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Treaty-based strategies are required to address the unique needs of Indigenous communities in Canada during the COVID-19 pandemic. A treaty-based approach should recognize provisions within the Numbered Treaties, including the Famine and Pestilence Clause and Medicine Chest Clause, agreed to during the signing of Treaty 6 in 1876. The Famine and Pestilence Clause established the Crown’s obligation to aid Indigenous Peoples within Treaty 6 Territory in the event of calamities such as locust raids, storms, starvation, and disease. The Medicine Chest Clause instituted the means through which the Crown would provide medical care for Indigenous Peoples within the jurisdiction. The Government of Canada has a legal obligation to invoke the Famine and Pestilence Clause and Medicine Chest Clause in a strategy to address the spread of COVID-19 in Indigenous communities.

This chapter talks about pursuing pathways to care, which is critical in the movement towards addressing the health status and its relationship to dementia amongst Indigenous older adults in their communities. It refers to the proportion of Indigenous older adults who are above 65 years of age that continues to rise despite the numbers being lower than their non-Indigenous counterparts. It also mentions dementia, which can represent a concern for families and prevent individuals from aging in place, and causes distress to individuals and their caregivers. The chapter points out the lack of access to dementia services and specialists in rural communities that exacerbates families' ability to care for their loved ones at home. It presents an examination of dementia among Indigenous peoples, including dementia care and rural access to care.

Guided by an Indigenous Methodology and a participatory research approach, we explored the experiences and priorities of Indigenous women living in Quebec regarding HIV prevention and care, overall health, and well-being. We drew from our research process to identify recommendations for conducting research with Indigenous women. These lessons include: (1) incorporating culturally adapted methods (e.g., sharing circles, arts, ceremony) facilitated participants’ safety and comfort; (2) conducting numerous workshops was valuable in building trust; and (3) validating findings with participants was essential to ensuring that the knowledge, experiences, and priorities of Indigenous women were respected. Our research findings regarding the care needs and priorities of women emphasize the importance of peer-led groups, culturally rooted healing strategies, accessible harm reduction, and social supports. Participatory research, led by members of the communities concerned, imbues the research with local knowledge and wisdom, which ensures the relevance of the research, the appropriateness of its conduct, and enables its overall success.

Caregivers are integral to the quality of life for older adults living with dementia who are aging in place. The lack of training and culturally appropriate resources available for caregivers of Indigenous Peoples living with dementia contributes to the accessibility gap for community-based respite care. Although current modules exist for respite care workers, there are limited culturally safe training modules designed for Indigenous caregivers and family members endeavouring to increase Traditional Knowledges around dementia. Developing an Indigenous, community-based caregiver toolkit for dementia creates culturally safe, accessible resources for community respite care. Guided by Indigenous Research Methodologies and community-based research, Morning Star Lodge, in partnership with File Hills Qu’Appelle Tribal Council at the request of a Community Research Advisory Committee, aims to promote Indigenous community-based models of support and to develop a toolkit for caregivers of people living with dementia and their families. The toolkit includes information such as: understanding dementia, strategies for care, links to online resources for caregivers, and resources specific to Indigenous cultures. The goal is to increase caregivers’ access to dementia related supports through the distribution of the toolkit and to build capacity for the provision of community-based respite care by creating an opportunity for education, training, and increasing awareness in Indigenous communities. Creating a caregiver toolkit will also help to relieve caregiver stress by providing education to family members about community-based respite care and services available.

Indigenous women experience a disproportionate burden of ill health, including high rates of HIV. To reduce disparities in disease burden and health outcomes, identification of the barriers preventing access to health care is necessary. Identifying and discussing these barriers can assist service providers in the provision of care, influence policies for health and social well-being, and advance the discourse on equitable health care for Indigenous Peoples. Our research goal was to identify evidence-based, community-driven and asset-based solutions from the perspective of Indigenous women living with HIV. We also aimed to identify the role of the social determinants of health that influence the rates of HIV among Indigenous women. We used a combination of community-based participatory research methodology and Indigenous storytelling during 148 one-on-one interviews with HIV- and/or HCV-positive Indigenous women. Nine additional interviews were executed with healthcare professionals, health directors, and Knowledge Keepers and Elders. The interviews included qualitative, open-ended questions. We utilized NVivo for data analysis as well as Nanâtawihowin Âcimowina Kika-Môsahkinikêhk Papiskîci-Itascikêwin Astâcikowina (NAKPA), an Indigenous method for qualitative data analysis. Through the analysis, we identified nine barriers to care including expenses for daily living and health care-associated costs, time, access to computers and/or internet, transportation, childcare, homelessness and missed appointments, age, experiences with healthcare professionals and the health care system, and language. These barriers prevent access to and engagement in health care, leading to poor HIV related health outcomes. Healthcare providers have an essential role in identifying barriers to care, improving access to care in a patient-centered approach, and working to improve culturally safe practices.

