A look at the relationship between indigenous peoples and the healthcare systems. Ways to improve and change these relationships. Peer-Reviewed Article
Welcome to our class presentation, discussing the effects of natural disaster on the lifestyle and resources provided to New Orleans citizens. Please take a second to watch our presentation. I hope you all enjoy!
How do we build power for the policies needed to achieve health equity, and to dismantle structural racism and other root causes of health inequities? Who are allies in this struggle for social justice? Who is the opposition and what do they gain from the status quo? Using #OneFairWage and Protect Immigrant Health Now! as examples, answers to these questions will be proposed by a leader of the Collaborative for Health Equity Cook County (www.CHECookCounty.org), part of the National Collaborative for Health Equity. A group dialogue will follow.
Monthly talk of the Center for Community Health Equity. Featuring James Bloyd, MPH (Cook County Department of Public Health) Tuesday, January 22 at 12:00pm to 1:00pm
Rush University Medical Center, Cohen Building - Field Auditorium, 1st floor 1735 W. Harrison, Chicago, Illinois
Presentation on January 22, 2019 to the Center for Community Health Equity at the Rush University Medical Center by James E. Bloyd, MPH, of the Collaborative for Health Equity Cook County, and the Cook County Department of Public Health. Topics included evidence of inequitable distribution of health and well-being; theoretical explanations of health inequity from Hawai'i State Department of Public Health and the World Health Organization; the Collaborative for Health Equity Cook County's (www.checookcounty.org) work on the minimum wage and Protect Immigrant Health Now!;
Role of US Health Care in causing poverty and health inequities among health care sector workers through a racist and sexist wage structure (Himmelstein & Venkataramani 2018). Includes references.
Promoting health and preventing illness among African American men, who die disproportionately from preventable diseases, is a challenging health disparity that has seen limited progress. However, focusing our efforts in places outside of traditional clinical and community settings such as the barbershop has shown promise for ameliorating these disparities.
Welcome to our class presentation, discussing the effects of natural disaster on the lifestyle and resources provided to New Orleans citizens. Please take a second to watch our presentation. I hope you all enjoy!
How do we build power for the policies needed to achieve health equity, and to dismantle structural racism and other root causes of health inequities? Who are allies in this struggle for social justice? Who is the opposition and what do they gain from the status quo? Using #OneFairWage and Protect Immigrant Health Now! as examples, answers to these questions will be proposed by a leader of the Collaborative for Health Equity Cook County (www.CHECookCounty.org), part of the National Collaborative for Health Equity. A group dialogue will follow.
Monthly talk of the Center for Community Health Equity. Featuring James Bloyd, MPH (Cook County Department of Public Health) Tuesday, January 22 at 12:00pm to 1:00pm
Rush University Medical Center, Cohen Building - Field Auditorium, 1st floor 1735 W. Harrison, Chicago, Illinois
Presentation on January 22, 2019 to the Center for Community Health Equity at the Rush University Medical Center by James E. Bloyd, MPH, of the Collaborative for Health Equity Cook County, and the Cook County Department of Public Health. Topics included evidence of inequitable distribution of health and well-being; theoretical explanations of health inequity from Hawai'i State Department of Public Health and the World Health Organization; the Collaborative for Health Equity Cook County's (www.checookcounty.org) work on the minimum wage and Protect Immigrant Health Now!;
Role of US Health Care in causing poverty and health inequities among health care sector workers through a racist and sexist wage structure (Himmelstein & Venkataramani 2018). Includes references.
Promoting health and preventing illness among African American men, who die disproportionately from preventable diseases, is a challenging health disparity that has seen limited progress. However, focusing our efforts in places outside of traditional clinical and community settings such as the barbershop has shown promise for ameliorating these disparities.
The impact of social policies on gender inequalities in healthsophieproject
"The impact of social policies on gender inequalities in health" by Laia Palència and Davide Malmusi, in the framework of the final conference of the European research project SOPHIE. 29th September 2015, Brussels
Challenges and benefits of implementation of the national standard on cultu...Ahmed Otokiti MD, MBA, MPH
The National cultural and linguistic standard is mandated by the Government(U.S DHHS).However there are challenges and benefit to its implementation. This paper looks at these challenges and benefits in two Bronx Hospitals, NY.
