Department of Health Science, Public Health, Bachelors of Health Science, Waterloo, Canada.
Dehcho First Nations, Fort Simpson, Northwest Territories (NT), Canada.
Int J Circumpolar Health. 2023 Dec;82(1):2215553. doi: 10.1080/22423982.2023.2215553.
The Canadian healthcare system bares a long legacy of colonisation and assimilation of Indigenous values and approaches to health and wellness. This system often perpetuates social and health inequities through systemic racism, underfunding, lack of culturally appropriate care and barriers to access care. Current funding legislation policies enacted across federal, provincialand territorial governments do not necessarily uphold Indigenous Peoples' rights to self-determination, health and wellness. We summarise literature on promising Indigenous health systems and practices that prioritise and/or improve rural Indigenous Peoples' health and wellness. The impetus for this review was to provide information on promising health systems, while Dehcho First Nations developed a health and wellness vision. Documents were gathered from indexed and non-indexed databases to obtain literature from peer-reviewed and non-peer reviewed sources. Two reviewers independently 1) screened titles, abstracts and full texts to ensure they met the inclusion criteria, 2) gathered relevant data from all included documents and 3) identified major themes and sub-themes. Reviewers then discussed and reached consensus on the themes. Thematic analysis revealed six themes for effective health systems for rural and remote Indigenous communities: 1) access to primary care, 2) multi-directional knowledge exchange, 3) culturally appropriate care, 4) training and building community capacity, 5) integrated care and 6) health system funding. Effective health and wellness systems must support Indigenous ways of knowing and doing in healthcare models based on collaborative partnerships with community members, health providers and government agencies.
加拿大的医疗保健系统承载着殖民化和同化土著价值观和健康与保健方法的悠久历史。该系统常常通过系统性种族主义、资金不足、缺乏文化上适当的护理以及获得护理的障碍来延续社会和健康方面的不平等现象。联邦、省和地区各级政府颁布的当前供资立法政策不一定维护土著人民的自决权、健康和保健权。我们总结了优先考虑和/或改善农村土著人民健康和保健的有前途的土著健康系统和做法的文献。进行此审查的动力是提供有关有前途的卫生系统的信息，同时德克肖第一民族制定了健康和保健愿景。从索引和非索引数据库中收集文件，以从同行评议和非同行评议来源获取文献。两名审查员独立地 1）筛选标题、摘要和全文，以确保它们符合纳入标准，2）从所有纳入的文件中收集相关数据，3）确定主要主题和子主题。然后，审查员对主题进行了讨论并达成了共识。主题分析揭示了农村和偏远土著社区有效卫生系统的六个主题：1）获得初级保健，2）多方向知识交流，3）文化上适当的护理，4）培训和建设社区能力，5）综合护理和 6）卫生系统供资。有效的健康和保健系统必须支持土著人民在以与社区成员、卫生提供者和政府机构合作的基础上建立的医疗保健模式中的认知和实践方式。
