Preventing the Tragedy of Suicide Among Indigenous People in Canada: Physician Advocacy Through the Training Pipeline and Beyond
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Published:
Nov 30, 2016
Keywords:
Indigenous Population, Health Services, Indigenous, Patient Advocacy, Education, Medical
Main Article Content
Abstract
ABSTRACT
For decades, Canada’s Indigenous populations have experienced high rates of suicide relative to the general population. This commentary suggests that suicide among Indigenous people cannot be explained solely through the causal effects of downstream determinants of health; upstream health determinants such as Canada’s colonial past and cultural continuity are equally, if not more, instructive in understanding the tragedy that is taking place in many Indigenous communities across Canada. Medical trainees and physicians can contribute to improvements in Indigenous health by advocating for culturally safe healthcare access and research, as well as Indigenous-oriented medical training.
RÉSUMÉ
Pendant des décennies, les populations autochtones au Canada ont connu des taux élevés de suicide comparativement à la population générale. Ce commentaire suggère que le suicide chez les personnes autochtones ne peut être expliqué uniquement par les effets causaux des déterminants de la santé « en aval » ; les déterminants de la santé « en amont », tels le passé colonial du Canada et la continuité culturelle, sont tout aussi, sinon plus importants pour comprendre la tragédie se déroulant dans plusieurs communautés autochtones à travers le Canada. Les médecins et étudiants en médecine peuvent contribuer à l’amélioration de la santé autochtone en plaidant pour de la recherche et un accès aux soins de santé qui sont culturellement sécuritaires, et pour des formations médicales axées sur la santé autochtone.
Article Details
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Commentary
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References
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2. Aboriginal Affairs and Northern Development Canada. Royal Commission on Aboriginal Peoples [Internet]. Ottawa (ON): Government of Canada; 2011 [updated: 2016 Jan 12; cited 2016 Feb 20]. Available from: http:// www.aadnc-aandc.gc.ca/eng/1307458586498/1307458751962.
3. Kirmayer LJ, Brass GM, Holton T, Paul K, Simpson C, Tait C. Suicide among Aboriginal people in Canada [Internet]. Ottawa (ON): The Aboriginal Healing Foundation; 2007 [cited 2016 Feb 20]. Available from: http://www.ahf.ca/ downloads/suicide.pdf.
4. Health Canada. First Nations and Inuit health: mental health and wellness [Internet]. Ottawa (ON): Health Canada; 2015 Jan 27 [cited 2016 Feb 22]. Available from: http://www.hc-sc.gc.ca/fniah-spnia/promotion/mental/ index-eng.php.
5. Galloway T, Saudny H. Inuit health survey 2007-2008: Nunavut community and personal wellness [Internet]. Montreal (QC): McGill University Centre for Indigenous Peoples’ Nutrition and Environment; 2012 [cited 2016 Feb 15]. Available from: http://www.inuitknowledge.ca/sites/naasautit/files/at tachments/2008CommunityPersonalWellness-nunavut.pdf.
6. Turecki G. Dissecting the suicide phenotype: The role of impulsive-aggres¬sive behaviours. J Psychiatry Neurosci. 2005;30(6): 398–408.
7. Currie J. Best Practices: Treatment and Rehabilitation for Youth with Sub¬stance Abuse Problems [Internet]. Ottawa (ON): Minister of Public Works and Government Services; 2001 [cited 2016 Feb 25]. Available from: http:// www.hc-sc.gc.ca/hc-ps/pubs/adp-apd/youth-jeunes/index-eng.php.
8. Pharris MD, Resnick MD, Blum RW. Protecting Against Hopelessness and Suicidality in Sexually Abused American Indian Adolescents. J Adolesc Health. 1997; 21(6): 400–406.
9. Borowsky IW, Resnick MD, Ireland M, Blum RW. Suicide
Attempts Among American Indian and Alaska Native Youth: Risk and Protective Factors. Arch Pediatr Adolesc Med. 1999; 153(6): 573–580.