Speaking at the 2015 CCIH Annual Conference, Patricia Kamara, Executive Director of the Christian Health Association of Liberia shares the organization's response to the 2014 Ebola outbreak, explaining how CHAL reached communities with health messages and engaged faith communities and volunteers.
The impact of social policies on gender inequalities in healthsophieproject
"The impact of social policies on gender inequalities in health" by Laia Palència and Davide Malmusi, in the framework of the final conference of the European research project SOPHIE. 29th September 2015, Brussels
Challenges and benefits of implementation of the national standard on cultu...Ahmed Otokiti MD, MBA, MPH
The National cultural and linguistic standard is mandated by the Government(U.S DHHS).However there are challenges and benefit to its implementation. This paper looks at these challenges and benefits in two Bronx Hospitals, NY.
Speaking at the 2015 CCIH Annual Conference, Patricia Kamara, Executive Director of the Christian Health Association of Liberia shares the organization's response to the 2014 Ebola outbreak, explaining how CHAL reached communities with health messages and engaged faith communities and volunteers.
Promoting Health Equity A Resource to Help Communities Add.docxbriancrawford30935
Promoting Health Equity
A Resource to Help Communities Address
Social Determinants of Health
Cover art is based on original art by Chris Ree developed for the Literacy for Environmental Justice/Youth
Envision Good Neighbor program, which addresses links between food security and the activities of
transnational tobacco companies in low-income communities and communities of color in San Francisco. In
partnership with city government, community-based organizations, and others, Good Neighbor provides
incentives to inner-city retailers to increase their stocks of fresh and nutritious foods and to reduce tobacco
and alcohol advertising in their stores (see Case Study # 6 on page 24. Adapted and used with permission.).
Promoting Health Equity
A Resource to Help Communities Address
Social Determinants of Health
Laura K. Brennan Ramirez, PhD, MPH
Transtria L.L.C.
Elizabeth A. Baker, PhD, MPH
Saint Louis University School of Public Health
Marilyn Metzler, RN
Centers for Disease Control and Prevention
This document is published in partnership
with the Social Determinants of Health
Work Group at the Centers for Disease
Control and Prevention, U.S. Department of
Health and Human Services.
1
Suggested Citation
Brennan Ramirez LK, Baker EA, Metzler M. Promoting Health Equity: A Resource
to Help Communities Address Social Determinants of Health. Atlanta: U.S.
Department of Health and Human Services, Centers for Disease Control and
Prevention; 2008.
For More Information
E-mail: [email protected]
Mail: Community Health and Program Services Branch
Division of Adult and Community Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
4770 Buford Highway, Mail Stop K–30
Atlanta, GA 30041
E-mail: [email protected]
Mail: Laura Brennan Ramirez, Transtria L.L.C.
6514 Lansdowne Avenue
Saint Louis, MO 63109
Online: This publication is available at
http://www.cdc.gov/nccdphp/dach/chaps
and http://www.transtria.com.
Acknowledgements
The authors would like to thank the following people for their valuable contributions to
the publication of this resource: the workshop participants (listed on page 5), Lynda
Andersen, Ellen Barnidge, Adam Becker, Joe Benitez, Julie Claus, Sandy Ciske, Tonie
Covelli, Gail Gentling, Wayne Giles, Melissa Hall, Donna Higgins, Bethany Young
Holt, Jim Holt, Bill Jenkins, Margaret Kaniewski, Joe Karolczak, Leandris Liburd, Jim
Mercy, Eveliz Metellus, Amanda Navarro, Geraldine Perry, Amy Schulz, Eduardo
Simoes, Kristine Suozzi and Karen Voetsch. A special thanks to Innovative Graphic
Services for the design and layout of this book.
This resource was developed with support from:
> National Center for Chronic Disease Prevention and Health Promotion
Division of Adult and Community Health
Prevention Research Centers
Community Health and Program Services Branch
> National Center f.
Working Together for HealthEfforts to improve public health occ.docxmayank272369
Working Together for Health
Efforts to improve public health occur around the world every day. However, simply attempting to fix a problem without acknowledging, and respecting, the relationship between culture and health is not likely to have long-term success. Successful interventions, such as those in the case studies presented in your resources, demonstrate organizational collaboration. They also highlight the value of cultural relativism to improve population health outcomes. Working for the people (and with the people) can make an important impact on health.
