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Reservation-based health initiatives have evolved over time, with both historical approaches and modern community collaborations playing a crucial role in improving the health and well-being of Indigenous populations.
In the 1950s, an area-based approach was implemented on the Navajo Indian reservation to address health challenges and promote overall well-being. This approach involved thorough documentation of health problems, analysis of patient care utilization, and nutrition studies. Additionally, Navajo community health workers played a vital role in providing interpretation of medical problems and coordinating care [1].
In recent years, there has been a shift towards collaborative efforts that emphasize cross-sector partnerships and resident engagement to address complex community problems. Collective impact and collective efficacy models have emerged, focusing on aligning public and private partnerships and leveraging the strengths of community members. These models aim to improve health outcomes by addressing social determinants of health and promoting holistic well-being [1].
One example of a modern community collaboration initiative is Promise Neighborhoods, inspired by the success of the Harlem Children's Zone. This program, administered by the US Department of Education, targets children and families in disadvantaged areas and provides comprehensive support and services. It has expanded to serve over 50 communities, aiming to break the cycle of poverty and improve health outcomes through education, health care, and community engagement [1].
These historical approaches and modern community collaborations have been instrumental in addressing health challenges faced by Indigenous populations. However, there are still ongoing challenges and disparities in Indigenous healthcare that need to be addressed, such as access to specialized services and funding discrepancies. By continuing to invest in and support Indigenous health initiatives, we can work towards creating a more equitable and inclusive healthcare system for all.
Investing in the health and well-being of Indigenous communities is a crucial step towards addressing the disparities and challenges they face. The government has made a commitment to prioritize Indigenous health and has taken steps to provide the necessary support and resources. This section will explore the government's commitment and the financial support allocated for Indigenous health services.
The Canadian government has demonstrated its commitment to Indigenous health by increasing spending on Indigenous priorities since 2015. According to the Canada Budget 2024, spending on Indigenous priorities has increased significantly, with an estimated spending of over $30.5 billion in 2023-24, rising further to approximately $32 billion in 2024-25. This funding is aimed at improving health outcomes, strengthening on-reserve income assistance and disability income support programs, and investing in primary health care, mental health, and food security.
Moreover, the federal government has actively worked with Indigenous Peoples to honor treaty rights, resolve historical wrongs, and implement rights. As a result, the federal government's total recorded liabilities have increased from $11 billion in 2015-16 to $76 billion in 2022-23, with the majority of these liabilities related to Indigenous claims and providing compensation for past harms of colonialism.
Investments in Indigenous communities have been substantial, totaling approximately $200 billion in support for Indigenous Peoples. These investments have focused on various areas, including health care, education, child and family services, housing, and infrastructure [2]. The government recognizes the need for financial support to address the unique health challenges faced by Indigenous communities.
By allocating significant funding to Indigenous health services, the government aims to improve access to specialized services, enhance health outcomes, and reduce health disparities. These financial resources support the development and delivery of culturally appropriate health programs, the recruitment and retention of Indigenous health professionals, and the improvement of healthcare infrastructure in Indigenous communities.
The government's commitment to investing in Indigenous health reflects the recognition of the historical injustices and ongoing disparities faced by Indigenous communities. By providing financial support and resources, the government aims to improve the overall health and well-being of Indigenous Peoples across the nation.
In the next sections, we will further explore the challenges in Indigenous healthcare, the importance of culturally competent care, and the specific healthcare landscape for Indigenous communities in the United States.
Indigenous healthcare faces several challenges that hinder access to specialized services and contribute to funding disparities. These challenges have significant implications for the well-being and health outcomes of Indigenous communities.
Children living on reserves often encounter difficulties in accessing specialized services, such as wheelchair assessments, hearing tests, and psychoeducational assessments. The lack of coverage for travel expenses poses a significant barrier to receiving the necessary services [3]. Unfortunately, this situation leads to a deprivation of essential services for these children.
Additionally, an opaque appeals process further complicates the situation. Filing requests and appeals for services can be challenging, and the lack of clear guidance on how to navigate the appeals process leaves patients waiting for assessments and services. This delay in receiving necessary medical help can have a detrimental impact on the health and well-being of Indigenous individuals [3].
