Aboriginal health research
Aboriginal communities and health researchers are working together to find solutions to health problems. This community-based research may be the best way to improve the health of Aboriginal Canadians.
Story by Connie Bryson/Illustrations by Sander Henriksen
The gap between the health of Aboriginal Canadians and that of non-Aboriginal Canadians is well known, but not particularly well understood. Understanding could come from research—but that has been problematic. The biomedical approach to research, which focuses on the diseases themselves, is clearly not the key to improving the health of Aboriginal Canadians. Now the emphasis is shifting: Aboriginal communities are getting involved in the research.
“Almost everywhere you look there is an inequity in the health indicators of Aboriginal people by comparison with the general population,” says Dr. Malcolm King, scientific director of the Canadian Institutes of Health Research (CIHR) Institute of Aboriginal Peoples' Health and a professor in the Faculty of Medicine and Dentistry at the University of Alberta. “I’ve heard people wonder why health outcomes are so different for Aboriginal people since the diseases we all get are essentially the same. You have to look at the context—the factors that contribute to how someone ends up developing a disease. These are known as the determinants of health. They include education, income, sanitation, nutrition, housing, environmental quality, and access to healthcare.”
Dr. King notes that research methods are changing, where Aboriginal health is concerned. The emphasis is now on community-based research, in which community members and researchers work together in planning studies. This approach to research is widely viewed as the best way to find solutions that are culturally appropriate and truly effective.
A case in point is the research of AHFMR Population Health Investigator Dr. Noreen Willows at the University of Alberta. She studies childhood obesity in Cree communities in Quebec and Alberta.
“We already know that Aboriginal people have a shorter life expectancy,” says Dr. Willows. “If, as the research suggests, Aboriginal children are becoming obese at a very young age, the prognosis is not good. So the key is prevention. But you can’t prevent something unless you understand it.” For example, in her Quebec study, elders voiced their concern that children have few opportunities to experience traditional Cree life and eat traditional Cree food. “I don’t come in as an expert and say, ‘Here are the issues.’ Our approach is to ask the community members what they believe the issues are. In this way, we can ensure that the results will be meaningful because they make sense to the community.”
Dr. Willows notes that obesity prevention will require a better understanding of the circumstances of people’s lives, and of the things that prevent individuals and communities from adopting healthy lifestyles. “There is low educational achievement, lack of opportunity for employment, and poverty in many Aboriginal communities; all these factors impact childhood obesity. I take an approach, where I look at individual-level factors, community-level factors, and the environments where people live. It’s not enough to just put your efforts at the level of the individual. If you educate individuals only, you give them the tools to make changes—but their ability to make those changes depends on whether they are empowered in the environment where they live. As a community-based researcher, you have to look at the bigger picture.”
The cornerstone of community-based research is community engagement, which entails a lot of groundwork. Community leaders must be consulted; local steering committees must be formed and become operational before research can even begin. “It’s about building relationships of trust. If you don’t build the relationships, you won’t be welcomed back,” says Dr. Willows.
The approach is extremely time-consuming. Given the limited time frames of many research grants, this can be a problem. However, granting agencies are becoming more flexible, and support organizations for researchers have sprung up in the past few years. For example, the University of Alberta’s Community–University Partnership for the Study of Children, Youth, and Families provides consulting, brokering of partnerships, and leadership in community-based research.
“I think we’re moving toward a time when community-based research will be better appreciated, better supported, and even more community-driven,” says Dr. Willows.
Health challenges faced by Canada’s Aboriginal people
- High rates of chronic diseases, such as diabetes. Type 2 diabetes affects First Nations and Métis people three to five times more than the general Canadian population. Although type 2 diabetes is currently less prevalent among the Inuit, they are beginning to acquire the disease in greater numbers.
- High rates of infectious diseases, such as tuberculosis. First Nations and Inuit tuberculosis rates are 10 times higher than for other Canadians.
- Low life expectancy of Aboriginal men and women. On average, First Nations men live seven years less than other Canadian men; and First Nations women, five years less than other Canadian women. Life expectancy for Inuit is also believed to be lower, although statistics are not available for all northern regions.
- High rates of suicide, especially among Aboriginal youth. The suicide rate for First Nations youth is five to six times higher than the national average; for Inuit youth, 11 times higher. Suicide is the most prevalent cause of injury-related death among Aboriginal people.