To prepare for this Discussion, review Chapter 2, "Communities Working to Achieve Health Equity," in the Promoting Health Equity document from Week 2. Select one case study to profile in your discussion. How do the key concepts, addressed in this week's Learning Resources, relate to the case study you selected?
1. Briefly describe the population and health issue addressed in the case study.
2. In what way did cultural beliefs and behaviors contribute to the health issue in these case studies?
3. Which public health (or other) groups intervened, and how did they cooperate to improve health for this population?
4. What measures did the organization take to ensure they respected the dignity of the individuals and their culture?
5. How does this case study relate to our class resources addressing culture and collaboration?
Public and Global Health Essentials
· Chapter 11, "Working together to improve global health"
Around the world professionals from numerous organizations rely on others to achieve their public health goals. This chapter stresses global cooperation, partnerships and collaborations vital to addressing health issues
Top of Form
For this discussion, I will access the overall health and identify key issues in Garland County, Arkansas. According to County Health Rankings of 2017, in the area of health outcomes Garland County, Arkansas ranked 44 out of 75 counties. When reviewing national and state results, Arkansas exceeded the U.S. median in all categories of health outcomes. For the health factors summary, they ranked much lower coming in at 28. In the category of health behaviors, 25% of adult Arkansans are smokers and 34% are obese. Both of these percentages are above national averages. Referring back to the topic of my previous discussion, the number of diagnosed sexually transmitted diseases was almost twice as many as the national average and the teen birth rate almost doubled the national average. In the category of clinical care Arkansas is near equal or slightly lower than national averages. Social and economic factors also rank fairly close to the national averages. Overall physical environment factors are no different than the national averages. In my opinion, Arkansas is a fairly clean and comfortable place to live.
After considering these statistics, I can answer the opening question of this discussion. "How healthy is your community?" Not very! As a health ...
Public health is defined as “the approach to medicine that is concerned with the health of the community as a whole” ("Definition of Public Health", 2013). Without public health, health care would be in vain. A person could be in perfect health one day, come in contact with a person with a contagious disease, and be dead within twenty-four hours. This paper will discuss the local health department.
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The United States health care system Presented By HCA 205 .docxwsusan1
The United States health care system
Presented By:
HCA 205: Introduction To Health Care
Martha Jennings
January 27, 2019
I’m pursuing my Bachelors In Healthcare Administration. I have been in the United States Navy for 6 years and within those 6 years I have 2 years of experience in the healthcare. In 2017 I obtained my Pharmaceutical license and work at HIV clinic for six months. After that I decided I wanted to be a nurse so I spent 6 months volunteering at the Naval Hospital working with ER patients, Cancer patients, and mental health patients. I am excited to talk about this week PowerPoint topic seeing how its close to home for me.
1
Overview
Explain Health Care System
Describe each revolutionary factors in the 17th,18th,19th,20th, and 21st Century
Explain how each revolutionary factor changed the healthcare system
Describe each major development from a financial, legal, ethical, regulatory, and social perspectives.
Explain how each development transformed the healthcare system.
Explain how the three stakeholders has impacted the healthcare system in both a positive and negative way.
The United States health care system is considered to be among the most unique in the world’s industrialized countries. Within this PowerPoint presentation I am going to go over how the healthcare system has evolved from the 17th century to the 21st. Furthermore, I will also be discussing how from a financial, legal, ethical, regulatory, and social perspectives how much the healthcare system has transformed. Lastly, I will be closing this PowerPoint with three stakeholders I have chosen and briefly explaining the impact that it has had on our healthcare system in both a positive and negative way.
2
The 17th century
During the 17th century leech therapy was a popular cure all for all health issues. It was said that the leeches would suck out any disease from the body.
During this time physicians were not used like they are today. In the 17th century the physician would go see the patient where they lived and the patient had self-home remedies they would use to cure there disease.
Dr. Bond and Benjamin Franklin founded the “Pennsylvania Hospital”. This facility was the first facility devoted to assisting mentally ill and became a major impact on the field of psychiatry. This impact open up the first American medical school known as “ University Of Pennsylvania”
Dr. Bond and Benjamin Franklin accomplishments shed a light publicly on the severity of mental illness . After they opened the ward in New York people began to see mental illness as a social issue.
These accomplishments listed above helped transform the health care system into what it is today because we are able to walk into any healthcare facility and receive proper treatment and care. In the early 17th century they didn’t have the luxury because leech therapy and self-home remedies was the answer to all issues and diseases.