Indigenous peoples around the world are concerned about the long-term impacts of industrial activities and natural resource extraction projects on their traditional territories. Environmental impact studies, environmental risk assessments (EAs), and risk management protocols are offered as tools that can address some of these concerns. However, these tools are not universally required in jurisdictions, and this Forum intervention considers whether these technical tools might be reshaped to integrate Indigenous communities’ interests, with specific attention to traditional knowledge. Challenges include unrealistic timelines to evaluate proposed projects, community capacity, inadequate understanding of Indigenous communities, and ineffective communicatio, all of which contribute to pervasive distrust in EAs by many Indigenous communities. Despite efforts to address these problems, substantive inequities persist in the way that EAs are conducted as infringement continues on constitutionally protected Indigenous rights. This article highlights challenges within the EA process and presents pathways for improving collaboration and outcomes with Indigenous communities.

This commentary examines the inequitable access to healthcare services that Indigenous peoples in Canada face on a daily basis. It considers not only geographical or physical access but also culturally safe access to healthcare. Racism is cited as a major deterrent in not accessing mainstream health services. Three recent studies are cited that reveal that racism, discrimination, stigma, sexism and bias prevent Indigenous peoples from accessing mainstream health services. Cultural safety training is recommended, as well as recruitment and retention of Indigenous health professionals. Several recommendations to address physical and geographical access are also recommended, including self-governance and capacity building; enhanced partnerships and collaboration to address jurisdictional issues, particularly for First Nations communities, and a national strategy for access to healthy and affordable food in northern, remote and rural communities.

Various multiple-disciplinary terms and concepts (although most commonly “interdisciplinarity,” which is used herein) are used to frame education, scholarship, research, and interactions within and outside academia. In principle, the premise of interdisciplinarity may appear to have many strengths; yet, the extent to which interdisciplinarity is embraced by the current generation of academics, the benefits and risks for doing so, and the barriers and facilitators to achieving interdisciplinarity, represent inherent challenges. Much has been written on the topic of interdisciplinarity, but to our knowledge there have been few attempts to consider and present diverse perspectives from scholars, artists, and scientists in a cohesive manner. As a team of 57 members from the Canadian College of New Scholars, Artists, and Scientists of the Royal Society of Canada (the College) who self-identify as being engaged or interested in interdisciplinarity, we provide diverse intellectual, cultural, and social perspectives. The goal of this paper is to share our collective wisdom on this topic with the broader community and to stimulate discourse and debate on the merits and challenges associated with interdisciplinarity. Perhaps the clearest message emerging from this exercise is that working across established boundaries of scholarly communities is rewarding, necessary, and is more likely to result in impact. However, there are barriers that limit the ease with which this can occur (e.g., lack of institutional structures and funding to facilitate cross-disciplinary exploration). Occasionally, there can be significant risk associated with doing interdisciplinary work (e.g., lack of adequate measurement or recognition of work by disciplinary peers). Solving many of the world’s complex and pressing problems (e.g., climate change, sustainable agriculture, the burden of chronic disease, and aging populations) demands thinking and working across long-standing, but in some ways restrictive, academic boundaries. Academic institutions and key support structures, especially funding bodies, will play an important role in helping to realize what is readily apparent to all who contributed to this paper—that interdisciplinarity is essential for solving complex problems; it is the new norm. Failure to empower and encourage those doing this research will serve as a great impediment to training, knowledge, and addressing societal issues.

Over the past several years, academic discourse has included discussions around improving research methodologies, particularly related to Indigenous people. Using Western research methodologies and methods when undertaking health research with Indigenous people, in the direction of Indigenous communities, has not been very effective. This is due to the fact that Western research methodologies do not address the need to foster relationships, mutual respect, and reciprocity. Engaging Indigenous communities empowers them to take an active role in how the research is conducted and ensures that the research is relevant to their communities. Engagement with Indigenous communities is also important during the analysis of qualitative data in the form of interviews, focus groups, and sharing circles. Without adequate engagement, data analysis often reverts back to Western methods, leaving the community out of the data analysis process. Bartlett et al. developed the “Collective Consensual Data Analytic Procedure” (CCDAP) in 2006 to address the lack of community involvement in the data analysis process. Analyzing the qualitative data using a community panel to reach a group consensus reduces the possibility of biases that any one person could bring to the research. Furthermore, group participation helps foster relationships and camaraderie within Indigenous communities. The process outlined by Dr. Bartlett could however become tedious and lengthy when dealing with a large number of interviews and data entries. This is why the CCDAP process was streamlined by first doing a thematic analysis of the data using the NVivo software. Following the thematic analysis, digitalization was added to the process by the way of Microsoft PowerPoint presentation and Excel spreadsheet. This made it quicker and easier to perform the analysis remotely using any videoconferencing platform that allows for screen sharing.

