+1(978)310-4246 credencewriters@gmail.com
  

Description

I’m attaching one file which needs to read and than write a report of 10 pages.Must be in APA 7 th edition format. Attaching screenshot for more instructions

In Plain Sight
Addressing Indigenous-specific Racism and
Discrimination in B.C. Health Care
Data Report
Addressing Racism Review
December 2020
Acknowledgements
Emotional Trigger
Warning
This report discusses topics that,
for Indigenous peoples, may
trigger memories of culturally
unsafe personal experiences
or such experiences of their
friends, family, and community.
The report is intended to explore
the prejudice and discrimination
experienced by Indigenous people
in the health care system and
to make Recommendations that
will help eliminate Indigenousspecific racism and create
substantive equity in health
care experiences, services and
outcomes. However, the content
may trigger unpleasant feelings
or thoughts of past abuse. First
Nations, Métis and Inuit peoples
who require emotional support can
contact the First Nations and Inuit
Hope for Wellness Help Line and
On-line Counselling Service toll-free
at 1-855-242-3310 or through
hopeforwellness.ca. The Métis
Crisis Line is available 24 hours
a day at 1-833-MétisBC
(1-833-638-4722). And the
KUU-US Crisis line is available
24/7 at 1-800-588-8717 to provide
support to Indigenous people in
B.C. For more information, visit:
kuu-uscrisisline.ca
On June 19, 2020, I was appointed by British Columbia’s Minister
of Health, the Hon. Adrian Dix, to conduct a review of Indigenousspecific racism in the provincial health care system.
I acknowledge that the resulting Addressing Racism Review has
taken place on the territories of First Nations peoples in B.C.,
and I also recognize the courage and determination shown by
thousands of Indigenous people across the province who shared
their experiences within the health care system to inform this
report.
In addition, I want to acknowledge the work of the skilled,
Indigenous-led team who supported the complex and urgent
Review that provided the basis for this report. And I would like
to thank the First Nations Health Authority, First Nations Health
Council and Métis Nation BC for their strong support during the
process. I also express my gratitude to the team at the Indian
Residential School History and Dialogue Centre at University of
British Columbia who provided collegial support and research to
assist in the preparation of the report.
Finally, I acknowledge that British Columbians and the B.C.
health care system are dealing with two pressing public health
emergencies – the opioid overdose crisis, and the COVID-19
pandemic. Despite the immense challenges and pressures
created by these health emergencies, thousands of health care
workers – along with their leaders and organizations – found the
time to participate in this Review. I thank them for that, and for
their dedication to confronting the matters raised in this report
and committing to implement the Recommendations.
Hon. Dr. M.E. Turpel-Lafond (Aki-Kwe)
Independent Reviewer
Table of Contents
Abbreviations and Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
1. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
2. Terminology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
3. Population Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
4. Data Sources and Methodology. . . . . . . . . . . . . . . . . . . . . . .
14
4.1 Data Sources Created by the Review . . . . . . . . . . . . . . . . . . . . . . . .
14
4.2 External Data Sources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
4.3 Limitations of the Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
4.4 Privacy and Data Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
4.5 Statistical and Analytical Tools. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
5. Findings: Surveys and Qualitative Data Sources. . . . . . . . .
24
5.1 Indigenous Peoples’ Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
5.2 Health Workers’ Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
43
5.3 Review Intake Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
59
5.4 San’yas Thematic Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
73
5.5 Indigenous-Specific Complaints. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
87
6. Findings: Quantitative Data Sources. . . . . . . . . . . . . . . . . . .
90
6.1 Data Associations Between Racism and Wellness . . . . . . . . . . . . .
90
6.2 Population Segments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
99
6.3 Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
6.4 Births. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
6.5 Primary Care Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
6.6 Hospital Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
6.7 Chronic Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
6.8 Mental Health and Substance Use . . . . . . . . . . . . . . . . . . . . . . . . . . 139
6.9 Multi-Morbidity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
6.10 Public Health Emergencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
6.11 Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
7. Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
151
Women’s Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Going Forward. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Appendix 1: Indigenous Peoples’ Survey Questions. . . . . . . .
158
Appendix 2: Survey Methodology . . . . . . . . . . . . . . . . . . . . . . .
174
Approach and Methodology – Indigenous Peoples’ Survey and
Health Workers’ Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Appendix 3: Health Workers’ Survey Questions. . . . . . . . . . .
177
Appendix 4: Data Limitations. . . . . . . . . . . . . . . . . . . . . . . . . . .