To address these challenges, there is a need to rewrite and clarify policies, ensure consistent application of policies across Canada, and establish clear guidance for families and healthcare providers to access necessary devices and services. Additionally, a streamlined appeals process with designated contacts for assistance is crucial to overcome bureaucratic barriers and ensure that Indigenous individuals receive the essential medical help they require.
Federal funding for First Nations and Inuit health services is provided through annual appropriations and is subject to discretionary increases or reductions by the federal government. Unlike the Canada Health Transfer, which is protected in legislation, funding for Indigenous health services lacks this level of protection [4]. This discretionary nature of funding can lead to disparities and unpredictability in financial support for Indigenous healthcare initiatives.
The underutilization of earmarked funds for First Nations children's health services is another challenge. Rewriting and clarifying policies, ensuring consistent application of policies across Canada, and establishing clear guidance for families and healthcare providers are crucial steps to address this issue. By doing so, Indigenous communities can access the necessary resources and services that are essential for their well-being and overall health.
Addressing funding disparities in Indigenous healthcare is vital to ensure equitable access to healthcare services and support the health and well-being of Indigenous communities across the country. It requires a commitment to stable and predictable funding, as well as collaboration between governments and Indigenous communities to address the unique healthcare needs of Indigenous populations.
Efforts to prevent and address substance use are crucial in communities across the country. The Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUPTRS BG or SUBG) program plays a significant role in providing funds and support for these initiatives. This section will provide an overview of the block grant and how funding is distributed.
The Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUPTRS BG or SUBG) program is designed to provide funds and technical assistance to all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, 6 Pacific jurisdictions, and 1 tribal entity. The primary goal of this program is to prevent and treat substance use while promoting public health [5].
Grantees of the SUBG program utilize the funds to plan, implement, and evaluate activities that address substance use prevention, treatment, and recovery support services. These activities are aimed at supplementing Medicaid, Medicare, and private insurance services, ensuring comprehensive and accessible care for individuals struggling with substance use [5]. By providing financial support and technical assistance, the block grant enables communities to develop and implement effective strategies to combat substance use and promote overall well-being.
The SUBG program is instrumental in distributing funds to various states, territories, and tribal entities for substance use prevention programs. The grant supports a wide range of services, including prevention, treatment, recovery support, and other related initiatives [5]. Grantees utilize the funds to supplement existing healthcare services and ensure the availability of comprehensive substance use treatment and prevention programs.
The block grant program recognizes the unique needs and challenges faced by different communities. By providing funding to states, territories, and tribal entities, the program aims to address disparities and promote equitable access to substance use prevention and treatment services. The funds are distributed based on an evaluation of each grantee's needs, capacity, and proposed strategies to address substance use within their jurisdiction.
The Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUPTRS BG or SUBG) program serves as a critical resource for communities across the country, enabling them to implement evidence-based approaches to prevent and address substance use. Through the allocation of funds and technical assistance, the program supports the development of comprehensive and effective substance use prevention programs that promote public health and enhance the well-being of individuals and communities.
Efforts to improve First Nations health services have focused on various aspects, including policy amendments and addressing travel barriers. These initiatives aim to enhance access to quality healthcare for Indigenous communities.
In recent years, policy amendments have been implemented to address the barriers faced by First Nations communities in accessing healthcare services. For example, in 2023, Canada renewed its 10-year funding agreement to support the First Nations Health Authority (FNHA) in British Columbia, with the goal of improving health outcomes for First Nations individuals [4]. These policy amendments provide the necessary funding and resources to enhance healthcare services, ensuring that the specific needs of First Nations populations are met.
To further improve healthcare services, it is crucial to rewrite and clarify policies, ensuring consistent application of policies across Canada. Clear guidance for families and healthcare providers on accessing necessary devices and services is essential. This transparency will help eliminate confusion and streamline the process for receiving medical help [3]. Additionally, establishing a streamlined appeals process with designated contacts for assistance can address bureaucratic barriers that prevent children from receiving essential medical help.
