The NCCAH is guided in its knowledge-sharing mission by a strong set of principles that inform all aspects of our Centre's commitment to serve the public health needs of First Nations, Inuit and Métis peoples in Canada. These principles are developed in consultation with Aboriginal leaders, organizations, communities and our NCCAH national advisory committee.
Indigenous Knowledge
At the heart of our NCCAH work is respect for Indigenous knowledge. In all our activities, we seek to build bridges between western scientific approaches to research and evidence in public health, and Indigenous ways of knowing and being. Although linking evidence to practice through knowledge translation is the core of our mandate, the National Collaborating Centre for Aboriginal Health strives to conceptualize “knowledge” “evidence” and “research” from an Indigenous perspective.
To date, the NCCAH has conducted gatherings such as “Dialogue Circles” that create “ethical spaces” for participants to safely explore exchange processes between cultures. In the coming year (2010-2011), the NCCAH will convene an international panel of Indigenous knowledge holders who will help articulate approaches for knowledge translation, dissemination and exchange in First Nations, Inuit and Métis communities. We will, with our panel's guidance, incorporate Indigenous world views into holistic approaches to inform our work on the social determinants of health. In preparation for this panel, we are supporting a literature review of health-related studies that have considered the validity of both Aboriginal and non-Aboriginal research frameworks.
"Indigenous philosophies are underlain by a world view of inter-relationships among the spiritual, the natural and the self, forming the foundation or beginnings of Indigenous ways of knowing and being."
Diversity
While the focus of the NCCAH is on the health of a population, Aboriginal peoples are in fact diverse in their culture, history, and geography. There are more than 50 cultural groups in Canada, each with its own distinct language and traditional land base. Politically, Aboriginal peoples represent themselves as belonging to one of three major groups: First Nations, Inuit and Métis. These are recognized in Section 35 of the Canadian Constitution Act, which also recognizes and reaffirms Aboriginal rights and treaty rights. Currently, of the 1.2 million Aboriginal people in Canada identified in the 2006 national Census, 60% are First Nations, 33% Métis, 4% Inuit; while others identified with more than one Aboriginal group. The Aboriginal population is young and growing each year, increasing by 45% from 1996 to 2006 [1].
All three groups have experienced processes of colonization affecting Indigenous cultures, languages, land rights, and self-determination in different ways [2]. Each, for instance, has varying legal entitlements under the Canadian Constitution of 1982; and each has varying experiences of issues such as quality of life and access to health services. For health intervention to be meaningful, the distinct experiences and perspectives of these populations must be recognized [3]. At the NCCAH, we continue to strive for inclusivity and respect for diversity in all aspects of our work.
Until recently, however, the diversity of Canada's Aboriginal peoples has not been generally reflected in research, data collection or in health programming [4]. This presents a critical challenge for Aboriginal public health and for the NCCAH role linking evidence, policy and practice. Research methodologies and survey approaches have been inconsistent, leading to fragmented data and incomplete information, while vital statistics continue to be challenged by a lack of accurate and complete identification of Aboriginal persons. Data gaps remain for various populations – such as off-reserve First Nations, Inuit and Métis people.
These issues are highlighted in our work at the NCCAH. This past year, we released our “Strength Through Numbers” fact sheet explaining the need for “disaggregated data,” while our UNICEF CANADA joint 2009 report on the health of Canada's Aboriginal children (Canadian Supplement to the State of the World's Children 2009 - Aboriginal children's health: leaving no child behind) brought the issue to broad public attention and included a call to action on the data gap.
"Addressing health disparities...is a huge challenge and requires a collective Canadian effort to tackle them. A starting place...begins with a holistic approach that builds on the attributes and strengths of First Nations, Inuit and Metis peoples."
Holistic Health
The NCCAH takes a holistic approach to public health, one that addresses a broad range of factors, from the cultural to the spiritual, and from the economic to the historical. Research into Indigenous health has been largely focused on disease and treatment. By contrast, Indigenous peoples define wellbeing far more broadly than merely physical health or the absence of disease. Living in balance “extends beyond the individual realm such that good health and healing also require that an individual live in harmony with others, their community, and the spirit worlds.[5]”
At the NCCAH, Indigenous health is visualized as the interconnected strands of a spiderweb, in which issues such as poverty, a history of colonization, geographic location and connection to land, gender, food security, education and other factors, intersect in the lives of individuals, families, communities, nations and peoples. This more holistic approach to health is rooted in Indigenous ways of knowing and being, and represents a significant step beyond health conceived as a matter of illness due to bio-medical cause and effect, or lifestyle choices.
Community Voice
An important goal of the NCCAH is to foster culturally appropriate materials, information, projects and activities that show tangible and meaningful results for individuals and communities. The NCCAH has responded to key concerns of Aboriginal communities, for instance, by synthesizing information on the prevalence and impact of fetal alcohol spectrum disorder, a significant gap in knowledge that has helped drive early NCCAH explorations of child and youth health issues. As we interact with researchers, frontline practitioners, students and many others, we encourage a stronger awareness of the critical importance of community voice and control in health research, initiatives, programs and planning.
"The peoples we're serving must have voice in what we're doing. It must be meaningful to them, it must be useful. We take really seriously the notion of creating space for voice to come through."
Community based research studies are necessary to address gaps that are most relevant to Aboriginal peoples, yet are still rarely undertaken [6]. However, guidelines that support a changing approach to research in Aboriginal health in Canada, three years in the making, are now available. These strengthen the role of communities as true partners with researchers, governments and other sponsors. Prepared by the Ethics Office of the Canadian Institutes of Health Research (CIHR), in conjunction with its Institute of Aboriginal Peoples' Health, the CIHR Guidelines for Health Research Involving Aboriginal People assists researchers and institutions in carrying out ethical research that involves Aboriginal people and that is in keeping with Aboriginal values and traditions.
Support for community capacity and infrastructure can help extend successful programs and initiatives to other communities in locally appropriate ways. As Senator Wilbert Keon told a 2009 NCCAH gathering showcasing the local role in adapting, developing and implementing parenting programs to meet community needs: “We know there is a tremendous health inequity between some Aboriginal communities and others, and between some Aboriginal communities and the majority of Canadians. But solutions will only come when interventions are made at the local level and not imposed from above."
Resilience
Resilience is what keeps people strong in the face of adversity and stress [7]. Although Aboriginal peoples have been forced to change the way they live in almost every aspect of their lives, many have drawn strength from spiritual connections, cultural and historical continuity, and ties with family, community and the land [8].
First Nations, Inuit and Métis communities are making improvements in education, employment, economic development, in language revitalization, self-governance, and many other areas. Yet, the epidemiological bias in population health and public health involves a focus on illness, disability, dysfunction and untimely death. Dr. Jeff Reading at the University of Victoria's Centre for Aboriginal Health Research argues that this tends to construct negative images about “what the world thinks about being Aboriginal in Canada,” and overlooks strengths in people and communities.[9]
At the NCCAH, we support a “strengths-based” approach to our programs and activities. Our national “Messages from the Heart” Showcase on Aboriginal Childrearing of 2009 was a highlight, featuring a panel of Elders who discussed the importance of traditional culture and values, and a panel of young mothers and fathers who shared the contemporary challenges that they face in raising their children. In speaking of their struggles with addictions or the legacies of their own parents' experiences of residential schools, these parents sent a clear message that it was possible to turn the legacies around. A strengths-based approach to health, rather than focusing on pathology and deficits, builds capacity, celebrates assets, and is guided by respect.