198
Small Populations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Data Linkages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Health System Matrix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Population Grouper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Regional Health Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
PREMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Opioid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Appendix 5: Population Segment Definitions . . . . . . . . . . . . .
202
Appendix 6: Recommendations from In Plain Sight . . . . . . . .
204
Appendix 7: Finding 11 Extract from In Plain Sight. . . . . . . . .
228
Abbreviations and Acronyms
a/s
age standardized
AAC
average annualized change
ACSC
ambulatory care sensitive conditions
ALC
alternate level of care
AMI
acute myocardial infarction
B.C.
British Columbia
BCCDC
BC Centre for Disease Control
BCPSLS
BC Patient Safety Learning System
CABG
coronary artery bypass graft
CI
confidence interval
CIHI
Canadian Institute for Health Information
CKD
chronic kidney disease
COPD
chronic obstructive pulmonary disorder
CT
computerized tomography
CTAS
Canadian Triage & Acuity Scale
DAD
Discharge Abstract Database
DP
day procedure
DRIPA
Declaration on the Rights of Indigenous Peoples Act
ED
Emergency Department
FIT
fecal immunochemical test
FN
First Nations
FNCF
First Nations Client File
FNHA
First Nations Health Authority
GS&S
general signs and symptoms
HCC
high complexity chronic condition
HSM
Heath System Matrix
HWS
Health Workers’ Survey
IPS
Indigenous Peoples’ Survey
IP
inpatient
ISD
insufficient data
LAMA
leaving against medical advice
LCC
low complexity chronic condition
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
1
Abbreviations and Acronyms
2
LTC
long-term care
M&A
mood and anxiety
MCC
medium complexity chronic condition
MCFD
Ministry of Children and Family Development
MCR
Métis Citizenship Registry
MDMA
3,4-methylenedioxy-methamphetamine
MH
mental health
MHSU
mental health and substance use
MNBC
Métis Nation British Columbia
MRI
magnetic resonance imaging
NACRS
National Ambulatory Care Reporting System
NINR
non-Indigenous & non-racialized
NP
nurse practitioner
OCAP®
ownership, control, access and possession
OCAS
ownership, control, access and stewardship
OPHO
Office of the Provincial Health Officer
OR
Other Residents
PCQO
Patient Care Quality Office
PG
Population Grouper
PHN
personal health number
PHSA
Provincial Health Services Authority
PREMS
Patient Reported Experience Measures Survey
PSBC
Perinatal Services BC
PTCA
percutaneous transluminal coronary angioplasty
PYLL
potential years of life lost
RHS
Regional Health Survey
SU
substance use
TDQSA
Tripartite Data Quality and Sharing Agreement
WHO
World Health Organization
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
Glossary of Terms
Anti-racism is the practice of actively identifying, challenging, preventing,
eliminating and changing the values, structures, policies, programs,
practices and behaviours that perpetuate racism. It is more than just
being “not racist” but involves taking action to create conditions of greater
inclusion, equality and justice.
Bias: A way of thinking or operating based explicitly or implicitly on a stereotype
or fixed image of a group of people.
Colonialism: Colonizers are groups of people or countries that come to a
new place or country and steal the land and resources from Indigenous
peoples, and develop a set of laws and public processes that are designed
to violate the human rights of the Indigenous peoples, violently suppress
the governance, legal, social, and cultural structures of Indigenous
peoples, and force Indigenous peoples to conform with the structures of
the colonial state.
Cultural humility is a life-long process of self-reflection and self-critique. It
is foundational to achieving a culturally safe environment. While western
models of medicine typically begin with an examination of the patient,
cultural humility begins with an in-depth examination of the provider’s
assumptions, beliefs and privilege embedded in their own understanding
and practice, as well as the goals of the patient-provider relationship.
Undertaking cultural humility allows for Indigenous voices to be front and
centre and promotes patient/provider relationships based on respect,
open and effective dialogue and mutual decision-making. This practice
ensures Indigenous peoples are partners in the choices that impact them,
and ensures they are party and present in their course of care.
Cultural safety: A culturally safe environment is physically, socially,
emotionally and spiritually safe. There is recognition of, and respect
for, the cultural identities of others, without challenge or denial of an
individual’s identity, who they are, or what they need. Culturally unsafe
environments diminish, demean or disempower the cultural identity and
well-being of an individual.