The 18th century
During the 18th century, a group of do.
Academic literature review of the best and promising models of integrated primary care and mental health and substance use community care across the lifespan.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
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In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
1. ORIGINAL ARTICLE
Modelling change and cultural safety:
A case study in northern British Columbia
health system transformation
Margo Greenwood1
Abstract
The relationship that Indigenous Peoples have to the Canadian healthcare system makes the system’s weaknesses and
complexities obvious. The long-standing lack of consideration to the historical and contemporary realities of Indigenous
Peoples has resulted in miscommunication, misunderstanding, mistrust and racism. Health leaders, including health authorities,
across the province are thus challenged to ensure that culturally safe environments are available and culturally safe practices are
being used. This article begins with an overview of contemporary social political contexts in which Indigenous individual and
collective realities are situated. Following is a conceptual discussion focused on health system change and the experiences of
Indigenous Peoples. Change at structural, systemic and individual levels is the focus of the change model presented in this article.
Throughout this exploration, examples of concrete actions currently underway in a health authority are offered. The article
concludes with visions for future change.
Introduction
The relationship that Indigenous Peoples have to the Canadian
healthcare system makes the system’s weaknesses and com-
plexities obvious. The long-standing lack of consideration to
the historical and contemporary realities of Indigenous Peo-
ples has resulted in miscommunication, misunderstanding,
mistrust and racism. Health leaders, including health author-
ities, across the province are thus challenged to ensure that
culturally safe environments are available and culturally safe
practices are being used. This article takes the position that
structural, systemic, and service delivery dysfunction in the
mainstream healthcare system for Indigenous Peoples in
Canada requires transformation at structural, systemic, and
service delivery levels—an approach that is modelled in
Figure 1.
The good news is that this transformation has already begun
to take shape in many jurisdictions, with Indigenous organi-
zations and individuals leading the way. In British Columbia,
for example, health authorities across the province have been
challenged to ensure culturally safe environments and prac-
tices, and in 2017, the province released its Declaration of
Cultural Safety and Humility (2017), which speaks directly to
culturally safe practice as a way to address anti-Indigenous
racism in healthcare systems. As an Indigenous scholar and
Vice-President of Indigenous Health in British Columbia’s
northernmost health authority, Northern Health (NH), I write
this article based on personal and professional experiences of
implementing actions designed to create and support culturally
safe practices and environments in British Columbia. I
acknowledge and am grateful to NH and to the First Nations
Health Authority (FNHA) for this opportunity. The article
begins with an overview of the contemporary socio-political
context in which Indigenous individual and collective realities
are situated in Canada. This is followed by a conceptual
discussion of healthcare system change at structural, systemic,
and service levels and the experiences of NH.
Throughout this exploration, I offer examples of concrete
actions currently underway in a health authority that is seeking
to create a healthcare delivery system that is experienced as
culturally safe by the many diverse Indigenous individuals,
families, and communities we serve. Humility in recognizing
that there is a different, better way to do things and that the best
knowledge about health is rooted in thriving communities
underpins the transformations underway at all three levels of
change explored here: service, systemic, and structural.
Background: A time of opportunity
One could argue that in the present historical moment, Indi-
genous Peoples have greater opportunities for change than ever
before. This change has been a long time in coming, and there
is still far to go, but in 1996 the Royal Commission on
Aboriginal Peoples (RCAP) envisioned a “circle of wellbeing”
in which self-government, economic self-reliance, partnerships
of mutual respect with Canada, and healing would feed into one
another. Together, each and all of these elements of reconci-
liation would work toward elimination of persistent inequities.
While too few of RCAP’s recommendations were implemented
in the decades following the conclusions of the commission, it
nonetheless became the impetus for a thorough examination of
residential school experiences of Indigenous Peoples through
the Truth and Reconciliation Commission (TRC; 2008-2015).
1
National Collaborating Centre for Aboriginal Health, Prince George, British
Columbia, Canada.
Corresponding author:
Margo Greenwood, National Collaborating Centre for Aboriginal Health,
Prince George, British Columbia, Canada.
E-mail: margo.greenwood@unbc.ca
Healthcare Management Forum
2019, Vol. 32(1) 11-14
ª 2018 The Canadian College of
Health Leaders. All rights reserved.
