Missing pathways to self-governance: Aboriginal health policy in British Columbia. Lavoie et al., (2015).

Lavoie, J., Browne, A.J., Varcoe, C., Wong, S., Fridkin, A., Littlejohn, D., & Tu, D. (2015). Missing pathways to self-governance: Aboriginal health policy in British Columbia. International Indigenous Policy Journal, 6(1). Retrieved from http://ir.lib.uwo.ca/iipj/vol6/iss1/2

Abstract from authors:

This article explores how current policy shifts in British Columbia, Canada highlight an important gap in Canadian self-government discussions to date. The analysis presented draws on insights gained from a larger study that explored the policy contexts influencing the evolving roles of two long-standing urban Aboriginal health centres in British Columbia. We apply a policy framework to analyze current discussions occurring in British Columbia and contrast these with Ontario, Canada and the New Zealand Māori health policy context. Our findings show that New Zealand and Ontario have mechanisms to engage both nation- or tribal-based and urban Indigenous communities in self-government discussions. These mechanisms contrast with the policies influencing discussions in the British Columbian context. We discuss policy implications relevant to other Indigenous policy contexts, jurisdictions, and groups.

Article can be found here.

Access to primary care from the perspective of Aboriginal patients at an urban emergency department. – Browne, Annette J., Smye, Victoria L., Rodney, Patricia, Tang, Sannie Y., Mussell, Bill, & O’Neil, John D. (2011).

Browne, Annette J., Smye, Victoria L., Rodney, Patricia, Tang, Sannie Y., Mussell, Bill, & O’Neil, John D. (2011). Access to primary care from the perspective of Aboriginal patients at an urban emergency department. Qualitative Health Research, 21(3), 333-348. doi: 10.1177/1049732310385824

Abstract from Authors:

In this article, we discuss findings from an ethnographic study in which we explored experiences of access to primary care services from the perspective of Aboriginal people seeking care at an emergency department (ED) located in a large Canadian city. Data were collected over 20 months of immersion in the ED, and included participant observation and in-depth interviews with 44 patients triaged as stable and nonurgent, most of whom were living in poverty and residing in the inner city. Three themes in the findings are discussed: (a) anticipating providers’ assumptions; (b) seeking help for chronic pain; and (c) use of the ED as a reflection of social suffering. Implications of these findings are discussed in relation to the role of the ED as well as the broader primary care sector in responding to the needs of patients affected by poverty, racialization, and other forms of disadvantage.

Article can be found here.

Closing the health equity gap: Evidence-based strategies for primary health care organizations. – Browne, Annette J., Varcoe, Colleen M., Wong, Sabrina T., Smye, Victoria L., Lavoie, Josée G., Littlejohn, Doreen, . . . Lennox, Scott. (2012).

Browne, Annette J., Varcoe, Colleen M., Wong, Sabrina T., Smye, Victoria L., Lavoie, Josée G., Littlejohn, Doreen, . . . Lennox, Scott. (2012). Closing the health equity gap: Evidence-based strategies for primary health care organizations. International Journal for Equity in Health, 11(59), 1-15. doi: 10.1186/1475-9276-11-59

Abstract from Authors:

Introduction

International evidence shows that enhancement of primary health care (PHC) services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector. Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss (a) the key dimensions of equity-oriented services to guide PHC organizations, and (b) strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations.

Methods

The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included: (a) in-depth interviews with a total of 114 participants (73 patients; 41 staff), (b) over 900 hours of participant observation, and (c) an analysis of key organizational documents, which shed light on the policy and funding environments.

Results

Through our analysis, we identified four key dimensions of equity-oriented PHC services: inequity-responsive care; trauma- and violence-informed care; contextually-tailored care; and culturally-competent care. The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through improvements in the quality of care, an improved ‘fit’ between people’s needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care. Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels: organizational, clinical programming, and patient-provider interactions.

Conclusions

These evidence- and theoretically-informed key dimensions and strategies provide direction for PHC organizations aiming to redress the increasing levels of health and health care inequities across population groups. The findings provide a framework for conceptualizing and operationalizing the essential elements of equity-oriented PHC services when working with marginalized populations, and will have broad application to a wide range of settings, contexts and jurisdictions. Future research is needed to link these strategies to quantifiable process and outcome measures, and to test their impact in diverse PHC settings.