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
3
Glossary of Terms
Culture: Refers to a group’s shared set of beliefs, norms and values. It is the
totality of what people develop to enable them to adapt to their world,
which includes language, gestures, tools, customs and traditions that
define their values and organize social interactions. Human beings are
not born with culture – they learn and transmit it through language and
observation.
Discrimination: Through action or inaction, denying members of a particular
social group access to goods, resources and services. Discrimination
can occur at the individual, organizational or societal level. In B.C.,
discrimination is prohibited on the basis of “race, colour, ancestry, place
of origin, religion, family status, marital status, physical disability, mental
disability, sex, age, sexual orientation, political belief or conviction of a
criminal or summary conviction offence unrelated to their employment.”
Epistemic racism: Refers to the positioning of the knowledge of one racialized
group as superior to another, including a judgment of not only which
knowledge is considered valuable, but is considered to be knowledge.
Ethnicity: Refers to groups of people who share cultural traits that they
characterize as different from those of other groups. An ethnic group
is often understood as sharing a common origin, language, ancestry,
spirituality, history, values, traditions and culture. People of the same race
can be of different ethnicities.
Health equity: Equity is the absence of avoidable, unfair or remediable
differences among groups of people, whether those groups are defined
socially, economically, demographically or geographically or by other
means of stratification. “Health equity” or “equity in health” implies that
everyone should have a fair opportunity to attain their full health potential
and that no one should be disadvantaged from achieving this potential.
Health care inequity: The practice of intentionally or unintentionally treating
people differently and unfairly because of their race, sex, national origin
or disability.
Health inequity: The presence of systematic disparities in health (or in the
major social determinants of health) among groups with different social
advantage/disadvantage.
Indigenous peoples: The first inhabitants of a geographic area. In Canada,
Indigenous peoples include those who may identify as First Nations (status
and non-status), Métis and/or Inuit.
4
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
Glossary of Terms
Indigenous-specific racism: The unique nature of stereotyping, bias and
prejudice about Indigenous peoples in Canada that is rooted in the
history of settler colonialism. It is the ongoing race-based discrimination,
negative stereotyping, and injustice experienced by Indigenous peoples in
Canada that perpetuates power imbalances, systemic discrimination and
inequitable outcomes stemming from the colonial policies and practices.
Intergenerational trauma: Historic and contemporary trauma that has
compounded over time and been passed from one generation to the
next. The negative cumulative effects can impact individuals, families,
communities and entire populations, resulting in a legacy of physical,
psychological, and economic disparities that persist across generations.
For Indigenous peoples, the historical trauma includes trauma created
as a result of the imposition of assimilative policies and laws aimed
at attempted cultural genocide and continues to be built upon by
contemporary forms of colonialism and discrimination.
Interpersonal racism: Also known as relationship racism, refers to specific
acts of racism that occur between people, and may include discriminatory
treatment, acts of violence and micro-aggressions.
Oppression: Refers to discrimination that occurs and is supported through
the power of public systems or services, such as health care systems,
educational systems, legal systems and/or other public systems or services;
discrimination backed up by systemic power. Denying people access to
culturally safe care is a form of oppression.
Prejudice: Refers to a negative way of thinking and attitude toward a socially
defined group and toward any person perceived to be a member of the
group. Like bias, prejudice is a belief and based on a stereotype.
Privilege: operates on personal, interpersonal, cultural, and institutional
levels and gives advantages, favours, and benefits to members of
dominant groups. Privilege is unearned, and mostly unacknowledged,
social advantage that non-racialized people have over other racial groups.
Profiling is creating or promoting a preset idea of the values, beliefs and
actions of a group in society and treating individuals who are members
of that cohort as if they fit a preset notion, often causing them to receive
different and discriminatory treatment.
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
5
Glossary of Terms
Race: Refers to a group of people who share the same physical characteristics
such as skin tone, hair texture and facial features. Race is a socially
constructed way to categorize people and is used as the basis for
discrimination by situating human beings within a hierarchy of social value.
Racism is the belief that a group of people are inferior based on the colour
of their skin or due to the inferiority of their culture or spirituality. It leads
to discriminatory behaviours and policies that oppress, ignore or treat
racialized groups as ‘less than’ non-racialized groups.
Stereotype: A fixed image. Refers to an exaggerated belief, image or distorted
truth about a person or group; a generalization that allows for little or no
individual differences or social variation.