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/0840470418807948
journals.sagepub.com/home/hmf
2. The TRC final report, released in 2015, offers 94 Calls to
Action to redress the legacy of residential schools and to
advance the process of Canadian reconciliation. The transfor-
mative change actions described in this article are anchored in
these Calls to Action (particularly Actions 18 to 24), alongside
a moral imperative that is long past due.
The opportunity for change presented by the conclusion of
the TRC coincided with the election of a new Federal Gov-
ernment in 2015. Under the leadership of Justin Trudeau, the
Liberal government committed to “a renewed nation-to-nation
relationship with Indigenous Peoples based on recognition,
rights, respect, co-operation, and partnership.”1
Now three
years into Liberal leadership, contentious politics regarding
pipelines and other territorial issues have called this commit-
ment into question by many, but at the same time promising
movements from both within and outside government are
seeking to hold the Canadian establishment to account for their
actions and non-actions impacting Indigenous rights, health,
and wellbeing. One of the government’s first steps in addres-
sing renewed Indigenous relationships in 2016 came in the full
endorsement of the United Nations Declaration on the Rights of
Indigenous Peoples, which up until then had only conditional
support from the Federal Government. Ruling in an ongoing
legal struggle for equity in funding for services for Indigenous
children, the Human Rights Tribunal found in 2016 that the
Government of Canada discriminates against First Nations
children on reserves by failing to provide the same level of
child welfare services that exist elsewhere, highlighting
decades of injustice and disadvantage. Children of the “Sixties
Scoop” are just starting litigation, while patients of Indian
hospitals are also beginning to come forward. These are all
painful, yet necessary and promising steps toward reconcilia-
tion. This action between Canada and Indigenous Peoples will
not happen quickly or without great tension and emotion—yet
we begin. The next sections describe some of the steps taken
toward transforming health systems and service delivery in
British Columbia, as we seek a way forward to healing and
renewed relationships within the healthcare system, presenting
at the same time a model to help conceptualize these changes.
A framework for getting to change:
Conceptualizing new relationships in health
It is one thing to conceptualize what types of changes must
occur to create a healthcare system that is safe and effective for
Indigenous Peoples, and it is quite another to consider how
those changes can happen on the ground. This section presents
a “change model” (Figure 1) depicting the three interconnected
layers or strata in which change must occur for genuine
transformation in the healthcare sector (structural change,
system change, and service delivery change) and uses examples
from British Columbia, Canada, to illustrate these changes in
action. Although these changes are still relatively new and
implementation is ongoing, they provide a useful grounding in
the ways a complex process of transformation is unfolding in
one corner of the colonized world.
Change in the sector of Indigenous health is complex and
multi-faceted because Indigenous health is complex and multi-
faceted. In order for genuine and lasting transformation in the
health of Indigenous Peoples, policy actions must cross diverse
sectors and disciplines and have to occur across multiple levels.
Social Determinants of Health (SDOH) approaches point to
wholistic ways to address the health inequities experienced by
Indigenous Peoples, and Canadians have been at the forefront
of understanding and developing SDOH. The Ottawa Charter
for Health Promotion declared in 1986 that health is “created
and lived by people within the settings of their everyday life,
where they learn, work, play, and love.”2
More than a decade
later in 1998, Health Canada developed a comprehensive list of
factors influencing health, labelling them the determinants of
health. The release of the World Health Organization’s Com-
mission on the SDOH’s final report, Closing the Gap in a
Generation (2009), argued for the need to address inequities
that affect some people more than others. By identifying and
focusing on the causes underlying the causes of ill health—for
example, high tuberculosis rates associated with overcrowding
and housing shortages linked to poverty and forced reloca-
tion—SDOH approaches require attention to the unique his-
torical and contemporary social political contexts which shape
the health of Indigenous Peoples. These include, among other
determinants, considering things like social environments,
physical environments, personal health practices and coping
skills, healthy child development, biology and genetic
endowment, health services, and gender and culture. Indigen-
ous Peoples have expanded upon these determinants, arguing
that factors such as land, spirituality, colonization, culture,
language, and self-determination are all important aspects of
health and wellbeing.3
Indigenous models of determinants of health, like those
offered by Reading et al.,4
Greenwood,5
and Reading and
Figure 1. A framework for creating change.
