Journal Article

Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study

Smye, Victoria, Khan, Koushambhi, Browne, Annette J., Godwin, Olive, Wong, Sabrina T., Lavoie, Josée, Tu, David, Fridkin, Alycia, Varcoe, Colleen, Krause, Murry

2016

Overview

Background Structural violence shapes the health of Indigenous peoples globally, and is deeply embedded in history, individual and institutional racism, and inequitable social policies and practices. Many Indigenous communities have flourished, however, the impact of colonialism continues to have profound health effects for Indigenous peoples in Canada and internationally. Despite increasing evidence of health status inequities affecting Indigenous populations, health services often fail to address health and social inequities as routine aspects of health care delivery. In this paper, we discuss an evidence-based framework and specific strategies for promoting health care equity for Indigenous populations. Methods Using an ethnographic design and mixed methods, this study was conducted at two Urban Aboriginal Health Centres located in two inner cities in Canada, which serve a combined patient population of 5,500. Data collection included in-depth interviews with a total of 114 patients and staff ( n  = 73 patients; n  = 41 staff), and over 900 h of participant observation focused on staff members’ interactions and patterns of relating with patients. Results Four key dimensions of equity-oriented health services are foundational to supporting the health and well-being of Indigenous peoples: inequity-responsive care, culturally safe care, trauma- and violence-informed care, and contextually tailored care. Partnerships with Indigenous leaders, agencies, and communities are required to operationalize and tailor these key dimensions to local contexts. We discuss 10 strategies that intersect to optimize effectiveness of health care services for Indigenous peoples, and provide examples of how they can be implemented in a variety of health care settings. Conclusions While the key dimensions of equity-oriented care and 10 strategies may be most optimally operationalized in the context of interdisciplinary teamwork, they also serve as health equity guidelines for organizations and providers working in various settings, including individual primary care practices. These strategies provide a basis for organizational-level interventions to promote the provision of more equitable, responsive, and respectful PHC services for Indigenous populations. Given the similarities in colonizing processes and Indigenous peoples’ experiences of such processes in many countries, these strategies have international applicability.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Acquired immune deficiency syndrome / AIDS / Analysis / Anthropology, Cultural / Canada - ethnology / Chronic illnesses / Chronic pain / Colonialism / Culture / Data collection / Drug use / Economic reform / Ethnography / Exposure to Violence - ethnology / Health Administration / Health aspects / Health care / Health care disparities / Health disparities / Health Equity - standards / Health facilities / Health Informatics / Health promotion / Health services / Health Services, Indigenous - standards / Healthcare Disparities - ethnology / Healthcare Disparities - statistics & numerical data / HIV / Human immunodeficiency virus / Humans / Indians, North American - ethnology / Indigenous peoples / Infant mortality / Life expectancy / Management / Medicine / Medicine & Public Health / Native North Americans / Nursing Research / Organization / Organizational Policy / Population / Primary Health Care - standards / Professional-Patient Relations / Public Health / Racial discrimination / Racism / Racism - ethnology / Racism - prevention & control / Racism - statistics & numerical data / Research Article / structure and delivery of healthcare / Trauma / Trust / Violence / Violence - prevention & control / Violence - statistics & numerical data / Womens health