Substantive equality refers to the requirement to achieve equality in
opportunities and outcomes, and is advanced through equal access, equal
opportunity and the provision of services and benefits in a manner and
according to standards that meet any unique needs and circumstances,
such as cultural, social, economic and historical disadvantage.
Systemic racism is enacted through routine and societal systems, structures
and institutions such as requirements, policies, legislation and practices
that perpetuate and maintain avoidable and unfair inequalities across
racial groups, including the use of profiling and stereotyping.
6
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
1. Introduction
In June 2020, B.C.’s Minister of Health commissioned an Independent
Review of Indigenous-specific racism in the provincial health care
system. The Review was met with extraordinary cooperation by the
health system, including delegation under the Ministry of Health Act to
access and examine data relevant to the scope of the Review.
Over a six-month period, a small team led by Dr. Mary Ellen
Turpel-Lafond, carried out the Review, which involved extensive
engagement, document review and qualitative and quantitative
analysis of data regarding health system performance for
Indigenous
peoples,
and
their
health
outcomes.
Almost
9,000 individuals directly shared their perspectives with the
Review, and approximately 185,000 Indigenous individuals were
reflected in the analysis of health sector data. The findings of this
Review are described in three reports: a summary report; a long
report; and this supplemental data report.
The Review sought to understand the prevalence of Indigenousspecific racism, the forms it takes, how it is experienced, and
its impacts on health system performance and Indigenous
peoples’ health and well-being. As such, this was a first-of-its-kind
examination of this issue in its depth and comprehensiveness,
and the Review received more data than could be fully presented
in either of the summary or long reports. This data is nevertheless
important in its own right, and therefore this data report was
prepared both to supplement the other reports issued by the
Review, as well as serve as a stand-alone report on health system
performance for Indigenous peoples in B.C.
This report provides analyses of qualitative and quantitative data
which were created or obtained in the Review. Starting with the
qualitative data, this Report includes analyses of the two surveys
convened by the Review – the Indigenous Peoples’ Survey (IPS) and
Health Workers’ Survey (HWS); submissions received by the Review
through its toll-free phone line and email address; Indigenous
patient complaints from external organizations; and a discussion
board on discrimination in health care administered through the
San’yas Indigenous Cultural Safety training of the Provincial Health
Services Authority (PHSA). It should be noted that these surveys,
and the individual submissions received, were not representative
In Plain Sight Summary of
Key Findings
The first volume of reports
released by the Review described
the self-perpetuating cycle that
holds Indigenous-specific racism
in place in B.C.’s health care
system – a cycle that is depicted in
the following visual.
Through the process of settler
colonialism in Canada, racist
beliefs were perpetuated about
Indigenous peoples. Those
beliefs have evolved through
time, but continue to persist in
the form of negative stereotyping
of Indigenous peoples as, for
example, bad parents, less capable,
and alcoholics. These stereotypes –
consciously or unconsciously –
result in discriminatory treatment
of Indigenous peoples in health
care. Abusive interactions take
place, there is poorer quality of
service, and inappropriate pain
management for Indigenous
patients. The result of
discriminatory treatment, paired
with intergenerational trauma and
systemic racism, is less access
to and avoidance of necessary
health care. Cumulatively, this
results in poorer health outcomes
for Indigenous patients – and
particularly Indigenous women.
The Review’s recommendations
seek to break this cycle and
create cultural safety by shifting
beliefs, behaviours and systems.
Recommendations are grounded
in Indigenous human rights as
described in the United Nations
Declaration on the Rights of
Indigenous Peoples, and require
strong anti-racism tools and the
practice of cultural humility.
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
7
Introduction
of randomized population-based responses, but represent the experiences of
respondents.
This report then describes numerous quantitative data sources on health service
utilization, including a focus on primary care and hospital services, and health
outcomes including chronic conditions, mortality, and the association of racism
with other self-reported health and wellness indicators. Data examining priority
issues such as the two current public health emergencies, and mental health and
wellness are included. A final discussion section offers some observations and
conclusions relating to the disparities in Indigenous health outcomes and access
to services as a result of insufficient and inadequate health system performance,
and the disproportionate burden shouldered by Indigenous women in B.C.