12 Healthcare Management Forum
3. Wein,6
all consider (in addition to the wholistic interrelated
nature of the determinants) a life course perspective, and the
necessity for multi-level, cross-disciplinary implementation
strategies of policies meant to ameliorate inequity. The Change
Framework presented in Figure 1 is anchored in these broad
principles and offers a deceptively simple structure with three
overarching and interrelated categories in which to take action
for change. The change model merges these broad determi-
nants of health principles with tenets borrowed from Bron-
fenbrenner’s7
ecological systems model to offer a seemingly
simple structure with three overarching categories in which to
take action for change. The model also has the flexibility to
take into account the “causes of the causes of the causes” in its
operational strategies and actions.
Aligning simultaneous actions across all three levels
(structural, systemic, service delivery) is necessary for long-
term and successful change. Structural change forms the outer
layer of the model, referring to high-level legislation, policies,
and/or formal agreements—in other words, structural enablers
of change. Structural enablers can either enable or hinder the
health and wellbeing of individuals and communities. An
example of structural enablers in the health sector in British
Columbia can be seen in the series of agreements and accords
signed by First Nations, the provincial government, and
the Federal Government detailed in Johnson et al.,8
which
culminated with the British Columbia Tripartite Framework
Agreement on First Nation Health Governance (2011). The
Framework Agreement outlined the commitment to support the
creation of the FNHA and transfer of responsibility and funding
for First Nations health from the Federal Government to the
FNHA within 2 years. Fully operational since 2013, the FNHA
has been instrumental in bringing about the system changes
discussed in the next section as regional health authorities in
British Columbia adopt innovative Indigenous-friendly prac-
tices, including the promotion of cultural safety for Indigenous
Peoples throughout health services.9
The second layer depicted in the model is systemic change.
This refers to direct services and systems, including the edu-
cation, health, child welfare, and justice systems. These sys-
tems drive schools, hospitals, mental health programs, and
early childhood programs. In British Columbia, the structural
enablers that precipitated significant changes in the way health
services for First Nations peoples are delivered include formal
agreements with the First Nations Council and the FNHA and
each of the province’s regional health authorities. In the
northern region of the province—a vast geographical region
home to some 50,000 First Nations, Métis, and Inuit people—
the Northern Health authority (Northern Health or NH), along
with the FNHA and the First Nations Health Council—
Northern Caucus, created a Northern Partnership Accord in
2012 in which they committed to create a joint health and
wellness plan. The Northern First Nations Health and Wellness
Plan is, in part, supported by working groups for each of five
(out of 16) priority areas. These groups provide a space for
representatives from NH, FNHA, and northern First Nations to
collaboratively work toward implementation of key actions in
each of the priority areas. In other words, there is a colla-
borative approach to operationalizing healthcare delivery.
Northern Health also created a senior executive position,
Vice-President of Indigenous Health, to provide leadership in
operationalizing the “new relationship” with First Nations in
northern British Columbia. In 2015, all Chief Executive Offi-
cers from British Columbia’s health authorities signed a
Declaration of Cultural Safety and Humility committing the
signatories to culturally safe service delivery for Indigenous
Peoples. These activities are examples of system enablers that
support the operationalization of service delivery changes.
Taken together, these structural and systemic changes are
interrelated and intended to support individual practice and the
experience of that practice, especially culturally safe practice.
At the centre of the model sits service delivery change. This
core of a larger integrated understanding reflects individual or
direct service delivery and is where people access and expe-
rience services more directly and acutely. At the scale of
human interaction, where people interface and interact with
each other is where the promotion of culturally respectful and
safe practice between Indigenous and non-Indigenous Peoples
becomes imperative. Northern Health is taking initial steps to
realize this commitment by providing healthcare professionals
in the health authority with education and training opportuni-
ties that will enhance their understanding and impact their
practice, including approximately 500 training seats annually
in cultural competency development offered by British
Columbia’s Provincial Health Services Authority. The demand
for this training continues to increase. Alongside this training,
the Indigenous Health team within NH created and released a
short animated video that introduces the concept of cultural
safety in an accessible way, including an overview of Indi-
genous health from early colonization to the present day. The
video is an invitation to all to participate in making health
systems more culturally safe for Indigenous Peoples. The
visual work is enhanced by a booklet and poster series
including terminology, factors contributing to a culturally safe
healthcare system, and features of culturally safe practices.