Article can be found here

Harm reduction, methadone maintenance treatment and the root causes of health and social inequities: An intersectional lens in the Canadian context. – Smye, Victoria L., Browne, Annette J., Varcoe, Colleen M., & Josewski, Viviane. (2011).

Smye, Victoria L., Browne, Annette J., Varcoe, Colleen M., & Josewski, Viviane. (2011). Harm reduction, methadone maintenance treatment and the root causes of health and social inequities: An intersectional lens in the Canadian context. Harm Reduction Journal, 8(1), 17. doi: 10.1186/1477-7517-8-17

Abstract from Authors:

Background:

Using our research findings, we explore Harm Reduction and Methadone Maintenance Treatment (MMT) using an intersectional lens to provide a more complex understanding of Harm Reduction and MMT, particularly how Harm Reduction and MMT are experienced differently by people dependent on how they are positioned. Using the lens of intersectionality, we refine the notion of Harm Reduction by specifying the conditions in which both harm and benefit arise and how experiences of harm are continuous with wider experiences of domination and oppression;

Methods:

A qualitative design that uses ethnographic methods of in-depth individual and focus group interviews and naturalistic observation was conducted in a large city in Canada. Participants included Aboriginal clients accessing mainstream mental health and addictions care and primary health care settings and healthcare providers;

Results:

All client-participants had profound histories of abuse and violence, most often connected to the legacy of colonialism (e.g., residential schooling) and ongoing colonial practices (e.g., stigma & everyday racism). Participants lived with co-occurring illness (e.g., HIV/AIDS, Hepatitis C, PTSD, depression, diabetes and substance use) and most lived in poverty. Many participants expressed mistrust with the healthcare system due to everyday experiences both within and outside the system that further marginalize them. In this paper, we focus on three intersecting issues that impact access to MMT: stigma and prejudice, social and structural constraints influencing enactment of peoples’ agency, and homelessness;

Conclusions:

Harm reduction must move beyond a narrow concern with the harms directly related to drugs and drug use practices to address the harms associated with the determinants of drug use and drug and health policy. An intersectional lens elucidates the need for harm reduction approaches that reflect an understanding of and commitment to addressing the historical, socio-cultural and political forces that shape responses to mental illness/ health, addictions, including harm reduction and methadone maintenance treatment.

Article can be found here.

Help bring back the celebration of life: A community-based participatory study of rural Aboriginal women’s maternity experiences and outcomes. – Varcoe, C., Brown, H., Calam, B., Harvey, T., & Tallio, M. (2013).

Varcoe, C., Brown, H., Calam, B., Harvey, T., & Tallio, M. (2013). Help bring back the celebration of life: A community-based participatory study of rural Aboriginal women’s maternity experiences and outcomes. BMC Pregnancy and Childbirth, 13(1), 26.

Abstract from Authors:

Background

Despite clear evidence regarding how social determinants of health and structural inequities shape health, Aboriginal women’s birth outcomes are not adequately understood as arising from the historical, economic and social circumstances of their lives. The purpose of this study was to understand rural Aboriginal women’s experiences of maternity care and factors shaping those experiences.

Methods

Aboriginal women from the Nuxalk, Haida and ‘Namgis First Nations and academics from the University of British Columbia in nursing, medicine and counselling psychology used ethnographic methods within a participatory action research framework. We interviewed over 100 women, and involved additional community members through interviews and community meetings. Data were analyzed within each community and across communities.

Results

Most participants described distressing experiences during pregnancy and birthing as they grappled with diminishing local maternity care choices, racism and challenging economic circumstances. Rural Aboriginal women’s birthing experiences are shaped by the intersections among rural circumstances, the effects of historical and ongoing colonization, and concurrent efforts toward self-determination and more vibrant cultures and communities.

Conclusion

Women’s experiences and birth outcomes could be significantly improved if health care providers learned about and accounted for Aboriginal people’s varied encounters with historical and ongoing colonization that unequivocally shapes health and health care. Practitioners who better understand Aboriginal women’s birth outcomes in context can better care in every interaction, particularly by enhancing women’s power, choice, and control over their experiences. Efforts to improve maternity care that account for the social and historical production of health inequities are crucial.

Article can be found here