Travel barriers pose significant challenges for First Nations individuals, particularly those residing in fly-in communities or remote areas. The cost of air travel from these communities in northern Ontario, for example, can be a significant obstacle to accessing necessary healthcare services, especially for children. Unfortunately, travel funding is often not covered by Health Canada's Non-Insured Health Benefits (NIHB) policy, resulting in denied services for these individuals [3].
Children living on reserves also face difficulties in accessing specialized services such as wheelchair assessments, hearing tests, and psychoeducational assessments due to the lack of coverage for travel expenses. This results in a situation where necessary services are not provided to these children. Moreover, an opaque appeals process further complicates the situation, as patients may have challenges filing requests and appeals for services, leading to delays in receiving necessary medical help [3].
To address these travel barriers, it is crucial to advocate for policy changes that ensure coverage for travel expenses related to accessing healthcare services. Providing appropriate funding and support for travel will help overcome geographic challenges and ensure that First Nations individuals can access the care they need.
Efforts to improve First Nations health services through policy amendments and addressing travel barriers are essential steps toward achieving equitable access to healthcare for Indigenous communities. By addressing these challenges, we can work towards providing quality healthcare services that meet the specific needs of First Nations individuals and contribute to better health outcomes.
When examining indigenous healthcare in the United States, it is important to consider the profile of the Indian Health Service (IHS) and the health disparities and challenges faced by the indigenous population.
The Indian Health Service (IHS) is an agency within the Department of Health and Human Services that is responsible for providing healthcare services to American Indians and Alaska Natives. The IHS reports a service population of approximately 1.51 million, with users having a median age of 24.2 compared to 32.9 years for the general U.S. population.
The IHS operates a comprehensive healthcare delivery system that includes hospitals, clinics, and health centers located in tribal communities across the country. Its mission is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. Despite the young population served by the IHS, the mortality picture often indicates diseases experienced by an older population, with heart disease and cancer being the leading causes of death [6].
Health disparities among American Indians and Alaska Natives persist, highlighting the challenges faced by indigenous communities in obtaining adequate healthcare. These disparities can be attributed to various factors, including social and cultural disruption of tribal societies, poor education, longstanding poverty, lack of political presence, limited access to health services, and a widening gap in healthcare spending [6].
One significant challenge is the funding disparity. Per capita spending for healthcare within the IHS is substantially lower compared to the general U.S. population, Medicare, Bureau of Prisons, and Veterans' Administration. This disparity in funding affects the availability and quality of healthcare services for indigenous communities.
To address these challenges, there is a need for increased government commitment and financial support for indigenous health services. Recognizing the importance of providing equitable healthcare, efforts are being made to improve policy amendments and address travel barriers that hinder access to specialized healthcare services. These initiatives aim to bridge the gap in healthcare disparities and improve the overall health outcomes for American Indians and Alaska Natives.
By understanding the profile of the Indian Health Service and acknowledging the existing health disparities and challenges faced by indigenous communities, steps can be taken towards achieving more equitable healthcare for all. It is crucial to support ongoing efforts to improve the healthcare infrastructure, accessibility, and funding for indigenous populations in the United States.
Culturally competent care is a vital aspect of healthcare delivery that recognizes and respects the cultural backgrounds, beliefs, and values of individuals seeking treatment. It involves understanding and responding to the unique needs of diverse populations to provide effective and equitable care. In this section, we will explore the importance of culturally competent care and its impact on health outcomes.
Culturally competent care has been defined as "a dynamic, fluid, continuous process whereby an individual, system, or health care agency finds meaningful and useful care delivery strategies based on knowledge of the cultural heritage, beliefs, attitudes, and behaviors of those to whom they render care" [7]. It goes beyond mere tolerance and aims to create an environment where individuals from diverse backgrounds feel respected, understood, and supported throughout their healthcare journey.
The importance of culturally competent care lies in its ability to address healthcare disparities and improve health outcomes. By understanding and incorporating cultural beliefs and practices into healthcare delivery, providers can establish trust, enhance communication, and promote patient engagement. This approach leads to better patient satisfaction, increased adherence to treatment plans, and improved health outcomes.
