatly to one’s health status; it refers to how easily one can obtain services necessary for maintaining good health and wellbeing. Indigenous communities experience a lower quality of health due to the lack of accessible healthcare. Unfortunately, there are a limited number of hospitals and healthcare professionals present within Indigenous communities due to the geographical remoteness (NCCAH, 2019). Nova Scotia experiences the burden of inequitable healthcare delivery despite having a sufficient number of healthcare staff such as physicians and nurses (NS Dept. of Health & Wellness, 2015). The geographical remoteness of hospitals within Indigenous communities makes it quite expensive to deploy healthcare practitioners and medical resources as well. Thus, these hospitals are often “ill-equipped and understaffed” (Carling & Mankani, 2020). In addition, Indigenous health services are also heavily underfunded which further emphasizes the poor condition of healthcare accessibility. The pandemic has only further increased this demand for mental support and physical healthcare within Indigenous communities and has exposed how access to health services is a major determinant of health. Being unable to adequately respond to an increase in COVID-19 cases on Indigenous territories can increase the risk at which the virus is transmitted and decrease the recovery rate as well. Consequently, these factors place Indigenous communities at a disadvantage in terms of pandemic preparedness.
What can we do?
Evidently, there are many gaps present within the Indigenous healthcare system as they are disproportionately affected by these social determinants of health. The pandemic has placed an excessive burden on the healthcare system and has shed light on the necessity of addressing these determinants of health. When discussing provincial pandemic preparedness and COVID-19 protocols, it is vital that it is approached in a culturally inclusive manner. Pandemic prevention measures are often designed in a way that accommodates non-Indigenous society and does not take into consideration the culturally distinct Indigenous values present within Canada (Goodwill & Morgan, 2020). For example, the necessity of physical distancing prevents Indigenous peoples from practicing their rituals and healing practices that require multiple people to come together (Goodwill & Morgan, 2020). Provinces must take into account Indigenous practices when implementing pandemic protocols as they are an important group within our society. One way this can be carried out is by appointing Indigenous peoples to health boards, senior roles and other health-related organizations (Turpel-Lafond, 2020). Rules and regulations impact the entire country; evidently, some communities are impacted more negatively than others. By including Indigenous peoples to share their concerns and opinions during discussions that lead to provincial changes, one can prevent the passing of culturally inconsiderate rules and regulations. For long-term change, laws must be revised and corrected to promote culturally inclusive health care and protect minorities (Mikkonen & Raphael, 2010). Only then, long-term changes can be initiated as a means to alleviate the negative impacts of the pandemic.
Current Resources and Research
Currently, there is an Indigenous Community Support Fund established for the wellbeing and safety of Indigenous communities in terms of COVID-19 (Government of Canada, 2021). These funds are allocated to support vulnerable community members and address issues that have been further magnified as a result of the pandemic (eg. food insecurity, mental health assistance) (Government of Canada, 2021).
There are also various research groups and organizations working together to improve and shed light on the health inequalities within Indigenous communities. Tui’kn is a partnership between five Cape Breton First Nations with a shared goal of improving health outcomes (Tui’kn Partnership, n.d.). A current project that is being carried out by the Tui’kn Partnership is the “Strength In Numbers'' project. The main aim is to increase access to data about population health in order to observe community health trends to improve decision making and resource allocation (Tui’kn Partnership, n.d.). The initiative so far has successfully created the “Nova Scotia First Nations Client Linkage Registry” (NSFLCL) (Tui’kn Partnership, n.d.). This registry links health information of First nations populations located in Nova Scotia with provincial health data sources, allowing First Nations to have greater access to health information (Tui’kn Partnership, n.d.). This is an ongoing initiative that continuously strives towards improving Indigenous health.
In terms of future research, the Tui’kin team has received a grant from the Canadian Institutes of Health Research (CIHR) to carry out a project that focuses on an important aforementioned SDoH, access to healthcare. The “Oral Health Reseach Project'' will focus on the inaccesibility of dental care, as it is a major cause of avoidable hospital admissions (Tui’kn Partnership, n.d.). This project will involve conducting a “large-scale” and “multi-faceted” research plan to identify oral health interventions that are culturally sound and appropriate.
References
Beaton, S. (2018, February 15). Shades of Green podcast, episode 3: Peace, friendship and environmental justice – The Alton Gas resistance. The Nova Scotia Advocate. https://nsadvocate.org/2018/02/15/shades-of-green-podcast-episode-3-peace-friendship-and-environmental-justice-the-alton-gas-resistance/
Carling, A., & Mankani, I. (2020, October 28). Systemic Inequities Increase Covid-19 Risk for Indigenous People in Canada. Human Rights Watch. https://www.hrw.org/news/2020/06/09/systemic-inequities-increase-covid-19-risk-indigenous-people-canada.
Goodwill, A., & Morgan, J. (2020). Pandemic experiences and impacts of COVID-19 on the mental health of Indigenous communities: Preliminary Knowledge Synthesis. Canadian Institutes of Health Research (CIHR).
Government of Canada. (2021). Indigenous Community Support Fund. Indigenous Services Canada. https://www.sac-isc.gc.ca/eng/1585189335380/1585189357198
MacDonald, E., & Rang, S. (2007). Exposing Canada's Chemical Valley: An Investigation of Cumulative Air Pollution Emissions in the Sarnia, Ontario Area. Ecojustice Canada .
Mikkonen, J., & Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management.
National Collaborating Center for Aboriginal Health (NCCAH). (2019). Access to health services as a social determinant of First Nations, Inuit and Metis Health. https://www.nccah-ccnsa.ca/docs/fact%20sheets/social%20determinates/Access%20to%20Health%20Services_Eng%202010.pdf.
NEJM Catalyst. (2017). Social Determinants of Health (SDOH). Retrieved from: https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0312#:~:text=The%20World%20Health%20Organization%20(WHO,global%2C%20national%20and%20local%20levels.
Nova Scotia Department of Health and Wellness. (2015). Statement of mandate 2015–2016. Available at https://beta.novascotia.ca/sites/default /files/documents/2015-2016-DHW-Statement-of-Mandate.pdf
Page, E., Daniel I., Sanderson J., Waldron I. (2020). There’s something in the water. Retrieved February 3, 2021, from https://www.netflix.com/title/81206890
Public Health Agency of Canada. (2020, October 7). Social determinants of health and health inequalities. Social determinants of health and health inequalities - Canada.ca. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html.
Reading, C. L., & Wien, F. (2009). Health Inequalities and Social Determinants of Aboriginal Peoples’ Health. National Collaborating Centre for Aboriginal Health.
Tui’kn Partnership. (n.d.). About Tui’kn. Retrieved July 12, 2021, from http://www.tuikn.ca/about-tuikn/
Turpel-Lafond, M. E. (2020). (rep.). In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care. British Columbia.
United Nations. (n.d.). COVID-19 and Indigenous peoples For Indigenous Peoples. United Nations. https://www.un.org/development/desa/indigenouspeoples/covid-19.html.
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