The “Understanding from Within” (UFW) project was part of the National Health Population Study of Neurological Conditions (NHPSNC), a 4-year study aimed at better understanding the scope of neurological conditions in Canada, and funded by the Public Health Agency of Canada. The goal of the UFW project was to develop a better understanding of how Aboriginal people conceptualize neurological conditions and the impacts on their families and communities, and the resources and supports needed to provide culturally safe and appropriate care. The research was qualitative and used an Indigenous Research Methodologies (IRM) approach to guide the design, collection of data, and analysis. Two methods were used to collect information: in-depth interviews and research circles (focus groups). A total of 80 people participated in the research, 69 women and 11 men. In-depth interviews were undertaken with key informants (22), with Aboriginal people living with a neurological condition (18), and with Aboriginal people caring for someone with a neurological condition (40). This paper examines the physical, mental, emotional, and spiritual impacts of neurological conditions on Aboriginal people, primarily women. It also examines other themes that emerged from the narratives, including recommendations to healthcare providers and cross-cutting themes that are relevant to culturally safe care and how it relates to neurological conditions.

First Nations communities in Canada are disproportionately affected by poor water quality. As one example, many communities have been living under boil water advisories for decades, but government interventions to date have had limited impact. This paper examines the importance of using Indigenous research methodologies to address current water issues affecting First Nations. The work is part of larger project applying decolonizing methodologies to Indigenous water governance. Because Indigenous epistemologies are a central component of Indigenous research methods, our analysis begins with presenting a theoretical framework for understanding Indigenous water relations. We then consider three cases of innovative Indigenous research initiatives that demonstrate how water research and policy initiatives can adopt a more Indigenous-centered approach in practice. Cases include (1) an Indigenous Community-Based Health Research Lab that follows a two-eyed seeing philosophy (Saskatchewan); (2) water policy research that uses collective knowledge sharing frameworks to facilitate respectful, non-extractive conversations among Elders and traditional knowledge holders (Ontario); and (3) a long-term community-based research initiative on decolonizing water that is practicing reciprocal learning methodologies (British Columbia, Alberta). By establishing new water governance frameworks informed by Indigenous research methods, the authors hope to promote innovative, adaptable solutions, rooted in Indigenous epistemologies.

Introduction Canada’s colonial policies and practices have led to barriers for Indigenous older adults’ access to healthcare and research. As a result, there is a need for Indigenous-led research and culturally safe practices. Morning Star Lodge is developing a training module to assist AgingTech researchers on ethical, culturally safe ways to engage Indigenous communities. This includes exploring Indigenous health research, community-based partnerships, reciprocal learning, and cultural safety; this is presented through a case study on ethically engaged research. Methods Morning Star Lodge developed a research partnership agreement with File Hills Qu’Appelle Tribal Council and established a Community Research Advisory Committee representing the eleven First Nations within the Tribal Council. The work designing the culturally safe training module is in collaboration with the Community Research Advisory Committee. Results Building research partnerships and capacities has changed the way the eleven First Nation communities within File Hills Qu’Appelle Tribal Council view research. As a result, they now disseminate the Knowledge within their own networks. Conclusions Indigenous Peoples are resilient in ensuring their sustainability and have far more community engagement and direction. Developing culturally safe approaches to care for Indigenous communities leads to self-determined research. Culturally safe training modules can be applied to marginalized demographics.

In this article, we share words spoken by Aboriginal elders from Saskatchewan, Canada, in response to the research question, “What would you like non-Aboriginal health care providers to know when providing end-of-life care for Aboriginal families?” Our purpose in publishing these results in a written format is to place information shared by oral tradition in an academic context and to make the information accessible to other researchers. Recent theoretical work in the areas of death and dying suggests that cultural beliefs and practices are particularly influential at the end of life; however, little work describing the traditional beliefs and practices of Aboriginal peoples in Canada exists to guide culturally appropriate end-of-life care delivery. Purposive sampling procedures were used to recruit five elders from culturally diverse First Nations in southern Saskatchewan. Key informant Aboriginal elder participants were videotaped by two Aboriginal research assistants, who approached the elders at powwows. Narrative analysis of the key informant interview transcripts was conducted to identify key concepts and emerging narrative themes describing culturally appropriate end-of-life health care for Aboriginal families. Six themes were identified to organize the data into a coherent narrative: realization; gathering of community; care and comfort/transition; moments after death; grief, wake, funeral; and messages to health care providers. These themes told the story of the dying person's journey and highlighted important messages from elders to non-Aboriginal health care providers.