10. World Health Organization Commission on Social Determinants of Health. Social determinants and Indigenous health: the international experience and its policy implications [Internet]. Geneva: World Health Commission; 2007 [cited 2016 Feb 22]. Available from: http://www.who.int/social_deter-minants/resources/indigenous_health_adelaide_report_07.pdf.
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12. Reading C, Wien F. Health Inequalities and Social Determinants of Aboriginal Peoples’ Health [Internet]. Prince George (BC): National Collaborating Cen¬tre for Aboriginal Health; 2013 [cited 2016 Feb 20]. Available from: http:// www.nccah-cnsa.ca/Publications/Lists/Publications/Attachments/46/ health_inequalities_EN_web.pdf.
13. Statistics Canada. Select Health Indicators of First Nations People Living Off Reserve, Métis and Inuit [Internet]. Ottawa (ON): Statistics Canada; 2013 [cited 2016 March 10]. Available from: http://www.statcan.gc.ca/pub/82- 624-x/2013001/article/11763-eng.htm.
14. Chandler MJ, Lalonde C. Cultural Continuity as a Hedge Against Suicide in Canada’s First Nations. Transcult Psychiatry. 1998; 35(2): 191-219.
15. Royal College of Physicians and Surgeons of Canada. CanMEDS [Internet]. Ottawa (ON): Royal College of Physicians and Surgeons of Canada; 2014 [cit¬ed 2016 Feb 20]. Available from: http://www.royalcollege.ca/portal/page/ portal/rc/canmeds.
16. IPAC-AFMC. Summary of Admissions and Support Programs for Indigenous Students at Canadian Faculties of Medicine [Internet]. Indigenous Physi¬cians Association of Canada and Association of Faculties of Medicine of Canada; 2008 [cited 2016 Feb 20]. Available from: https://www.afmc.ca/ pdf/IPAC-AFMC_Summary_of_Admissions_&_Support_Programs_Eng.pdf.
17. Macauley A. Improving Aboriginal Health: How Can Health Care Profession¬als Contribute? Can Fam Physician. 2009; 55(4): 334–336.
18. First Nations Information Governance Centre. The First Nations Principles of OCAP® [Internet]. Ottawa (ON): First Nations Information Governance Centre; 2016 [cited 2016 Feb 28]. Available from: http://fnigc.ca/ocap.html.
19. Participatory Research at McGill. PRAM [Internet]. Montreal (QC): McGill University; 2016 [cited 2016 Feb 20]. Available from: http://pram.mcgill.ca/.
20. Canadian Medical Schools Struggle to Recruit Aboriginal Students. Healthy Debate [Internet]. 2013 May 2 [cited 2016 Feb 27]. Available from: http:// healthydebate.ca/2013/05/topic/quality/recruitment-of-aboriginal-health-care-workers.
21. Statistics Canada. Aboriginal Peoples in Canada: First Nations People, Métis and Inuit [Internet]. Ottawa (ON): Statistics Canada; 2015 [cited 2016 Feb 20]. Available from: https://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99- 011-x/99-011-x2011001-eng.cfm.
22. Anderson M, Lavallee B. The Development of The First Nations, Inuit and Métis Medical Workforce [Internet]. Med J Aust. 2007 [cited 2016 Feb 20];186 (10):539-540. Available from: https://www.mja.com.au/jour¬nal/2007/186/10/development-first-nations-inuit-and-m-tis-medical-work¬force
23. Arkle M, Deschner M, Giroux R, Morrison R, Nelson D, Sauve A, Singh K. Indigenous peoples and health in Canadian medical education CFMS po¬sition paper [Internet]. Canadian Federation of Medical Students: 2015 [cited 2016 Feb 20]. Available from: http://www.cfms.org/attachments/ article/163/2015%20Indigenous%20Peoples%20and%20Health%20in%20 Medical%20Education.pdf.