Kim Paul J
Department of Medicine, University of Toronto, Toronto, Canada.
Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada.
Health Equity. 2019 Jul 25;3(1):378-381. doi: 10.1089/heq.2019.0041. eCollection 2019.
Indigenous populations in Canada have experienced social, economic, and political disadvantages through colonialism. The policies implemented to assimilate Aboriginal peoples have dissolved cultural continuity and unfavorably shaped their health outcomes. As a result, indigenous Canadians face health inequities such as chronic illness, food insecurity, and mental health crises. In 2015, the Canadian government affirmed their responsibility for indigenous inequalities following a historic report by the Truth and Reconciliation Commission of Canada. It has outlined intergenerational traumata imposed upon Aboriginals through decades of systemic discrimination in the form of the Residential School System and the Indian Act. As these policies have crossed multiple lifespans and generations, societal conceptualization of indigenous health inequities must include social determinants of health (SDOH) intersecting with the life course approach to health development to fully capture the causes of intergenerational maintenance of poor health outcomes. To provide culturally sensitive care for those who have experienced intergenerational trauma, health care providers should be aware of and understand two key SDOH inequity influencing the indigenous life course, including the residential school system and loss of socioeconomic status, over time due to colonialism.
加拿大的原住民群体在殖民统治下经历了社会、经济和政治上的劣势。为同化原住民而实施的政策破坏了文化传承,并对他们的健康状况产生了不利影响。因此,加拿大原住民面临着诸如慢性病、粮食不安全和心理健康危机等健康不平等问题。2015年,在加拿大真相与和解委员会发布一份具有历史意义的报告后,加拿大政府确认了其对原住民不平等问题的责任。该报告概述了通过寄宿学校制度和《印第安人法》等数十年系统性歧视对原住民造成的代际创伤。由于这些政策跨越了多个生命周期和几代人,对原住民健康不平等的社会认知必须包括健康的社会决定因素(SDOH)与健康发展的生命历程方法相交织,以充分理解代际间健康状况不佳持续存在的原因。为了为经历过代际创伤的人提供具有文化敏感性的护理,医疗保健提供者应该意识到并理解影响原住民生命历程的两个关键SDOH不平等因素,包括寄宿学校制度以及由于殖民主义导致的社会经济地位丧失。