Culturally competent care also plays a crucial role in reducing health disparities among marginalized populations. It helps to address barriers to healthcare access, such as language barriers, discrimination, and cultural misunderstandings. By recognizing and accommodating the diverse needs of patients, healthcare providers can work towards eliminating disparities and achieving equitable healthcare outcomes.
The impact of culturally competent care on health outcomes is significant. When healthcare providers take the time to understand and respect the unique cultural backgrounds of their patients, it fosters a sense of trust and confidence. This, in turn, leads to better patient-provider communication, increased patient satisfaction, and improved treatment adherence.
Furthermore, culturally competent care allows healthcare providers to better tailor their treatment plans to align with patients' cultural values and beliefs. It acknowledges the influence of culture on health behaviors, attitudes towards illness, and treatment preferences. By integrating culturally appropriate practices, healthcare providers can improve treatment outcomes and reduce healthcare disparities.
Studies have shown that culturally competent healthcare services have the potential to increase health system efficiency and client satisfaction, as well as improve health outcomes among immigrant populations [7]. For example, mobile health clinics that provide accessible, holistic, and culturally and linguistically appropriate healthcare services have been well-received by immigrant women in Toronto. Building relationships and understanding the cultural context of patients' lives is key to successful health promotion and improved health outcomes.
By embracing culturally competent care, healthcare providers can create a more inclusive and equitable healthcare system that recognizes and respects the diverse needs of all individuals. It is a crucial step towards reducing healthcare disparities and ensuring that everyone has access to high-quality and culturally appropriate care.
As the population of Saskatchewan becomes increasingly diverse, it is essential for the healthcare system to address the unique healthcare needs of immigrants. In recent years, Saskatchewan has experienced significant demographic shifts primarily due to changing immigration patterns. Between 2011 and 2016, Saskatchewan witnessed the largest percentage increase in the immigrant population across Canada, with a growth rate of 74% and the arrival of 47,935 immigrants over five years in a province with a population of just over 1 million [7].
The influx of immigrants has led to substantial changes in Saskatchewan's population composition. In 2016, approximately 11% of the Saskatchewan population consisted of visible ethnic minorities. This percentage is expected to continue growing as recent immigrants predominantly originate from Asia and the Middle East. Notably, over 50% of recent immigrants to Saskatchewan, Manitoba, Prince Edward Island, New Brunswick, and Yukon were admitted under provincial nominee programs, compared to the national average of 16.4% under such programs [7].
Newcomers to Saskatchewan may encounter various barriers when accessing healthcare services. These barriers include low health literacy, lack of familiarity with the healthcare system, cultural competency, cost, traditional beliefs, language difficulties, appointment time limitations, and lack of childcare or transportation. Refugees may also face additional barriers to healthcare due to discrimination and stigmatization [7].
To ensure equitable healthcare access and delivery, it is crucial for healthcare providers and systems to address these barriers. Culturally competent care plays a significant role in meeting the healthcare needs of immigrants. Culturally competent care involves understanding and respecting the cultural heritage, beliefs, attitudes, and behaviors of individuals receiving care. By providing culturally and linguistically appropriate healthcare services, healthcare providers can improve health system efficiency, client satisfaction, and health outcomes for newcomers [7].
Efforts to improve immigrant healthcare in Saskatchewan have included the creation of mobile health clinics that provide highly accessible, holistic, and culturally appropriate healthcare services. Building relationships with clients has been identified as a key component of successful health promotion among immigrant women. These initiatives aim to bridge traditional beliefs and practices with Western medicine, ultimately improving healthcare experiences and outcomes [7].
In conclusion, as Saskatchewan experiences significant demographic shifts due to immigration, it is vital for the healthcare system to adapt and meet the healthcare needs of newcomers. By addressing barriers to accessing healthcare and providing culturally competent care, Saskatchewan can ensure that all residents, regardless of their background, have equitable access to quality healthcare services.
