Health Technology Assessment

Through the Lens of the TRC

Shelley Francis

Director, Nutsihpiluwewicik

(Indigenous Nursing Program)

University of New Brunswick

Territorial Acknowledgement

I would like to begin by acknowledging that we are in Mi’kma’ki, the traditional

ancestral and unceded territory of the Mi’kmaq People. This territory is

covered by the “Peace and Friendship Treaties” which Mi’kmaq and

Wolastoqiyik (Maliseet) Peoples first signed with the British Crown in 1726.

The treaties did not deal with surrender of lands and resources but were the

foundations of what was to be a mutually beneficial relationship.

Disclosures

None

TRC Calls to Action

• Calls #18-24 are directly related to the Health of Indigenous Peoples

• Common themes related to these specific calls include:

Access to care

Culturally safe care & recognizing distinct health needs

Incorporating holistic care

Utilizing traditional healing practices

Increasing Indigenous HR in the healthcare system

Access to Care

• Not just any care…culturally safe & trauma informed care!

• For both remote and urban Indigenous communities (on-reserve)

• Recognize that barriers exist for urban & rural Indigenous population (off-reserve)

• Talking with their Feet as an example of research leading to action using

remote health technology

• https://www.tru.ca/__shared/assets/Talking_With_Their_Feet24609.pdf

Trauma

InformedCulturally Safe

Indigenous Social Determinants

of Health

• Specific to Indigenous history, culture and reality

• Includes Indigenous ways of knowing, being, doing

• Considers the Indigenous lived experience

Incorporating Holistic Care

• Wellbeing is supported by upholding Indigenous Peoples’ identities in

connection to culture, spirituality, families, the land, community and nation

• Community needs to be involved in healthcare delivery planning

• Incorporating cultural and scientific evidence to support planning

(participatory research such as TWTF)

• Ensuring healthcare team is grounded in cultural safety

Utilizing Traditional Healing Practices

• Elders are our knowledge keepers and need to be involved in healthcare

• Ceremony must be seen as critical to wellness for many Indigenous People

• Culturally safe spaces -access to and support of ceremony in the healthcare

system (ie: smudging, drumming and singing, Sweatlodge, language, healing

ceremonies with Elders, food, prayer circles etc.)

• Access to and support of traditional medicines for healing

Increasing Indigenous HR in the

Healthcare System

• Increase access to health sciences education through remote campuses (UCAN – Saskatchewan, NOSM – Ontario, UBC etc.) and Designated Seat Processes

• Remote supportive programs to major educational centers – keeps students’ connection to their community and culture

• Incorporate telehealth practices in the curriculum – increases confidence on graduation and increases community capacity

• AHHRI (2005-2010…needs to be re-established to finish what they started)

What Do We Need?

• Seamless, timely access to culturally safe & trauma informed healthcare

• Recognition and understanding of Indigenous-specific social determinants of health that inform decision makers and leadership

• Collaboration with Indigenous Knowledge Keepers and adaptations to health services based on these teachings

• Safe environments to practice Indigenous cultural healing traditions

• Allies to support these processes

“You can’t have a quality health care system unless you have equitable health for all” (Turnbull, 2017)

What Do We Need?

• A shared vision with stakeholders that is based on trust, recognition, respect

for Indigenous rights and title, commitment to action and transparency

• Participatory research with Indigenous communities to ascertain the level of

disparity and encourage community-based supports & services

• Follow up and support of healthcare staff (don’t drop the ball)

• Funding

5 Basic Features of Culturally Safe HTA’s

• Community-based and community-led

• Based on culturally safe research that is rooted in OCAP Principles (ownership, control, access & possession)

• Technically and clinically efficient and safe for Indigenous People

• Must involve ALL stakeholders (specifically Indigenous People)

• Must focus beyond cost savings and politics to enhance consumer satisfaction and improved health outcomes

Potential Strategies

• Remote presence robotic technology – culturally safe mental health care

• Portable scans for chronic disease diagnosis & management

• Perinatal care (including support for midwives)

• Comprehensive diabetes management (eyes, heart, feet, insulin mgt etc.)

• Culturally safe health & cultural education for patients & healthcare staff

• Patient Portals & Virtual Appointments

• Revisit AHHRI to increase numbers of Indigenous HCP, Researchers and Scholars

References

• Gracey M, King M. Indigenous health part 1: Determinants and disease patterns. Lancet. 2009;374:65–75. [PubMed]

• Let's make our health system healthier. (n.d.). Health Equity in Northern Ontario: Thinking Locally. Retrieved April 15, 2018, from http://www.hqontario.ca/Blog/ArtMID/30956/ArticleID/76/CategoryID/1/CategoryName/Health-Equity/Health-Equity-in-Northern-Ontario-Thinking-Locally

• Andermann, A. (2017). Language selection. CCDR, 43, 6.

• Canada, H. (2016, November 16). Aboriginal Health Human Resources Initiative Fact Sheet. Retrieved April 15, 2018, from https://www.canada.ca/en/indigenous-services-canada/services/first-nations-inuit-health/reports-publications/health-care-services/aboriginal-health-human-resources-initiative-fact-sheet.html?wbdisable=true

• Truth and Reconciliation Canada. (2015). Honouring the truth, reconciling for the future: Summary of the final report of the Truth and Reconciliation Commission of Canada. Winnipeg: Truth and Reconciliation Commission of Canada.