Indigenous knowledge(s) and practices reside within Indi-
genous communities, and in order to deliver culturally safe
care, health practitioners must understand and be respectful of
such knowledge in their practice. Accordingly, NH is seeking
to engage with Indigenous communities in a direct and ongoing
way through the work of eight sub-regional Aboriginal Health
Improvement Committees (AHICs). These committees are
eclectic in nature, geographically defined, and comprised of
local NH and First Nations health leadership including First
Nations Health Directors and other Indigenous organizations
and professionals. Representatives from sectors such as
education, child and family services, policing, and British
Columbia ambulance services are also welcomed. The AHIC
tables create opportunities for direct, local change through
activities and initiatives specific to the communities sitting at
the table.
Recent work undertaken by the AHICs has been guided by
the simple question: “If I was a new health practitioner coming
Greenwood 13
4. into your community, what would you like me to know about
you?” This question, paired with small amounts of annual
funding, has resulted in the development of a growing amount
of diverse and innovative culturally specific resources, activi-
ties, and events. In less than 5 years, the diversity of these
products has highlighted the Indigenous ways of knowing and
being as expressed in the distinct traditions, cultures, protocols,
and environments of each community. The resources are being
used to create safe, welcoming health service spaces, as well
as supporting the growth of knowledge, understanding, and
cultural safety among healthcare practitioners. They are also
being shared broadly throughout NH and beyond. A webinar
series hosted by the Indigenous Health team at NH provides a
platform for AHICs to offer highlights of the local cultural
resources developed by themselves.
The Indigenous Health team at NH has also developed
resources for use across the NH employee landscape and for
users of healthcare services. These resources include cultural
safety presentations delivered internally to different depart-
ments within NH (eg, finance and communications) and
externally to nursing students, clinician orientation sessions,
and hospital volunteers. Facilitated workshops and patient
journey mapping are other ways in which healthcare practi-
tioners and community members have engaged and learned
together. With the same intent of learning and respect, the
Indigenous Health team has also developed materials for users
of healthcare services. One pressing issue for many Indigenous
individuals is how to express concerns and complaints about
the services provided by the health system. The What to do with
Questions, Concerns and Complaints booklet supports Indi-
genous people to voice concerns with their healthcare experi-
ences, summarizing the steps and processes available for
individuals who have questions, concerns, or complaints about
their healthcare experience. The Sacred Spaces and Gathering
Places booklet is another example of an effort to improve the
cultural safety of direct services. This booklet informs Indi-
genous individuals of the spaces available in NH buildings and
grounds for their family and community members to gather.
Closing comment
Northern Health is a geographically vast and diverse health
authority sitting at the crossroads of innovative practice and
system change. Using the three-level model of change and NH
as an example, the interconnections between structural change,
system change, and service delivery change become more
clear. The exciting work at the community level represented by
the AHICs and the work of NH’s Indigenous Health team is
enabled by changes at the systemic level of interconnected
health organizations and agencies, which in turn are shaped
at the structural level of agreements, accords, legislation, and
policy as Indigenous and non-Indigenous partners negotiate a
way forward.
Creating a healthcare delivery system that is experienced
as culturally safe is essential to the overall system goal of
improving health outcomes for Indigenous Peoples. This is a
long and often difficult journey for healthcare organizations
such as NH—a journey where health leaders, policy-makers,
managers, and service providers learn how to shift their
approach to one of humility, seeking to understand with an
openness to learning and changing practices. Although this
journey has seemingly just begun, we celebrate the progress
that has been made and commit to continue the partnered
work that ultimately will close the health status gap for
Indigenous Peoples.
References
1. Office of the Prime Minister. Minister of Indigenous Servicers
Mandate Letter. Ottawa, Ontario, Canada: Government of Canada.
October 4, 2017. Available at: https://pm.gc.ca/eng/minister-indi
genous-services-mandate-letter. Accessed November 15, 2018.
2. World Health Organization. Ottawa charter for health promotion.
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ences/previous/ottawa/en/index1.html. Accessed November 15,
2018.
3. Greenwood M, de Leeuw S, Lindsay N, Reading C. Beyond the
Social: Determinants of Indigenous Peoples’ Health. Toronto,
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4. Reading JL, Kmetic A, Gideon V. First Nations Wholistic Policy
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6. Reading CL, Wien F. Health Inequalities and the Social Determi-
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