It must be stressed that the focus of this report is health system performance
for Indigenous peoples, and its role as a contributor to health outcomes as
measured by that system. The data, as will be shown in this report, point to
inherent deficits in the system, not amongst Indigenous peoples and, due
to this emphasis on health system performance, do not include the many
measures of health and wellness that matter to Indigenous peoples.1
This data report offers further evidence in support of the conclusions, findings
and Recommendations described in the Review’s first volume of reports. Taken
together, these three reports clearly demonstrate the need for immediate,
principled and comprehensive efforts to eliminate all forms of prejudice and
discrimination against Indigenous peoples in the B.C. health care system. They
provide the pathway to follow in creating an accessible and effective health
care system. Finally, these reports establish the baseline measures that can
assess progress in reaching a state of substantive equality in health care
and outcomes for Indigenous peoples that adequately address the legacy
of colonialism in health care and enable the expression and enjoyment of
Indigenous human rights and improved quality of life.
These Review reports speak to the value of data to inform evidence-based
solutions, and clearly demonstrate that accessing and producing this data in
a timely manner is possible – and is now, in fact, imperative to driving positive
change. The health system and Indigenous organizations are strongly urged to
routinely produce timely data to underpin and inform policy decisions, assure
accountability for improvement in health system performance for Indigenous
peoples, and make data available to Nations and mandated First Nations and
Métis organizations to drive improvement locally, regionally and provincially.
1
8
The reader is directed to excellent resources that consider strength-based measures
of Indigenous wellness, such as the Population Health and Wellness Agenda, which is a
collaboration of the First Nations Health Authority (FNHA) and Office of Provincial Health Officer
(OPHO), and the B.C. First Nations Regional Health Survey reports available from the FNHA.
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
In Plain Sight: Addressing Indigenous-specific
Racism and Discrimination in B.C. Health Care
Introduction
BREAK THE CYCLE
GOOD HEALTH AND WELLNESS OUTCOMES
Indigenous right to health
Self-determination and
Indigenous leadership
Cultural safety and humility
Anti-racism
INDIGENOUS SYSTEMS,
KNOWLEDGE, PRACTICES
NEGATIVE HEALTH AND
WELLNESS IMPACTS
INDIGENOUS SYSTEMS,
KNOWLEDGE, PRACTICES +
SUBSTANTIVE EQUALITY
HEALTH CARE
SYSTEM
COLONIALISM
Systems of
subjugation or
oppression, and a set
of beliefs intentionally
cultivated about the
inferiority of
Indigenous peoples.
Built on colonial
underpinnings.
History of segregation,
racism and
discrimination.
Negatively a ects health
outcomes:
Higher suicidation
Higher stress
Reduced life expectancy
Increased rates of
chronic disease
Higher infant mortality
POOR OUTCOMES
Negatively a ects
access to health care:
Unwelcoming
LESS ACCESS
environments
Lower GP/NP attachment
Geographic barriers
Mistrust
Avoidance of health care
Widespread and ongoing stereotyping
and racism:
Less “worthy”
Drinkers/alcoholics
Drug-seeking
Bad parents
STEREOTYPES
“Frequent flyers”
Non-compliant
Less capable
Get “stu for free”
Misogynist views of
Indigenous women
DISCRIMINATION
Leads to
discrimination
embedded in systems
and experienced at the
point of care:
Abusive interactions
Denial of service
Ignoring and shunning
Inappropriate pain management
Medical mistakes
Disdain for cultural healing
Summary Report: https://engage.gov.bc.ca/app/uploads/sites/613/2021/11/In-Plain-Sight-Summary-Report.pdf
Full Report: https://engage.gov.bc.ca/app/uploads/sites/613/2021/11/In-Plain-Sight-Full-Report.pdf
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
9
2. Terminology
The lexicon of Indigeneity is dynamic and complex, spanning individual and
Nation preferences, government legislation, policy and practices, and emerging
social norms and understandings.
In this report, ‘Indigenous’ is used preferentially as the overall descriptor of the
population who are the focus of the Review, and encompassing First Nations,
Métis and Inuit. B.C.’s Declaration on the Rights of Indigenous Peoples Act (DRIPA)
defines ‘Indigenous’ the same way the federal Constitution Act, 1982 defines
‘Aboriginal’.
From a data perspective, the term of choice within many government databases
is ‘Aboriginal’. ‘Aboriginal’ is used in the federal census and B.C. data collection
policies. Where the originating data source uses the term ‘Aboriginal’, this
usage is carried over into this report. It is also used with respect to the Interior
region of B.C. based on the preference of First Nations and Métis peoples in
that area.