Consultations with concerned stakeholders are a cornerstone to effective impact assessment, not only within Canada, but internationally as well. The environment is of paramount importance to Indigenous communities, as many continue to rely heavily on the land and natural resources for their subsistence, including their socio-economic, cultural, spiritual and physical survival. Indigenous communities want reassurances from governments and industry that negative impacts associated with projects, programs or policies in their territories will be minimized and that positive impacts will be maximized. Communities want to be involved in the development, implementation and interpretation of the impact assessment report to assure themselves of the environmental, social, spiritual and health impacts associated with the exploitation of the local natural resources. This paper presents efforts by the Environmental Health Research Division of the First Nations and Inuit Health Branch, Health Canada, to assist Indigeno...

This paper examines the multiple oppressions faced by Aboriginal women as a result of Canada's sexist and racist colonial past. We explore the destructive affects of colonization on gender relations and societal structures and argue that Aboriginal women suffer higher rates of poverty, ill-health, violence and sexual exploitation than non-Aboriginal women as a result. The Sisters in Spirit Campaign (2004) and Amnesty International's “Stolen Sisters” report (2004) illustrate how violence is a result of the social and economic marginalization of Aboriginal women. Short term solutions focus on serious jail sentences and fines on those who procure, exploit and prepetrate crimes on girls and women while long term solutions must address the elimination of poverty among Aborignal women while simultaneously revaluing Aborignal women and their culture. Unless these underlying causes of poor health for Aboriginal women are addressed there is little chance of improvement.

The Southern Saskatchewan/Urban Aboriginal Health Coalition is an interdisciplinary, intersectoral team of researchers and communities dedicated to exploring what 'culturally respectful' care means in Aboriginal communities. Although the purpose of the research project was to examine this concept in an effort to improve health care service delivery and education for health professions, the members of the Coalition realized early in the process that one of the primary factors related to the success of the project would be the building and sustaining of relationships. This paper describes a relational process that was used to initiate, facilitate, and support a research partnership with the Aboriginal communities. Through a community-based process, two communities and the Coalition used sharing circles and workshops as a method to create relationships and begin a discussion about what constitutes key elements of culturally respectful health care and education. These elements have not yet been determined as the Coalition and community members have focused on fostering relationships which have been critical to building the partnership with the Aboriginal communities.

For community engagement to be successful, the interests of the community must be taken into account and researchers must become facilitators. Patience is required. Meaningful and sustainable relationships that have been developed over time promote mutual learning and capacity building among the partners (Elders, community members, health care providers, and researchers). In addition, community engagement leads to the sharing of available resources (eg, human, time, and financial) and to a sustained commitment by the partners. This mutual commitment makes future projects easier to develop and complete. Thus, authentic transformative health development, informed by participatory health research, becomes an ongoing process.

The Southern Saskatchewan/Urban Aboriginal Health Coalition is an interdisciplinary, intersectoral team of researchers and communities dedicated to exploring culturally respectful care in Aboriginal communities. Through a community-based research approach, the communities and the Coalition used sharing circles to determine the key elements that 2 Saskatchewan Aboriginal communities see as requisite for culturally competent care. Through triangulation and thematic analysis, 9 initial themes and 4 broad thematic groupings were derived. The lessons from this study could inform further research with these communities and other culturally diverse groups with respect to cultural competency in terms of both health-care providers and health services.

The Saskatchewan Ministry of Health has committed to a multi-million dollar investment toward the implementation of Lean methodology across the province's healthcare system. Originating as a production line discipline (the Toyota Production System), Lean has evolved to encompass process improvements including inventory management, waste reduction and quality improvement techniques. With an initial focus on leadership, strategic alignment, training and the creation of a supportive infrastructure (Lean promotion offices), the goal in Saskatchewan is a whole health system transformation that produces "better health, better value, better care, and better teams." Given the scope and scale of the initiative and the commitment of resources, it is vital that a comprehensive, longitudinal evaluation plan be implemented to support ongoing decision-making and program design. The nature of the initiative also offers a unique opportunity to contribute to health quality improvement science by advancing our understanding of the implementation and evaluation of complex, large-scale healthcare interventions. The purpose of this article is to summarize the background to Lean in Saskatchewan and the proposed evaluation methods.

The relationship between the First Peoples of Canada and researchers is changing as processes of self-determination and reconciliation are increasingly implemented. We used storytelling and ceremony to describe a historic event, the Indigenous Women’s Data Transfer Ceremony, where quantitative data of 318 Indigenous women living with HIV were transferred to Indigenous academic and community leaders. Relationship building, working together with a common vision, the Ceremony, and the subsequent activities were summarized as a journey of two boats. The Truth and Reconciliation Commission of Canada's Calls to Action and Indigenous ethical principles were central to the process. The article ends with team members’ reflections and the importance of shifting power to Indigenous Peoples in regard to data collection, their stories, and the resulting policies.