The federal government also continues to use the terminology ‘Registered or
Treaty Indian’, ‘Indian reserves’, and ‘Indian Status’ in its documentation – a byproduct of the Indian Act. However, in this report, these terms are only used to
accurately identify a data’s original descriptors. ‘First Nations’, with the subset
‘non-status First Nations’ are otherwise used. The report also uses the terms
‘Métis’ and ‘Inuit’ consistent with contemporary practice.
These aggregate terms fail to capture the tremendous linguistic, cultural and
other social diversity of the vibrant self-determining Nations which predated
settler colonialism and the establishment of Canada, and which continue to
exist today.
10
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
3. Population Overview
In the 2016 Census, which is the last broad enumeration of the Indigenous
population in B.C., 5.9 per cent of the provincial population, or 270,585 persons,
identified as Aboriginal. This represents a five-year growth of 16.5 per cent
from the 2011 Census, and is related to relatively high fertility rates in the
Aboriginal population as well as a trend to increasing numbers of individuals
who are reporting Aboriginal identity in the Census.2
For B.C. specifically, 64.8 per cent (172,520) of the Aboriginal population further
identified as First Nations (North American Indian), 33.0 per cent (89,405)
as Métis and 0.6 per cent (1,615) as Inuit. The remaining 1.6 per cent were
individuals who identified as having multiple Aboriginal identities.3
Of the 125,635 First Nations people with Registered or Treaty Indian status
(72.8 per cent) in 2016, 40.1 per cent lived in one of B.C.’s First Nations
communities, while the rest lived off reserve. Approximately 30.3 per cent of
Aboriginal peoples in B.C. lived in rural areas, which was a higher proportion
than the overall population. Vancouver had the largest Aboriginal population
among Census metropolitan areas and Census agglomerations. Twentythree per cent of B.C.’s Aboriginal population (61,455 persons) lived in
Vancouver in 2016. Victoria had the second largest Aboriginal population
(17,245 persons).4
When compared to the non-Aboriginal B.C. population, both First Nations and
Métis populations were more youthful in 2016, particularly seen with those
under 25 years of age. In general, Indigenous peoples have not experienced the
effects of population aging to the extent seen in the non-Indigenous population.
Population aging is defined as an increasing median age of a population or
an alteration in the age structure of a population, with the result that elderly
persons are increasingly represented within a country’s overall age structure.
This aging-related difference is evident in Figure 1 of the First Nations, Métis
and non-Aboriginal populations, starting at age groups older than 34 years, and
culminating in the 75-plus years age group, where there is an approximately
three fold difference between the First Nations and Métis proportions of the
population ages 75-plus and that seen in the non-Aboriginal population.
2
3
4
https://www150.statcan.gc.ca/n1/daily-quotidien/171025/dq171025a-eng.htm
The Census has a degree of under-reporting, as some First Nations communities choose
to not participate. As well, other groups may similarly choose non-participation, such
as homeless persons and Aboriginal persons who do not accept the jurisdiction and/or
mandate of the Census.
https://www2.gov.bc.ca/gov/content/data/statistics/infoline/infoline-2017/17-138-2016census-indigenous-people-canada
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
11
3. Population Overview
First Nations
(North American Indian)
Métis
14.9%
10.9%
7.2%
14.8%
13.4%
12.8%
14.5%
11.6%
6.3%
2.6%
13.8%
12.3%
16.7%
13.7%
11.5%
23.0%
4.9%
2.1%
12.9%
9.7%
16.7%
14.3%
12.1%
% of population
27.2%
Figure 1: Age Distribution, 2016 Census, B.C.
Non-Aboriginal
0 to 14
25 to 34
45 to 54
65 to 74
15 to 24
35 to 44
55 to 64
75 years
Much of the health status and health service utilization data which follow in
this report are based on a subset of First Nations and Métis populations – those
that are identifiable in First Nations and Métis population registries which
can then be matched with health administrative databases.5, 6 The difference
is fairly small between the First Nations population which can be analyzed
in a health study (e.g., First Nations with registered status), and those who
are missed (First Nations who do not have registered status – approximately
10 per cent in the Census). With respect to the Métis, the existence of a registry
of their population which can be used to identify health data is fairly recent,
and approximately 20,500 Métis individuals are currently registered.
Regions
For First Nations, the most populous region in B.C. in 2016/17 was Northern
(26.0% of the total First Nations population), and the least populated was
Vancouver Coastal (15.3%). These were also the two regions where there was
a very slight majority of male First Nations (50.4%); in the other regions, the
female population ranged from 50.7 per cent to 51.6 per cent.
5
6
12
The Métis are self-identified in the Canadian Census. In B.C., Métis Nation British Columbia
(MNBC) administers a voluntary citizenship application process. As part of the application,
Métis individuals can provide approval for their health data to be used in data linkages with
provincial health databases.
The First Nations Client File (FNCF) is a repository of demographic information for B.C.
resident First Nations who are registered under the Indian Act.
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
3. Population Overview
Figure 2: First Nations Population by Region, 2016/17
26.0%
Northern
22.0%
Vancouver Island
20.5%
Interior
16.3%
Fraser
15.3%
Vancouver Coastal
% of population
FNCF, 2016/17
Over a 10-year period (2008/09 to 2016/17), the highest annual growth was
in Fraser (1.3%) and Vancouver Island (1.0%), followed by Interior (0.5%), and
Northern (0.3%). There was minimal change in the Vancouver Coastal First
Nations population (0.1%).7
In contrast to First Nations people who are more likely to reside in regions that
are northerly and remote, the regions with the highest Métis population were
Interior (30.2%) and Fraser (23.4%) in 2017/18.8
Figure 3: Métis Population by Region, 2017/18
30.2%
Interior
23.4%
Fraser
22.0%
Northern
16.9%
Vancouver Island
Vancouver Coastal
7.5%
% of population
MCR, 2020
7
8
FNHA. 2020.
Review. 2020.
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
13
4. Data Sources and Methodology
The Review placed a strong emphasis on prioritizing the direct input and
collecting the voices of Indigenous people who use the health care system
and on gathering the experiences of health care workers in B.C. Including
surveys, email and toll-free phone submissions, and stakeholder interviews,
nearly 9,000 voices helped shape the Review findings. The Review Team also
completed extensive qualitative and quantitative analysis of existing data
related to health system performance for more than 185,000 Indigenous
individuals. The Review engaged both Indigenous and non-Indigenous
methodologies in data collection and analysis, included multiple quantitative
and qualitative data sources, and followed established Indigenous data
governance principles and processes.9
4.1 Data Sources Created by the Review
The sources of information created in this Review and covered in this report
include:
• Indigenous Peoples’ Survey (IPS)
• Health Workers’ Survey (HWS)
• Intake file created through individual histories submitted to a toll-free
phone number and email address.
Indigenous Peoples’ Survey10
The IPS was established as a way to capture the experience of Indigenous
people in B.C. related to racism or discrimination in the B.C. health care system;
even so, it was open to the general public. It was launched on July 9, 2020 as a
primarily online survey (hard copy written responses were also accepted) and
was open for responses over a five-week period. (Survey, Appendix 1; Survey
9
10
14
The Review Team was headed by two Indigenous women – the Independent Reviewer and
the Executive Director. The team included a combination of Indigenous and non-Indigenous
members with public health and direct clinical experience, included physicians and nurses
and public health leaders, and those with extensive knowledge of the health care system
and expertise in conducting complex investigations, interpreting data, and Indigenous rights
and anti-racism. The Review engaged external Indigenous reviewers with strong data and
data governance backgrounds and training, and followed governance protocols of FNHA and
MNBC with respect to accessing and publishing data.
The IPS was developed by the Review Team based on an instrument designed by PHSA, and
reviewed and finalized in consultation with stakeholders and Indigenous leadership. The
survey was hosted and managed by the Public Engagement Team at the Ministry of Citizens’
Services on behalf of the Review. Analysis was conducted by an independent research firm
under the close direction of the Review Team.
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
4. Data Sources and Methodology
approach and methodology, Appendix 2). The IPS was heavily promoted
through the Review’s social media channels, on its website, through the
networks of Indigenous and non-Indigenous health care organizations, and
via traditional media coverage.
The IPS solicited the following from respondents:
• Feelings of safety or lack of safety in the health system
• Perspectives on the care received
• How Indigenous people utilize systems established to address complaints
• How Indigenous-specific racism might be best addressed.
The final number of surveys available for analysis was 2,780 (full and partial
completions). Sixty-five per cent of respondents identified as First Nations,
10 per cent as Métis, and five per cent as Inuit or another Indigenous people
from outside of B.C. – for a total of 80 per cent Indigenous respondents.
Health Workers’ Survey11
The HWS was launched online on July 30, 2020 and remained open until
Aug. 27, 2020. (Survey, Appendix 3; Survey approach and methodology,
Appendix 2). It was designed to seek feedback on the issue of Indigenousspecific discrimination in the health care workplace, and was expanded to
solicit the views of the non-Indigenous racialized population on this topic. The
HWS was heavily promoted through the Review’s social media channels, on its
website, through the networks of health regulators and via traditional media
coverage.
The HWS solicited the following from respondents:
• Experience of racism towards health care users, and in health care settings
• Experiences of racism among health workers
• The responsiveness of the health care system to dealing with discrimination
• Presence of relevant training in health workers’ education
• Cultural safety in the workplace
11
The HWS was developed by the Review Team based on an instrument designed by Fraser
Health, and was reviewed and finalized in consultation with stakeholders and Indigenous
leadership. As with the IPS, the HWS was hosted and managed by the Public Engagement
Team at the Ministry of Citizens’ Services on behalf of the Review and analysis was conducted
by an independent research firm with direction from the Review Team.
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
15
4. Data Sources and Methodology
• Improvement of cultural safety in health care for both users and health
workers.
The final number of HWS surveys available for analysis was 5,440 (full
and partial completions). Just over 70 per cent of respondents were nonIndigenous and not from a racialized population (NINR); 22 per cent identified
as racialized; and seven per cent were Indigenous (4% First Nations, 3%
Métis and 1% Inuit). Eighty per cent of respondents were female (a similar
percentage to what is seen in the provincial health care system), and the
majority had worked in health care for more than 10 years.
Toll-free Telephone and Email Submissions
A toll-free telephone line and email inbox collected histories from both
Indigenous and non-Indigenous respondents, including patients, family
members and caregivers, health care workers, third-party witnesses and others.
The toll-free line and email inbox were both launched on July 9, 2020. Callers
utilizing the toll-free line were prompted to record a submission of up
to 20 minutes in length, or leave contact information for a member of the
Review Team to return their call and take their submission by telephone. All
submissions were recorded on a spreadsheet that included 28 categories,
ranging from the health authority in which the incident occurred, to the health
care provider(s) involved, to the outcome for the patient. The spreadsheet also
included an open text field where key details of specific cases were logged.
4.2 External Data Sources
The Review collected large amounts of data from a number of sources. As the
Independent Reviewer and a small number of team members were provided
delegation under the Ministry of Health Act, confidential complaints and other
row-level data from various sources were available to be examined.
Data Linkages
Much of the quantitative Indigenous-specific data in this report related to
health system utilization and health outcomes have been sourced from
databases which were linked to population registries that are specific to B.C.
First Nations or Métis populations:
• The FNCF: a cohort of B.C. resident First Nations people registered under
the Indian Act, and their unregistered descendants for whom entitlementto-register can be determined, linkable through their B.C. Ministry of Health
Personal Health Number (PHN).
16
In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care
4. Data Sources and Methodology
• The MNBC Métis Citizenship Registry (MCR): a database of all those people
who apply and meet MNBC criteria to be considered Métis citizens, and who
have agreed to have their information, including PHN, used for data linkages
purposes.
Linked databases which are included in this report are:
a) Health System Matrix
The Health System Matrix (HSM) is a provincial database that summarizes how
people use provincial health services every year. The HSM divides the B.C.
population into population groups according to their utilization of available
sources of health services and includes approximately 70 per cent of all
provincial health expenditures for individuals who have chosen/been able to
access health services.
b) B.C. Chronic Disease Registry
The B.C. Chronic Disease Registry uses a standardized methodology based on
administrative data, mainly from hospital and physician records, to estimate
the prevalence rate of individual chronic conditions in a population.
c) Canadian Institute for Health Information (CIHI) Population Grouper
(PG)
CIHI’s Population Grouping Methodology uses data from multiple sectors
to create clinical profiles and to predict the entire population’s current and
future morbidity burden and health care utilization. The population grouping
methodology starts with everyone who is eligible for health care, including
those who have not interacted with the health care system. It uses diagnosis
information from hospital and physician services over a two-year period to
create health profiles of 227 health conditions.
d) Perinatal Services BC (PSBC)
PSBC collects and analyzes data on delivery, postpartum transfer/readmission,
newborn, and newborn transfer/readmission records submitted to PSBC’s
British Columbia Perinatal Data Registry. The registry captures >99 per cent of
deliveries and births that occur in the province. Records used to generate this
report meet the following conditions:
• Mother delivery and baby newborn records are linked. Unlinked mother
delivery or newborn records are excluded (
Purchase answer to see full
attachment

  
error: Content is protected !!